Health inspection·October 12, 2023

F 0727 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many 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 eight consecutive hours a day, 7 days a week for 4 of 30 days (9/24/23, 9/30/23, 10/1/23, and 10/8/23) reviewed. (September 2023 and October 2023) The facility did not have RN coverage for 2 days in September 2023. The facility did not have RN coverage for 2 days in October 2023. This failure could place residents at risk by leaving staff without supervisory coverage for RN specific nursing activities and for coordination of events such as an emergency care and disasters. Findings included: Record review of a timecard report for 09/24/2023, 09/30/2023, 10/01/2023, and 10/08/2023 indicated the DON RN was present and worked 8.5 consecutive hours on those days however on 09/24/2023, 09/30/2023, 10/01/2023 and 10/08/2023 the scheduled DON RN was not in the facility at all on those days. During an interview on 10/12/2023 at 2:10 pm, the DON stated she was not sure who input the time on the timesheet for RN coverage. She stated she was responsible for ensuring an RN was in the facility 8 hours a day 7 days a week either from a charge nurse or administrative nurse position. She said she thought if she worked 40 hours for the week that she could not perform RN coverage on the weekends according to PBJ. She said that her normal weekend RN had quit on 09/22/2023 and she had not been able to replace her. She stated not having an RN could affect the residents if an emergency was to occur. During an interview on 10/12/2023 at 3:05pm, the Corporate Clinical Nurse said she was not sure who input RN coverage hours on the timesheet print out. She said she thought it was someone in corporate that inputs RN hours for the QIPP program. She said the DON was responsible for ensuring a RN was in the facility 8 hours a day 7 days a week. She said that staffing had been hard in their area. During an interview on 10/12/2023 at 4:00 pm, the Administrator said the DON was responsible for ensuring that an RN was on shift 8 hours a day 7 days a week. He said he was not aware that there was not RN coverage on 09/24/23, 09/30/23, 10/01/23, and 10/08/23. He said he learned in September 2023 that there was not RN coverage for the weekends. He said according to PBJ he did not think the DON could work as RN coverage for the weekends if she had already worked 40 hours during the week. He said by not having an RN at the facility 8 hours a day 7 days a week could affect the residents' health. (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: 675217 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 675217 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Elkhart 214 Jones Rd Elkhart, TX 75839 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)