Health inspection·June 21, 2023

F 0914 Provide bedrooms that don't allow residents to see each other when privacy is needed. Level of Harm - Minimal harm or potential for actual harm Based on observations and interviews the facility failed to ensure total privacy for residents in 14 (Rooms 1, 2, 3, 5, 6, 8, 9, 10, 11, 29, 30, 34, 35, and 36) of 25 resident rooms reviewed for privacy. Residents Affected - Some The facility failed to provide privacy curtains to ensure resident privacy in Rooms 1, 2, 3, 5, 6, 8, 9, 10, 11, 29, 30, 34, 35, and 36. This failure placed residents at risk of decreased self-worth by being exposed during resident care. Findings included: Observation on 06/21/23 starting at 9:10 AM of Rooms 1, 2, 3, 5, 6, 8, 9, 10, 11, 29, 30, 34, 35, and 36 revealed privacy curtains were hung from the ceiling to provide residents of the A bed with total privacy, there was no curtain hung at the end of the B bed to provide that resident with total privacy. Observations of the rooms revealed there was no track on the ceiling to enable a curtain to be hung at the end of the B bed. Interview on 06/21/23 at 1:00 PM, Resident #1 stated he used a bedside commode, and he did not like that he was visible from the hallway, and it was embarrassing to him. Interview on 06/21/23 at 1:10 PM, Resident #2 stated there had never been a curtain at the end of her bed and she did worry sometimes that someone could walk in and see her exposed. Interview on 06/21/23 at 1:20 PM, LVN A stated double occupied rooms could not provide complete privacy for the resident in the B bed because the room lacked a curtain at the end of the B bed. She stated there had never been a curtain in place for as long as she knew. She stated staff would close the door and pull the middle curtain to provide some privacy. Interview on 06/21/23 at 1:24 PM, the Housekeeping Supervisor stated he was responsible for changing out privacy curtains when they were dirty. He stated he had never seen a curtain at the end of the B bed of the rooms. Interview on 06/21/23 at 1:30 PM, the Administrator stated he was aware that each resident required total privacy when care was being provided but he did not know that there needed to be a curtain at the end of the B bed. Interview on 06/21/23 at 1:40 PM, the DON stated total privacy to her meant that the resident could (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: 675374 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 675374 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Irving 619 N Britain Rd Irving, TX 75061 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)