Health inspection·July 13, 2023

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few draining his catheter; however, she forgot to ensure he had a privacy bag. CNA C stated she realized he did not have a privacy bag after the DON asked her why it was not covered. According to CNA C, not having a privacy bag put residents at risk of dignity issues. CNA C stated it was the responsibility of the nursing staff to ensure residents with catheters had a privacy bag at all times. Review of Resident 44's MDS quarterly assessment, dated 04/23/23, revealed the resident was a [AGE] year-old male who was initially admitted to the facility on [DATE] and readmitted on [DATE]. Resident #44's diagnoses included urinary tract infection, infection, and inflammatory reaction due to indwelling urethral catheter, neuromuscular dysfunction of bladder (urinary bladder problems due to disease or injury of the central nervous system). The assessment reflected the resident's cognitive was intact, with a BIMS score of 15. Resident #4's functional status with toileting is extensive assistance with one-person physical assistance. Resident #4 bowel and bladder indicated an indwelling catheter (including suprapubic catheter). Review of Resident #44's care plan, dated 07/10/23, reflected: Resident #44 required an indwelling urinary catheter related to neurogenic bladder. Resident will have catheter care managed appropriately as evidenced by not exhibiting signs of infection or urethral trauma. Approach start date 04/2423 included observe for leakage, change catheter bag every month, do not allow tubing or any part of the drainage system to touch the floor, position bag below level of bladder, provide catheter care every shift, use a catheter strap. Observation on 07/11/23 at 11:41 AM revealed Resident #44 observed resident in his wheelchair in the hallway entering the dining area for lunch. The resident had a catheter urinary bag which was not covered by a privacy bag. The urinary catheter bag had urine inside. Observed resident to continue to get his meal tray. There were several residents in the dining area eating lunch. During interview on 07/11/23 at 2:30 PM with Resident #44 revealed while in the dining room, CNA D put on a privacy bag to cover his catheter during lunch. According to Resident #44, he did not have a problem with the catheter not being covered; however, someone else could be bothered by it and it could bother others. Resident #44 stated he did not want to make others feel uncomfortable. Resident #44 stated he usually used his manual wheelchair which had a privacy bag, due to the change to the electric chair may have prompted the missing privacy bag so he felt he needed to alert CNA D. Interview on 07/12/23 at 9:32 AM with CNA D revealed she assisted Resident #44 out of bed and into his electric chair on yesterday morning (07/11/23). CNA D stated while in the dining room, Resident #44 mentioned to her that there was not a privacy bag covering his catheter bag. CNA D stated she then went to grab a privacy bag to place over the catheter. CNA D stated not having a privacy bag put Resident #4 at risk of affecting his dignity. CNA D stated, I would not want anyone seeing my pee so I don't think he would want that for himself CNA D stated the nursing staff were responsible for ensuring the privacy bag was on at all times. Interview on 07/13/23 at 1:22 PM with LVN B revealed she worked Hall F with Resident #4 and Resident #44. LVN B stated neither Resident #4 or Resident #44's urine collection bag had a privacy cover. She stated it was facility protocol to have urinary collection bags covered at all times. LVN B stated it was the responsibility of all staff, especially aides and nurses, to ensure bags were covered. LVN A stated she had completed training regarding privacy bags and noted urine collection bags should be covered to ensure the resident's privacy and to prevent infections. Interview on 07/13/23 at 2:10 PM with the DON revealed a urinary collection catheter bag should (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675144 If continuation sheet Page 2 of 9 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 675144 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Burleson 600 Maple St Burleson, TX 76028 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 0550 Level of Harm - Minimal harm or potential for actual harm always be covered. She stated all staff were responsible for ensuring the urinary collection catheter bags were covered. She stated the negative outcome of the collection bag not being covered was that it could affect the resident's dignity and the resident's right to privacy. Review of the facility's policy titled Dignity revised February 2021, reflected the following: Residents Affected - Few .Demeaning practices and standards of care that compromise dignity are prohibited. Staff are expected to promote dignity and assist residents, for example: a. Helping the resident to keep urinary catheter bags covered FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675144 If continuation sheet Page 3 of 9 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 675144 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Burleson 600 Maple St Burleson, TX 76028 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure residents fed by enteral means received the appropriate treatment and services to prevent complications of enteral feedings for 1 of 2 residents (Resident #20) reviewed for tube feeding. LVN A failed to check placement of Resident #20's g-tube (a tube going into the stomach through the abdomen to administer medications and liquid nutrition) placement prior to flushing with water and administered bolus feeding. LVN A did not flush g-tube with the correct amount of water before and after bolus feeding. Facility failed to follow physician order for Resident #20 when cleaning enteral stoma site by not applying gauze dressing. This deficient practice could place residents who require enteral feedings at risk for weight loss, dehydration, metabolic abnormalities, and hospitalizations. Findings included: Record review of Resident #20's Face Sheet, dated 07/13/23, revealed Resident #20 was an [AGE] year-old male who admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses that included dysphagia oropharyngeal phase (difficulty swallowing) and gastrostomy status (surgical opening into the stomach). Record review of Resident #20's quarterly MDS Assessment, dated 06/26/23, revealed Resident #20 had a BIMS score of 09, which indicated cognition was moderately impaired. Resident #20's MDS Assessment Section K revealed nutritional approach was feeding tube. Record review of Resident #20's Care Plan, dated 04/24/23, revealed the following: Feeding tube: Enteral feedings related to CVA, Inability to swallow PO and brain tumor. Goal: [I] will maintain adequate parameters of nutrition through tube feedings as evidence by stable weight and labs within normal limits. Approach: Administer water flushes per MD order. Administer tube feeding formula per MD order. Check placement of tube prior to each addition of feeding, fluids, or medication. Cleanse peg tube site with soap and water. Dehydration/Fluid Maintenance: At risk of dehydration related to diuretic therapy, meds, swallowing problems (NPO status), tube feeding. Goal: [I] will be free of s/s of dehydration. Approach: Encourage fluids frequently. Feeding tube: At risk of aspiration due to resident needing feeding tube. Goal: Airway will be clear to prevent no aspiration over the next 90 days. Approach: Check tube placement, by auscultation, before each feeding and med administration. Check gastric residual as ordered. Monitor ostomy site and report irritation or breakdown. Record review of Resident #20's physician order dated 01/17/23, revealed an order for: Enteral Stoma Site Care: (With Dressing - Routine) Clean with Normal Saline. Pat dry. Apply split gauze (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675144 If continuation sheet Page 4 of 9 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 675144 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Burleson 600 Maple St Burleson, TX 76028 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 0693 dressing. Once a day. Level of Harm - Minimal harm or potential for actual harm Record review of Resident #20's physician order dated 01/17/2023, revealed an order for: Enteral Stoma Site Care: (With Dressing - PRN) Clean with Normal Saline. Pat dry. Apply split gauze dressing. Residents Affected - Few Record review of Resident #20's physician order dated 06/13/2023, revealed an order for: Enteral Feeding Bolus Administration: Jevity 1.5, Bolus 237ML 6 times per day via gravity. Total Bolus in 24 Hours: 1,185ML Total Kcal per Day: 1775Kcal. Record review of Resident #20's physician order dated 06/13/2023, revealed an order for: Enteral Free Water: Administer bolus (100) ML of Water before and after administration of enteral feeding 6 times per day. Observation and interview on 07/11/23 at 12:14 PM of Resident#20 sitting in the facility common area. Resident #20 stated he was doing well. Resident stated he had a g-tube and had already had his feeding. He stated his g-tube did not bother him or hurt him. Resident #20 pulled his shirt up and stated he did not have any redness or signs of infection. There was no observation of a dressing around the g-tube. Observation on 07/12/23 at 12:17 PM revealed LVN A prepping to provide Resident #20 his bolus feeding. LVN A reviewed Resident #20 treatment screen and stated Resident #20 would be receiving one can of Jevity 1.5 Bolus and 100 ml of water before and after feeding. Observed LVN A grab the formula can and an empty clear 5 oz cup. LVN A entered the resident's room without her stethoscope. Observed LVN A add water to the cup. She checked for the g-tube for gastric content residual but did not check for placement of the g-tube. The g-tube was flushed with approximately 10 -15ml of water before the bolus administration. LVN A then provided Resident #20's formula via gravity and flushed with approximately 20 - 30ml of water via gravity. Observed cup to still be half full of water. Interview on 07/12/23 12:50 PM with LVN A revealed she had been working for the facility for a couple of months. She stated she had been Resident #20 nurse since working here and she was the nurse assigned to Resident #20 today (07/12/23). LVN A stated she reviewed Resident #20 order's before entering the room, and stated resident had an order for 100ml of water before and after feeding. LVN A stated the syringe she used can hold 60 cc of fluids. LVN A stated if Resident #20 needed 100ml of water she should have provided Resident #20 with 60 cc and then another 40 cc of water. LVN A stated she failed to provide Resident #20 with his full 100ml of water before and after his bolus feeding. LVN A stated she normally would provide the correct amount; however, she was nervous and forgot. LVN A stated the risk of not providing Resident #20 with his water fluids could cause dehydration and g-tube to get clogged. LVN A stated she cleaned the g-tube site daily. LVN A stated she was not aware that the order states to apply slip gauze dressing. LVN A stated since Resident #20 g-tube site had no signs or symptoms of irritation she did not need to apply gauze, she stated she was looking at the PRN orders. She stated the risk of not applying a dressing could cause an infection. LVN A stated she failed to follow physician order regarding applying a gauze dressing. LVN A stated there are two ways for checking placement of the g-tube. She stated one way of checking placement would be checking for residual and if residual comes out the g-tube is in place. Second way of checking would be by using a stethoscope and inserting a little air inside the g-tube. LVN A stated when she checked Resident #20 g-tube there was no residual. When asked how she checked for placement, LVN A stated she should have used a stethoscope but failed to do so. LVN A stated the risk of not checking placement could cause aspiration or g-tube to be clogged. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675144 If continuation sheet Page 5 of 9 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 675144 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Burleson 600 Maple St Burleson, TX 76028 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview on 07/13/23 at 2:59 PM with the ADON revealed her expectations are for her nurses to follow physician orders and policy. The ADON stated prior to nurses entering a resident room, nurses should check physician orders and prepare supplies. She stated each nurse should have a measuring cup for water. Nurses should check for placement by using a stethoscope, then check for residual and then flush with water depending on the order, continue with bolus feeding via gravity and then flush again. The ADON stated if any of the nurses failed to follow physician orders could cause dehydration and tube can get clogged. The ADON stated residents with g-tube have two orders; one is for cleaning the g-tube site and applying a dressing daily and the other order was PRN in case the dressing comes off or is soiled the nurses can change them. She stated the risk of not following physician order could cause an infection around the g-tube placement. Interview on 07/13/2023 at 3:19 PM with the DON revealed she just started working at the facility 3 weeks ago. She stated she had not provided any in-services to her nurses regarding g-tubes and has not observed her nurses provide bolus feedings yet. The DON stated her expectations are for her nurses to follow physician orders. She stated residents with g-tube have two orders; one is for cleaning the g-tube site and applying a dressing daily and the other order was PRN in case the dressing comes off or is soiled the nurses can change the dressing accordingly. The DON stated it was the ADON and herself responsibility to ensure their staff are following physician orders. The DON stated risk of not following orders could cause dehydration, and skin irritation. Record review of the facility policy Enteral Nutrition revised date November 2018 reflected the following: .11. The nurses confirms that orders for enteral nutrition are complete. A. the enteral nutrition product; b. delivery site (tip placement); c. the specific enteral access device; d. administration method (continuous, bolus, intermittent). 12). The provider will consider the need for supplemental orders, including: a. confirmation of tube placement; e. head of bed elevation; g. checks for gastric residual volume (GRV). 14). Staff caring for resident with feeding tubes are trained to how to recognize and report complications associated with insertion and /or use of a feeding tube, such as: a. spiration; b. tube misplacement or migration; c. skin breakdown around insertion site; f. clogging of the tube FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675144 If continuation sheet Page 6 of 9 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 675144 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Burleson 600 Maple St Burleson, TX 76028 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 - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on observation, interview, and record review, the facility failed to 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 one (C Hall cart) of three nurse medication carts reviewed for medication storage. LVN A failed to remove expired medications for Resident #14 from the nurse medication cart for the C Hall cart. This failure placed residents at risk of receiving medications that failed to deliver their full effectiveness. Findings included: Observation on 07/12/23 at 12:50 PM of nurse medication cart on C Hall revealed two Fluconazole inhalers , labeled for Resident #14, had expired on 05/31/23. Interview on 07/12/23 at 12:52 PM LVN A stated she had administered Resident #14's Fluconazole that morning. She stated she did not notice the medication was expired. She stated the risk of giving an expired medication included the resident not receiving the full effects intended by the physician. Interview on 07/12/23 at 1:00 PM the DON stated she expected the nurses to check their medications for expiration dates before they administer them. The DON stated the nurses were responsible for re-stocking their carts and checking for expired medications before making their rounds. She stated the risk of giving a resident expired medications was the resident not receiving the therapeutic effects of the medication. Review of Resident #14's July 2023 MAR revealed Fluconazole was not on the list of medications. Review of Resident #14's physician orders revealed Fluconazole had been discontinued on 05/01/23. Interview on 07/12/23 at 2:20 PM Resident #14 was confused, he could not recall if he had taken an inhaler in the morning. He stated he was not feeling short of breath. Interview on 07/13/23 at 10:00 AM with LVN A revealed she must have misunderstood what the surveyor was asking her on 07/12/23 about administering the Fluconazole. She stated she just had the medication on her cart but had not administered it. LVN A stated the nurses were responsible for checking their carts and removing expired or discontinued medications. She stated she did not know why the Fluconazole was still on the cart when it had been discontinued over two months ago. Interview on 07/13/23 at 11:03 AM with the DON revealed she had followed-up with all the nurses on 07/12/23 and checked all the medication carts for expired medications. The DON stated she did not know why LVN A had stated she had given the Fluconazole because if it was not on the MAR she would not have been triggered to give it. Review of the facility's Administering Medications policy and procedure, dated April 2019, reflected: .12. The expiration/beyond use date on the medication label is checked prior to administering FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675144 If continuation sheet Page 7 of 9 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 675144 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Burleson 600 Maple St Burleson, TX 76028 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 0925 Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. 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 effective pest control program to ensure the facility was free of pests for 1 (Hall B) of 6 halls, 1 of 1 nurses' station and 1 of 1 dining room. Residents Affected - Some The facility failed to ensure Hall B, nurses' station and the dining room were free from flies. This failure could place residents at risk for the potential spread of infection, cross-contamination, and decreased quality of life. Findings included: Observation of Hall B on 07/11/23 10:20 AM, Resident #14 had flies circling in his room and landing on his personal items. Observation of Hall B on 07/11/23 10:44 AM, Resident #57 had flies circling in his room and landing on his personal items. Resident #57 stated staff spray a chemical for the flies but does not seem to help. He stated he does not like them but got used to them already. Observation and interview of Hall B on 07/11/23 at 10:46 AM, there were several flies on Resident #21 while he was in bed. Resident #21 stated flies were a major issue and it has gotten worse since summer started. Resident #21 stated he had informed staff but all they do is say Sorry about that. Observation of Hall B on 07/11/23 11:07 AM, Resident #16 had flies circling in his room and landing on his personal items Observation on 07/11/23 11:35 AM, there were a few flies sitting on some of the dining tables where residents were sitting at and flying around residents' plates. Record review of facility pest control binder revealed the following: 06/7/23 - Location (Hall/Room/Area) B5, B6, B7, B8 - Issues Flies, 07/11 - Location (Hall/Room/Area) B6. Interview during a confidential group meeting on 07/12/23 at 2:00 PM, eight out of twelve residents revealed concerns regarding flies. Residents stated they have seen pest control company spraying chemicals; however, it did not seem to help. During the meeting there was residents observed with fly swatters on their wheelchairs. Observation on 07/13/23 during the times of 10:00 AM - 3:00 PM, there were several flies observed around the nurses' station. The staff were observed brushing the flies off. Interview on 07/13/23 at 10:50 AM with Nurse Aide E revealed she had been working at the facility for 5 months. She stated at the beginning of this summer they have had a constant issue with flies. She stated it was worse when summer started and had gotten better. She stated she has had residents complain about flies, but it seemed like they have gotten used to them that they did not complain as much. She stated she would report the concerns to the Administrator and Maintenance Supervisor. She stated she was not sure if pest control had come by. She stated they had fly swatters to kill them. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675144 If continuation sheet Page 8 of 9 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 675144 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Burleson 600 Maple St Burleson, TX 76028 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 0925 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Interview on 07/13/23 at 11:00 AM with the Pest Control Technicain revealed at the facility today (07/13/23) to complete the facility's monthly pest control visit. He stated last month monthly visit was on 06/08/23, and the facility had concerns regarding flies. He stated when he entered the facility the first thing he did was review the pest control binder to review if the facility had any concerns. He stated they treated the entire building first and if the facility had a concern regarding a specific room, they would treat that room after the building had been completed. He stated pest control also came when the facility had an emergency, such as when they were at the facility on 07/11/23 to treat flies. He stated that treatment should still be active. Interview on 07/13/23 at 1:12 PM with Housekeeper F revealed she had been working at the facility since April 2023. She stated she was assigned to A, B, C, D Hall. She stated she has had residents complain about flies. She stated the worst hall was B Hall. She stated she killed about 20-30 flies a day. She stated she did not know what attracted them. She stated she cleaned the rooms every day and at times twice mostly on B Hall. She stated when a resident reported a complaint regarding pest, she reported it on the maintenance pest control log. She stated Maintenance was responsible for following up on the complaints. She stated pest control had been at the facility; however, she dod not think the treatment they were applying was working because they still had flies. She stated it had gotten worse since summer started. Interview on 07/13/23 at 4:23 PM with the Maintenance Supervisor revealed he has had complaints regarding flies. He stated it was worse when summer started; however, it had gotten better. He stated pest control had been at the facility for their monthly visits and on 07/11/23 for an emergency visit to treat flies. He stated pest control applied a treatment powder and sprayed outdoor and indoor. He stated about two months ago they ordered fly lights on Halls B, C, D. They still had an outstanding order for the other Halls A, F, E. He stated he did his rounds and would kill any that he observed. He stated they called pest control on Tuesday due to the number of flies they observed. The Maintenance Supervisor stated other than being a pest control issue the risk would be residents being annoyed by them. Interview on 07/13/23 at 4:35 PM with the Administrator revealed flies had been a constant issue. He stated this year had been worse than others. The Administrator stated since May 2023 they have had monthly services with an additional service to treat the flies. The Administrator stated they treated it as best as they were able; however, pest control could not enter the resident rooms with residents inside and some residents did not want to leave their rooms. He stated housekeeping went inside the room twice a day to clean the rooms. He stated the heaviest halls with flies were Hall B and D due to the door leading outside. The Administrator stated the risk would be infection control in the environment. Review of the facility's Pest Control policy, revised dated [NAME] 2008, reflected: Our facility shall maintain an effective pest control program. 1. This facility maintains an on-going pest control program to ensure that the building is kept free of insects and rodents .6. Maintenance services assist, when appropriate and necessary, in providing pest control service . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675144 If continuation sheet Page 9 of 9