F 0880
Provide and implement an infection prevention and control program.
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 maintain an infection prevention and control
program, including hand hygiene, designed to provide a safe, sanitary, and comfortable environment, and to
help prevent the development and transmission of communicable diseases and infections for one (Resident
#2) of fifteen residents reviewed for infection control practices, in that: The facility failed to ensure the WCN
performed hand hygiene for at least 20 seconds prior and after performing Resident #2's wound care. This
failure could place residents that require wound care at risk for healthcare associated cross-contamination
and infections. Findings include:Record review of Resident #2's face sheet dated 08/19/25 reflected a
[AGE] year-old-female with an original admission date of 05/06/2012. Diagnoses included Alzheimer's
disease (progressive brain disorder that slowly damages memory, thinking, and learning skills), dementia
(loss of thinking, remembering, and reasoning skills), cerebral infarction (occurs when the blood vessel in
the brain is blocked, leading to a lack of blood supply and oxygen to the brain), chronic atrial fibrillation
(long-standing and persistent uncoordinated activation of the atria leading to irregular heartbeats) and
hypertension (high blood pressure). During an observation on 08/19/2025 at 9:00 AM, the WCN washed
her hands for approximately 9 seconds prior to providing wound care on Resident #2. During an
observation on 08/19/2025 at 9:21 AM, the WCN washed her hands for approximately 18 seconds after
completing wound care on Resident #2. Record review of Resident #2's physician orders dated 06/20/25
reflected:Cleanse re-opened stage four (severe type of pressure injury, extending deeply into muscle,
tendons, and even bone) to coccyx (tailbone) with normal saline, pat dry with gauze, apply collagen sheet
(aides in enhancing the body's natural healing process that promotes new tissue growth) to wound bed,
cover with calcium alginate (highly absorbent dressing made from alginate that promotes moisture balance
and keep wounds clean and supports the healing process) and cover with silicone super absorbent
dressing (absorbent dressing that aides in wound healing) daily and as needed. In an interview on
08/19/2025 9:25 AM, the WCN stated hand washing should be at least 20 seconds or greater. The WCN
stated she sang Happy Birthday twice in her head and thought she washed her hands long enough. She
stated she was nervous. The WCN stated washing hands for the appropriate amount of time was important
to stop the spread of infection and to prevent cross contamination. The WCN stated Resident #2's wound
could get infected if exposed to bacteria. In an interview on 08/20/2025 at 9:13 AM, the DON stated staff
should perform hand hygiene for 20 seconds minimum to ensure to get all the bacteria off the hands,
around the wrist, the cuticles, and under the nails. The DON stated Resident #2 could be at risk for infection
if the wound came in contact with germs. In an interview on 08/20/2025 at 9:16 AM, the Staff Development
Nurse stated when washing hands, the lathering should be done for a minimum of 20 seconds to create
friction. The Staff Development Nurse stated staff are taught to sing Happy Birthday twice or count to 20
seconds during the lathering process to prevent cross contamination. The Staff Development Nurse stated
the WCN was checked of last
Residents Affected - Few
(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:
455923
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
08/20/2025
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 0880
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
month on handwashing and did well with no concerns. The Staff Development Nurse stated the WCN was
probably just nervous. Record review of the facility's Handwashing/Hand Hygiene policy dated August 2019
reflected:Policy StatementThis facility considers hand hygiene the primary means to prevent the spread of
infections. 2. All personnel shall follow the handwashing/hand hygiene procedures to help prevent the
spread of infections to other personnel, residents, and visitors. ProcedureWashing Hands2. Rub hands
together vigorously for at least 15 seconds, covering all surfaces of the hands and fingers. Record review of
the facility's Hand Washing Procedure Form reflected: WHAT IS THE RIGHT WAY TO WASH YOUR
HANDS?Rub your hands together to make a lather and scrub them well; be sure to scrub the backs of your
hands, between fingers & under your nails.Continue rubbing your hands for at least 20 seconds. Need a
timer? Hum the Happy Birthday song twice from beginning to end.
Event ID:
Facility ID:
455923
If continuation sheet
Page 2 of 2