Inspection·May 3, 2023

F 0550 dining room with her feeding pump uncovered. Level of Harm - Minimal harm or potential for actual harm During an observation on 5/01/2023 at 11:45 AM, CNA D was pushing Resident #19. back to her room from the dining room without a privacy cover on the feeding pump. Residents Affected - Few During an interview on 5/02/2023 at 11:05 AM, CNA D said she had been employed at the facility for 2 years. She said when a resident had a feeding tube, she would cover the resident's body with a sheet, so the g-tube was not exposed, but had never been told anything about covering the feeding pump when the resident was out of their rooms. During an interview on 5/2/2023 at 2:45 PM, the DON said she had been employed at the facility since August 2022. She said she was made aware of Resident #19 being out of her room without her feeding pump being covered. She said she was not aware nor was any of her staff that anything attached to a pole had to be covered when leaving the room. She said she was informed by the Regional Nurse about the feeding pump needed to be covered when leaving the room. She said she would in-service staff about privacy and dignity. She said dignity could be an issue for a resident if taken out of their rooms without the feeding pump being covered. She said she never thought about a feeding pump needed to be covered when a resident was out of their room. During an interview on 5/2/2023 at 2:50 PM, the Regional Nurse said she was notified by the DON earlier that day about Resident #19 being out of her room without her feeding pump being covered. She said any resident who has anything attached to a pole should be covered when they leave their rooms. She said going forward she would provide education to staff and all feeding pumps would be covered with a pillowcase or something to cover it. She said the facility did not have a policy on dignity. She said a resident could have negative feelings about not having their feeding pump covered. During an interview on 5/3/2023 at 9:25 AM, the Administrator said he was made aware of Resident #19 being taken out of her room without a dignity cover on her feeding pump. He said going forward residents with a pole would have dignity covers if out of their rooms. He said the facility started an in-service on yesterday 5/2/2023 with all staff about dignity and privacy covers. He said a resident could feel embarrassed or feel like the odd one out compared to anyone else because this was their home. Record review of the facility's statement of resident rights with a revised date of 12/1/2018 indicated, .You, the resident, do not give up any rights when you enter a nursing facility. The facility must encourage and assist you to fully exercise your rights. 5. Be treated with courtesy, consideration, and respect and in recognition of the individual's dignity and individuality . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455550 If continuation sheet Page 2 of 12 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 455550 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Center 280 Moffitt Dr Center, TX 75935 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 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to refer all residents with newly evident or possible serious mental disorder, intellectual disability, or a related condition for level II resident review upon a significant change of condition for 1 of 4 Residents (Resident #19) reviewed for PASSAR (Preadmission Screening and Resident Review Services). The SW failed to refer Resident #19 for a resident review after being diagnosed with bipolar disorder current episode manic severe with psychotic features. The onset of the diagnosis was 3/11/2022. This deficient practice could place residents at risk of not receiving the needed PASSAR services. The findings were: Record review of a PL1 (PASSR Level 1 Screening) for Resident #19 was completed on 1/24/2023 following a hospital stay and indicated the resident was negative for mental illness (MI). Record review Record review of a face sheet for Resident #19 dated 5/2/2023 indicated she admitted to the facility on [DATE] and was [AGE] years old with diagnoses of gastrostomy (feeding tube placed in the stomach), functional quadriplegia (complete inability to move due to severe disability), bipolar disorder (mental illness that causes shifts in a person's mood), and dementia with behavioral disturbance (mental disorder that causes a person to lose the ability to think, remember, learn, make decisions, and solve problems) Record review of an admission MDS dated [DATE] for Resident #19 indicated she was not considered by the state level 2 PASSR process to have serious mental illness and/or intellectual disability or a related condition. She had severe impairment in cognition with a BIMS score of 4. She had a psychiatric mood disorder with diagnoses of anxiety disorder and bipolar disorder. Record review of a care plan dated 2/14/2023 for Resident #19 indicated she has increased potential for psychosocial well-being/mood problem related to diagnoses of mood affective disorder and bipolar disorder with anxiety. Approaches included to consult with the physician and daughter about medicinal intervention as indicated. Record review of Form 1012 titled Mental Illness/Dementia Resident Review for Resident #19 was submitted to the physician signed on 5/2/2023 and indicated the resident does not have a dementia diagnosis or has a dementia diagnosis but it is not primary. The nursing facility action was a new positive PASSR Level 1 Screening that was submitted on 5/2/2023 according to the instructiond on the form since it was indicated that Resident #19 had a mood disorder under mental illness. If any of the responses were yes, the nursing facility must complete a new PASSR Level 1 Screening and a full PASSR evaluation would be conducted after the nursing facility submits the new positive PASSR Level 1 Screening. Record review of a new PASSR Level 1 Screening was completed on 5/2/2023 and indicated the resident was positive for mental illness. Record review of a certificate of achievement dated 5/2/2023 certified that the SW and MDS nurse (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455550 If continuation sheet Page 3 of 12 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 455550 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Center 280 Moffitt Dr Center, TX 75935 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 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few completed the course An Overview of the PASSR Process FY 2023 which was an online computer-based training offered by the Texas Health and Human Services Commission. During an interview on 5/2/2023 at 2:30 PM, the SW said Resident #19 had a negative PL1 and was not referred based on the screening that was completed by hospital staff prior to admission to the facility on 1/24/2023. She said the only time she referred residents for a PASSR evaluation was if the PL1 indicated the resident was positive for mental illness, intellectual disability, or developmental delay and Resident #19 did not have a mental illness. During an interview on 5/3/2023 at 9:00 AM, the SW said she had been employed at the facility for many years. She said if a resident identified as having a newly evident or possible MI, ID, or related condition after admission, the MDS nurse entered the diagnoses in the charting system as an active diagnosis and they would discuss in the care plan meetings with new diagnoses, new medications, or changes. She said the facility did have a psychiatrist and counseling services that came to the facility and Resident #19 was not receiving any counseling services and was not taking any antipsychotic medications. She said she was responsible for making the referrals to the local authority and entering the PASSR information into the portal. She said she resubmitted a new PL1 for Resident #19 on yesterday 5/2/2023 after this surveyor questioned if Resident #19 had a mental illness diagnoses without a PASSR evaluation to indicate Resident #19 was positive for MI and sent the form 1012 (Mental Illness/Dementia Resident Review) to the physician for review. During an interview on 5/3/2023 at 9:15 AM, the MDS nurse said she had been employed at the facility for 3 1/2 years and was responsible for completing the MDS assessments for all the residents in the facility. She said she was aware that Resident #19 had a diagnosis of bipolar and schizophrenia but was not responsible for the PASSR information. She said she reviewed diagnoses from hospital records and physician orders and would enter them into the charting system as active diagnoses for the residents. She said the physician would review the diagnoses and sign the orders if applicable. She said if a resident had a new diagnosis, the SW was aware, and the information came from hospital records after a hospital stay or a change in condition. During an interview on 5/3/2023 at 9:25 AM, the Administrator said he had been employed at the facility for a few months and was not aware of the circumstances for Resident #19. He said the SW informed him on yesterday 5/2/2023 that she had submitted a new PL1 for Resident #19 related to her diagnoses. He said going forward the facility would ensure all residents would receive correct services and follow the regulations. He said the PASSR information and diagnoses would be reviewed from day one of admission. He said a resident was at risk of not being appropriately cared for and or receiving needed services. He said the facility did not have policy related to PASSR, but they did follow the rules and regulations by Texas Health and Human Services Commission. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455550 If continuation sheet Page 4 of 12 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 455550 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Center 280 Moffitt Dr Center, TX 75935 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide pharmaceutical services, including procedures that assures the accurate acquiring, receiving, dispensing, and administering of medications for 1 of 5 residents (Resident # 2) reviewed for medication administration. LVN C failed to administer Resident # 2's water flush through his feeding tube as ordered by the physician with medication administration. This failure could place residents who receive medications through a feeding tube at risk of not receiving the intended therapeutic benefit of the medications. Findings included: Record review of facility face sheet dated 05/02/2023 indicated Resident #2 admitted to the facility on [DATE] with a diagnosis of sepsis (blood infection), hypotension (low blood pressure), and encounter for gastrotomy (feeding tube). Record review of physician order dated 4/10/2023 indicated enteral feeding flush with 30-60 ml of water before and after medication administration and 5-15 ml of water between each medication. Record review of admission MDS dated [DATE] indicated Resident # 2 had a BIMS of 06 indicating severely impaired cognition and required nutritional and hydration support of a feeding tube. Record review of comprehensive care plan indicated Resident # 2 required a feeding tube and to provide flushes as ordered by physician. During a medication pass observation on 05/02/23 at 07:25 AM LVN C administered Resident #2's medications per his feeding tube without flushing the feeding tube with water before and after medication administration and between each medication as ordered by the physician. During an interview on 05/02/2023 at 0755 LVN C stated she should have flushed Resident #2's feeding tube before and after medication administration and between each medicine. She reviewed Resident #2's orders and stated the order was for 30-60ml water flush before and after medication administration and 5-15 ml water flush between each medication. She stated she had been trained on proper flush technique during medication administration through a feeding tube and knew the orders but was nervous. She stated she had been a nurse for 20 years and employed at the facility 5 years. She stated the risk of not flushing medications through a feeding tube as ordered could be improper medication delivery or feeding tube occlusion. During an interview on 05/03/23 at 09:28 AM the DON stated the nurses have had yearly proficiencies and LVN C had been properly trained on feeding tube medication pass and water flushes. She stated she and the ADON were responsible for overseeing the nurses and the risk to the resident could be dehydration or a clogged feeding tube. She stated her plan was to retrain all nurses and expects that each nurse understands the risk to the resident. During an interview on 05/03/23 at 09:48 AM the Admin stated the DON and ADON were responsible for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455550 If continuation sheet Page 5 of 12 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 455550 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Center 280 Moffitt Dr Center, TX 75935 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete nurse training and oversight of residents with feeding tubes. He stated the risk could be a clogged tube and prevent proper delivery of medication. He stated his expectation is that all nurses appropriately administer medications through a feeding tube. Record review of policy and procedure titled Medication Administration dated 12/2017 section nasogastric/gastric medication administration indicated, .procedure 12. attach the barrel of the syringe to the tube and pour water into the syringe per physician order 13. flush the tube between medications as ordered, 14. pour additional water as ordered by the physician into the tube and instill to clear the tube of medication. Event ID: Facility ID: 455550 If continuation sheet Page 6 of 12 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 455550 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Center 280 Moffitt Dr Center, TX 75935 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure drugs and biologicals used in the facility were stored in accordance with currently accepted professional principles, and included the appropriate accessory and cautionary instructions, and the expiration date when applicable for 2 of 2 medication carts (nurse cart unit 1 and unit 2) and 1 of 2 medication storage rooms (unit 2) reviewed for labeling and storage. The facility failed to remove expired insulin from the nurse medication cart on unit 1 and unit 2 for Resident # 11 and Resident # 21. The facility failed to remove expired tuberculin PPD (purified protein derivative) Mantoux testing solution from the medication storage room on unit 2. These failures could place residents who receive medications at risk of not receiving the intended therapeutic benefit of the medications. Findings included: Record review of facility face sheet dated 05/01/2023 indicated Resident # 11 admitted to the facility on [DATE] with diagnoses of sepsis (infection in blood), urinary tract infection, diabetes (blood sugar disorder). Record review of comprehensive care plan dated 1/30/23 indicated Resident # 11 had a diagnosis of diabetes and to administer insulin as ordered. Record review of Quarterly MDS dated [DATE] indicated Resident # 11 had a BIMS of 09 indicating moderately impaired cognition and required insulin injections. Record review of physician order dated 1/30/2023 indicated Resident # 11 required Humulin R insulin per sliding scale three times a day as needed for elevated blood sugar. Record review of face sheet dated 05/01/2023 indicated Resident # 21 admitted to the facility on [DATE] with diagnoses dementia, diabetes, and anxiety. Record review of Annual MDS dated [DATE] indicated Resident # 21 had a BIMS of 03 indicating severely impaired cognition and required insulin injections. Record review of comprehensive car plan dated 04/30/2023 indicated Resident # 21 had diabetes mellitus and to provide diabetes medication as ordered by doctor. Record review of physician order dated 09/22/2022 indicated Resident #21 required insulin lispro (Humalog) per sliding scale two times a day as needed for elevated blood sugar. Order dated 04/10/2023 indicated Resident # 21 required insulin glargine 100 units/ml inject 30 ml subcutaneous once a day. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455550 If continuation sheet Page 7 of 12 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 455550 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Center 280 Moffitt Dr Center, TX 75935 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During an observation on 05/01/23 at 11:06 AM the nurse medication cart located on unit 1 stored Humulin R belonging to Resident # 11 with an open date of 3/23/2023. Medication storage directions indicated Humulin R was good for 31 days after opening and should have been discarded on 4/23/23. During an interview on 05/01/2023 at 11:16 am LVN A stated the nurses were responsible for checking all medications before administering including the open dates to ensure the medication can be given. She stated she had been trained on how long insulin was good for once opened or stored at room temperature and they had a table to follow as well. She stated she did not realize Resident # 11's Humulin R had passed the use by date. She stated the risk could be inaccurate blood sugars and adverse reactions. During an observation on 05/01/23 at 11:20 am the nurse medication cart located on unit 2 stored Humalog with an open date of 3/31/23 and insulin glargine with an open date of 4/01/23 belonging to Resident # 21. Medication storage directions stated Humalog was good for 28 days after opening and should have been discarded on 4/28/23 and insulin glargine was good for 28 days after opening and should have been discarded on 4/29/23. During an observation on 05/01/23 at 11:28 AM the medication storage room on unit 2 had 1 vial of tuberculin (Tubersol) PPD Mantoux solution in the refrigerator with an open date of 6/27/2022. The medication storage directions indicated Tubersol solution was to be discarded after 30 days of opening. During an interview on 05/01/23 at 11:33 AM LVN B stated that the nurses were responsible for checking all medication dates before administering. She stated the tuberculin solution was given by the nurses and tuberculin solution was good for 30 days once opening. She stated the admitting nurses administer tuberculin to the residents most of the time. She stated insulin expires at different times and she thought they had all been checked and updated. She stated they had been trained on medication expiration dates and was provided a table to follow as well. She stated the risk of residents receiving expired medication could be any complication. During an interview on 05/01/23 at 11:50 AM the DON stated the night shift nurses and the weekend RN supervisor were responsible for checking medication carts and the medication refrigerator for expired medications, but it was all nurse's responsibility before administering medications that they are in date. She stated the nurses had a table at each station to reference for expiration dates for multiuse vials. She stated the risk could be blood sugar abnormalities and incorrect tuberculin readings. She stated she would retrain all nursing staff on following expiration dates and expects that each nurse follows the policy and regulation. During an interview on 05/03/23 at 09:52 AM the Admin stated the DON, ADON and nurses were responsible for ensuring medications were labeled and stored correctly and that the use by date was followed. He stated the risk could be medication effectiveness. He stated the expectation going forward was that all nurses are retrained and understand the use by date and remove those medications when they have expired. Record Review of policy and procedure titled Medication Vials and ampoules of injectable dated 12/2017 indicated, .#4. Medication may be used until manufacturer's expiration date or for the length of time allowed by state law if inspection reveals problems. Record review of facility document titled Medication Open Vial Expiration Dates dated December 2017 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455550 If continuation sheet Page 8 of 12 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 455550 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Center 280 Moffitt Dr Center, TX 75935 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete indicated, Humalog and Lantus duration 28 days for opened vial at room temperature or in fridge, Humulin R duration 31 days after opening, and TB test solution duration 30 days after opening. Record review of the FDA reference 22. [NAME] S, et al. Effect of oxidation on the stability of tuberculin purified protein derivative (PPD) In: International Symposium on Tuberculins and BCG Vaccine. Basel: International Association of Biological Standardization, 1983. Dev Biol Stand 1986;58:545-552. Accessed at https://www.fda.gov dated 11/9/2020 indicated .A vial of TUBERSOL which has been entered and in use for 30 days should be discarded. Do not use after expiration date . Event ID: Facility ID: 455550 If continuation sheet Page 9 of 12 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 455550 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Center 280 Moffitt Dr Center, TX 75935 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews the facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 1 of 1 resident's reviewed for infection control. Residents Affected - Few The facility failed to ensure that the urinary catheter bag for Resident #2 did not touch the floor. This failure could place residents at risk for infection. Findings Included: Record review of Resident #2's face sheet dated 5/2/23 revealed a [AGE] year-old male originally admitted to the facility on [DATE] and most recent admission on [DATE] with diagnoses including: sepsis (a serious condition in which the body responds improperly to an infection), hypotension (low blood pressure), pressure ulcer of sacral region (bedsore - injury to skin and underlying tissue), and functional quadriplegia (the complete inability to move due to severe disability or frailty caused by another medical condition without physical injury or damage to the spinal cord). Record review of care plan with start date of 2/27/23 for Resident #2 revealed that he had indwelling catheter related to pressure area to coccyx. Interventions included .check tubing for kinks and maintain the drainage bag off the floor . Record review of the Resident #2's admission MDS dated [DATE] revealed the resident had a BIMS of 6 out of 15 indicating the resident had severe cognitive impairment. Question H0100 indicated that resident had an indwelling catheter. Record review of physicians' orders dated 5/2/23 for Resident #2 revealed that he had an order for Foley catheter care every shift and prn with start date of 4/11/23. During an observation on 5/2/23 at 9:45 a.m. Resident #2's urinary drainage bag was observed on floor next to bed. Bed was observed in lowest position with drainage bag hanging on side of bed frame covered by a privacy bag which was open at the bottom allowing the bottom of drainage bag to touch the floor. During an interview with LVN C on 5/2/23 at 9:45 a.m. she said that she knew the bag was not supposed to be on the floor due to risk for infection. She said she had received training on infection control, and it was just an oversight. She said that she would ensure it was hung elsewhere to ensure it was not touching the floor. During an interview with DON on 5/2/23 at 11:15 a.m. she said that she had never seen his drainage bag on the floor. The charge nurse was to ensure that bag was properly positioned and not touching the floor. She said that she would ensure all staff were keeping it off the floor. She said that the drainage bag being on the floor placed the resident at risk for infection. She said that she would begin in-servicing staff on infection control and catheter care. She said that going forward she would expect her staff to keep drainage bags off the floor and follow proper infection control (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455550 If continuation sheet Page 10 of 12 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 455550 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Center 280 Moffitt Dr Center, TX 75935 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 0880 procedures. Level of Harm - Minimal harm or potential for actual harm During an interview with Admin on 5/3/23 at 9:20 a.m. he said that the charge nurse was to ensure that urinary drainage bags are cared for properly and he would expect his staff going forward to keep all urinary drainage bags off the floor. He also said that if the bag was on the floor, it could put the resident at risk for infection. Residents Affected - Few Record review of facility policy titled Catheters - Insertion and Care - Indwelling, Straight, Suprapubic and External dated 12/2017 stated .Properly position bag below level of bladder (must not touch floor) . Record review of facility policy titled Infection Control - Prevention and Control Program dated 12/2017 stated .Implementing measures to prevent to transmission of infectious agents and to reduce risks for device and procedure-related infections . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455550 If continuation sheet Page 11 of 12 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 455550 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Center 280 Moffitt Dr Center, TX 75935 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 0912 Level of Harm - Potential for minimal harm Residents Affected - Some Provide rooms that are at least 80 square feet per resident in multiple rooms and 100 square feet for single resident rooms. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure bedrooms measured at least 80 square feet per resident, in 5 of 18 resident rooms reviewed for required square footage. (Resident room #s 300, 306, 308, 309 and 310). The facility did not have at least 80 square feet per resident in resident room #s 300, 306, 308, 309, and 310. This failure could place residents at risk of having inadequate space for personal belongings, guests, and limit the resident's ability to move about in the room. Findings included: During an interview on 05/02/23 at 2:30 p.m., the Administrator said there had been no structural changes to the building and he knew there had been a waiver granted in the past for five rooms on the secured unit. The Administrator said he would complete HHSC form 3762 (room size waiver for facilities). During an observation on 05/02/23 from 10:00 a.m. until 10:24 a.m., room [ROOM NUMBER] was used for maintenance, rooms [ROOM NUMBERS] were used for the dining area, room [ROOM NUMBER] was used for an office and room [ROOM NUMBER] was used as a sitting area. The rooms measured approximately as follows: * room [ROOM NUMBER]- 6 x 4 feet at entry and the main area was 13.4 x 10.4 feet; * room [ROOM NUMBER]/308- 25.8 x 12.3 feet; * room [ROOM NUMBER]- 12 x 12.4 feet; and * room [ROOM NUMBER]- 12.8 x 12.3 feet. A bed classification worksheet dated 05/02/23 indicated there were 18 resident rooms on the secured unit. (Hall 300) The facility census report dated 05/02/23 indicated 9 residents resided on the secured unit. Resident room #s 300, 306, 308, 309 and 310 were not occupied by residents. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455550 If continuation sheet Page 12 of 12