Health inspection·March 21, 2024

F 0850 Hire a qualified full-time social worker in a facility with more than 120 beds. Level of Harm - Minimal harm or potential for actual harm Based on record review and interview, the facility, with a capacity of more than 120 beds or less, failed to employ a qualified social worker for the facility reviewed for administration in that: Residents Affected - Some The facility did not have a qualified social worker since 11/6/2023. This failure could affect any residents in need of social services and place them at risk of psycho-social decline and poor-quality of life. Findings included: Record review of the Facility Summary Report from Tulip dated 3/20/2024 revealed the facility had a maximum capacity of 120. Record review of facility's personnel file accessed on date 3/20/2024 , completed by HR indicated there was not full time Social Worker on staff. In an interview with the HR director, on 03/20/2024 at 10:30 AM, she said, the Social Worker's last day at the facility was 11/6/2023 and there was a prn Social Worker and there has been an attempt to hire a new Social Worker waiting to see if she would accept the facilities offer. During an interview with Resident #1 on 3/20/2024 11:00 AM, she stated she requested to be transferred to a different facility . she stated she has not been able to speak to any Social Worker. she had talked to the Ombudsman, Nurses, DON and Administrator. she said that she was told they are working on it. In an interview with the DON, on 03/20/2024 at 12:00PM, she said the Social Worker's last day at the facility was at the beginning of November 2023, and there was a prn Social Worker , who only worked a couple of hours in the evening when she could, due to her full-time employment elsewhere. She said she has attempted to do what she could in the Social Worker's absence, but she was not a licensed Social Worker. In an interview with the facility's Ombudsman on 03/20/2023 at 4:00PM, she said there have been several residents with the request to transfer out of this facility, but without the full time Social Worker, it had been an impossible or a slow process of transfer placement. In an interview with the Regional Director of Operations on 3/21/2024, at 1:30 PM, she said the last Social Worker's last day at the facility was at the beginning of November 2023. She stated the Social Worker had quit for another job and there was no current full time Social Worker. She said the (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 2 Event ID: 455485 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 455485 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/21/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Petal Hill 900 S Baxter Ave Tyler, TX 75701 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)