Inspection·August 14, 2025

F 0804 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some was poured from the beverage glass and was added to the food processor to the thin the macaroni and cheese; the pureed macaroni and cheese was poured into a square stainless-steel pan and placed on the steamtable.- Two (2) 4-ounce (1/2 cup) scoops of diced parsley carrots were removed from the rectangular pan on the steamtable; an unmeasured amount of vegetable juice was removed with a serving spoon from the rectangular pan containing carrots and was added to the carrots in the food processor; the pureed carrots were poured into a square stainless-steel pan and placed on the steamtable.- Two (2) wheat dinner rolls were placed in the food processor and an unmeasured amount of cold milk was added; the rolls were blended until smooth and poured into a square stainless-steel pan which was placed on the food preparation counter located to the left of the steamtable.- Mandarin oranges from 2 dessert bowls were poured into the food processor and 3 tablespoons of food thickener were added to the mandarin oranges. The DM divided and poured the pureed mandarin oranges into 2 dessert bowls without measuring the amount for each serving. The DM stated each bowl had contained a 1/2 cup serving. During an interview and observation on 8/14/2025 at 11:52 AM, the DM stated the mechanically altered hot food items would be warmed enough on the steamtable, and she did not place the food in the oven to reheat. The DM had documented the temperature of the regular diet bone-in chicken at 170 degrees F on her food temperature log. She stated the temperature had been measured when she had taken the chicken out of the oven and placed it on the steamtable. She did not say what time she had placed the pan with chicken on the steamtable. Observation on 8/14/2025 at 11:55 AM revealed the DM measured food holding temperatures for the steam table hot food items with a digital thermometer, and alcohol wipes were used to sanitize the thermometer between food items. Food temperatures were measured at less than 140 degrees F for the following:- The regular diet bone-in chicken was measured at 133.8 degrees F but another piece was measured at 145.8 degrees F.- The mechanical soft diet ground chicken was measured at 133.7 degrees F.- The pureed macaroni and cheese was measured at 123.8 degrees F. Observation on 8/14/2025 at 12:14 PM revealed the last hall meal tray cart was sent from the kitchen for Hall E. The cart contained 5 resident meal trays plus one test tray with a regular diet as had been requested. Thermal plate holders and covers were used for hall cart meal trays and plastic wrap was placed over beverage glasses and dessert bowls. Observation on 8/14/2025 at 12:19 PM revealed the last meal tray was served to the residents for Hall E. Observation on 8/14/2025 at 12:20 PM, 6 minutes after the Hall E meal tray cart was sent from the kitchen, the sample test tray with a regular diet was evaluated by the survey team. The food was luke warm but was not hot. The cheese sauce for the macaroni and cheese was very thick and tasted bland. Record review of the facility's policy and procedure for Food Preparation Guidelines, dated as reviewed/revised 7/23/25, revealed the following [in part]:Policy:It is the policy of this facility to prepare foods in a manner to preserve a resident's nutrition and hydration status.Definitions:Food palatability refers to the taste and/or flavor of the food.Proper (safe and appetizing) temperature means both appetizing to the resident and minimizing the risk for scalding and burns.Policy Explanations and Compliance Guidelines:1.Prepare menu items following the menus and standardized recipes.2.Prepare food by methods that conserve nutritive value, flavor and appearance.a. Minimize exposure to light and air when storing food.b. Prepare foods as directed such as using the appropriate amount of liquid.c. Minimize holding time prior to meal service.3. Food and drinks shall be palatable, attractive, and at a safe and appetizing temperature. Strategies include:a. Meals that vary in color and texture. b. Season food with spices or herbs in accordance with recipes and resident preference.c. Serve hot foods/drinks hot and cold food/drinks cold . Record review of the facility's policy and procedure for Food Production Food Temperatures, dated as revised 5/01/2014, revealed the following [in part]:Guideline:Foods should be served at (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455555 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 455555 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Graham 1224 Corvadura St Graham, TX 76450 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 0804 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete proper temperature to insure food safety and palatability.Procedure:1.Wash, rinse and sanitize a dial face, metal probe-type thermometer with alcohol wipe .2. Insert thermometer into center of product. Allow time for stabilization. Wait until there is no movement for 15 seconds .3. Record reading on Meal Temperature Record .at beginning of tray-line. If temperatures do not meet acceptable serving temperatures, reheat the product (to 165 F) or chill the product to (< 41 F) the proper temperature. Take the temperature of each pan of product before serving.4. Acceptable serving temperatures are:Meat, entrees > 140 but preferably 160-175 FPotatoes, pasta, rice > 140 but preferably 160-175 FPureed foods, hot > 140 but preferably 160-175 FVegetables > 140 but preferably 160-175 F . Review of the USDA Food Safety and Inspection Service website, 2025, specified the following [in part]: Leaving food out too long at room temperature can cause bacteria (such as Staphylococcus aureus, Salmonella Enteritidis, Escherichia coli O157:H7, and Campylobacter) to grow to dangerous levels that can cause illness. Bacteria grow most rapidly in the range of temperatures between 40 F and 140 F, doubling in number in as little as 20 minutes. This range of temperatures is often called the Danger Zone.Keep Food Out of the Danger ZoneNever leave food out of refrigeration over 2 hours. If the temperature is above 90 F, food should not be left out more than 1 hour.Keep hot food hot-at or above 140 F. Place cooked food in chafing dishes, preheated steam tables, warming trays, and/or slow cookers.Keep cold food cold-at or below 40 F. Place food in containers on ice. Event ID: Facility ID: 455555 If continuation sheet Page 3 of 3