Health inspection·December 15, 2025

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure a resident with pressure ulcers received necessary treatment and services, consistent with professional standards of practice, to promote healing, prevent infection and prevent new ulcers from developing for 1 of 4 resident (Resident #1) reviewed for pressure ulcers.The facility failed to ensure Resident #1 received wound care according to physician orders on 11/05/25, 11/21/25, 11/24/25 and 11/27/25.The failure placed residents at risk for pressure ulcer deterioration and infection.Findings included:Record review of Resident #1's face sheet, dated 12/15/25, reflected the resident was a [AGE] year-old male who was admitted to the facility on [DATE], readmitted on [DATE] and discharged on 12/02/25. Record review of Resident #1's admission MDS assessment, dated 11/06/25, reflected his diagnoses included chronic obstructive pulmonary disease (ongoing lung condition caused by damage to the lungs), essential hypertension (high blood pressure), hyperlipidemia (high cholesterol), and type 1 diabetes mellitus (blood glucose, or blood sugar, levels are too high). Resident #1's BIMS score was 10 which indicated moderate cognitive impairment. The MDS further revealed Section M Skin Conditions indicated Resident #1 had 1 unstageable pressure injuries presenting as deep tissue injury that were present upon admission/entry to the facility, surgical wound and skin tear(s). Record review of Resident #1's care plan, undated, reflected Resident #1 had pressure ulcers or the potential for pressure ulcer development. The care plan interventions included: Monitor/document/report PRN any changes in skin status: appearance, color, wound healing, s/sx of infection wound size, state. The resident requires the bed as flat as possible to reduce shear. The resident prefers to be repositioned with (2 people, lifter, slider). Follow facility policies/protocols for the preventions/treatment of skin breakdown. The resident requires (Specify: Pressure relieving/reducing device) on (Specify: bed/chair). Treat pain as per orders prior to treatment/turning etc. to ensure the resident's comfort.Record review of Resident #1's physician orders, dated 10/31/25 reflected: cleanse with NS, pat dry, paint with betadine and leave open to air every evening shift. right lower leg(front): cleanse with NS, pat dry, apply Xeroform and cover with dry DRSG every evening shiftRecord review of Resident #1's Initial Wound Evaluation & Management Summary, dated 11/12/25, reflected the following Treatment Plan/Orders: (Site 1) Non-Pressure wound of the right, distal shin partial thickness: Sodium hypochlorite gel (Anasept) apply once daily and as needed: if saturated, soiled, or dislodged. For 30 days; Collagen powder apply once daily and as needed: if saturated, soiled, or dislodged. (Site 2) Unstageable DTI of the right heel undetermined thickness: Betadine apply once daily and as needed: if saturated, soiled, or dislodged. (Site 3) Non- Pressure wound of the right, anterior, medial ankle: Betadine apply once daily and as needed: if saturated, soiled or dislodged.Record review of Resident #1's TAR for November 2025 reflected there was no documentation showing that wound care was provided on 11/05/25, 11/21/25, 11/24/25 and 11/27/25.Interview on 12/15/25 at 3:01 PM, ADON A revealed the charge nurses were responsible for providing daily wound care to the nurses. Residents Affected - Few (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: 675270 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 675270 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Kennedale 413 E Mansfield Cardinal Kennedale, TX 76060 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)