Inspection·January 10, 2024

F 0623 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on 01/09/24 at 10:00 a.m., Case Manager C said she was the case manager on duty today at the behavioral hospital Resident #101 was transferred to. She said Case Manager B was Resident #101's case manager but she was off this week. Case Manager C said she could provide information from Case Manager C's notes. Case Manager C said the facility told them they would not take Resident #101 back and did not help find placement for him. She said the family said the facility kicked Resident #101 out. The behavior hospital provided the family with resources to find placement and placed him in a personal care home. Case Manager C said the facility should have been more active in finding placement for Resident #101. She said they did not find placement for residents. Case Manager C said the nurses at the behavioral hospital did the admissions; the case managers did discharges. She said the facility sending the resident to the behavioral hospital was responsible for finding alternate placement for residents or they were responsible for taking them back. Case Manager C said the behavioral hospital attempted 3 times on 09/13, 09/14 and 09/15/23 to return Resident #101 to the facility who sent him, but the facility refused to admit him back. Case Manager C said the notes did not indicate who refused but indicated spoke to facility. Case Manager C said were told by the facility the family discharged the resident. She said the DON said the family took him out and wanted him out of the facility. Case Manager C called the family for the discharge plan and received no answer. She said the family later said Resident #101 was kicked out of the facility. During an Interview on 01/09/24 at 10:11 a.m., Resident #101's RP said he was sent out and the facility did not accept him back. She said the facility had to give them a 30-day notice before making him leave and did not. The RP said she did not plan to move the resident to another city. The RP said she got Resident #101's belongings when he was sent to the behavioral hospital because he was kicked out in the middle of the night. The RP said Resident #101 was now at another facility. During an Interview on 01/10/24 at 2:52 p.m., the SW said Resident #101 was not given a discharge notice. She said the facility was going to provide one but Resident #101 transferred to a behavioral hospital and never returned to the facility. The SW said when Resident #101 went to the behavioral hospital his RP picked up Resident #101's belongings and said he was not returning to the facility. She said she did not speak with the behavioral hospital on any attempts to return the resident. The SW said she inquired at 7 nursing homes to assist with placement of Resident #101 with no positive response. The SW said she was not involved in admissions or readmissions. She said Resident #101 could take care of himself; he would need a follow up with his primary care physician and a care giver to watch him in the evening if he was wandering. During an interview on 01/10/24 at 3:00 p.m., the DON said Resident #101 was not given a 30-day discharge notice because he left for a behavioral hospital and at the time of transfer the family said they wanted him transferred to a facility in another city so he would not return to this facility. She said the family picked up Resident #101's belongings and signed his personal inventory sheet. The DON said Resident #101's family did not like him being on the locked unit. She said the facility was under the assumption that Resident #101 was not returning to the facility. The DON said the behavioral hospital called the facility one time to report and she informed them the family had taken his belongings and discharged him. She said the family did not want him here and he was no longer their resident. The DON said the risk of not providing a 30-day notice was the potential of not giving the family time to make a safe discharge. During an interview on 01/10/24 at 3:10 p.m., the Administrator said Resident #101 was not provided a 30-day discharge notice. She said if he had continued to stay at the facility, she should have provided one. The Administrator said she could not meet his needs; the resident did not want to be here, and the family did not want him here. The Administrator said the family wanted Resident #101 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455001 If continuation sheet Page 2 of 3 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 455001 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Beaumont 4195 Milam St Beaumont, TX 77707 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0623 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few closer to family in another city. The Administrator said the behavior hospital accepted Resident #101 on the pretense that the resident and family did not want him to return to this facility and the facility could not meet his needs. She could not remember the name of whom she had spoken to. The Administrator said she informed the behavioral hospital she would help find placement for him if needed. She said the family had packed up all of Resident #101's belongings, signed his personal inventory sheet, discharged him, and said he was not returning. She said she thought it had just worked out. The Administrator said when Case Manager B at the behavioral hospital called wanting to readmit him, she said no because she had established with the hospital prior to them accepting him that he would go to another facility on discharge due to the family not wanting him to return. She informed the behavioral hospital she would assist finding him placement as needed. She said Case Manager B stated she understood, and she did not hear from the behavioral hospital after that and thought it was taken care of. The Administrator said she was responsible for giving residents a 30-day discharge notice. She said the risk of a resident not given the proper 30-day notice was a family may not be set up to properly care for a Resident. During an Interview on 01/10/24 at 3:00 p.m., Activities Staff A said she was unsure if the facility provided a 30-day discharge notice to Resident #101. She said Resident #101 packed up his items frequently and said he was leaving. She said she frequently heard him say he was leaving, telling other residents he was leaving, and someone was coming to get him. He did not say where he was going or who was coming to get him. Record review of a facility policy, revised March 2021, titled, Transfer or Discharge Notice indicated, .Residents and/or representatives are notified in writing, and in a language and format they understand, at least thirty (30) days prior to a transfer or discharge.d. discharge refers to the movement of a resident from a bed in one certified facility to a bed in another certified facility or other location in the community, when return to the original facility is not expected.7. Residents have the right to appeal a facility-initiated transfer or discharge through the state agency that handles appeals. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455001 If continuation sheet Page 3 of 3