Health inspection·February 18, 2026

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Note: The nursing home is disputing this citation. Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure that alleged violations involving abuse are reported immediately, but not later than 2 hours after the allegation is made, if the events that cause the allegation involve abuse for 2 of 7 residents (Residents #1 and #2) reviewed for abuse. The facility failed to report abuse on 2/4/26 at approximately 3:38 p.m. when Resident #2 allegedly struck Resident #1 in the face with a closed fist. This failure could place residents at risk of abuse, emotional distress, and loss of dignity.Findings included: 1.Record review of an admission Record, dated 2/18/26, for Resident #1 indicated a [AGE] year-old male, readmitted [DATE], with diagnoses of autistic disorder (impacts how person perceives and socializes with others), muscle wasting and atrophy (weakness from disuse), and diabetes mellitus. Record review of a quarterly MDS, dated [DATE], indicated Resident #1 was rarely or never understood and a BIMS was not conducted. Record review indicated he required partial assistance with toileting hygiene, upper body dressing, lower body dressing, and personal hygiene. Further record review indicated Resident #1 required substantial assistance with eating, oral hygiene, and putting on/taking off footwear. Record review of a comprehensive care plan, dated 2/4/26, indicated Resident #1 had behavioral symptoms related to severe intellectual disability which included biting himself and yelling out when agitated. Further record review indicated interventions included maintaining a calm environment, using calming techniques, and calming words with resident and removing the resident from the area if the behavior interfered with others. 2. Record review of an admission Record, dated 2/18/26, for Resident #2 indicated an [AGE] year-old male, admitted [DATE] with diagnoses of unspecified dementia (altered cognition) and psychotic disorder with delusions due to known physiological condition. Record review of an admission MDS, dated [DATE], indicated Resident #2 had severely impaired cognition with a BIMS of 4. The MDS indicated Resident #2 required supervision with eating, partial assistance with oral hygiene, upper body dressing, lower body dressing, and personal hygiene. Further review of the MDS indicated he required substantial assistance with toileting hygiene, shower/bathing, and putting on/taking off footwear with no noted physical or behavioral symptoms directed toward others. Record review of a comprehensive care plan, dated 2/4/26, indicated Resident #2 was at risk for impaired social interactions related to mood disorder and psychotic disorder. Record review indicated care planned interventions included administer medications as ordered and monitor for side effects and effectiveness. Review of an incident report for physical aggression, dated 2/4/26 at 3:38 p.m., indicated LVN A was assisting a resident in their room when she heard someone call out for the nurse. LVN A exited the room and saw Resident #2 make contact with another resident (Resident #1) on the cheek. LVN A separated the two residents from each other and notified the DON, NP, and RP. No distress or injuries were noted during the assessment. During an interview on 2/18/26 at 10:55 a.m., LVN A said she witnessed the resident-to-resident altercation between Residents #1 and #2. LVN A said she was coming out of a Page 1 of 2 455565 455565 02/18/2026 Avir at Town Creek 1816 Tile Factory Rd Palestine, TX 75801

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Note: The nursing home is disputing this citation. room, after assisting another resident, and saw Resident #2 appeared to hit Resident #1 in the face with a closed fist. LVN A said she separated the residents and notified the DON, NP, and RP. LVN A said she conducted a skin assessment on Resident #1 and noted no injuries. LVN A said Resident #1 was moved off the secured unit away from Resident #2. LVN A said Resident #1 was nonverbal and did not appear to be emotionally distressed following the incident. LVN A said she had training in the form of in-services which covered reporting abuse. LVN A said she reported the incident immediately to the DON but was unsure if the ADM was informed. Record review of a skin assessment, dated 2/4/29 at 3:29 p.m. completed by LVN A, indicated Resident #1 had no alterations in skin integrity. During an interview on 2/18/26 at 11:30 a.m., the DON said she was familiar with the resident-to-resident altercation involving Residents #1 and #2. The DON said she and the ADM discussed the incident and determined it was not reportable due to the residents involved limited cognition he could not willfully act. The DON said the facility did investigate the incident and took measures to ensure resident safety including increased supervision and psychiatric services. The DON said it was determined that Resident #1 exhibited behaviors (loud noises) which appeared to be triggering to Resident #2. During an interview and observation on 2/18/26 at 1:58 p.m., Resident #2 was observed in his room, lying in bed. Resident #2 presented clean and well-groomed with no noted offensive odor. Resident had no noted marks, bruises, or skin tears. Resident #2 opened his eyes and looked toward the surveyor but did not answer interview questions. During an interview and observation on 2/18/26 at 2:15 p.m., Resident #1 was observed in his room, sitting in a wheelchair. Resident #1 presented clean and well groomed with no offensive odors. Resident had no suspicious marks, skin tears, or bruising noted. Resident #1 did not respond to interview questions. During an interview on 2/18/26 at 2:30 p.m., the ADM said she was notified of the resident-to-resident altercation involving Residents #1 and #2 the day of the incident. The ADM said she did not believe the incident required reporting to the state due to Resident #2's cognition making him unable to willfully act. The ADM said she planned on in-servicing all staff again on abuse and reporting requirements. During interviews conducted on 2/18/26 between 10:00 a.m. and 1:00 p.m. all staff interviewed said they had training covering abuse and reporting requirements. All staff interviewed said they would report witnessed or suspected abuse to the ADM immediately. Staff interviewed included (CNA B, LVN C, CNA D, Housekeeping Supervisor). Record review of facility in-service titled, Abuse, Neglect, and Misappropriation, dated 1/7/2026, indicated 21 nursing staff members attended the training, including the DON. Record review of a facility policy titled, Abuse, Neglect, Exploitation and Misappropriation Prevention Program, dated 2021, indicated .Residents have the right to be free from abuse, neglect, misappropriation of property and exploitation. Record review of a facility policy titled, Abuse, Neglect, Exploitation or Misappropriation - Reporting and Investigating, dated 2022, indicated, .If resident abuse, neglect, exploitation, misappropriation of resident property or injury of unknown source is suspected, the suspicion must be reported immediately to the administrator and to other officials according to state law and HHSC reporting guidelines. 455565 Page 2 of 2