Health inspection·December 29, 2025

F 0806 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review the facility failed to provide food that accommodates residents' allergies, intolerances, and preferences for 1 (Resident #1) of 5 residents reviewed for food preferences and allergies. The facility failed on 10/20/25, 10/22/25, 11/17/25, 12/8/25, and 12/27/25 to serve Resident #1 meals that excluded foods she was allergic to or foods that aligned with her religious beliefs. This failure placed residents at risk of food-related medical emergencies and did not honor their religious preferences. Findings included: Review of Resident #1's quarterly MDS dated [DATE] reflected a [AGE] year-old female who admitted to the facility on [DATE] with the following diagnoses: anemia (deficiency of red blood cells), neurogenic bladder (a condition where neurological conditions affect bladder function, leading to issues with bladder control), anxiety (feelings of worry, nervousness or unease), bipolar disorder (mental disorder characterized by wide mood swings), schizophrenia (mental disorder characterized by hallucinations, delusions, disorganized thinking or behavior), respiratory failure (inability of the respiratory system to perform adequate gas exchange), colostomy malfunction (complications that can arise after a colostomy surgery, which diverts waste from the rectum to an opening in the abdominal wall), and morbid obesity (BMI of 40 or higher). In Section K - Swallowing/Nutritional Status, Resident #1 was indicated as being on a therapeutic diet (e.g., low salt, diabetic, low cholesterol). Resident #1 had a BIMS score of 15, indicating intact cognition. Review of Resident #1's comprehensive care plan dated 11/25/25 reflected in the allergies list, and allergy of tomatoes. Resident #1 had a ‘no salt on tray' diet with regular texture and consistency. Interventions were to provide and serve diet as ordered. Review of Resident #1's food preferences assessment dated [DATE] reflected that she did not like pork on 5 different spaces provided. The tomato allergy was also printed. Review of meal photos revealed the following items were severed to the resident:*12/27/25 Resident #1 was served 3 slices of pork, meal ticket stated dislikes of pork and no raw tomatoes *12/8/25 Resident #1 was served a dinner salad with raw tomatoes*11/17/25 Resident #1 was served a dinner salad with tomato seeds visible*10/22/25 Resident #1 was served raw tomatoes on her tray, meal ticket read, two turkey sandwiches, lettuce, pickles, mayo, ketchup, mustard*10/20/25 Resident #1 was served a turkey sandwich with a plate of lettuce, onion, and raw tomato on the side, meal ticket stated a dislike of pork and no raw tomatoes, 2 turkey sandwiches, lettuce, pickle, mayo Review of Resident #1's November MAR revealed a Benadryl was administered on 11/19/25 at 2100 (9:00PM). In an interview/observation on 12/29/2025 at 9:18 AM with Resident #1 she stated she had an allergy to raw tomatoes, but that she could eat cooked tomatoes. She stated that it was her religious preference not to eat pork, but that the facility continued to serve it to her. She stated the facility did not go over her food preferences until February 2025. She told the facility at that time that she could eat beef, chicken, and/or turkey. Resident #1 provided pictures of meals that she had been served that contained tomatoes and/or pork and her meal tickets were visible in some of the photos. A picture showing tomato seeds on her plate dated 11/17, Resident #1 informed the surveyor she had to take Benadryl that day due to ingesting the tomato seeds in her salad. She stated her mouth would swell and she got hives on her back if she ingested raw tomato. In an interview on 12/29/2025 at 9:42 AM with [NAME] A, she stated that there was a new cook aide that could have been responsible for serving tomatoes to Resident #1 because they did not have resident preferences memorized. She stated that she had informed the new aide to pay attention to the resident meal tickets, because it was on the counter in front of them as they prepared trays. She stated that the cook was responsible for ensuring what was on the ticket was being (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455785 If continuation sheet Page 2 of 3 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 12/29/2025 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)

F 0806 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete served accurately. She stated they started that process about a couple weeks ago, ensuring plates were accurate before sending out. In an interview on 12/29/2025 at 9:45 AM with the DA, she stated that she was well aware of Resident #1's allergy and preferences because Resident #1 would often write things on her meal tickets and send them back to the kitchen. She stated that on 12/24/25, [NAME] A had to leave due to getting sick at work, and the DA had to take over food preparation. She stated that it was an emergency and if she were responsible for any food mistakes she was horribly mistaken and apologetic. She stated that she had been in-serviced about a month ago on resident preferences and she knew how to look at resident tickets before making their side dishes. In an interview on 12/29/2025 at 11:27 AM with the DM, she stated she became the DM in October 2025 and prior to that, she was the cook for about 5 years. She stated she was aware of the preferences of Resident #1. She stated that she had been working on going around and completing all the residents' food preferences and that sometimes the nurses would send her communication slips pertaining to diet changes. She stated she was in the process of doing every resident's food preference while also learning her role. She stated that it was important to honor allergies because it could affect the resident's health, and they honor preferences so residents could enjoy their food. She stated that on 12/27/25 Resident #1 was served sliced ham. She stated that she talked to her cook and the cook stated that agency staff were giving residents the wrong trays, and trays were having to be re-made that day. She stated that agency was only to blame on that one occurrence. She provided the surveyor with a copy of employee counseling she had done with the new cook aide that may have been responsible for passing tomatoes to Resident #1 on multiple occasions. In an interview on 12/29/2025 at 12:23 PM with the ADM, he stated that the food on 12/27/25 should not have left the kitchen to go to Resident #1 due to there being pork on the plate. He stated that he, nursing staff, and kitchen staff were aware of Resident #1's allergies and preferences and that the DM had conducted an in-service before on accuracy in meal service. He stated that trays should be checked before leaving the kitchen and ensuring the right tray is given to the right residents. He stated that it was a resident right to eat what they wanted and adhering to resident allergies would prevent adverse health reactions. Review of an in-service dated 11/18/25, titled [Resident #1] and conducted by the DM reflected, Staff was in serviced of not putting tomatoes on Resident food. 3 cooks and 2 dietary aide signatures were visible. Review of 2 records of employee counseling dated 12/10/25 and 11/27/25 reflected that the DM had provided education/counseling to a dietary aide pertaining to reviewing meal tickets prior to trays leaving the kitchen. Review of the facility's ‘Food and Nutrition Services' policy dated October 2017 reflected, Each resident is provided with a nourishing, palatable, well-balanced diet that meets his or her daily nutritional and special dietary needs, taking into consideration the preferences of each resident.Food and nutrition services staff will inspect food trays to ensure that the correct meal is provided to each resident Event ID: Facility ID: 455785 If continuation sheet Page 3 of 3