Health inspection·July 24, 2025

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to develop and implement a comprehensive, person-centered care plan for each resident that included measurable objectives and time frames to meet, attain, and/or maintain the resident's highest practicable physical, mental, and psychosocial well-being for 3 of 3 residents (Resident #5, Resident #20 and Resident #53) reviewed for care plans in that: The facility failed to ensure Resident #5 had a care plan in place for use of a mechanical lift.The facility failed to ensure Resident #20 had a care plan in place for use of a mechanical lift.The facility failed to ensure Resident #53 had a care plan in place for hospice services. This failure could affect residents by placing them at risk of not receiving individualized care and services to meet their needs safely.The findings included the following:Resident #5Review of Resident #5's Resident Face Sheet dated 07/24/2025, revealed he was a [AGE] year-old male admitted to the facility on [DATE] with medical diagnoses of heart failure, type 2 diabetes mellitus, stage 4 (an ulcer that extends through the muscle) pressure ulcer, peripheral vascular disease (insufficient blood circulation to the arms and legs), dementia, difficulty sleeping, anxiety, gout (a type of arthritis), major depressive disorder, amputation of left foot, weakness, iron deficiency, high blood pressure, alcohol abuse, nicotine dependence, and nausea. Review of Resident #5's Quarterly MDS assessment dated [DATE], Section C - Cognitive Patterns, subsection C0500 BIMS Score Summary revealed Resident #5 scored 15 out of 15 indicating intact cognition. Section GG - Functional Abilities, subsection GG0110 Prior Device Use C. Mechanical Lift was not selected. Record review of Resident #5's Comprehensive Care Plan reviewed/revised 07/22/2025 did not include use of a mechanical lift for transfers as a focus of care or intervention. During an interview and observation on 07/23/2025 at 10:10 AM, Resident #5 was sitting in his wheelchair in the dining room. Noted mechanical lift sling under the resident. Resident stated the staff got him out of bed using the mechanical lift due to his inability to bear weight related to the amputation of his left foot and his size. Resident #20Review of Resident #20's Resident Face Sheet dated 07/24/2025, revealed she was a [AGE] year-old female admitted to the facility on [DATE] with medical diagnoses of heart failure, high blood pressure, obesity, anxiety, major depressive disorder, atrial fibrillation, enlarged heart, chronic obstructive pulmonary disease (a progressive lung disease that makes it difficult to breathe), gastrointestinal (stomach and intestine) bleeding, chronic pulmonary embolism (blood clot in the lung), nerve pain, difficulty with coordination, and respiratory failure. Review of Resident #20's admission MDS Assessment, dated 05/05/2025, Section C - Cognitive Patterns, subsection C0500 BIMS Score Summary revealed Resident #20 scored 15 out of 15 indicating intact cognition. Section GG Functional Abilities, subsection GG0110 Prior Device Use C. Mechanical Lift was not selected. Record review of Resident #20's Comprehensive Care Plan reviewed/revised 06/09/2025 did not include use of a mechanical lift for transfers as a focus of care or intervention. During an interview on 07/23/2025 at 6:34 AM, Resident (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 3 Event ID: 455744 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 455744 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Stephenville 1670 Lingleville Rd Stephenville, TX 76401 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)