Health inspection·May 14, 2025

F 0583 Record review of the facility policy titled Dignity dated revised February 2021 revealed the following: Level of Harm - Minimal harm or potential for actual harm Policy Statement - Each resident shall be cared for in a manner that promotes and enhances his or her sense of well-being, level of satisfaction with life, and feelings of self-worth and self-esteem. Residents Affected - Few Policy Interpretation and Implementation 1. Residents are treated with dignity and respect at all times . 11. Staff promote, maintain, and protect resident privacy, including bodily privacy during assistance with personal care and during treatment procedures . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675055 If continuation sheet Page 2 of 26 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 675055 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Childress 1200 7th St NW Childress, TX 79201 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure each resident the right to a safe, clean, comfortable, and homelike environment including but not limited to receiving treatment and supports for daily living safely for 1 (Resident #33) of 12 residents reviewed for homelike environment. The facility failed to ensure Resident #33's personal refrigerator was free of rotten and expired food and that his personal food was stored properly. This failure could place residents at risk of contracting food borne illness. Findings Included: Record review of Resident #33's face sheet dated 05/13/25 revealed an [AGE] year-old male admitted to the facility on [DATE] with diagnoses that included, but were not limited to, Parkinsonism (conditions that affect the ability to move and live independently), need for assistance with personal care, and unspecified dementia (breakdown of thought process). Record review of Resident #33's quarterly MDS completed on 02/25/25 revealed the following: Section C Cognitive Patterns: Resident #33 had a BIMS score of 12 which indicated moderately impaired cognition. Section GG Functional Abilities: Resident #33 needed only setup or clean-up assistance with eating. Record review of Resident #33's care plan dated 04/01/25 revealed he was independent with setup related to eating. During an observation on 05/12/25 at 11:09 AM a jar of sweet gherkin pickles ¾ full was sitting on Resident #33's nightstand. During an observation on 05/12/25 at 12:26 PM a jar of sweet gherkin pickles ¾ full was sitting on Resident #33's nightstand. During an observation on 05/13/25 at 09:45 AM a jar of sweet gherkin pickles ¾ full was sitting on Resident #33's nightstand. The jar was sticky to touch, room temperature, and the label read Refrigerate after opening. Inside Resident #33's personal refrigerator was a square plastic lidded container labeled watermelon with a use by date of 05/07/25. The container was ½ full of pinkish liquid and lumps with a nickel-sized white fuzzy spot floating on top of the liquid. During an interview on 05/14/25 at 09:12 AM LVN C stated all staff were responsible for cleaning out resident personal refrigerators and ensuring residents store their personal food properly. She stated staff check refrigerator temperatures each night. LVN C stated if residents have expired, rotten, or improperly stored food, They can get sick, they can start throwing up, they can aspirate. A plethora of things. That is not okay. During an interview on 05/14/25 at 09:27 AM CNA D stated housekeeping used to be responsible for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675055 If continuation sheet Page 3 of 26 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 675055 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Childress 1200 7th St NW Childress, TX 79201 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few cleaning out resident refrigerators and ensuring residents stored their personal food appropriately, but she thought it was now night shift's responsibility. She stated, If I have extra time, I try to wipe them (resident refrigerators) out. CNA D stated she very, very seldom had extra time. She stated if residents had rotten or expired food or food not properly stored They could get very sick, very ill. During an interview on 05/14/25 at 09:30 AM ADON stated night shift checked resident refrigerator temperatures. She stated she and DON needed to go behind staff to be sure they were checking resident refrigerators for expired or rotten food. She residents could eat rotten, expired, or improperly stored personal food and get sick. During an interview on 05/14/25 at 09:38 AM DON stated she thought all staff were responsible for ensuring Resident refrigerators were clean and did not contain expired or rotten food. She stated, I don't know there is a designated person. I believe it should be direct care staff and nursing who should be monitoring it (resident personal food storage and refrigerators). She stated residents could get food poisoning if they had improperly stored, expired, or rotten food. During an interview on 05/14/25 at 09:43 AM ADM stated housekeeping was responsible for cleaning out resident's personal refrigerators and ensuring residents personal food was stored properly. He stated residents could be negatively impacted by improperly stored, expired, or rotten food in that, It can make them sick and even lead to death. During an interview on 05/14/25 at 09:50 AM HSK E stated he did not know who was responsible for cleaning out resident refrigerators and ensuring residents stored their personal food properly. He stated, Well, I guess I am, I thought it was night shift. Record review of facility policy titled Resident Personal Food Policy and dated 9/11/23 revealed the following: . It is the policy of this facility to provide safe and sanitary storage, handling, and consumption of all food including food and fluids brought to residents by family and other visitors. The objective/intent of this requirement is to ensure that the facility: . 2. Follows proper sanitation and food handling practices to prevent the outbreak of foodborne illness. Safe food handling for the prevention of foodborne illnesses begins when food is received from the vender, resident representative, or others . i. Facility staff will be appointed to check resident refrigerators for proper temperatures, food containment and quality, and disposal of items per facility policy. ii. Facility staff will be appointed to check resident rooms, through daily housekeeping process, safe and sanitary storage and handling of food and beverage items. f. Staff will examine food for quality to identify potential concerns. If concerns are identified, staff will notify the resident or resident representative of findings and necessary actions per proper food and beverage safe handling guidelines will be taken to ensure resident safety. Record review of facility policy titled Safe and Homelike Environment and dated 5/13/25 revealed the following: . In accordance with residents' rights, the facility will provide a safe, clean, comfortable and homelike environment . 'Environment' refers to any environment in the facility that is frequented by residents, including (but not limited to) the residents' rooms . 'homelike environment' is one that de-emphasizes the institutional character of the setting .and allows the resident to use those personal belongings that support a homelike environment. 'Sanitary' includes, but is not limited to, preventing the spread of disease-causing organisms by keeping resident care equipment clean and properly stored. Resident care equipment includes, but is not limited to, equipment used in the completion of the activities of daily living. 3. Housekeeping and maintenance services will be (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675055 If continuation sheet Page 4 of 26 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 675055 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Childress 1200 7th St NW Childress, TX 79201 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 0584 provided as necessary to maintain a sanitary, orderly and comfortable environment. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675055 If continuation sheet Page 5 of 26 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 675055 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Childress 1200 7th St NW Childress, TX 79201 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 0679 Provide activities to meet all resident's needs. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and record review the facility failed to provide an ongoing program to support residents in their choice of activities designed to meet the interests of and support the physical, mental, and psychosocial well-being for all residents reviewed for activities. Residents Affected - Some A. The activity calendar was not followed. B. There were no daily activities occurring on a regular basis in the facility. C. The activities did not meet the needs of the residents. D. Room visits were not conducted and did not meet the needs of the residents. The facility's failure to provide an ongoing program to support residents in their choice of activities designed to meet the interests of and support the physical, mental, and psychosocial well-being could potentially place all residents at risk of decreased self-worth, boredom, poor quality of life, depression, behaviors and decreased cognitive function. Findings include: During entrance to the facility on 5/12/25 at 10:25 am, seven residents in wheelchairs were sitting in the lobby. There were no activities ongoing in the facility. In a confidential interview a facility employee stated the AD had taken a resident to a clinic physician appointment. During record review of the activity calendar for May 2025 on 5/12/25 activities listed for the day for all residents were: Monday 5/12/25 8:30 AM Outside Visit 9:30 AM Room visits 10:00 AM Kick-off Nursing Home Week 2:00 PM Residents Car Wash Tuesday 5/13/25 8:00 AM Morning Chat 8:30 AM Walk the Halls 9:30 AM Puzzle/Word Search 2:00 PM Minute 2Win It Wednesday 5/14/25 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675055 If continuation sheet Page 6 of 26 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 675055 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Childress 1200 7th St NW Childress, TX 79201 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 0679 8:30 AM Humpday News Level of Harm - Minimal harm or potential for actual harm 9:30 AM Room Visits 2:00 PM Pick A game Residents Affected - Some 3:30 PM McCurley's Bible Talk In an observation and a confidential interview on 5/12/25 at 11:00 am a resident was in bed with no light or tv. He stated he was bored so he slept a lot because there was nothing to do. He stated he would attend activities if he were asked but he never knew when or where they would be. He stated no one ever asked him if he wanted to go to any activities. He stated he needed assistance to get out of bed. He stated he had not had any room activities from anyone. He stated he had no special activity requests and liked a variety of activities. In an observation of the facility on 5/12/25 at 2:10 PM, there were no activities being conducted in the building. There was no car wash activity outside. In an observation on 5/12/25 at 3:00 pm the AD was observed alone in her office. In an observation of the facility on 5/13/25 at 8:30 am the AD was observed walking the halls of the facility alone. The AD had a Hawaiian skirt on and was passing out flower necklaces. There were no additional activities observed to include or incorporate the residents into this activity. In a confidential interview on 5/13/25 at 9:40 am, one employee stated The residents are bored. You never know when the activities will occur or if the calendar will be followed. If you try to suggest an activity to the AD she does not listen. During a confidential group interview on 5/13/25 at 10:00 a.m., 8 residents confirmed the activity calendar is not followed. All resident's confirmed activities are not being held. All residents stated they are bored. All residents agreed the AD does not have activities that meet their needs. All residents agreed they had not been asked what they would like to do and if they did express a desire to play Bingo, they had been told they could not. All agreed they love Bingo but had not had Bingo in a long time. All residents agreed the AD does not like to do Bingo and that was why Bingo had not been offered in a long time. One resident stated she would like to play dominoes and had been told other residents would like to play dominoes as well, but it had never been scheduled. She stated she had her own dominoes and she and another resident play dominoes in her room. All residents stated they would like to exercise but it had never been offered. All residents agreed they did not have any activities on the weekends or go on outings. All residents agreed they would like to go on outings and have more activities on the weekends. All agreed the AD would rather sit outside and talk which is what she usually did. All residents stated the AD will give them coloring pages, but they did not want to color much. Residents stated activities were never announced nor did anyone come to tell them there was an activity about to start. All 6 residents said they would like more exercising activities. Residents also stated that they would like some field trips since Covid is over. All residents stated there had not been any outings in over a year. Residents also said that activities got canceled a lot. Residents stated there is no church on Sundays and they would like church offered to them. The Activity calendar was reviewed with the group. None of the residents knew what the activities called Making Rounds, Lets do Experiments or Walk the Halls were. The group stated they had not participated in those activities. the group stated table games in the lobby, room visits and morning chat (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675055 If continuation sheet Page 7 of 26 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 675055 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Childress 1200 7th St NW Childress, TX 79201 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 0679 had not occured. Level of Harm - Minimal harm or potential for actual harm In an interview on 5/13/25 at 3:15 pm the AD was asked to review the activity schedule. The AD stated Outside Visit was where she and the residents sat on the porch of the facility. She stated Making Rounds was just her going up and down the halls saying hello and seeing if the residents needed anything. She stated of Trivia she would read a short paragraph and asked questions, and the residents guessed the answer. She stated 'Let's do Experiments' was setting up a microscope and the residents could look through the microscope at an Alka Seltzer and see it fizz. When asked if the activity listed on 5/12/25 of Outside Visit, Room visitsor Residents Car Washhad occurred, the AD stated there were no activities done that day. When asked what the Resident Car Wash was, she stated the residents were going to wash the staff cars. The AD stated Walk the Halls was an activity where she would walk around the halls and make faces at the residents. She stated the residents had not walked the halls with her. The AD stated 'Bingo had not been offered in a long time because the tv was out and calling Bingo was hard. The AD stated she did not offer any exercise classes and stated she did not have a reason for not offering exercises. The AD stated the bible studies offered on Wednesday and Thursday afternoons were provided by visitors. The AD stated the Walmart trips did not include residents. She stated she took the money and a list of what they wanted and got it for them. She stated she planned on starting some outings for the residents in the future. The AD stated of the activities listed on Saturday and Sunday were tv programs and there were no activities on the weekends. The AD stated she had not encouraged all residents to come to the activities and had not allowed time for them to get up. She stated she did activities with the residents who were already in the dining room or the front lobby. The AD stated she had not been documenting on the residents who participate in activities or who she did room visits with. She stated she just found out she was supposed to document the room visits. When the AD was asked what the consequences of not having activities that meet the needs of the residents would do to them, she stated the residents would not get what they needed and would be bored and get depressed. Residents Affected - Some In an observation of the facility on 5/14/25 from 9:25 to at 9:55 am there were no activities being conducted in resident rooms for room visits. In a confidential interview on 5/14/25 at 10:00 am one resident, who was listed on the AD's list of room visits, stated he had never had any room visits from the AD. He stated if there were exercise classes he would get up and go. He stated he had never been asked to join any activities and stayed in bed most of the time. He stated he was thinking of getting arm weights so he could exercise in bed since there are no exercise classes. In a confidential interview on 5/14/25 at 10:20 am, one resident, who was listed on the AD's list of room visits, and a family member who was visitng, stated he had not been offered any room activities and had not had any activities in the room since his admission. The family member confirmed the resident had not had any room visits since admission. In confidential interviews on 5/14/25 from 10:10 am to 10:30 am, 4 residents from the list provided by the AD for room visits, were asked if they had ever had any room visits from the AD or had any activities in the room. None of the residents interviewed knew who the AD was or had been offered any room activities. Record review of the facility policy titled Activity Programs dated November 2021, documented: Activity programs designed to meet the needs of each resident are available on a daily basis. Our activity programs are designed to encourage maximum individual participation and are geared to meet (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675055 If continuation sheet Page 8 of 26 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 675055 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Childress 1200 7th St NW Childress, TX 79201 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 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete individual needs. Activities consist of individual and small group activities that stimulate the cardiovascular system and assist with range of motion such as exercise, movement to music Intellectual activities, outings, at least one evening activity is offered per week, at least 2 group activities per day are offered on Saturday and Sunday, at least 4 group activities offered per day Monday through Friday, Activities are provided to residents who are bedbound or visually impaired . Individualized activities are provided that reflect the schedules and choices of residents. Event ID: Facility ID: 675055 If continuation sheet Page 9 of 26 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 675055 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Childress 1200 7th St NW Childress, TX 79201 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 0680 Ensure the activities program is directed by a qualified professional. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to provide an activities program directed by a qualified professional for 1 of 1 Activity Director reviewed for staff qualifications . Residents Affected - Some The facility Activity Director was not a qualified therapeutic recreation specialist or an activities professional that met state licensing requirements. This failure could place residents at risk for reduced quality of life due to lack of activities that were individualized to match the skills, abilities, and interests/preferences of each resident. Findings Include: During an interview on 5/13/25 at 3:15 pm, the AD stated she had not become a certified AD and had not started the classes to become certified. The AD stated she started the job as the AD on 9/12/24. The AD stated she had never been an AD before and had not had any experience in activities. The AD stated the facility would not pay for the classes up front and would reimburse her once she completed the classes. She stated she had not had the money to start the classes. She stated she hoped to start the classes in September. When asked if anyone was supervising her as the AD, she stated the ADM was her direct supervisor. She stated no one had told her there was a time limit on beginning the class. The AD stated a few people had tried to help her plan activites and stated if she has any questions, she could ask the DM who a previous AD. was The AD stated she usually did not ask her any questions. The AD stated the consequenses of not having a certified AD would be residents not having the activities they need. In an interview on 5/14/25 at 8:20 am, the DM stated when the AD started the job, she had tried to assist the AD by telling her how she set up activities, but the AD did not want to hear it. The DM stated the AD wanted to do it her way. The DM stated the last time she had done any activities with the residents was a week before the AD started her job as the AD in September of 2024. The DM stated the corporate office had told her to stay in the kitchen and did not want her doing activities. The DM stated she did not supervise the AD. In an interview on 5/14/25 at 8:40 am, the ADM stated the DM is a certified DM and she supervises the AD and helps her as needed. He stated the facility was working off the DM activity license. He stated the AD had not had any AD classes. Record Review of the Activity Director's personnel file indicated this employee was hired at the facility as the AD on 9/3/24 and started working on 9/12/24. Record review of the facility document titled Job Description Activity Director, dated 5/20/21, revealed: Under the supervision of the ADM, the AD develops, coordinates, and implements activity programs for the personal enjoyment and benefit of the residents in accordance with current federal, state and local standards to ensure the spiritual, emotional, recreational and social needs of residents are met on an individual basis. Must be able to obtain the qualifications outlined in the federal. state regulations. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675055 If continuation sheet Page 10 of 26 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 675055 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Childress 1200 7th St NW Childress, TX 79201 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 0680 Record review of the facility document titled Activity Programs- Staffing, dated August 2006, revealed: Level of Harm - Minimal harm or potential for actual harm Our activity programs are staffed with personnel who have the appropriate training and experience to meet the needs and interests of each resident. our activity programs are under the supervision of a qualified professional who is licensed or eligible. and has completed a training course approved by the state. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675055 If continuation sheet Page 11 of 26 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 675055 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Childress 1200 7th St NW Childress, TX 79201 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure a resident who is incontinent of bladder receives appropriate treatment and services to prevent urinary tract infections and to restore continence to the extent possible for 1 (Resident #44) of 12 residents reviewed for continence. The facility failed to ensure Resident #44's catheter was changed timely. This failure could place residents at risk of harm due to infection. Findings Included: Record review of Resident #44's face sheet dated 05/12/25 revealed a [AGE] year-old male admitted to the facility on [DATE] with diagnoses that included, but were not limited to, unspecified sequelae of cerebral infarction (long-term effects and complications occurring after a stroke) and neuromuscular dysfunction of bladder (the nerves and muscles of the bladder do not work well resulting in the bladder not filling or emptying well). Record review of Resident #44's quarterly MDS completed on 05/05/25 revealed the following: Section C Cognitive Patterns: Resident #44 had a BIMS score of 12 which indicated moderately impaired cognition. Section H Bladder and Bowel: Resident #44 had an indwelling catheter. Record review of Resident #44's care plan revised on 04/24/25 revealed he had a catheter and was at risk of developing a UTI. Staff were to change drainage bag per policy. Record review of Resident #44's active orders as of 05/13/25 revealed the following orders for his catheter: Order start date of 03/12/25 Foley Catheter: Change catheter and drainage bag as needed for indications of blockage, increased sediment, infection, displacement. Order start date of 03/12/25 Foley Catheter: Size 18FR 5-10ml Diagnosis: Neuromuscular dysfunction of bladder, unspecified. Order start date of 03/12/25 Foley Catheter: Catheter secured to leg to promote comfort, minimize catheter tension / tissue trauma. Order start date of 03/12/25 Foley Catheter: Provide catheter care as needed. Order start date of 03/12/25 Foley Catheter: Provide catheter care every shift. Record review of Resident #44's MAR from his admission on [DATE] through 05/12/25 revealed his catheter had not been changed while in the facility. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675055 If continuation sheet Page 12 of 26 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 675055 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Childress 1200 7th St NW Childress, TX 79201 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Record review of Resident #44's progress notes from his admission through 05/12/25 revealed an agency nurse changed his catheter on 03/13/25 due to Resident #44 pulling the old catheter out. Resident #44's catheter was mentioned one other time in the progress notes by a note stating he had an indwelling catheter on 01/15/25. During an observation and interview on 05/12/25 at 12:30 PM Resident #44 was lying on his back in bed. He stated his catheter tubing had not been changed in three months. He lifted the sheet and displayed the tubing from his leg to the catheter bag hanging on the side of his bed. The tubing was stained a mustard yellow color and was opaque in most places though in a few places it was possible to see into the tube and see crystallization/sediment buildup. The tubing, as it was handled by Resident #44, appeared to be stiff and not easily manipulated. Resident #44 stated his catheter had not been changed since he was admitted to the facility. During an interview and observation on 05/13/25 at 08:57 AM DON stated the frequency of catheter changed depends. She stated, Sometimes a doctor does not want them to be changed every 30 days. Depends on the patient and the orders. Usually every 30 days or PRN. When asked how staff would know it was time to change a catheter if the order was PRN, DON stated, Look at the tubing and the urine. She stated the color of the tubing and if it was stained or had built up inside the tubing would indicate it was time to change the catheter. DON walked to Resident #44's room and looked at this catheter tubing which was clear and supple. Resident #44 stated staff changed the tubing the night of 05/12/25. He stated on the tubing was changed, not the part that was attached to his penis. He stated the nurse who changed the tubing was LVN A. DON asked him when his catheter was last changed, and he told her it had not been changed since he was admitted . During an observation and interview on 05/13/25 at 09:07 AM DON stated Resident #44 seems like he is with it, but he gets confused. She stated she was not sure it was possible to change just the tubing and not the actual catheter. She walked to the supply closet and looked at catheter supplied. DON held up a catheter in one hand and catheter tubing in the other hand and said it was possible to change just the tubing. She stated she would look in Resident #44's chart and find out if his catheter had been changed since he was admitted to the facility. During an interview on 05/13/25 at 01:21 PM LVN A stated she was the nurse who worked the night of 05/12/25 and changed the tubing of Resident #44's catheter. She stated, He said his brief was a little wet. LVN A stated she took tubing, a catheter, and a syringe into Resident #44's room to check on his catheter and possible change it. She stated she only ended up changing the tubing of his catheter. LVN A stated, He refused to have the part that inserted into his penis. He told me to look at the tubing because it was yellow, and I changed that but told him it would not stop the catheter from leaking. LVN A stated, We used to change them (catheters) like monthly and then they started saying we change them PRN. LVN A stated, regarding the condition of Resident #44's catheter tubing, Well, it was looking like it had some sediment in the tubing, but he doesn't like a lot of invasive procedures and stuff. Whenever (I) walked in there with syringes he said I was not sticking him. I explained that I was not going to stick him I was going to take water out of your catheter and try to readvance it. But he refused. It wasn't leaking real bad. LVN A stated it was a not common for a catheter to leak and she did not know if it was because the catheters they were using are cheap or what. She stated a possible negative impact on a resident of not changing a catheter timely was, They can get UTIs and stuff. I think when they get all gunky, it could cause UTIs. An interview was attempted with the facility's medical director on 05/13/25, but the call was not returned. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675055 If continuation sheet Page 13 of 26 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 675055 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Childress 1200 7th St NW Childress, TX 79201 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 0690 Level of Harm - Minimal harm or potential for actual harm During an interview on 05/14/25 at 09:12 AM LVN C stated she looked at catheter bag and tubing to determine if it was time to change a catheter when the orders called for PRN changes. She stated it was time to change a catheter, If you see any type of sedimentation in it (tubing) 'cause that could cause it to back up and cause UTI. LVN C stated not changing a catheter timely could lead to UTI and/or hospitalization. Residents Affected - Few During an interview on 05/14/25 at 09:30 AM ADON stated nurses would know it was time to change a catheter, If there is sediment in it; if it is dislodged; if it is leaking; if the brief is wet; if they (resident) request it because they are hurting. She stated tubing you could see through or that had sediment built up inside it was an indicator it was time to change the catheter. She stated if a catheter was leaking normally it is a worn-out kind of thing. She stated UTIs could result from not changing catheters timely. She stated if a resident refused a catheter change nurses would need to document the refusal in the progress notes and let her and the DON and the physician and the family know. She stated another staff member should attempt to convince the resident to allow the change. ADON stated, They (resident) just might not like that person. It is all about the approach. During an interview on 05/14/25 at 09:38 AM DON stated if a resident refuses a catheter change, We document it and care plan it, and educate resident on risk factors. Record review of facility policy titled Indwelling Catheter Use and Removal and dated 2022 revealed the following: .4. If an indwelling catheter is in use, the facility will provide appropriate care for the catheter in accordance with current professional standards of practice . 8. Catheters and drainage bags should be changed based on clinical indications such as infection, obstruction, or when the closed system is compromised. Record review of facility policy titled, Appropriate Use of Indwelling Catheters and dated 08/10/2023 revealed the following: . Indwelling urinary catheters . will be utilized in accordance with current standards of practice, with interventions to prevent complications to the extent possible. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675055 If continuation sheet Page 14 of 26 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 675055 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Childress 1200 7th St NW Childress, TX 79201 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 0727 Level of Harm - Minimal harm or potential for actual harm Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis. Based on interview and record review the facility failed to use the services of a registered nurse for at least 8 consecutive hours a day, 7 days a week for 1 of 1 facility reviewed for RN coverage. Residents Affected - Many The facility failed to ensure RN coverage for 51 days of the last 6 months. This failure could place residents at risk of harm due to being left without supervisory coverage for coordination of events such as emergency care and disasters. Findings Included: Record review of the facility payroll-based journal for the first quarter of fiscal year 2025 revealed the facility did not have RN coverage on November 16, 17, and 30 and December 1, 14, 15, 28, and 29 of 2024. Record review of facility payroll revealed the facility did not have RN coverage for January 20; February 8, 9, 12, 13, 18, 20, 21, 22, 23, 24, 25, 26 ,27, and 28; March 3, 4, 5, 6, 7, 8, 9, 15, 16, 22, 23, 29, and 30; April 1, 2, 3, 4, 5, 6, 12, 13, 19, 26, and 27; May 3, 4, 10, and 11 of 2025. During an interview on 05/13/25 at 11:20 AM ADM provided the last quarter RN hours and stated he did not have any RN hours for the rest of the time beginning on April 1st. He stated his only RN was the DON and she started on April 7th and worked M-F. He stated he was planning to get this tag because he knew he was lacking RN hours. During an interview on 05/13/25 at 11:27 AM ADM stated he had been advertising for a weekend RN position and a regular RN position and had not had anyone apply. He stated the only weekend day DON had worked since starting was Easter Sunday, April 20, 2025. He stated not having RN coverage could negatively impact residents. ADM stated, Resident's health would be at risk if something happens, something could get missed as far as assessment or needing to go to the hospital. During an interview on 05/14/25 at 09:12 AM LVN C stated it was important to have an RN in the building each day. She stated, Because as an LVN we need that reference point. Their skill set is higher than ours they have a larger scope of practice. We do need the reference point if we have a question or are wondering about something. It is like asking your parent or your boss. During an interview on 05/14/25 at 09:30 AM ADON stated it was important to have an RN in the building every day. She stated, You need a reliable RN in case you second guess yourself. During an interview on 05/14/25 at 09:38 AM DON stated it was important to have an RN in the building each day. She stated, I just think you need that higher level of educated person to be available. She stated she and ADM shared the responsibility for ensuring RN coverage. She stated, We keep updating the ad (for RN positions available) and even saying PRN. We have tried everything. When asked if the facility could use agency RNs, DON stated, It is not in the budget, they can charge up to 100 dollars an hour for an agency RN. During an interview on 05/14/25 at 09:43 AM ADM stated he was responsible for ensuring RN coverage. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675055 If continuation sheet Page 15 of 26 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 675055 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Childress 1200 7th St NW Childress, TX 79201 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 0727 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Record review of facility policy titled Staffing and dated 9/28/23 revealed the following, . 4. The facility utilizes the services of a registered nurse for at least 8 consecutive hours a day, 7 days a week. Record review of facility policy titled Director of Nursing Services and dated 2006 revealed the following: . 2. The Director is employed full-time (40-hours per week) and is responsible for, but is not necessarily limited to: . g. Recruiting and retaining the number and levels of nursing personnel necessary to meet the nursing care needs of each resident. Event ID: Facility ID: 675055 If continuation sheet Page 16 of 26 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 675055 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Childress 1200 7th St NW Childress, TX 79201 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interview, and record reviews the facility failed to provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of each resident for 1 (Resident #33) of 12 residents reviewed for pharmacy services and 1 of 1 treatment cart and 1 of 1 medication room. 1. The facility failed to ensure LVN B did not leave medications unattended with Resident #33. 2. The facility failed to ensure the medication room did not contain expired medications and expired IV tubing and the treatment cart did not contain expired medications. These failures could place residents at risk of harm due to not receiving needed medication, receiving expired medication; receiving medication at the wrong time or in the wrong dose; or receiving another resident's medication. Findings Included: 1. Record review of Resident #33's face sheet dated 05/13/25 revealed an [AGE] year-old male admitted to the facility on [DATE] with diagnoses that included, but were not limited to, Parkinsonism (conditions that affect the ability to move and live independently), need for assistance with personal care, and unspecified dementia (breakdown of thought process). Record review of Resident #33's quarterly MDS completed on 02/25/25 revealed the following: Section C Cognitive Patterns: Resident #33 had a BIMS score of 12 which indicated moderately impaired cognition. Section N Medications: Resident #33 was receiving antidepressant, antianxiety, diuretic, opioid, and antiplatelet medications. Record review of Resident #33's care plan dated 04/01/25 revealed he exhibited behaviors not directed at others. The goal for this was Resident will not harm self and/or others. Resident #33 was noted to be receiving anticoagulant (blood thinner) medication and staff were to administer medication as ordered. He was noted to be receiving psychotropic medication for generalized anxiety disorder. Resident #33 was noted to have cognitive loss and staff were to explain their actions as they provided care. Record review of Resident #33's active orders as of 05/13/25 revealed he was to receive the following medications in the morning and throughout the day as indicated: -allopurinol tablet 100 mg by mouth once a day in the morning -aspirin 81 tablet mg by mouth once a day in the morning -buspirone tablet 5 mg by mouth twice a day in the morning and the evening (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675055 If continuation sheet Page 17 of 26 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 675055 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Childress 1200 7th St NW Childress, TX 79201 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 0755 -apixaban tablet 5 mg by mouth once a day in the morning Level of Harm - Minimal harm or potential for actual harm -furosemide tablet 20 mg by mouth once a day in the morning -magnesium oxide tablet 400 mg by mouth twice a day in the morning and the evening Residents Affected - Some -meclizine 12.5 mg by mouth twice a day at lunch and dinner -meclizine 25 mg tablet by mouth twice a day in the morning and the evening -omeprazole capsule delayed release 20 mg by mouth once a day in the morning -potassium chloride packet 20 mEq once a day in the morning -carbidopa-levodopa tablet 25-100 mg by mouth twice a day in the morning and the evening Record review of Resident #33's MAR for the morning of 05/13/25 revealed he received the following medications from LVN B: allopurinol tablet 100 mg, aspirin 81 tablet mg, buspirone tablet 5 mg, apixaban tablet 5 mg, furosemide tablet 20 mg, magnesium oxide tablet 400 mg, meclizine 25 mg tablet, omeprazole capsule delayed release 20 mg, potassium chloride packet 20 mEq, and carbidopa-levodopa tablet 25-100 mg. During an observation on 05/13/25 at 08:28 AM Resident #33's room door was closed and LVN B was standing at the medication cart outside his door. During an observation on 05/13/25 at 08:31 AM Resident #33's closed door was knocked on and opened by this surveyor. Resident #33 was seated in his w/c next to his tray table. On the tray table was an opaque plastic up ¾ full of orange liquid and a small opaque plastic medication cup containing 3-4 small pills. During an observation on 05/13/25 at 08:32 AM LVN B entered Resident #33's room, glanced at his tray table, and walked back out of his room. During an interview on 05/13/25 at 09:39 AM LVN B stated she was the nurse who gave Resident #33 his medications this morning. She stated, I stand at his door, and he came and shut it behind me, but I stand there until he takes them (the medications). He likes to take them one at a time. I generally try to stand there 'til he is done. She stated there was a possible negative outcome to leaving medications behind closed doors with residents. She stated, But when he closed the door that is when you went in, and I went in behind you. We don't leave medications with residents and move on. During an interview on 05/13/25 at 09:10 AM DON stated it was never okay for a nurse to leave medications with a resident. She stated nurses were to stay with residents until the medication was consumed. DON stated she did a training on this subject on 04/15/25. During an observation and interview on 05/13/25 Resident #33 was in the therapy room doing bicep curls. When asked if the nurse leaves his medication with him instead of watching him take it, he stated, Yes. She trusts me. During an interview on 05/13/25 at 09:50 AM ADON stated it was never okay to leave residents (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675055 If continuation sheet Page 18 of 26 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 675055 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Childress 1200 7th St NW Childress, TX 79201 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some unsupervised with medications. She stated, They can forget to take it, it can sit there and somebody else might take it, they can be double dosed or take it at the wrong time of the day. During an interview on 05/13/25 at 10:02 AM DON stated if residents are left behind closed doors alone with their medication They might not get their medication and that can cause ill effects to the resident and another resident might get the medication which could cause ill effects to that resident. During an interview on 05/14/25 at 09:12 AM LVN C stated it was never okay to leave medications with residents unsupervised. She stated, They might choke on it, they might not take it, could put it in their pocket and what if at night they get their meds and find that one from morning in their pocket? They could take a double dose. And what if it is blood pressure medicine. No, girl, that is bad. We gotta watch them take the medicine. Record review of facility policy titled Administration Procedures for all Medications and dated 6/1/2022 did not directly address nurses remaining with residents until medications are swallowed but it revealed the following: . To administer medications in a safe and effective manner. Security: All medication storage areas (carts, medication rooms, central supply) are locked at all times unless in use and under the direct observation of the medication nurse/aide. J. After administration, return to cart . Record review of staff in-service dated 04/15/25 revealed the following: Topic: Medication administration: Remain with resident until all medications have been taken. Do not leave unattended Instructor(s): [name of DON] RN DON The signatures section of the in-service revealed LVN B signed the in-service on 04/15/25. 2. On 05/13/25 at 09:30 AM, an observation of the medication room was conducted with ADON. 64 - 5ml normal saline syringe was found with expiration date 02/28/25 and 03/31/25. Two IV tubing one with expiration date 12/15/22 and one with expiration date 11/18/21. During an interview on 05/13/25 at 09:35 AM with ADON, she stated there should be no expired medications in the medication room. She stated anything that was expired should be thrown away. She stated the expired normal saline syringes and the IV tubing was just missed. She stated the medication room was checked a few days ago. She stated all staff had been trained and it was the nurse's responsibility to monitor medications in the medication room. On 05/13/25 at 10:00 AM, an observation of the treatment cart was conducted with LVN B. Two 5ml normal saline syringes with expiration date 03/31/25 and one with expiration date 02/28/25. During an interview on 05/13/25 at 10:05 AM with LVN B, she stated there should be no expired medications on the treatment cart. She stated any expired item needs to be thrown away or replaced. She stated she has had training on checking the treatment cart for expired medications. During an interview on 05/14/25 at 08:40 AM with the DON, she stated med room and carts were checked monthly by the pharmacist and weekly by the night nursing staff. She stated staff have been trained. She stated expired meds need to be thrown away to prevent giving expired meds to residents. She stated there was no reason why expired meds should be left in medication room. She stated the potential negative outcome could be ill effects to a resident. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675055 If continuation sheet Page 19 of 26 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 675055 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Childress 1200 7th St NW Childress, TX 79201 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During an interview on 05/14/25 at 08:54 AM with the ADM, he stated expired meds should be thrown away. He stated expired normal saline could grow bacteria and be harmful to the resident. He stated all staff have been trained. He stated nursing was responsible for checking medication and treatment carts and medication room. He stated it was scheduled for the night shift nurse once a week. He stated any nurse can check the medication room and medication and treatment carts. He stated the potential negative outcome could be normal saline could cause infection especially going into the circulatory system. Record review of the facility-provided policy titled, Storage of Medications, revised November 2020, revealed: Policy - The facility stores all drugs and biologicals in a safe, secure, and orderly manner . 4. Drug containers that have missing, incomplete, improper, or incorrect labels are returned to the pharmacy for proper labeling before storing. Discontinued, outdated, or deteriorated drugs or biologicals are returned to the dispensing pharmacy or destroyed . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675055 If continuation sheet Page 20 of 26 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 675055 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Childress 1200 7th St NW Childress, TX 79201 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, interview, and record review, the facility failed to ensure all drugs and biologicals were stored properly for 2 of 2 carts (medication cart, treatment cart) reviewed for medication storage. The medication cart had undated insulin pen. The treatment cart had undated wound care supplies. These failures could place residents at risk of receiving expired medications. The findings included: On 05/13/25 at 09:15 AM, an observation of the medication cart was conducted with LVN C. One insulin pen was found in top drawer opened with no date. During an interview on 05/13/25 at 09:20 AM with LVN C, she stated all opened multiuse insulin pens should have the date they were opened. She stated she did not know why the pen was not dated. She stated she had been trained to dated insulin pens at the time they were opened. She stated the potential negative outcome was you do not know how long it's been in medication cart and could give expired insulin to resident. 05/13/25 at 10:00 AM, an observation of the treatment cart was conducted with LVN B. Two open bottles of wound cleanser were found with no open date. One bottle of povidone-iodine 10% solution was found opened with no open date. During an interview on 05/13/25 at 10:05 AM with LVN B, she stated all items opened should have an open dated at the time they were opened. She stated she was not aware the wound cleaner or povidone-iodine 10% solution did not have an open dated. She stated she does not know when they were open. She stated she has been trained to date items at the time it was opened. During an interview on 05/14/25 at 08:40 AM with the DON, she stated insulin pens should be dated when opened, any multiuse supplies (wound cleanser or povidone-iodine) should be dated when open. She stated med room and carts were checked monthly by the pharmacist and weekly by the night nursing staff. She stated staff have been trained. She stated there was no reason why supplies in medication cart were not dated. She stated the potential negative outcome could be ill effects to a resident. During an interview on 05/14/25 at 08:54 AM with the ADM, he stated all items opened should have an open date written on it. He stated all staff have been trained. He stated nursing was responsible for checking medication and treatment carts and medication room. He stated it was scheduled for the night shift nurse once a week. He stated any nurse can check the medication room and medication and treatment carts. He stated the potential negative outcome could be not knowing how long it's been the cart and medications may not work how it's supposed to especially insulin. Normal saline could cause infection especially going into the circulatory system. Record review of the facility-provided policy titled, Storage of Medications, revised November (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675055 If continuation sheet Page 21 of 26 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 675055 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Childress 1200 7th St NW Childress, TX 79201 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 0761 2020, revealed: Level of Harm - Minimal harm or potential for actual harm Policy - The facility stores all drugs and biologicals in a safe, secure, and orderly manner . Residents Affected - Some 4. Drug containers that have missing, incomplete, improper, or incorrect labels are returned to the pharmacy for proper labeling before storing. Discontinued, outdated, or deteriorated drugs or biologicals are returned to the dispensing pharmacy or destroyed . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675055 If continuation sheet Page 22 of 26 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 675055 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Childress 1200 7th St NW Childress, TX 79201 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 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to store, prepare, and serve food under sanitary conditions in 1of 1 kitchen when they failed to: Residents Affected - Many A. Ensure general cleanliness was maintained. B. Ensure kitchen equipment was in good repair. These failures placed residents who ate food served by the kitchen at risk of cross contamination and food-borne illness. Findings included: In an observation on 5/12/25 at 10:32 am, of the kitchen revealed the plastic drawers holding utensils was grimy and sticky to the touch. There were food crumbs on the outside and inside of the drawers. The stainless-steel prep table shelves had crumbs and food debris on the lower shelves. The toaster had crumbs in the bottom of the toaster and was sticky to the touch. Observation of the door of the walk-in cooler revealed the door handle was black and sticky to the touch. The walk-in pantry had food crumbs and trash in the floor. In an observation on 5/12/25 at 10:35 am, the walk-in cooler thermometer read 45 degrees. The milk cartons and juice container were warm to the touch. In an interview and observation of the walk-in cooler on 5/12/25 at 11:00 am revealed the walk-in cooler thermometer read 44 degrees. The DM stated, The cooler had not been cooling right. We have thrown so much food out because it goes bad. Every time it quits working, I call the MD. The repairman came out and did something, but it still did not work right. We need a new one. The DM stated the consequences of not having a cooler that worked correctly was a lot of spoiled food. In an observation of the walk-in cooler on 5/12/25 at 12:40 pm revealed the walk-in cooler thermometer read 45 degrees. In an observation of the walk-in cooler on 5/12/25 at 2:40 pm revealed the walk-in cooler thermometer read 45 degrees. In an interview and observation of the walk-in cooler on 5/13/25 at 8:40 am revealed the walk-in cooler thermometer read 44 degrees. [NAME] F stated, The cooler keeps freezing up. It has not been cooling right. They keep bandaging it up. The milk goes bad real fast. We have had to throw out a lot of food because it does not cool right. We need a new cooler. In an observation on 5/13/25 at 9:45 am, of the kitchen revealed the plastic drawers holding utensils was grimy and sticky to the touch. There were food crumbs on the outside and inside of the drawers. The stainless-steel prep table shelves had crumbs and food debris on the lower shelves. The toaster had crumbs in the bottom of the toaster and was sticky to the touch. Observation of the door of the walk-in cooler revealed the door handle was black and sticky to the touch. In an observation of the walk-in cooler on 5/13/25 at 2:40 pm revealed the walk-in cooler (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675055 If continuation sheet Page 23 of 26 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 675055 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Childress 1200 7th St NW Childress, TX 79201 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 0812 thermometer read 44 degrees. Level of Harm - Minimal harm or potential for actual harm In an interview on 5/13/25 at 3:30 pm the DM stated of the cleaning that she expected all staff to clean as needed. She stated the consequences of not cleaning were food borne illness and contaminated food. Residents Affected - Many In an interview on 5/14/25 at 12:50 pm, the MD stated last night the cooler went out. He stated the repairman was called and was there currently. The MD stated he thought the facility had had trouble with the cooler for the past 2 weeks. The MD stated about 2 weeks ago the repairman came out and worked on the cooler. The next day the cooler did not work. The repairman took the defrost timer off and it worked for a couple of days. The MD stated the cooler is really old and it needed to be replaced. He stated the cooler was as old as the Mayflower. The MD stated he was not responsible for repairing the cooler. He stated any time the DM tells him it is not working he calls a repairman. In an interview on 5/14/25 at 1:20 pm the ADM stated he was not sure what they would do with the cooler. He stated the facility rented two refrigerators today. Record review of the Refrigerator and Freezer log for April 2025 revealed the cooler temperatures were above 41 degrees on 4/2/25,4/3/254/12/254/13/25, 4/28/25, 4/29/25 and 4/30/25. Record review of the Refrigerator and Freezer log for May 2025 revealed the cooler temperatures were above 41 degrees on 5/1/25,5/2/25, 5/6/25, 5/7/25. Record review of the repair invoice for the walk-in cooler dated 4/3/25 revealed the cooler was checked. There was no further information on the invoice. Record review of the repair invoices dated 5/2/25, 5/5/25 and 5/6/25 revealed onsite maintenance tasks on the cooler were done. Record review of the cleaning sheets for the kitchen had been signed as completed for all tasks. Record review of the policy titled Cabinets, Drawers and Shelving dated 2018, revealed the facility will maintain cabinets drawers and shelving free of food particles and dirt to minimize the risk of food hazards. Cabinets, drawers and shelving will be cleaned a minimum of every week or as needed. Record review of the policy titled Food Handling dated June 1, 2019, revealed the facility will maintain all cold prepared items at a temperature of 41 degrees or below. Check the temperature of all refrigerators to make sure the temperature stays below 41 degrees. When temperatures are outside the designated range, notify maintenance. Record review of the policy titled General Kitchen Sanitation dated 2018, revealed: Clean all food pre areas, food contact surfaces, and equipment. Keep food contact surfaces free of encrusted grease deposits and other accumulated soil. Clean nonfood surfaces as necessary. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675055 If continuation sheet Page 24 of 26 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 675055 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Childress 1200 7th St NW Childress, TX 79201 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 0921 Level of Harm - Minimal harm or potential for actual harm Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Based on observation, interview, and record review, the facility failed to provide a safe, clean, and comfortable homelike environment for 1 of 2 shower rooms (100 hall) reviewed for homelike environment. Residents Affected - Few A. The facility failed to ensure the shower room on the 100 Hall did not have black grime buildup on the walls and floor of the shower room. B. The facility failed to ensure the shower room on the 100 Hall did not have a foul smell coming from the drain. These failures could place the residents at risk for a decreased quality of life, an uncomfortable, unhomelike environment due to unsanitary conditions. Findings included: During the confidential Resident Council meeting one resident stated there was black mold in the shower room and a putrid smell. She stated she felt the mold and the smell in the shower played a part in her not being able to breathe. She stated it was not good for her to breathe in the mold or the smell in the shower. She stated the mold had been in the shower for at least a month. During an observation and interview on 5/13/25 at 1:10 pm, with the DOR revealed the shower room on the 100 Hall had a putrid gas smell and the floor and the lower walls of the shower had thick black gunk on them. When asked what she thought the smell and the black gunk was she stated I don't know. It's hard to tell what that is. During an interview on 5/13/25 at 1:30 pm, the MD stated, It's just mold. You can clean it. He stated that was housekeeping's job to clean the showers. The MD stated he did not know how long the mold had been in the shower. During an observation and interview on 5/13/25 at 2:00 pm, with the Housekeeping Supervisor (HSK E) revealed the shower room on the 100 Hall had a putrid gas smell and the floor and the lower walls of the shower had thick black gunk on them. The HSK E stated it looked like the shower room had not been cleaned. He stated he had not cleaned the shower. He stated the other housekeeper was supposed to clean and disinfect the shower every day. He stated he tried to go behind her and check to make sure the work had been done but he had not always had time to check. HSK E used his foot to rub the mold and stated he would get it cleaned up. He stated of the smell that the shower smells because of the pipe not being set right. He stated they call it sewer gas. He stated the shower had been remodeled about 5 years ago and the contractor did not put the drain in right. He stated the consequence of not cleaning the shower daily would be mold and unhygienic surfaces for the residents and could result in residents getting sick. During an interview on 5/14/25 at 10:20 am, the Administrator stated he was made aware of the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675055 If continuation sheet Page 25 of 26 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 675055 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Childress 1200 7th St NW Childress, TX 79201 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 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few condition of the shower on the 100 Hall that morning (the morning of 5/14/25). The Administrator said housekeeping was responsible for cleaning the showers. The Administrator said the showers should be cleaned daily by housekeeping. He stated the consequences of not having the shower cleaned properly would be spreading mold infection around the facility the ADM stated of the pea trap there was not one. he stated the bathroom was remodeled a while back and the smell was due to not having the pea trap. He stated the shower would have to be torn up and redone. He stated the facility had talked about it in the past, but nothing had been planned or was in writing. During an interview on 5/14/25 at 12:50 pm the MD stated the smell in the bathroom was from the pea trap. He stated there was not one in the drain. He stated we are trying to find one. He stated when you install a shower it loops and goes into the drain. If you don't have a pea trap the water would stay in the bottom of the drain. When they redid this shower 6 years ago, they did not put in the pea trap. That was why it smells. Record review of the facility's policy titled, Safe and Homelike Environment, revised 5/13/25, indicated, The facility will provide a safe, clean, comfortable and homelike environment. This includes ensuring that the resident can receive care and services safely and that the physical layout of the facility maximizes resident independence and does not pose a safety risk. Environment refers to any environment in the facility that is frequented by residents (including but not limited to) the resident rooms, bathrooms dining areas . Orderly is defined as an uncluttered physical environment that is neat and well kept. Sanitary includes but is not limited to preventing the spread of disease-causing organisms by keeping resident care equipment clean and properly stored. Record review of the facility's policy titled, Bathrooms, revised February 2020, indicated, Bathrooms, including showers, are cleaned and disinfected daily in accordance with our established procedures. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675055 If continuation sheet Page 26 of 26