Health inspection·January 22, 2025

F 0624 Prepare residents for a safe transfer or discharge from the nursing home. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interviews, the facility failed to provide and document sufficient preparation and orientation to residents to ensure safe and orderly transfer or discharge from the facility for one (1) of one resident reviewed for transfer and discharge rights. (Resident #2) Residents Affected - Few The facility failed to plan for a safe discharge for Resident #2. This failure could place residents at risk for not receiving care and services to meet their needs upon discharge. Findings included: Review of Resident #2's Face Sheet dated 12/10/2024 reflected a [AGE] year-old male admitted [DATE] at 2:44 PM. with diagnoses of Unspecified Dementia (a general term for a decline in mental abilities that affects a person's daily life), Major depressive disorder with psychotic symptoms, Essential (Primary) Hypertension (abnormally high blood pressure that not caused by a medical condition), Pain, unspecified (pain that does not have a clear cause or diagnosis), and Major Depressive Disorder (persistent low mood and loss of interest in activities that people enjoy). Resident #2 was discharged on 12/11/2024 at 10:17 AM. Record Review of the Medical Record was completed on 01/22/2025. These records were reviewed to assess the admission process. There was no MDS, Care Plan, Interdisciplinary Discharge Summary, or 30-Day Discharge Letter included in the Medical Record. During a phone interview on 01/22/2025 at 9:52 AM with the complainant, she stated Resident #2's was brought to the ER for a psychiatric evaluation by family member after leaving the nursing facility. The complainant contacted the NF and was told the NF would take Resident #2 back if he was appropriately medicated. The complainant stated Resident #2 was in the ER for 5 days awaiting placement and was placed at an alternative facility. During an interview on 01/22/2025 at 2:33 PM with the DON she reported the Ombudsman was notified of the discharge . During an interview with the facility Administrator on 01/22/2025 at 2:37 PM she reported she was out on vacation at the time of the admission and discharge of Resident #2. Per her report based on her email chain of the situation, Resident #2 came from home after being seen by his primary care provider and was placed on the secure unit. The Interim DON in charge at the time spoke with family upon admission. Based on the email report, Resident #2 was getting acclimated then the next day Resident (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: 455489 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 455489 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Jeffrey Place 820 Jeffrey Dr Waco, TX 76710 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)