Inspection·April 14, 2023

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Observation and interview on 04/11/23 at 10:34 am revealed Resident #29 in the memory care unit, sitting in wheelchair in the dining room, calm and in no distress. Resident #29 responded she was doing good. Interview on 04/13/23 at 9:55 am with LVN A revealed the care plans were developed to include goals and interventions of focused areas of care. LVN A said a resident residing in the memory unit had special needs or care areas that were different than living in the general facility such as requiring more supervision, the resident's cognitive dementia, different activities and were exit seeking. LVN A said she had not seen a care plan for Resident #29 residing in the memory care unit. LVN A said she had not informed the MDS Coordinator/RN B to update and include a care plan for Resident #29 living in the memory care unit. Interview on 04/13/23 at 10:09 am with MDS Coordinator/RN B revealed a care plan for Resident #29 residing in the memory care unit should have been developed. MDS Coordinator/RN B said she had overlooked the care plan for Resident #29. Interview on 04/13/23 at 10:29 am with the DON revealed that there was not a care plan developed for Resident #29 living in the memory care unit. The DON said this could cause staff not to provide the necessary care such as more supervision and other interventions that would be developed for this area of care. 2) Record review of the admission record for Resident #17 dated 4/13/2023 indicated Resident #17 was admitted on [DATE] with a re-admit date of 4/01/2023. Resident #17 was a [AGE] year old female with a diagnoses that included Hypoxia (respiratory failure), Congestive Heart Failure (the heart muscles do not pump blood as well as it should), Atrial Fibrillation (irregular and often faster heartbeat), Atrial Flutter (abnormal heart rhythm), Aortic Stenosis ( narrowing of the aortic valve), Dementia (loss of cognitive function), Atrophy (wasting of muscles), Fluid overload (too much fluid in your body), and Depression. Record review of Resident #17's physician orders dated 3/19/2023 indicated an order for Eliquis (anticoagulant medication) 2.5 mg, give 1 tablet by mouth two times a day related to presence of heart-valve replacement. Record review of Resident #17's quarterly MDS dated [DATE] indicated a BIM score of 12. Resident #17 required extensive assistance by two persons for bed mobility, dressing, required extensive assistance by one person for, transfers, eating, toilet use and personal hygiene. Record review of Resident #17's care plans dated 03/31/23, indicated no care plan for the anticoagulant medication, Eliquis. Observation of Resident # 17 on 04/11/23 at 10:37 am revealed Resident #17 in wheelchair going into her room to grab a crossword puzzle and go sit outside with staff member. Resident #17 was in a pleasant mood. Interview with the Care Plan Coordinator on 04/13/23 at 10:10 am., the Care Plan Coordinator stated, only Coumadin was care planned and the facility typically does not care plan for Eliquis. The Care plan Coordinator stated, Eliquis was not care planned because it does not require special monitoring and if the resident was noted with bruising, then it would be care planned. The Care Plan Coordinator stated that the facility will start care planning for Eliquis but has not been since the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455923 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 455923 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Beeville 600 S Hillside Dr Beeville, TX 78102 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 0656 Level of Harm - Minimal harm or potential for actual harm medication Coumadin, has more known side effects than Eliquis and did not think it needed to be care planned. This surveyor asked if anticoagulant medications have mostly the same side effects, and Care Plan Coordinator stated, Yes. Side effects can include bruising and bleeding, but some residents respond differently, and Coumadin has more of a risk. The Care Plan Coordinator stated the facility will start to care plan all anticoagulants from now on. Residents Affected - Some According to [NAME], Eliquis side effects could be, bruising, hemorrhaging, anemia (low blood cell count), low blood pressure, thrombocytopenia (low platelet count). Interview with the DON on 04/13/23 at 10:28 am., the DON stated, usually the facility does not care plan Eliquis because there are no labs drawn and monitoring for that medication. The DON stated, it wasn't care planned since there is no monitoring required for Eliquis, but since the medication Eliquis was the same classification (anticoagulants), the medication Eliquis could pose with the same side effects, and the facility will start care planning for all anticoagulants. 3) Record review of the admission record for Resident #16 dated 4/12/2023 indicated Resident #16 was admitted on [DATE] with a re-admit date of 4/01/2023. Resident #16 was a [AGE] year-old female with a diagnoses that included, Cerebral Infarction (stroke), Type 2 diabetes (insufficient production of insulin causing high blood sugar), Chronic Obstructive Pulmonary Disease (a condition that affects respiratory functions and system), Alzheimer's Disease (brain disorder that causes problems with memory, thinking and behavior), Fracture to Left Femur (as of 3/08/2023), Heart failure, and Atrophy (muscle wasting). Record review of Resident #16's quarterly MDS dated [DATE] indicated Resident #16 had a BIM score of 3, and required extensive assistance by two persons for eating, and total dependance-full staff performance every time during entire 7-day period for bed mobility, transfers, locomotion to unit, locomotion off unit, dressing, personal hygiene, and toilet use. Record review of Resident #16's care plans dated 03/22/23, indicated no care plan for a left femur fracture. Interview with the Care Plan Coordinator on 4/11/2023 at 2:30pm., the Care Plan Coordinator stated, care plan for Resident #16, does not state anything about the fracture injury that occurred on 3/8/23. The Care Plan Coordinator stated, the care plan should have been updated for Resident #16 and was not sure if she was in the Care Plan Coordination position at the time of Resident #16's left femur fracture, and it might have been the DON who was doing care plans at that time. As of 4/1/2023, facility changed ownership and she was Care Plan Coordinator prior to the change in ownership of the facility and then the DON took over for about month up until 4/1/2023. The Care Plan Coordinator stated, all care plans must be updated for any change of condition so staff can properly care for the residents. Interview with the DON on 4/11/23 at 2:40pm., the DON stated, care plans were updated for any change of conditions in residents, quarterly, yearly and with any incident. The DON stated, there was no reason for the care plan not to be updated and it was important for the care plan to be updated on every resident so individualized care can be given for that resident. The Care Plan Coordinator is responsible for updating all care plans for residents. Review of facility Care Plan Policy dated 3/13/2020 and revised on 10/2020 states, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455923 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 455923 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Beeville 600 S Hillside Dr Beeville, TX 78102 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some It is the practice of this facility to develop and implement a comprehensive person-centered care plan for each resident, consistent with resident rights, that includes measurable objectives and time frames to meet a resident's rights, that includes measurable objectives and time frames to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the resident's comprehensive assessment. The facility will ensure resident who display or are diagnosed with dementia receive the appropriate treatment and services to attain or maintain his or her highest practicable physical, mental, and psychosocial well-being. Person-centered care means to focus on the resident as the locus of control and support the resident in making their own choices and having control over their daily lives. The facility supports the resident's right to be informed of, and participate in, his or her care planning and treatment (implementation of care). Standard of Practice Explanation and Compliance Guidelines: Line 14 states, The comprehensive care plan will be reviewed and revised by the interdisciplinary team after each comprehensive, significant change of condition and quarterly MDS assessment. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455923 If continuation sheet Page 4 of 4