Health inspection·March 10, 2025

F 0679 followed. Level of Harm - Minimal harm or potential for actual harm An interview was conducted with LVN A on 3/4/2025 at 1:38 PM. LVN A was asked what was being implemented to reduce aggression within MSU, and she stated behaviors were reduced when the residents were kept busy and occupied. LVN A reported that organized activities were rarely hosted within the unit, and the residents sometimes have bingo but that it was inconsistent. She also explained the residents expected bingo on Monday/Wednesday/Friday per the usual routine and would prepare the bingo supplies in anticipation of the event and express disappointment when the event did not occur. LVN A was asked if individual, one-on-one activities ever occur within the residents' rooms, and she said no. LVN A was asked if the residents were ever taken out of the unit to participate in facility-wide group activities, and she responded that the residents would leave MSU when occupational therapy or physical therapy come to get the resident for individual therapy sessions but that nobody ever came to get them for activities. LVN A stated she had voiced her concerns to AD C and ADON D but there were no changes after those conversations. Residents Affected - Some During a subsequent interview with LVN A on 3/5/2025 at 09:50 AM, she was asked why she felt like the residents become aggressive with each other and had physical altercations, and she answered that it was because the residents were bored and under stimulated. She continued that they have nothing to do most of the time so they fight with each other. ADON D was interviewed on 3/6/2025 at 09:50 AM. ADON D was asked about activities and engagement on MSU. ADON D reported that AD C participates in care plan meetings all day on Tuesday and all day on Wednesday, so his schedule limited the number of activities that he could do on those days. ADON D stated she had absolutely been made aware of staff concerns regarding lack of activities and attributed it to AD C's schedule because he can't be in two places at one time. ADON D was then asked how the activities were performed when AD C was unable to attend, and she stated some of the staff would find things for the residents to do, but not all the staff members would do this. ADON D was asked if the residents on MSU ever participated in facility group activities, and she explained many of the residents could not tolerate the stimulation of large-scale activities, but a few would be picked to participate and integrate with mixed success. AD C was interviewed on 3/6/2025 at 1:05 PM. AD C explained he attended just about all of the care plan meetings because the other activities director was new. AD C stated group participation during activities in MSU was pretty decent and the residents required a lot of encouragement for participation. In response to question regarding notification to residents about activities, AD C stated the monthly calendar was often posted on the main activities board around the 5th or 6th of the month because the printing company took several days to print the large print calendar. AD C stated that something was planned every day. AD C was asked how the residents were made aware of activities in that time frame, before the calendar was available. AD C answered that he would go door to door or leave notes. He also said the residents knew that bingo occurred on Monday/Wednesday/Friday and did not usually need reminders for that event. AD C was asked if he did any in-room activities and what types of activities he hosted in an individual environment, for residents who were unable or unwilling to attend group activities. AD C answered that he typically did and that he had session where we talk about current events. He also reported that he would engage in conversations when he was inviting residents to group activities. In response to a question about hosting activities when he was unavailable, AD C explained he would ask the other activities director if she could bring some of the MSU residents to participate in her scheduled events. He also stated he had asked a few of the CNAs to host events in MSU but that it was hard to get them onboard to help you out . I could use a little more support from them . it's not an issue on the women's unit, they'll usually jump in and call bingo or (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455020 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 455020 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at New Braunfels 821 US Hwy 81 W New Braunfels, TX 78130 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 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some whatever, but not there. AD C said he had brought up his concerns with leadership at the facility and was told that they would see what they could do. AD C indicated residents who did not receive activities could experience sadness, depression, and isolation. Record review of group activity attendance and individual activities for 90 day period were requested for review from AD C on 3/6/2025 at 07:48 AM. AD C stated he did not maintain records detailing attendance for group activities or records for individual activities performed. AD C explained his documentation consists of quarterly progress notes written in the EMR during care planning, with no other routine documentation. Record review of activity progress notes from February 2024 through March 2025 for Residents #1-6 revealed documentation consistent with AD C's description except that all 6 residents progress notes contained one additional note detailing daily activity for a single date concurrent with on-site investigation time frame. Calendars of activities for January-March 2025 were reviewed on 3/7/2025 to confirm that daily activities were planned for MSU residents. Facility policy titled Activity Programs revised 2021, states at least two group activities per day are offered on Saturday, Sunday, and holidays and at least four group activities are offered per day Monday through Friday. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455020 If continuation sheet Page 3 of 3