Inspection·July 17, 2023

F 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Record review of Resident #2's care plan, last reviewed on 6/2/23, revealed a focus care for falls with interventions of call bell within reach, educate and encourage use, and answer promptly. During an interview and observation on 7/17/23 at 10:23 AM, Resident #2 was in bed, the call light was on the floor. red signs on wall that said ask for help and use the call light. Resident #2 stated he had been in the facility for several weeks. Resident #2 was asked about call light placement and use but he did not answer questions. During an interview on 7/17/23 at 1:17 PM, CNA A stated she had worked with Resident #1 in the past several times. CNA A stated Resident #1 was able to use the call light. CNA A stated she was trained that call lights were to remain within reach of all residents. CNA A stated that residents who do not having call lights within reach could potentially get hurt if they were to lean over to reach for call light the fall and hit their head. CNA A stated all staff were responsible for ensuring call lights were within reach and CNA's would have to check call light placement before exiting a room at least every 2 hours. CNA A did not have a reason for Resident #1 and Resident #2 not having call light within reach. During an interview on 7/17/23 at 1:37 PM, CNA B stated it was her first day working at the facility. CNA B stated she had been trained to keep call lights within reach of resident. CNA B stated she would ask residents where they preferred to have it and would tend to place it closer to their dominant hand for easy access. CNA B stated she had been trained to do rounds at least every 2 hours to ensure residents were ok and they had their call lights within reach. CNA B stated if residents did not have call lights within reach then the residents would not be able to call for help when needed. CNA B did not have a reason for Resident #1 and Resident #2 not having call light within reach During an observation and interview on 7/17/23 at 2:05 PM, Resident #1 was not in room, call light was still on the floor from last observation at 10:19 AM. The ADON stated the call lights were expected to always be in bed and within reach. The ADON stated CNA's were responsible of ensuring call lights were within reach. The ADON stated by not having call lights within reach could potentially reduce their quality of life. The ADON stated charge nurse should be checking call light placement at least during each encounter with residents. The ADON stated staff get training on call light placement upon hire and verbal reminders daily. During an interview on 7/17/23 at 2:06 PM, CNA C stated Resident #1 was able to use call light. CNA C stated she was trained that call lights were to remain within reach of all residents. CNA A stated that not having call lights within reach could potentially experience emotional and mental distress due to them lying in bed just waiting for someone to come and assist. CNA A stated all staff were responsible for ensuring call lights were within reach of residents and CNA's would have to check call light placement before exiting a room at least every 2 hours. CNA C did not have a reason for Resident #1 and Resident #2 not having call light within reach During an interview on 7/17/23 at 2:53 PM, the Administrator stated DON and ADON were responsible for training staff upon hire. The Administrator stated she did not know how often staff received training regarding call light placement. The Administrator stated call lights were expected to be within reach of residents and rounds should be conducted daily to ensure residents needs were met. During an interview on 7/17/23 at 3:20 PM, the DON stated call lights were required to be within reach of residents and all staff were responsible for ensuring call light placement was appropriate. The DON stated every time a staff exited the resident room, they should be checking for call light (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675522 If continuation sheet Page 2 of 6 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 675522 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Monahans 1200 W 15th St Monahans, TX 79756 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 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete placement and nursing staff were expected to be doing rounds at least every 2 hours or as needed. The DON stated that not having call light within reach of resident could affect residents' assistance and care be delayed. The DON stated she does not know when the last in-service was provided regarding call light placement. The DON stated all staff get daily verbal reminders regarding call light placement within reach. During a joint interview 7/17/23 at 4:05 PM, the Administrator and Regional Nurse stated the facility did not have a call light policy. Event ID: Facility ID: 675522 If continuation sheet Page 3 of 6 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 675522 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Monahans 1200 W 15th St Monahans, TX 79756 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to develop and implement comprehensive person-centered care plan that includes measurable objectives and time frames to meet a resident medical and nursing needs to be furnished to attain or maintain the residents highest practicable physical, mental, and psychosocial well-being for 1 of 5 (Resident #5) residents reviewed for care plans. The facility failed to have a care plan for Resident #5 foley catheter. This failure could place residents with urinary catheter at risk of infection due to lack of ongoing monitoring. The findings included: Record review of Resident #5's face sheet undated revealed a [AGE] year-old female who was admitted on [DATE] and readmitted on [DATE]. Diagnosis included urinary tract infection, paranoid schizophrenia, cognitive social or emotional deficit following cerebral infraction Record review of Resident #5's MDS dated [DATE] revealed a BIMS score of 0, she was severely cognitive impaired. Bladder and bowel section reflected Resident #5 had an indwelling catheter. Record review of Resident #5's care plan last reviewed on 7/13/23 revealed no focus area addressing foley catheter. During an observation on 7/17/23 at 1:51 PM, Resident #5 was taken to nurses' station with the ADON, the Foley catheter was hanging on the right side of the wheelchair arm rest. Urine was noted on the Foley catheter and in the foley catheter tubing. During an interview on 7/17/23 at 3:07 PM, the Regional Nurse stated she had noticed this morning Resident #5 did not have care plan to address her foley catheter during a full chart audit she was conducting. The Regional Nurse stated the admitting nurse should had been the person to include foley catheter in baseline care. The Regional Nurse stated Resident #5's care plan was not accurate and could affect the ongoing monitoring of Foley catheter provided. During an interview on 7/17/23 at 3:20 PM, the DON stated Resident #5 had been admitted to the hospital few months back and returned with a foley catheter. The DON stated Regional Manager had notified her of Resident #5's foley catheter missing on the care plan. The DON stated by not having accurate care plan could affect the ongoing monitoring of Foley catheter provided. The DON stated nursing administration were responsible of overseeing residents' medical records and did not have reason for Resident #5 not having foley catheter care plan. Record review of Care Plans, Comprehensive Person-Centered policy dated December 2016 revealed A comprehensive, person-centered care plan includes measurable objectives to meet the residents physical, psychosocial and functional needs is developed and implemented for each resident. The comprehensive, person-centered care plan will: describe the services that are to be furnished to attain or maintain the residents highest practicable physical, mental, and psychosocial well-being. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675522 If continuation sheet Page 4 of 6 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 675522 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Monahans 1200 W 15th St Monahans, TX 79756 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 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, record review the facility failed to ensure that a resident who is continent of bladder and bowel on admission receives services and assistance to maintain continence unless his or her clinical condition is or becomes such that continence is not possible to maintain for 1 of 5 (Resident #5) residents reviewed for urinary catheter. The facility failed to ensure Resident #5's urinary foley bag was placed below the bladder. The facility failed to have a physician order for Resident #5's foley catheter. This failure could place residents with urinary catheter at risk of infection. The findings included: Record review of Resident #5's face sheet undated revealed a [AGE] year-old female who was admitted on [DATE] and readmitted on [DATE]. Her diagnoses included urinary tract infection, paranoid schizophrenia, cognitive social or emotional deficit following cerebral infraction. Record review of Resident #5's MDS dated [DATE] revealed a BIMS score of 0, indicating she was severely cognitive impaired. Bladder and bowel section reflected Resident #5 had an indwelling catheter. Record review of Resident #5's electronic active physician orders dated July 2023 revealed no orders found for foley catheter placement. During an observation on 7/17/23 at 1:51 PM, Resident #5 was taken to nurses' station with the ADON, the Foley catheter was hanging on the right side of the wheelchair arm rest. Urine was noted in the Foley catheter bag and catheter tubing. Resident #5 was then taken to the common area by the window. During an observation and interview on 7/17/23 at 1:52 PM, the ADON stated she had not noticed Resident #5's foley catheter hanging on the right side of the wheelchair arm rest. The ADON walked over to Resident #5 and placed the foley catheter under the wheelchair. The ADON stated she noticed there was urine in the foley tubing and the urine was not flowing properly because it was not below the bladder. The ADON stated the nursing department was responsible of ensuring foley catheters were placed below the bladder. The ADON stated she does not recall the last training that was provided regarding foley catheter placement. The ADON stated that by not having foley catheter below the bladder could result in urinary tract infection. The ADON did not have an answer for Resident #5's foley catheter not positioned below the bladder. During an interview on 7/17/23 at 2:53 PM, the Administrator referred foley catheter questions to the nursing department. During an interview on 7/17/23 at 2:56 PM the Regional Nurse stated resident's foley catheter position was required to be below the bladder. The Regional Nurse stated the foley catheter should be hanging off the bed rail and when in wheelchair, under the wheelchair to ensure proper urine flow. The (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675522 If continuation sheet Page 5 of 6 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 675522 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Monahans 1200 W 15th St Monahans, TX 79756 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Regional Nurse stated foley care placed on arm rest in wheelchair was not appropriate due to not allowing the urine flow and could result in backflow of urine resulting in urinary tract infection. The Regional Nurse was not sure how often nursing department received training on foley catheter care. the Regional Nurse stated she had noticed this morning Resident #5 did not have a physician order to address her foley catheter during a full chart audit she was conducting. The Regional Nurse stated the admitting nurse should had been the person to include foley catheter input physician order. The Regional Nurse stated Resident #5's records were not accurate and could affect the ongoing monitoring of Foley catheter provided. The Regional Nurse did not have answer for Resident #5 not having a physician order for foley catheter. During an interview on 7/17/23 at 3:20 PM, the DON stated foley catheter was required to be placed below the bladder. The DON stated foley care placed on arm rest in wheelchair was not appropriate due to not allowing urine flow and could result in backflow of urine resulting in urinary tract infection. The DON stated the nursing department was responsible for ensuring foley catheters were properly placed. The DON was not sure how often nursing department received training on foley catheter care. During an attempted interview on 7/17/23 at 3:37 PM, Resident #5 did not want to talk. Record review of Catheter Care policy dated September 2014 revealed The purpose of this procedure is to prevent catheter-associated urinary tract infections. Maintaining unobstructed flow: the urinary drainage bag must be held or positioned lower than the bladder at all times to prevent the urine in the tubing and drainage bag from flowing back into the urinary bladder. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675522 If continuation sheet Page 6 of 6