Health inspection·November 26, 2025

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some moderate assistance with toileting hygiene, showering/bathing. Interview with housekeeping staff on 11/25/25 at 1:30 p.m. Housekeeping staff that she worked in housekeeping for the facility and she stated that they have been working hard to get the facility cleaned as the administration was in the building to address some of the issues that they have been having. She stated that she is a single mother and that they recently instated a requirement for the housekeeping staff to work a weekend rotation and she was worried that she would not be able to do that due to having to have someone watch her children. She stated that she feels like the facility needs more housekeeping staff as it seems hard for her to keep up with the daily cleaning tasks. She stated that she is not aware of any specific examples but she stated that it would be believable that a resident's room was not cleaned daily. She stated that she had voiced her staffing concerns with the administration but does not believe they will hire more housekeeping staff. Interview with LVN A on 11/25/25 at 1:45 p.m., LVN A stated that the halls should not smell of urine or fecal matter and that sometimes the facility can be dirty but she was not aware of any issues with housekeeping. She stated that they could not use air fresheners and sometimes if the facility was not cleaned appropriately it could smell. Interview with family member of Resident #1 on 11/25/25 at 3:15 p.m. Family member of Resident #1 stated that the facility was clean today because the investigator was here but that it was normally filthy. She stated she and other family have cleaned Resident #1's room themselves to make it comfortable. She stated that she believed she continues to have C. Diff and get UTI's because they are not cleaning her room appropriately. She stated that the entire facility smells horrible to her most days. Interview with CNA C on 11/26/25 at 10:30 a.m., CNA C stated that there were times when the facility was not clean and that residents would sometimes complain about trash in their rooms or unclean floors. She stated that there should not be any unpleasant odors in hallways and that proper cleaning would take care of most of that. Interview with CNA D on 11/26/25 at 10:58 a.m., CNA D stated that even the housekeeping staff were overwhelmed and overworked and were now being made to work rotations on the weekends. She stated that the facility was sometimes dirty and smelled bad due to not having enough staff to clean or staff calling in due to being overworked. She stated that some of the residents can have bowel movements that the smell carries outside of their room but that should not be a lasting smell. She stated that she had heard residents complain about the cleanliness of the facility. Interview with CNA G on 11/26/25 at 11:45 a.m., CNA G stated that housekeeping does not appear to do their job and stated that they were cleaning feverishly after the investigator arrived. She stated that there was always trash overflowing in the residents' rooms, dirty floors and bathrooms and she stated that it had made her want to quit due to the unclean environment. She stated that she did not feel like they have good infection control or take careful precautions to isolate residents with contagious infections. Interview with Regional RN on 11/26/25 at 12:20 p.m., Regional RN stated that she was at the facility to address some of the same issues that the investigator is looking into such as complaints regarding the resident's rooms being cleaned frequently. She stated that the administration was implementing some policies to increase the cleanliness and infection control practices of the facility and that the facility should not smell any foul odors in the hallways or bedrooms on a regular basis. She stated that some residents may have bowel movements or infections that cause the odor to be stronger than normal but that appropriate cleaning processes would help to alleviate most of the concerns related to that. She stated that they are going to create a weekend rotation for housekeeping so that there was always housekeeping staff on duty to clean during the day. Observation of Resident #8's room on 11/26/25 at 2:40 p.m., there was a strong odor of urine and fecal matter. Observation of Resident #7's room on 11/26/25 at 2:44 p.m., there was a strong odor of urine and fecal (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455678 If continuation sheet Page 2 of 9 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 455678 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Longview 301 Hollybrook Dr Longview, TX 75605 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete matter in both rooms of the suite. Observation of Resident #9's room and interview on 11/26/25 at 2:53 p.m., there was a strong odor of urine and fecal matter. Observation of hallway outside and inside of Resident #10's room on 11/26/25 at 3:29 p.m., there was a strong odor of urine and fecal matter. Resident #10 did not wake up to be interviewed. Interview with ADM on 11/26/25 at 4:15 p.m., ADM stated that the facility should not smell any foul odors for any extended period of time and that they are implementing weekend rotations for housekeeping to help keep up with cleaning protocols at the facility. She stated that Resident #10 urinates into his air conditioning which caused the strong odor in his bedroom. She stated that Resident #1 had C. Diff which could cause a strong odor. Record review of Resident Rights Policy dated February 2021 which indicated that residents have a right to a dignified existence, to be treated with respect, kindness and dignity, to be free from neglect. Event ID: Facility ID: 455678 If continuation sheet Page 3 of 9 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 455678 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Longview 301 Hollybrook Dr Longview, TX 75605 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 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure a resident who was unable to carry out activities of daily living received the necessary services to maintain grooming and personal hygiene were provided for 4 of 7 (Residents #1, 3, 5 and 7) residents reviewed for ADLs. The facility failed to ensure Residents #1, 3, 5, and 7 received showers, brief checks and changes as needed in October and November 2025. These failures could place residents at risk of not receiving services/care and decreased quality of life. Findings Include: Resident #1Record review of Resident #1's face sheet indicated that Resident#1 was a [AGE] year old female admitted to the facility on [DATE] with diagnoses of gastroparesis (stomach takes too long to empty into the intestines), constipation (infrequent bowel movements that are often hard to pass),and neuromuscular dysfunction of the bladder (have trouble urinating, leaking or feeling like you can't full empty the bladder). Record Review of Resident #1's MDS assessment dated [DATE] indicated that she had a BIMS of 15 which means that the resident was fully oriented and cognitively intact. Record review of Resident #1's care plan dated 10/6/25 indicated the following care areas: * Resident required total care with all ADL's, interventions indicated that resident is dependent on staff for all ADL's *She had a history of UTI's, no intervention listed*a potential for skin integrity issues. Interventions were to educate the patient and patient representative on the importance of keeping skin dry and clean and for the facility to provide skin care per the facility guidelines and PRN as needed. Record review of Resident #1's Kardex dated 11/26/2025 indicated that she was on enhanced barrier precautions for high contact. Interview with Family Member of Resident #1 on 11/25/25 at 12:19 p.m. Family member stated that Resident #1 has had UTI's in the past and they installed cameras in Resident #1's room and it did not seem like the facility staff were changing her brief as needed or checking on her every two hours as they were supposed to do. She stated another family member visited Resident #1 on the morning of 11/21/25 and Resident #1 had a full brief that needed to be changed. The family member stated they informed an aide (name unknown) and they said they would come to change her. She stated they visited with the resident for over an hour and no one ever came to change Resident #1. The family member stated that they came back that evening and that the brief did not appear to have been changed in that time period as they could still see the blood from Resident#1's hemorrhoid mixed in with the fecal matter in the brief as it had appeared that morning. The family member stated that Resident# 1 had complained that she had not been given a bath in a long period of time and that Resident # 1 likes to be clean. Interview with family member of Resident # 1 on 11/25/25 at 3:15 p.m. Family member of Resident # 1 stated Resident # 1 wanted to be bathed but they will only give her bed baths and never get her out of bed. She stated that Resident #1 was supposed to be at the facility for rehabilitation and should be up and walking but due to her infection, they did not allow her to leave the room. She stated that her relative goes to the hospital with UTI's but she cannot remember that last time and thinks it was a couple of months ago. She stated that she believed she continued to have C. Diff and get UTI's because they are not changing Resident #1 frequently. Record review of a photograph provided on 11/25/25 at 10:00 a.m. by family member of Resident #1 and taken on 11/21/2025 at 6:49 p.m. which showed a full brief with blood mixed with feces. This is stated to be a picture of Resident #1's brief that was stated to not have been changed during the day on 11/21/2025. Interview with the DON on 11/25/25 at 11:30 a.m DON stated that the expectation of the facility administration was that residents be checked at least every two hours and changed if their brief was wet or soiled. DON stated that the risk of this not being done is an increase in infections such as urinary tract infections and skin breakdown and Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455678 If continuation sheet Page 4 of 9 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 455678 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Longview 301 Hollybrook Dr Longview, TX 75605 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some the possible development of pressure ulcers, other wounds and a decrease in the quality of life for the residents. DON stated that hand hygiene was also important to decrease infections. DON stated that a clean environment was also important for keeping infections down as surface bacteria can lead to infections. DON stated that she reviewed the infection surveillance report which looked back at the last three months and showed that there have been 29 UTI's in the facility which was high based on their total filled beds of 63. DON stated that Resident #1 has had a C. Diff infection for a long period of time and that could cause frequent bowel movements and she was going to do an in-service on c.diff with nursing and CNA staff to explain that cleaning the bed and the person was very important to avoid reinfection. She stated that Resident #1 last had a UTI in September of this year. DON stated that the source of the UTI's was unknown but could come from being left in a soiled brief for extended periods of time. Interview with the ADM on 11/25/25 at 11:55 a.m. ADM stated that it was her expectation that no resident would be left in a soiled brief for any extended period of time and that the staff should be checking and changing the residents as needed, but at least every two hours. She stated that she had recently hired a new DON and hoped to correct many of the issues she discovered after the last DON left. She stated that wound care tracking and infection control were not properly tracked and that they were working on correcting that. She stated that staff should ensure that residents have water to drink and respond to call lights in a timely manner. Observation of Resident #1 on 11/25/25 at 12:35 p.m. Resident #1 was observed lying in bed and appeared appropriately groomed. Investigator observed her left foot and saw no injuries at the time of observation. Interview with Resident #1 on 11/25/25 at 12:35 p.m. Resident # 1 stated that it was often a long time in between baths and that they usually gave her bed baths and she did not feel like this gets her as clean as she needs to be. She stated that she had told the staff but that they continued to give her bed baths more often than actual showers. She stated it was often a long time in between when they change her when she has a soiled brief. She stated that they often ran out of ice and did not bring water when she ran out. She stated that they brought her water a few minutes ago. Resident #3Record Review of Resident #3's face sheet face sheet which indicated that Resident #3 was a [AGE] year old female admitted to the facility on [DATE] with diagnoses of UTI (an infection of the urinary tract), and constipation (infrequent bowel movements that are often hard to pass). She had a BIMS of 15 which means that the resident was fully oriented and cognitively intact. Record review of Resident #3's Kardex indicated that staff should check the resident every two hours and assist with toileting as needed, provide peri care after each incontinent episode, she used briefs and could use the call light and was able to inform CNA and nurses when she had been incontinent, observe for and report to nurse any of the following signs or symptoms of a UTI: pain, burning, blood tinged urine, urinary frequency, foul smelling urine, altered mental status, change in behavior, such as confusion, increased restlessness or wandering. Record review of Resident #3's care plan dated 9/10/25 indicated that staff will assist with grooming needs, comb hair, wash face and hands, oral hygiene and shave as needed. Staff were to monitor BMs for amount and frequency. Record review of Resident #3's MDS assessment which indicated that she was dependent on staff for toileting, shower/bathing, dressing, putting on and taking off footwear as well as all mobility needs. Observation of Resident #3 and interview on 11/25/25 at 12:55 p.m. Resident #3 was observed eating her lunch and lying in bed. She appeared clean and well groomed. The resident's room was clean at the time and did not have any foul odors to note. Resident #3 stated the hospice nurse and aide were the ones that give her bathes and the weekend staff also gave her baths. She stated that the hospice aide came every day and changed her and other than that she had gone all day without being changed. She stated she would hit her call light button (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455678 If continuation sheet Page 5 of 9 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 455678 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Longview 301 Hollybrook Dr Longview, TX 75605 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some to let them know she needed to be changed and they would not come. She stated that she knew how it felt when she had a urinary tract infection and she did not currently have one. She did not know if she had had one since being placed in this facility. Interview with Hospice Aide on 11/25/25 at 1:05 p.m. Hospice Aide stated that she was an aid for Resident #3 and comes 5 days per week to provide personal care services for Resident #3. She stated that she will frequently come and Resident # 3 will be wet or have had a bowel movement and the resident would tell her that she has not been changed in many hours. She stated that when hospice was not here with Resident #3, the facility should have been checking and changing her as needed every two hours. She stated that Resident #3's family has asked her to make sure that Resident #3 has water before she left as she was with Resident #3 for about 40 minutes each visit, unless more time is needed. Interview with family member of Resident # 3 on 11/26/25 at 9:37 a.m. Family member of Resident # 3 stated that her family member was very capable of telling everything that goes on and she often told her that if hospice or the weekend staff did not do it, it would not get done She stated that Resident # 3 had complained many times that the staff do not change her and will ignore her needs for water and other things. She stated that hospice gave her baths and that the administrator came on one occasion and changed her when she needed to be changed. She stated that the staff would often have attitudes when they were asked to do something for a resident and that Resident #3 would wait for one of her relatives or the hospice staff to show up to get things taken care of. She stated that her relative has had UTI's in the past and they thought she had one recently, but Resident #3 knows when she has one and said that she does not. Resident #5Record Review of Resident #5's face sheet which indicated that Resident #5 was a [AGE] year old female admitted to the facility on [DATE] with diagnoses of Parkinson's Disease (a neurological disorder that causes tremors, and stiffness of the muscles), and UTI (an infection of the urinary tract). Record review of Resident #5's care plan and Kardex were basic and not fully completed due to her recent admission to the facility. Her care plan indicated that she had a colostomy bag and was to receive care every shift and as needed. Observation of Resident #5 and interview on 11/25/25 at 1:20 p.m. was observed sitting in her bedside chair appropriately groomed and in no apparent distress. Her room was clean and there was nothing abnormal to note. Resident #5 stated that she had been at the facility for several weeks. She stated that she had gone a couple of weeks without a bath and that when she complained, it was ignored. She stated that the staff fuss at her for things outside of her control. She stated that she had a colostomy bag, it had busted and came loose all the time, and the staff argued with her and told her that she was messing with it or moving too much. She stated that she cannot control her movement as she had Parkinson's Disease. She stated that she had relatives that all live nearby and can visit her frequently. She stated that a CNA yelled at her for peeing too much and she thinks that they fired her. She stated that she can hold her bladder for a short period of time but they told her to just urinate in her diaper and that has been hard to get used to as she does not like to be wet or dirty and they did not come very often to change her. She stated that they did not check on her every two hours on any shift. Interview with family member of Resident #5 on 11/26/25 at 9:31 a.m. Family member of Resident #5 stated that they have seen on camera on more than one occasion where Resident #5 will have their colostomy bag come loose and she will have fecal matter on her and lie in bed for several hours with no one checking on her. She stated that she would try to call the facility but was never able to reach anyone to let them know what was going on. She stated that Resident #5 has gone weeks without a bath or fresh sheets on her bed. She stated that Resident #5 was upset about not being bathed and being left in her own waste for a long period of time. She stated that she has tried to report it to the facility but they do not answer their (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455678 If continuation sheet Page 6 of 9 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 455678 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Longview 301 Hollybrook Dr Longview, TX 75605 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some phones and when they are visiting with Resident #5 they will bring it to an aide's attention and they will tell them that they will come take care of changing the resident and they will wait more than an hour and no one will ever come. Resident #7Record Review of Resident #7's face sheet which indicated that she was a [AGE] year old female admitted to the facility on [DATE] with diagnoses of dementia (where memory is impaired, constipation (infrequent bowel movements that are often hard to pass). Record review of Resident #7's care plan dated 4/23/25 indicated that she has an altered urinary elimination related to: history of recurrent UTI. Record review of Resident #7's MDS assessment indicated that she required partial or moderate assistance with toileting hygiene, showering/bathing. Observation of Resident #7 and interview on 11/26/25 at 2:44 p.m. was observed sitting in her chair beside her bed. There was a strong odor of urine in her bedroom as well as the bedroom of her suitemate. She stated that she felt staff change her brief as needed and that though she does not like being in a facility she has nothing else to compare it to and has no specific complaints. Interview with LVN A on 11/25/25 at 1:45 p.m. LVN A stated that the facility did not have enough aides to adequately care for the residents. She stated that they are phasing out the med aides and that task has been passed on to the nursing staff. She stated that they do their best to help the aides in caring for the residents' daily living tasks, but that passing meds and their nursing duties keep them tied up for most of the shift. She stated that the staff do their best but she was sure that some residents had gone for more than two hours without being checked and changed as there are not enough staff in the building to complete rounds on 63 residents and handle all of their needs in a two hour period. She stated that the risk of not being checked and changed in a timely manner was an increase in infections including wounds as well as UTI's and bedsores. She stated that skin integrity was greatly affected by being left in soiled or wet diapers for an extended period of time. She stated Resident # 1 had C Diff which was the reason she received bed baths as they tried not to get her out of her room. She stated she felt on her shift call lights are answered in a timely manner and that no one's call light goes unanswered for more than 15 minutes at the most. She stated that the morale was very low for staff at the facility due to the demanding workload and the decision to phase out medication aides. She stated she felt that the facility could use at least 2 more CNAs per shift if they were expected to complete all of their tasks in a timely manner. Interview with RN B on 11/25/25 at 1:55 p.m. RN B stated her shift was caring for the residents on their hall appropriately, but the workload was very high and there were not enough aides to complete all of their tasks. She stated the decision had been made recently to do away with medication aides and she did not believe that this would help things improve at the facility. She stated she was not aware of any residents being left in a soiled or wet brief for a long period of time, but she could imagine that it does happen as there are only 4 to 5 CNA's during the day and even less at night to cover the entire facility. She stated that they answer call lights in a timely manner and that if they are able, the nurses also help with CNA duties, but this was less common as they are now also passing medications. Interview with CNA C on 11/26/25 at 10:30 a.m. CNA C stated that she had worked for the facility for a little over a year. She stated that they had a great team and then the facility made changes to staffing reducing the number of CNA's doing away with med aides and staff started quitting because the workload was unmanageable. She stated she was working as a CNA and her job was to check on the residents every two hours, check and change them if necessary. She stated the residents were not being checked on in timely manner due to the short staffing and lack of aides. She stated that nurses are having to help with changes but their load was already heavy as they are having to administer medication, finger sticks and wound care. She stated that nurses help out on the floor as much as they could, but most days it (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455678 If continuation sheet Page 7 of 9 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 455678 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Longview 301 Hollybrook Dr Longview, TX 75605 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some felt impossible. She stated that the risk associated with being left in a wet brief for a long period of time was skin breakdown, UTI's, bed sores, and things like that. She stated the staff did their best but they needed more help and to have med aides to divide the workload. She stated that when she first started there were six or seven aides working at the facility in addition to 2 med aides. She stated some of the residents were being neglected by being left in wet briefs and not having water when they needed it. She stated that she showered residents and if a resident complains that they did not get a shower on their shower day, she would shower them. Interview with CNA D on 11/26/25 at 10:58 a.m. CNA D stated that she had worked at this facility for several years. She stated that the facility had a great team up until about 90 days ago when they eliminated the medication aides and reduction in the number of aides on the floor. She stated that the workload was unmanageable and that they could not keep up and everyone was overloaded with work. She stated that residents were being neglected due to the workload on staff. She stated that residents were not being changed timely or given baths timely and regularly which placed them at risk of bedsores, skin breakdowns and other things. Interview with CNA E on 11/26/25 at 11:30 a.m. CNA E stated that they needed at least one more CNA to adequately do their jobs. She stated that residents were likely left in wet briefs for longer than they should have been due to not having enough staff to help with checking and changing. She stated that the nurses tried to help but they were also overburdened with work as they were having to do the administration of medication and all of their other nursing duties. She states that the risk to the residents being wet was skin integrity issues and infection and that she was not aware of anyone specifically that was being left in wet or soiled briefs but she had no doubt that it did happen. Interview with CNA F on 11/26/25 at 11:41 a.m. CNA F stated she felt that residents were left in wet briefs and soiled briefs for long periods of time due to the overwhelming workload that the CNA's had. She stated that they did the best they could but it felt impossible to get the job done correctly with the number of staff that they had. She stated that she did not know of any residents specifically that were being left in wet or soiled briefs or were not being bathed but she did think that happened because it was hard to do rounds every two hours with the staff that they had. Interview with CNA G on 11/26/25 at 11:45 a.m. CNA G stated housekeeping did not appear to do their job and stated that they were cleaning feverishly after the investigator arrived. She stated that there was always overflowing trash in the residents' rooms, dirty floors and bathrooms and she stated that it had made her want to quit due to the unclean environment. She stated that she did not feel like they have good infection control or take careful precautions to isolate residents with contagious infections. Interview with DON on 11/26/25 at 12:00 p.m. DON stated that she felt like there were enough staff to get the job done and that staffing was no excuse to leave anyone in a soiled or wet brief for an extended period of time. She stated that she believed it was a matter of getting staff that want to work and that the administration had stated that there were plans to hire more staff. She stated that an acceptable infection rate in a facility with 63 residents, she would like to see it at or below 10% and that though she did not know the source of the UTI infections that 29 residents having an infection in three months was concerning to her. She stated that this could have been the result of being left in wet or soiled briefs. Interview with Regional RN on 11/26/25 at 12:20 p.m. Regional RN stated that she had been with the facility for a few weeks as the regional nurse. She stated that she was at the facility to address some of the same issues that the investigator was looking into such as CNA staff not rounding every two hours, residents not receiving baths and clean sheets as scheduled. She stated that being left in a wet brief for a long period of time had a number of risks mostly dealing with skin integrity, bed sores and UTI's. She stated that they had developed a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455678 If continuation sheet Page 8 of 9 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 455678 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Longview 301 Hollybrook Dr Longview, TX 75605 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete plan to deal with that and will be providing it to the investigator. Record review of the document entitled Action Plan and dated 11/19/25 and indicated issues identified by facility regional administration were wound tracking, weight documentation being completed timely, documentation not being completed timely by facility staff, care plans not completed timely and do not accurately reflect each resident's needs. These tasks were being addressed by the facility by close monitoring by the DON and ADON as well as the administrator to ensure correction. Record review of the Weekly Shower Schedule for Residents 1, 3, 5, and 7 were to be given showers on Mondays, Wednesdays and Fridays. Record review of the Infection Surveillance Report dated 11/25/25 which indicated that since August 2025 the facility has had 29 urinary tract infections. Record review of grievances filed at the facility from May 2025 to present which showed that on 5/5/25, 5/23/25, 6/13/25, 7/25/25, 11/11/25, 11/24/25 (2) grievances were filed for not being showered, and on 6/13/25, 7/8/25 and 7/25/25 (2) grievances were filed for briefs not being changed. Record review of in-service documentation dated 11/24/25 indicated the following areas were addressed in the in-service: *Showers being given as scheduled, *2-hour rounds being completed,*The correct size briefs are being used and no one is put in a double brief. Record review of an in-service dated 11/10/25 indicated instructed participants to check and change including that incontinent rounds are to be conducted every two hours throughout the shift.fresh ice is to be passed every shift.do not leave dirty briefs in the trashcans in the rooms.all showers are to be given per schedule. Record review of the facility action plan dated 11/19/25 and indicated that the entire facility had a skin sweep completed on 11/20/25 and that there was a plan in place to update and complete skin assessments and wound documentation daily in the clinical meeting. This document identified a problem of some residents care plans are not completed timely and some do not match the needs of the residents The facility implemented a plan to get care plans back on track to identify accurately the needs of each resident in a timely manner upon admission into the facility. The facility identified a problem of an increase in UTI's in the facility and the plan to address this was to ensure that nursing staff are in-serviced on 2 hour incontinent care, importance of hydration at bedside, ADON or Designee will do spot checks of CNA's ensuring that 2 hour rounds are being completed on both the day and night shift. DON and ADON will ensure that CNAs are proficient in handwashing and peri care competencies. Record review of the Abuse, Neglect, Exploitation and Misappropriation Prevention Policy dated April 2021 that indicated that neglect is defined as the failure of the facility, its employees or service providers to provide goods or services to a resident that are necessary to avoid physical harm , pain, mental anguish or emotional distress.neglect occurs when the facility is aware of, or should have been aware of, goods or services that a resident requires but the facility fails to provide them and this has resulted in (or may result in)physical harm, pain, mental anguish, or emotional distress.includes cases where the facility's indifference to or disregard for resident care, comfort or safety results in (or could have resulted in) physical harm, pain, mental anguish or emotional distress. Record review of the facility Resident Rights policy dated February 2021 and indicated a right to a dignified existence, to be free from abuse and neglect. Event ID: Facility ID: 455678 If continuation sheet Page 9 of 9