Inspection·June 13, 2024

F 0727 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis. Based on interview and record review, the facility failed to use the services of a RN for at least 8 consecutive hours a day, 7 days a week for 16 days in Quarter 2 2024 reviewed for Licensed Nursing coverage from January 2024, February 2024 reviewed for nursing services. The facility did not have the required 8 consecutive hours of RN coverage during the month of January 2024 (11 days) and February 2024 (5 days). This failure could place residents at risk for not having their nursing care and medical needs met. Findings included: Review of PBJ [Payroll Based Journal] Staffing Data Report, with a run date of 06/06/2024 revealed Failed to have Licensed Nursing Coverage 24 Hours/Day was triggered for the fiscal year Quarter 2 2024 (January 1 - March 31). The infraction dates were 01/01 (MO); 01/02 (TU); 01/03 (WE); 01/04 (TH); 01/05 (FR); 01/08 (MO); 01/16 (TU); 01/17 (WE); 01/18 (TH); 01/24 (WE); 01/25 (TH); 02/02 (FR); 02/08 (TH); 02/16 (FR); 02/21 (WE); 02/22 (TH). Record review of the January 2024 schedule/time sheets indicated no 24-hour licensed nursing coverage for any of the dates. Record review of the February 2024 schedule/time sheets indicated no 24-hour licensed nursing coverage for any of the dates. In an interview on 6/12/24 at 4:12 pm, ADON stated that facility only had one RN employed full time and no DON during the Quarter 2. The ADON stated that on the days in question they had no RN coverage. In an interview on 6/12/24 at 4:30 pm, Regional Compliance Nurse stated that the facility only had 2 PRN RNs and agency RNs. Regional Compliance Nurse stated that she checked clock in logs and was unable to find any proof of RN coverage for any of the days in question. The Regional Compliance Nurse stated that she has been covering for the DON since October 2023. Stated she did not work any of the days in question. In an interview on 6/13/24 at 11:30 am, Administrator stated that the facility lost staff when the company changed to new owners. Administrator stated that they had no DON and were unsuccessful in getting RN coverage during that time. Stated she attempted to provide coverage with agency RNs and Regional Compliance Nurse but was unsuccessful. A new DON was hired and started that week. Review of undated facility policy titled Departmental Supervision, revised August 2006 revealed, in part: Policy Statement: The nursing services department shall be under the direct supervision of a Registered Nurse at all times. A Registered Nurse (RN) will be employed as the Director of Nursing (DON). The DON will be on duty (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675522 If continuation sheet Page 2 of 8 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 06/13/2024 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 0727 during the day shift Monday through Friday. During the absence of the DON, a Registered Nurse/ Nurse Supervisor will be responsible for supervision of all direct care staff. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675522 If continuation sheet Page 3 of 8 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 06/13/2024 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on observation, interview, and record review, the facility failed to provide pharmaceutical services, including procedures that ensure the accurate administering of all drugs to meet the needs of the residents, for 1 of 1 medication rooms inspected for medication storage. The facility failed to ensure the medication room did not have an expired vial of Tuberculin (TB) medication in the refrigerator. (TB formula is used to test people for tuberculosis). This failure could place residents at risk of receiving medications that were expired and not produce the desired effect. The findings were: During an observation on 06/12/24 at 09:29 AM, the medication room was inspected with CMA D present. Inside the refrigerator was a 1 ml vial of TB formula with an open date of 04/29/24. The TB formula box indicated Discard opened product after 30 days. CMA D said she did not administer TB tests, so she was not aware of the expired formula. During an interview on 06/12/24 at 09:39 AM, the DON said the TB formula was supposed to be dated when opened and discarded or returned to pharmacy when expired or after 30 days. The DON said whichever nurse used the TB formula was responsible to check the expiration date. The DON said she normally checked the medication room once a month, but she had just started working at the facility and today was her third day on the job. The DON said if the expired TB formula was used it could lead to inaccurate results. The DON said she believed the failure occurred because the nurses that had used the TB formula had not paid attention to the expiration date. The DON said she would dispose of the TB formula. During an interview on 06/13/24 at 02:52 PM, the Administrator said it was her expectation for nursing staff to dispose of medications once they were expired. The Administrator said it was all the nurses responsibility to monitor the medication room refrigerator for expired medications and remove them when expired. The Administrator said the failure occurred because the nurses did not notice the TB formula had expired. The Administrator said if the TB formula was used it could lead to an inaccurate test. Record review of the facility's policy titled Storage of medications and dated April 2007 indicated in part: The facility shall store all drugs and biologicals in a safe, secure and orderly manner. The facility shall not use discontinued, outdated or deteriorated drugs or biologicals. All such drugs shall be returned to the dispensing pharmacy or destroyed. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675522 If continuation sheet Page 4 of 8 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 06/13/2024 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, interview, and record review, the facility failed to store all drugs and biologicals in locked compartments and permit only authorized personnel to have access to the keys, for one (Treatment Cart) of 3 medication carts reviewed for drug storage. The facility failed to ensure the treatment cart was not left unlocked and unsupervised. This failure could place clients at risk for drug diversion or accidental ingestion. The findings included: During an observation on 06/11/24 at 09:38 AM, the treatment cart was seen unlocked and unattended. Inside the cart were several types of medications such as antifungal creams, triple antibiotic ointments, scissors, nail clippers and several other medicated bandages. During an interview on 06/11/24 at 10:15 AM, the DON was made aware of the observation of the unlocked treatment cart. The DON said the cart was supposed to be locked when unattended. The DON said if the cart was left opened some of the residents could get into the cart. The DON said she was not sure who left it open and proceeded to lock it. The DON said it was the nurses or med aides job to lock their cart when left unattended and that she and the ADON would did rounds and checked to see that the carts were locked if unattended. During an interview on 06/13/24 at 02:59 PM, the Administrator said it was her expectation for the medication or treatment carts to be locked when nursing staff were not using it or away from the carts. The Administrator said if the carts were left unlocked and unattended a resident or unauthorized staff could get access to the cart. The Administrator said the failure probably occurred because the nurse who was using the cart got sidetracked and walked away and did not notice the cart was left unlocked. The Administrator said the DON, ADON and she did walking rounds and would check to see that the carts were locked when unattended. Record review of the facility's policy titled Storage of medications and dated April 2007 indicated in part: The facility shall store all drugs and biologicals in a safe, secure and orderly manner. Compartments (including but not limited to drawers, cabinet rooms, refrigerators, carts and boxes) containing drugs and biologicals shall be locked when not in use, and trays or carts used to transport such items shall not be left unattended if open or otherwise potentially available to others. Record review of the facility's policy titled Medication storage and dated 01/2024 indicated in part: Medications and biologicals are stored properly, following manufacturer's or provider pharmacy recommendations to keep their integrity and to support safe effective drug administration. The medication supply shall be accessible only to licensed nursing personnel, pharmacy personnel or staff members lawfully authorized to administer medications. In order to limit access to prescription medications, only licensed nurses, pharmacy staff and those lawfully authorized to administer medications (such as medication aides) are allowed access to medication carts. Medication rooms, cabinets and medication supplies should remain locked when not in use or attended to by persons with authorized access. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675522 If continuation sheet Page 5 of 8 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 06/13/2024 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment to help prevent the development and transmission of communicable diseases and infections for 2 (Residents #4 and #17) of 12 residents reviewed for infection control. The facility failed to ensure: Residents Affected - Some The facility failed to ensure CNAs A and B washed or sanitized their hands prior to putting on gloves and change their gloves after they became contaminated during incontinent care while assisting Resident #4. The facility failed to ensure CNA C changed her gloves after they became contaminated during incontinent care while assisting Resident # 17 This failure could place resident's risk for cross contamination and the spread of infection. Finding include: RESIDENT #4 Record review of Resident #4's face sheet dated 06/11/2024 indicated she was admitted to the facility on [DATE] with diagnoses which included cognitive communication deficit, muscle wasting and atrophy. She was [AGE] years of age. Record review of Resident #4's MDS assessment dated [DATE] indicated in part: BIMS Summary Score = 12 indicating she had moderately impaired cognition. Bladder and Bowel: Urinary Continence =. 2. Frequently incontinent. Bowel Continence =. 2 Frequently incontinent. Record review of Resident #4's care plan dated 03/04/24 indicated in part: Problem: Resident is incontinent of bladder/bowel. Goal: resident will be maintained in a clean, dry state and prevent complication of incontinence by checking and changing resident at regular intervals x 90 days. Approach: ensure staff is aware of resident need for incontinent care. provide incontinent care as needed post each incontinent episode. During an observation on 06/11/24 at 11:21 AM, CNA A and CNA B performed incontinent care for Resident # 4. Both CNAs entered the resident's room and put some gloves on without first sanitizing or washing their hands. CNA B undid the resident's brief and wiped the resident's vaginal area with some wet wipes and there was some bowel movement noted on the wipe. While wearing the same gloves she used to wipe off the bowel movement, CNA B repositioned the resident by pulling her towards her so that CNA A could wipe the resident's bottom. CNA A then took some wet wipes and cleansed the bowel movement from the resident's rectal area. While wearing the same gloves both CNAs fastened the new brief to the resident then straightened her gown and bed sheets back on the resident. While still wearing the same gloves, CNA B placed the call light on Resident #4's bed, gave her the bed remote and adjusted the residents' pillow. During an interview on 06/11/24 at 03:24 PM, CNA A and CNA B said they had forgotten to wash their hands or use hand sanitizer prior to putting gloves on when providing incontinent care for Resident #4. Both CNAs said they should have changed their gloves once they became contaminated during the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675522 If continuation sheet Page 6 of 8 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 06/13/2024 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some incontinent care. Both CNAs said they should have changed their gloves when they went from dirty to clean to prevent cross contamination. Both CNAs said they should have changed their gloves prior to assisting Resident #4 with her gown, call light and bed remote as that could also lead to possible contamination. Both CNAs said the reason that occurred was because they got nervous and forgot to wash their hands or sanitize their hands and changed their gloves during the resident care. Both CNAs said they had received training on proper handwashing and glove use. RESIDENT #17 Record review of Resident #17's face sheet dated 06/13/2024 indicated she was a [AGE] year-old female. Resident #17 was admitted to the facility on [DATE] with diagnoses that included dementia, muscle wasting and atrophy. Record review of Resident #17's MDS dated [DATE] indicated in part: Resident #17's BIMS Summary Score was 03. Under the section for Bladder and Bowel showed for urinary Continence that indicated the resident was Frequently incontinent. For Bowel Continence was Always incontinent. Record review of Resident #17's care plan dated 06/12/24 indicated in part: Problem: Resident is incontinent of bladder/bowel. Goal: resident will be maintained in a clean, dry state and prevent complication of incontinence by checking and changing resident at regular intervals x 90 days. Approach: ensure staff is aware of resident need for incontinent care. provide incontinent care as needed post each incontinent episode. During an observation on 06/12/24 at 04:10 PM, CNA C performed incontinent care for Resident #17. CNA C unlatched Resident #17's brief tucking the brief under resident. CNA C wiped the resident's vaginal area with wet wipes. CNA C turned the resident to her side then wiped the resident's bottom using wet wipes. CNA C removed resident's soiled brief and placed in trash. Without changing gloves CNA C placed a clean brief under the resident. CNA C rolled resident to her back and adjusted and fastened brief. CNA C, without changing gloves, pulled residents pants up, adjusted resident's shirt, placed resident's shoes on resident's feet and adjusted resident's blanket on the bed. During an interview with CNA C on 06/12/23 at 04:40 pm, CNA C stated she would not have done anything differently. CNA C stated she only changed gloves if they are visibly soiled. Surveyor informed CNA C that after touching the soiled brief, the gloves then are considered contaminated and should be changed. CNA C stateds she could see how that is an infection control issue and had not thought of it that was before. CNA C stateds she will follow the facilities policy on hand hygiene and glove changing. Record review of the facility's policy titled Diarrhea and fecal incontinence and dated October 2010 indicated in part: The purpose of this procedure is to provide guidelines that will aid in preventing the resident's exposure to feces. The following equipment and supplies will be necessary when performing this procedure. Place the clean equipment on the bedside stand or overbed table. Arrange the supplies so they can be easily reached. Wash and dry your hands thoroughly. Put on gloves. Remove soiled items. Replace with clean dry briefs or under pad as indicated. Discard disposable equipment and supplies in designated containers. Remove gloves and discard into designated container. Wash and dry your hands thoroughly. Record review of the facility's policy titled Handwashing/hand hygiene and dated April 2012 indicated in part: This facility considers hand hygiene the primary means to prevent the spread of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675522 If continuation sheet Page 7 of 8 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 06/13/2024 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some infections. All personnel shall follow the handwashing/hand hygiene procedures to help prevent the spread of infections to other personnel, residents and visitors. Employees must wash their hands for at lead fifteen (15) seconds using antimicrobial or non-antimicrobial soap and water under the following conditions: Before and after direct resident contact - Before and after assisting a resident with personal care - upon and after coming in contact with a resident's intact skin - after removing gloves or aprons. Hand hygiene is always the final step after removing and disposing of personal protective equipment. The use of gloves does not replace handwashing/hand hygiene. Record review of the facility's policy titled Infection prevention and control program and dated 05/11/2023 indicated in part: This facility has established and maintains an infection prevention and control program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of communicable diseases and infections as per accepted national standards and guidelines. All staff shall assume that all residents are potentially infected or colonized with an organism that could be transmitted during the course of providing resident care services. Hand hygiene shall be performed in accordance with out facility's established hand hygiene procedures. All staff shall use personal protective equipment (PPE) according to established facility policy governing the use of PPE. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675522 If continuation sheet Page 8 of 8