Inspection·November 24, 2025

F 0760 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Nursing (DON) verified that the staff nurse, LVN A entered an incorrect medication start date, which resulted in a delay in treatment. A review of the facility progress notes assessment dated from 09/26/2025 to 11/20/2025, revealed documentation of no fever, no pain discomfort related to foley, and urine color noted clear since readmission to facility on 09/26/2025. A review of the Hospice Nurse visit documentation on 09/29/25 indicated Indwelling Catheter Assessment: No problems noted or verbalized. Drainage system: Bedside drainage, date last changed 09/26/2025, urine characteristics clear /yellow, odor slight. Clinical Findings: Genitourinary No problems noted or verbalized. On 11/20/2025 at 9:30A.M., observed and interviewed Resident # 1 was in his room seated in a wheelchair watching, the resident is interview able, alert and oriented. Resident # 1 was fully dressed, clean and well groomed, bed in low position, water at bedside, call light was in reach. Resident #1 denied abuse or neglect and said he still had his foley but currently there were no issues with his foley. On 11/20/2025 at 2:00P.M., an interview with the DON revealed that the intent of the provider's order was for the resident to begin the next dose of Sulfamethoxazole-Trimethoprim Bactrim orally upon return to the facility on [DATE]. The DON confirmed that the resident should had started the antibiotic immediately after re-admission from the hospital. The DON further stated, she was unsure of how the medication error was discovered, she revealed she was not the DON at the time of discovery. The DON said she was contacted by the VA case manager for clarification as to why the doctor re-ordered the Bactrim to re-start on 10/2/2025. The DON stated the staff nurse entered the wrong date and the veteran (Resident did not start the antibiotic). The DON stated the doctor was notified of the incorrect transcribe start day and immediately re-ordered the po antibiotic Bactrim. On 11/24/2025 at 1:30 P.M., an interview with the VA RN case manager said, that during a chart review, it was noted that Resident #1 had a new order for Bactrim orally for sepsis dated 10/02/25. The VA case manager said she requested clarification as to why the Doctor had re-ordered the Bactrim PO. The VA case manager said the DON reported that the that the intent of the provider's order was for the resident to begin the next dose of Sulfamethoxazole-Trimethoprim Bactrim orally upon return to the facility on [DATE]. She stated, the DON said that the staff nurse LVN A entered the incorrect start date and failed to initiate the next dose of antibiotic. After notifying the physician, the medication was scheduled to start at 9:00P.M. on 10/2/2025. As a result, Resident #1 missed six days of antibiotic therapy following hospitalization for post-sepsis treatment and ureteral stent placement. On 11/24/2025 1:45 P.M., an attempt was made to contact LVN A, however there was no answer. A message was left requesting a return call to the State Surveyor phone number, but no return call was received during the investigation. On 11/24/2025 at 2:00 P.M., interview with the Hospice RN said, Resident #1 had a history of chronic pain related to a prior electrocution injury, which contributed to ongoing pain and discomfort. The hospice RN said that the resident exhibited no fever or pain associated with the catheter and reported no urinary discomfort. She confirmed that the urinary catheter was intact, and the urine was clear and yellow in color, with no urinary complaints noted. On 11/24/2024 at 2:30 P.M., interview with the DON revealed that the original order received from the hospital, and that the admitting staff nurse is responsible for entering all into orders into the system. The DON stated the facility's process for verifying medication orders upon readmission is the responsibility of ADON and DON, who are expected to review all orders entered. The DON reported that LVN A had been employed at the facility since 11/20/2012 and had no prior disciplinary action in her personnel file. She further stated that nursing staff had been educated, and re-educated on receiving orders, accurate medication transcription, medication administration, documentation, and antibiotic stewardship. The DON added that an Action Plan dated 10/2/2025 had been implemented, with ongoing monitoring by the DON and ADON, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675320 If continuation sheet Page 2 of 3 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 675320 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Bradburn 520 Bradburn Rd Grand Saline, TX 75140 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 0760 Level of Harm - Minimal harm or potential for actual harm and review through QAPI every three months. Review of facility policy for documentation of Medication Administration, Antibiotic Stewardship, and Abuse & Neglect, revealed all seven (7) elements were addressed: Screening, Training, Prevention, Identification, Investigation, Protection and Reporting. There were no concerns with facility policy. In-services were reviewed and were compliant. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675320 If continuation sheet Page 3 of 3