Health inspection·September 6, 2024

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure a resident who was incontinent of bladder receives appropriate treatment and services to prevent urinary tract infections and to restore continence to the extent possible for 1 of 1 resident (Resident #1) reviewed for incontinence care, in that: Resident #1 was provided with inadequate incontinence care by CNA A and CNA B. This failure could place residents who required incontinence care at risk for the development of new or worsening urinary tract infections. The findings included: Record review of Resident #1's face sheet, dated 9/5/24 revealed an [AGE] year-old male admitted to the facility on [DATE] with diagnoses that included type 2 diabetes (a long-term condition in which the body has trouble controlling blood sugar and using it for energy), dementia without behavioral disturbance (impaired ability to remember, think, or make decisions that interferes with doing everyday activities), heart disease, hyperlipidemia (high fat levels in the blood), and hypothyroidism (abnormally low activity of the thyroid gland resulting in slowing of metabolic changes in adults). Record review of Resident #1's most recent MDS quarterly assessment, dated 7/30/24 revealed the resident was severely cognitively impaired for daily decision-making skills and was always incontinent of bowel and bladder. Record review of Resident #1's comprehensive care plan with initiation date 8/12/24 revealed the resident was at risk for abdominal discomfort related to constipation with interventions that included to provide incontinence checks every two hours and as needed. Observation on 9/5/24 at 3:04 p.m. during incontinence care revealed CNA A retracted the foreskin from Resident #1's penis and wiped the tip of the penis with one wipe in a back-and-forth motion. CNA A continued with incontinence care but did not clean the shaft of the penis to Resident #1. During a joint interview on 9/5/24 at 3:16 p.m., CNA B, who assisted CNA A with incontinence care to Resident #1 stated she noticed CNA A did not properly provide incontinence care to Resident #1 because CNA A used several passes with one wipe to clean Resident #1's penis. CNA B stated, CNA A should have used one wipe in a clockwise motion and then tossed it out and then should have taken another wipe to continue cleaning the tip of the penis counterclockwise and then toss the wipe. CNA B (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: 675452 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 675452 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/06/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Converse 7700 Mesquite Pass Converse, TX 78109 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)