Health inspection·November 9, 2024

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observations, interviews, and record review, the facility failed to provide a safe and sanitary environment to help prevent the development and transmission of communicable diseases and infections 1 of 1 facility reviewed for infection control. Residents Affected - Some The facility failed to clean and disinfect soiled shower chair in combined shower room A and B. The facility failed to clean and discard soiled wipes left on the floor in shower room C. This failure could place resident at risk of infection transmission. Findings included: Observation on 11/09/2024 at 10:30 AM revealed a combined shower room A and B shower chair had dried bowel movement on the top left seat and inside left corner of the shower chair. Observation on 11/09/2024 at 10:38 AM revealed shower room C had soiled wipes left on the shower room floor. Interview on 11/09/2024 at 11:44 AM with CNA A stated in combined shower room A and B it was dried bowel movement on the shower chair seat. CNA A stated in shower room C it was soiled wipes on the shower room floor. CNA A stated that she did not know who used the shower rooms last and it was expected to clean and disinfect the shower rooms after each use. Interview on 11/09/2024 at 12:23 PM with RN B stated she would not know who used the shower rooms last and did not clean the shower chair or pick up soiled wipes off the floor. RN B stated the expectations were for the CNAs to clean and disinfect the shower rooms after each use and in between residents. RN B stated it was unknown how long the shower chair was soiled or last used. RN B stated once wipes were used it was expected to be discarded in the personal hygiene trash bag ,tied up, and discarded. Interview on 11/09/2024 at 12:30 PM with the ADM stated it was expected for the shower rooms to be cleaned and disinfected after each use. The ADM stated it was unacceptable for the shower chair to be soiled and the soiled wipes to be on the floor of the shower rooms. The ADM stated not cleaning and disinfecting after each use could cause transmission of diseases and infections that may cause illness. Interview on 11/09/2024 at 1:24 PM with CNA C stated it was expected to disinfect and clean showers after each use. CNA C stated she had observed the shower chairs left uncleaned with feces. CNA C (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 2 Event ID: 675144 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 11/09/2024 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)