Inspection·February 16, 2024

F 0584 Level of Harm - Potential for minimal 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 observation, interview and record review the facility failed to provide a safe, comfortable, and homelike environment for 3 (RM# 304, RM#112 and RM#216) rooms observed for maintenance. The facility failed to maintain resident occupied RM#304, RM# 112 and RM#216: -RM# 304 had unaligned and broken floor tiles. -RM#112 had part of the ceiling texture was falling. -RM#216 had an unsecured door. These failures could place residents in rooms at risk for injury or a declined sense of worth. Findings were: On 2/15/2024 at 11:45 a.m. observation of RM#216 revealed an upside-down door propped up against the closet in the room. The door was unsecure. On 2/15/2024 at 12:01 p.m. observation of room [ROOM NUMBER] revealed popcorn ceiling texture peeling away from the rest of the ceiling. The ceiling area was above the television area across from the resident's bed. On 2/15/2024 at 12:15 p.m. observation of room [ROOM NUMBER] revealed uneven and disarray of tiles upon entrance to room [ROOM NUMBER]. The tiles were loose with uneven lines and portions of the tiles were missing. During an interview on 2/15/2024 at 11:00 a.m., Resident #1, residing in room [ROOM NUMBER], stated the floor is messed up and needs to be fixed. During an interview on 2/15/2024 at 12:02 p.m., Resident #2, residing in room [ROOM NUMBER], stated the ceiling does bother me. During an interview on 2/16/2024 at 1:26 p.m., the Maintenance Director stated, I know when things need repair by rounding (walking the halls and entering rooms) at the beginning of each day and through the work orders entered into the computer system by staff. He also stated he was unaware of the maintenance concerns in room [ROOM NUMBER], 216, and 304 until 2/15/2024 when it was brought to his (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 2 Event ID: 455697 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 02/16/2024 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)