Health inspection·October 16, 2024

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. 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 that residents received treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the residents' choices for one (Resident #1) of three residents reviewed for quality of care. Residents Affected - Few The facility failed to complete an accurate skin assessment on Resident #1 upon readmission from the hospital on [DATE] in which six insect bites were not noted to his right hip. These failures could place residents at risk of not receiving necessary medical care, skin breakdown, and pain. Findings included: Review of Resident #1's undated face sheet reflected a [AGE] year-old male who was admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses including type II diabetes, end-stage renal disease, paraplegia (a form of paralysis that mainly affects the lower body), and muscle weakness. Review of Resident #1's admission MDS assessment, dated 09/09/24, reflected a BIMS score of 15, indicating he was cognitively intact. Review of Resident #1's initial care plan, dated 10/03/24, reflected he had a skin impairment to the top of his right foot with an intervention of keeping the skin clean and dry. Review of Resident #1's readmission assessment, dated 10/14/24 and locked by the DON, reflected dryness to his feet. During an observation and interview on 10/16/24 at 12:12 PM, Resident #1 stated he had been bitten by ants. He stated when he was admitted to the hospital (on 10/09/24) he had ants falling out of his pants. He pulled down the sheet covering him which revealed six round insect bites on his right hip. He stated they were not causing him pain nor were they causing him to itch. During an observation and interview on 10/16/24 at 12:25 PM, the DON stated she only locked Resident #1's readmission assessment and she believed LVN A had completed the assessment. The DON and Surveyor went to Resident #1's room and she observed his right hip. She confirmed the insect bites and stated it would be her expectation that they would have been addressed in the readmission skin assessment. (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: 455785 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 455785 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Western Hills 512 Draper Dr Temple, TX 76504 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)