Health inspection·October 17, 2023

F 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews the facility failed to ensure residents received services in the facility with reasonable accommodations of each resident's needs for 4 of 5 residents (Residents #1, #2, #3 & #4) reviewed for call lights in that: Residents Affected - Some Residents #1, #2, #3, & #4's call lights were not within reach. This failure could affect all residents who needed assistance with activities of daily living and could result in needs not being met. Findings included: Resident #1 Record review of Resident #1's admission record dated 10/17/23 documented a [AGE] year-old female admitted on [DATE]. Resident #1's documented diagnoses included: Unspecified Dementia (loss of thinking abilities), Disorder of bone density (thin fragile bones), Weakness, Essential hypertension (elevated blood pressure), Fracture of the third cervical vertebra (broken vertebra in the neck region) Record review of Resident #1's Significant change MDS assessment dated [DATE] revealed the resident had a BIMS score of 99 indicating severe cognitive impairment. The MDS also revealed the resident required extensive assistance in various areas of activities of daily living such as bed mobility, dressing, and personal hygiene. Record review of Resident #1's care plan dated 08/25/22 revealed Resident #1 was care planned for falls and requires monitoring for safety. The MDS also revealed the resident required extensive assistance in various areas of activities of daily living such as bed mobility, dressing, and personal hygiene. Observation of Resident #1 on 10/17/23 at 10:20am revealed Resident #1's call light is lying on the floor around bedside table leg out of reach of resident. Resident #1 was not interviewer able. Resident #2 Record review of Resident #2's admission record dated 10/17/23 documented a [AGE] year-old male admitted on [DATE]. Resident #2's documented diagnoses included: Unspecified Dementia (loss of thinking abilities), Type 2 Diabetes Mellitus (elevated blood sugar), Repeated falls, Essential Hypertension (elevated blood pressure) (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 3 Event ID: 675096 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 675096 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Hillsboro 411 Old Brandon Rd Hillsboro, TX 76645 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)