Health inspection·November 30, 2023

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview on 11/30/23 at 9:18 am with CNA C revealed Resident #2's urinary catheter tubing was on the floor and did not have a plastic sleeve on the tubing. CNA C said CNAs and nurses were responsible to make sure the catheter bag and tubing were not not on floor the because the urinary catheter could get contaminated and lead to infections. CNA C said she was in-serviced on infection control and proper placement of urinary catheter bag and tubing. CAN C said she would go tell the nurse to come and replace the tubing since it was already contaminated while on the floor. Interview on 11/30/23 at 9:33 am with CNA D revealed she had gone into Resident #2's room earlier in the morning and she and another CNA had to reposition Resident #2 up for his breakfast and she removed the urinary catheter bag and tubing. CNA D said she clipped the urinary catheter bag on the bedside rail and forgot to place the tubing where it would not touch the floor. CNA D said the urinary catheter could get contaminated if it touched the floor. The urinary tubing should have had a plastic sleeve in case the tubing touched the floor. CNA D said the CNAs and nurses were responsible to ensure the urinary catheter tubing had a plastic tubing and did not touch the floor. Interview on 11/30/23 at 9:37 am with LVN B revealed Resident #2's urinary catheter bag and tubing should not be on the floor. The urinary catheter tubing should have a plastic sleeve to prevent contamination if the tubing touched the floor. LVN B said the CNAs and nurses were responsible to ensure the urinary catheter tubing had a plastic sleeve to prevent the tubing from contamination if it touched the floor. Interview on 11/30/23 at 9:54 am with the DON revealed the urinary catheter tubing should not be on the floor because the catheter could get contaminated. The DON said she and the charges nurses and CNAs were responsible to ensure the urinary catheter tubing had a plastic sleeve to prevent contamination. Record review of the facility policy's titled Catheter Care, Urinary dated September 2014 reflected under Infection Control Use standard precautions when handling or manipulating the drainage system. Be sure the catheter tubing and drainage bag are kept off the floor. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455697 If continuation sheet Page 2 of 4 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 455697 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Corpus Christi 202 Fortune Dr Corpus Christi, TX 78405 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 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and, interview the facility failed to ensure the environment remained free of accident hazards as posible for 2 of 2 unlocked resident rooms reviewed for accidents and hazards. The facility failed to ensure the two resident rooms [ROOM NUMBERS] were free of cluttered storage of equipment, Hoyer lifts, furniture, boxes, walkers, wheelchairs in a secured manner. This failure could place residents at risk of being in an unsafe environment and at risk for accidents and injury. Findings include: Observation on 11/29/23 at 8:54 am revealed rooms #222 and #220 located at the end of the 200 hall, were filled to the doorway in an unorganized manner, beds, wheelchairs, furniture, desks, walkers, computers, televisions, closed and opened boxes stacked to the ceiling. Both rooms were unlocked and accessible to residents or staff to enter. A wooden pallet approximately eight feet by eight feet was placed against the wall outside in hallway by room [ROOM NUMBER]. Observation revealed 34 residents residing on hall 200. Interview on 11/30/23 at 9:25 am with Resident #1 revealed he was not aware there were rooms that were used for storage and were not locked. The resident stated there could be a potential for any resident to walk into these rooms and get hurt with all the storage items not placed in an orderly manner. Interview on 1/30/23 at 10:21 am with the Maintenance Supervisor revealed they would not have any stored items in resident rooms. The Maintenance Supervisor said they should not use resident rooms for storage because the resident census might need to use those rooms. Maintenance Supervisor said the two rooms were being used for storage because they had no other space to store these items. Interview on 11/30/23 at 3:15 pm with CNA A revealed rooms #222 and #220 currently were not occupied with residents. Rooms #222 and #220 were used for storage of furniture, equipment, boxes, etc and were kept unlocked. CNA A said most of the residents on the 200 hall were ambulatory. CNA A said she was not aware residents could walk into the unlocked rooms that were used for storage and could get hurt. Interview on 11/30/23 at 3:20 pm with the Maintenance Supervisor revealed room [ROOM NUMBER] was an office room that was used to store furniture, equipment, boxes, etc and was currently being cleared to use as an office. He said room [ROOM NUMBER] was not a resident's room. room [ROOM NUMBER] had not been kept locked. The Maintenance Supervisor said room [ROOM NUMBER] was a resident's room and had been temporarily used as storage and was full of furniture, boxes, equipment, etc. room [ROOM NUMBER] had not been kept locked. The Maintenance Supervisor said he could understand a resident might walk in and get hurt. Interview on 11/30/23 at 4:14 pm with LVN B revealed she was aware rooms #222 and #220 had furniture and equipment and the rooms were not locked. The residents on hall 200 were not wanderers and she didn't think anyone would just go into those rooms. LVN B said she had not seen any resident go (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455697 If continuation sheet Page 3 of 4 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 455697 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Corpus Christi 202 Fortune Dr Corpus Christi, TX 78405 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 0921 towards those rooms. Level of Harm - Minimal harm or potential for actual harm Interview on 11/30/23 at 4:04 pm with the Administrator revealed they had used room [ROOM NUMBER] to store equipment and was to be remodeled as of today for an office for one of their staff. room [ROOM NUMBER] was a resident's room that was formerly occupied by a resident who had an incident and they were in the process of remodeling, cleaning up the room to be used for residents. The Administrator said he understood both room [ROOM NUMBER] and #220 were temporarily used for storage with furniture, equipment, Hoyer lifts, boxes, etc. and were locked. The Administrator said there was a potential for residents to wander in and get hurt by the random manner the stored items were scattered all over these rooms. The Administrator said they would be locking these rooms until they cleared all the stored items. He stated they did not have a policy to address this concern. All staff were responsible to supervise residents to prevent them from wandering into these rooms and he was responsible to ensure these rooms were not used for storage and were kept locked to prevent accidents. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455697 If continuation sheet Page 4 of 4