Health inspection·April 10, 2025

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review the facility failed to ensure residents had the right to a safe, clean, comfortable, and homelike environment, including but not limited to receiving treatment and supports for daily living safely for 1 of 8 (Resident #8) residents reviewed for environment. 1. The facility failed to ensure Resident #8's bathroom floor and toilet was free of brown substances from 2/28/2025-3/18/2025. 2. The facility failed to ensure soiled briefs were removed from Resident #8's trash can on 2/28/2025. 3. The facility failed to ensure the bathroom floor was free from debris of toilet paper scattered on the floor from 2/28/2025-3/18/2025. These failures could place residents at risk of an unsafe or uncomfortable environment and a decrease in quality of life and self-worth. Findings include: Record review of Resident #8's, face sheet dated 4/9/2025 reflected a [AGE] year-old female who was admitted to the facility on [DATE]. Resident #8 had diagnoses which included Alzheimer's disease (progressive disease that destroys memory and other important mental functions), hypertension (high blood pressure), urinary tract infection (an infection that occurs when a bacteria enters the urinary tract system) and insomnia (difficulty falling asleep or staying asleep). Record review Resident #8's quarterly MDS assessment, dated 3/7/2025, reflected Resident #8 had a BIMS of 09, which indicated moderate cognitive impairment. Resident #8 had no behaviors, was occasionally incontinent of bladder and was continent of bowel. Resident #8 required supervision with toileting. Record review of Resident #8's care plan dated 3/5/2024 indicated she had memory/recall problems related to Alzheimer's. The Care plan dated 9/23/2024 indicated Resident #8 had experienced bladder incontinence related to overactive bladder placing her at risk for urinary tract infections and skin impairment. During a phone interview on 04/8/2025 at 10:23 A.M., the RP said Resident #8 was having issues with the resident in the adjoining room leaving a mess in the connecting bathroom. She said the bathroom Page 1 of 4 455678 455678 04/10/2025 Avir at Longview 301 Hollybrook Dr Longview, TX 75605

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some would be dirty with feces, towels, and trash everywhere on the floor and toilet. The RP said she was concerned Resident #8 would slip on the urine and feces on the floor while for attempting to use the bathroom. The RP said the Administrator was notified and adjoining resident was provided with a bedside commode to use. During an interview on 4/8/2025 11:20 AM, Resident #8 said she shared a restroom with Resident #9 in the adjoining room. Resident #8 said the resident in the adjoining room would make a mess in the bathroom and she had to clean up the mess. Resident #8 said the nurses and aides would try to help and the housekeeper would come in every other day to clean. Resident # 8 said she observed feces, urine, dirty clothing, and toilet paper on the floor. Resident # 8 provided collaborating pictures of the bathroom. She said she did not feel heard when she reported her issues to the Administrator. She was not able to provide the date reported. Resident #8 8 said she was a clean person and it made her feel she did not matter. She said the staff were cleaning her bathroom now. She said the dirty bathroom caused her stress and felt short of breath and felt like she was going to have a heart attack. During a review of photos presented by Resident #8 dated 2/28/2025 at 7:00 PM, revealed a bathroom with a white brief located in the trash can in the bathroom with white debris on the floor. During a review of a photo presented by Resident #8 dated 3/1/2025, revealed a bathroom with a liquid substance on both sides of the toilet with white toilet paper debris soaking up the liquid substance. During a review of a photo presented by Resident #8 dated 3/1/2025 at 7:37 PM, revealed a toilet with brown substance at the bottom of the toilet. During a review of a photo presented by Resident #8 dated 3/3/2025 at 7:54 PM, revealed a brown substance on the toilet handle and toilet paper scattered in front of the toilet soaking up a liquid. During a review of a photo presented by Resident #8 dated 3/4/2025 revealed a pile of toilet paper scattered on the floor and a partially used roll of toilet paper intact. During a review of a photo presented by Resident #8 dated 3/5/2025 at 8:46 PM, revealed a brown substance smeared across the lower part of the toilet bowl with toilet paper in the toilet and in front of the toilet on the floor. During a review of a photo presented by Resident #8 dated 3/6/2025 at 7:18 AM, revealed a brown substance smeared on the lower part of toilet and white toilet paper debris on the floor with a brown liquid on the seat of the toilet seat. During a review of a photo present by Resident #8 dated 3/7/2025 at 8:48 AM, revealed a liquid on the floor in the bathroom with toilet paper soaking up liquid. During a review of a photo presented by Resident #8 on 3/8/2025 at 8:42PM, revealed a bathroom with white toilet paper around the perimeter of the toilet. During a review of a photo presented by Resident #8 dated 3/10/2025 at 5:07 AM, revealed a white brief located next to the toilet. During a review of a photo presented by Resident #8 dated 3/14/2025 at 12:24 PM, revealed a pair of 455678 Page 2 of 4 455678 04/10/2025 Avir at Longview 301 Hollybrook Dr Longview, TX 75605

F 0584 gray pants with a wet appearance hanging on the bathroom grab bar next to the toilet. Level of Harm - Minimal harm or potential for actual harm During a review of a photo presented by Resident #8 dated 3/15/2025 at 2:44 PM, revealed white toilet paper soaking up a substance in front of the toilet. Residents Affected - Some During a review of a photo presented by Resident #8 dated 3/18/2025 at 4:57 PM, revealed a brown substance on the rim of the toilet. During a record review of a grievance log , revealed no grievances or concern with Resident #8 in February 2025 or March 2025. During an interview on 4/9/2025 at 9:30 AM, Housekeeper D said she had not observed any resident rooms with feces, urine, toilet paper on the floor. She said housekeeping was not at the facility at night and the housekeepers left at 4 pm. Housekeeper D said she did not know who responsible for cleaning rooms after the housekeepers left. She said if she was told about a room, she would go clean it. During an interview on 4/9/2025 9:43 AM, Housekeeper E said she worked the hall Resident #8 resided on. She said Resident #9 resided in the adjoining room to Resident #8. She said Resident #9 just moved to another room. She said Resident #9 was moved to another room due to having poop everywhere on the floor and handrails of the bathroom shared with Resident #8. Housekeeper E said there was no housekeepers available after 4 pm and nobody would clean until the next day. She said the aides could clean up the mess. During an interview on 4/9/2025 at 12:36 PM, LVN F said she had not observed any feces or urine on the floor. She said housekeepers were responsible for keeping the rooms clean. LVN F said the staff did not have access to cleaning supplies and toilet paper. During an interview on 4/9/2025 at 12: 56 PM, the DON said the aides were responsible for ensuring the residents' rooms were clean after the housekeeper left at 4 pm. She said the staff did not have access to the chemicals but did have access to towels, sanitizing wipes and water. She said not keeping a resident's room clean could be an infection control issue. She said that was the resident's home and the staff should always keep it clean. During an interview on 4/9/2025 at 3:22 PM, the Administrator said she was made aware of the bathroom situation with Resident #8 on 3/18/2025 or 3/19/2025 after staff was complaining to the DON. She said the facility started Resident #9 with a bedside commode and had therapy go assist. She said the facility had a care plan meeting and made the decision to move Resident #9 from the adjoining room to a private room. She said the staff had been trying to keep her bathroom clean. The Administrator presented a grievance form that was not previously located in the grievance log. During a review of a grievance log presented dated 3/20/2025 indicated Resident #9 was unsanitary and tended to wipe her feces on the walls, floors, and fixtures, unintentionally creating an unsanitary environment. The grievance indicated an action plan to make room arrangements to move Resident #9 to a private room with a private bathroom. The resolution was dated 3/21/2025. The grievance was not signed or dated by the employee who reviewed with family, administrator, or grievance coordinator. During an interview on 4/10/2025 at 9:32 AM, Resident #8 said a couple of nurses would go in and 455678 Page 3 of 4 455678 04/10/2025 Avir at Longview 301 Hollybrook Dr Longview, TX 75605

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some clean her bathroom. Resident # 8 voiced she was upset because she could not use the bathroom when she wanted because it was dirty. She said she would tell the CNAs's and they would not do anything, but the nurses would help her clean the bathroom. She said she did not always tell the staff each time, she would clean it herself. During an interview on 4/10/2025 at 9:15 AM, CNA B said she been at the facility for 4 months. CNA B said she provided care for residents and ensured they were comfortable and safe. The CNA B said they were responsible for cleaning after housekeeping left for the day. CNA B said they used towels, wipes, and paper towels. She said if the toilet was clogged up, they would call maintenance. She said the housekeepers were mainly responsible for ensuring the bathrooms were clean. During an interview on 4/10/2025 at 11:12 AM, ADON A said she expected the resident bathrooms to be cleaned timely and expected the CNAs to keep bathrooms clean after hours. She said housekeeping was responsible for ensuring the bathrooms were clean. The ADON A said having unclean floors with feces, urine on the floor could be an infection control hazard or a fall hazard. The ADON said she expected the staff to report any ongoing situation to the Administrator or DON. During an interview on 4/10/2025 at 11:25 AM, the ADM said she expected the staff to keep the bathrooms clean day and night. She said she expected staff to report any issues on a regular basis. She said if there was feces on the floor or urine, it could cause the resident to contract an infection. She said the resident could have incontinent issues themselves due to not wanting to use the dirty bathroom. She said a resident could slip and injury themselves if there was urine or feces on the floor. She said it could affect them negatively emotionally and start having issues with the other resident causing confrontations and arguments. She said housekeeping and charge nurse were responsible for ensuring the rooms were cleaned. Record review of the facility's policy revised February 2021 titled Homelike Environment indicated, Residents are provided with a safe, clean, comfortable, and homelike environment .2 facility staff and management maximize, to the extent possible, the characteristics of the facility .a. clean, sanitary, and orderly environment . Record review of the facility's policy revised September 2022 titled Standard Precautions indicated, Standard precautions are used in the care of all residents regardless of their diagnoses, or suspected or confirmed infection status. Standard precautions presume that all blood, body fluids, secretion and excretions, non-intact skin and mucous membranes contain transmissible infectious agents. 5. Resident-care equipment .soiled with blood, body fluids, secretions, and excretions are handleds in a manner that prevents skin and mucous membrane exposure, contamination of clothing and transfer of microorganisms to other residents and environments .Environment surfaces, beds, bedrails, bedside equipment, and other frequently touched surfaces are appropriately cleaned. 455678 Page 4 of 4