Inspection·July 29, 2025

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some day, dated 4/1/25. Review of Resident #6's care plan revealed:No care plan for Resident #6's ADL's including eating, dressing, bathing, hygiene, and bed mobility.No care plan for the use of anti-depressants.No care plan for the use of opioid medication.No care plan for hospice services. 3. Review of Resident #33's admission Record, dated 7/29/25, revealed she was a [AGE] year-old female admitted to the facility on [DATE] with diagnosis including aftercare for surgery. Review of Resident #33's Initial MDS Assessment, dated 4/23/25, revealedShe scored a 12 of 15 on her Brief Interview for Mental Status (indicating she was moderately cognitively impaired).She had constipation.She took an anti-depressant and a diuretic. Review of Resident #33's Order Summary, dated 7/29/25, revealed orders:Docusate Sodium 100 mg twice a day dated 4/17/25.Trazadone 50 mg for insomnia at bedtime dated 4/17/25. Review of Resident #33's care plan, dated 5/14/25 revealed:Focus: Resident #33 enjoys the following solitary activities: word search, coloring, talking. The identified goal was Resident #33 would be provided opportunities to enjoy solitary activities of choice. There were no interventions identified.There was no care plan for the Docusate Sodium 100 mg.There was no care plan for the Trazadone 50 mg or insomnia. Interview on 07/28/2025 at 3:32 PM the Business Office Manager said the Social Worker was responsible for care plans. Interview on 07/28/2025 3:32 PM the MDS Coordinator stated the transition from the previous electronic documentation program to the current documentation occurred in March 2025. The MDS Coordinator stated she did not do a care plan in the current documentation program because the RN or DON had to approve or open the care plan. The MDS Coordinator stated the Corporate RN went over care plans. The MDS Coordinator said there were a lot of care plans that were not updated or not in the current electronic program. The MDS Coordinator stated the old care plans were printed and at the nurse's station. The MDS Coordinator said she did not know why it took over 4 months long to get the care plans transferred into the new program. The MDS Coordinator stated the DON did immediate care plans with antibiotics or behaviors. Interview on 07/28/2025 at 3:47 PM the DON said there was an issue with care plans because the care plans were not entered into the current electronic documentation program. The DON stated they talked to the MDS Coordinator to get them updated and into the system. The DON said the Corporate RN stepped down but offered to help the MDS Coordinator because she was responsible for MDS assessments in two buildings so the facility could catch up. The DON agreed it took over three months get the care plans into the electronic documentation system. The DON said she did some of the care plans to help get them updated. The DON said she in-serviced the nurses on getting care plans updated once it was opened. The DON stated the facility did have interdisciplinary care plan meetings with the Social Services Designee, the Activity Director, and Dietary were responsible for putting in their own care plans. The DON stated she did an audit on resident records two weeks ago and the care plans did not appear complete. The DON stated she identified issues with dietary orders, code status, resident preferences, and interventions for falls and wound care. The DON said there were a lot of issues that were not care planned and the facility needed to follow up. The DON said she did not have an answer for why emergent issues were not care planned. Interview on 7/29/25 at 1:52 PM the Administrator and DON stated there were care issues not care planned. The Administrator said the MDS Coordinator was supposed to be helping enter in the care plans. The Administrator said she never did a chart audit because she was never trained on how to do one, but she knew how to access the information. The surveyor asked for the policy on care plans and a policy was not provided. Interview on 07/29/2025 at 4:19 PM the Social Service Designee stated his responsibility for care plans was to hold the care plan meetings. He stated he mainly did code status care plans. The Social Service Designee stated the RN could open the care plan and he would enter in his part. The Social Service Designee stated he did not know why he was getting blamed for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675522 If continuation sheet Page 2 of 10 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 07/29/2025 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 incomplete or not entered care plans. 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 10 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 07/29/2025 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure adequate supervision and assistance devices was provided for 2 of 3 residents reviewed for transfers (Resident #26 and #52).The facility failed to ensure staff locked the breaks of the mechanical lift (device used to assist in lifting a resident) during transfer for Resident #26.The facility failed to ensure staff completed gait belt transfer correctly for Resident #52. This deficient practice has the potential to affect residents in the building who required extensive assistance with proper transfers. The findings included: Resident #26Review of Resident #26's Quarterly MDS assessment dated [DATE] revealed Resident #26 was a [AGE] year-old female originally admitted to the facility on [DATE] with diagnoses including arthritis, osteoporosis (bone thinning due to loss of calcium) without fracture, and contractures.Resident #26's Brief Mental Status was scored at 13 of 15 (indicating she was cognitively intact).Resident #26 had range of motion impairment on both sides of her lower extremities.Resident #26 was totally dependent on staff for transfers.Observation at [DATE] at 10:13 AM revealed CNA A and CNA H entered the room and donned(put on) gloves. The aides put the sling(material used to hold resident) under Resident #26, then hooked the sling to the electrical mechanical lift. CNA A told CNA H to make sure the sling was positioned high enough on Resident #26's head. CNA A operated the lift while CNA H steadied the resident. CNA A did not lock the lift while raising or lowering Resident #26. While lowering the Resident #26, the lift was noted to rock back and forth not allowing Resident #26 to be positioned in her wheelchair correctly. Interview on [DATE] at 1:27 p.m. the DOR stated the mechanical lift should be locked when moving a resident up and down because the weight was unsteady and it could cause the lift to roll away. The DOR said if the lift moved away while the resident was still up in air they could not be controlled during the lowering of the resident. The DOR stated especially the electrical lifts needed to be locked. The DOR stated they had not done any checkoffs regarding resident Hoyer lift transfers for the nursing staff. Resident #52Review of Resident #52's admission Record, dated [DATE], revealed she was an [AGE] year-old female admitted to the facility on [DATE] with diagnoses including unspecified dementia. Resident #52's admission care plan, dated [DATE], did not have transfer status checked. Resident #52 did not have an admission MDS as she was still in her assessment period. Observation on [DATE] at 3:11 PM revealed CNA I and CNA A putting a gait belt on Resident #52 loosely. CNA A locked both sides of the wheelchair. Both aides were observed hooking their arms under Resident #52. CNA I grabbed the gait belt that slid up Resident #52's torso. CNA A grabbed the back of Resident #52's pants. Interview on [DATE] at 3:19 PM CNA A said Resident #52 could be spicy and she (CNA A) got bit by Resident #52 on [DATE]. CNA A said she grabbed the back of Resident #52's pants because she felt like the like the belt was slipping. Interview on [DATE] at 1:27 p.m. PTA J stated a two-person gait belt transfer should be completed by putting the gait belt on the resident and one staff stand on each side of the resident. PTA J stated at the count of three both aides should lift the resident by the front and back of the gait belt. PTA J said in her opinion it was not ok to hold a resident by the back of their pants. The Director of Rehab who was present stated it was not acceptable to hook their arms under a resident. The DOR stated grabbing the back of the pants was not comfortable for the resident and there was no point if the gait belt was present. PTA J stated the last time the therapy department in-serviced the facility on transfers was 1.5 years ago. Interview on [DATE] at 1:52 the Administrator and DON were informed of the transfers. The DON stated a two-person transfer was supposed to look like the aides putting on the gait belt at the waist or right above the hips tight enough to slide two fingers under the belt. The DON stated the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675522 If continuation sheet Page 4 of 10 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 07/29/2025 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete aides were supposed to grab the gait belt on each side and help the resident stand up on the count of three. The DON stated hooking under the arms was not ok because the arms were more prone to fractures. The DON said if the resident had weight bearing issues the resident should be a mechanical lift. The Administrator stated picking up a resident by the waist of the pants would not be comfortable. The DON said she did not have a chance to do checkoffs for transfers because she had only been in the facility three months. The DON stated the expectation for the mechanical lift was for the aide controlling the lift to lock the lift when the resident was going up or down. The DON said if the lift was not locked the staff could lose control of the resident. The DON stated if the resident was being placed in the wheelchair, the lift unlocked could cause the resident to not be aligned properly. The Administrator and DON stated they understood the issue with transfers. Review of the Facility's policy and procedure for Safe Lifting and Movement of Residents, revised 7/2017, revealed: In order to protect the safety and well being of staff and residents, and to promote quality care, this facility uses appropriate techniques and devices to lift and move residents. Resident safety, dignity, comfort and medical condition will be incorporated into goals and decisions regarding the safe lifting and moving of residents. Nursing staff, in conjunction with the rehabilitation staff, shall assess individual residents' needs for transfer assistance on an ongoing basis. Staff will document resident transferring and lifting needed in the care plans. Such assistance shall include: Resident's mobility (degree of dependency); weight bearing status; cognitive status; whether the resident is usually cooperative with staff; and the resident's goals for rehabilitation, including restorative or maintaining functional abilities. Staff responsible for direct resident care will be trained in the use of manual (gait/transfer belts, lateral boards) and mechanical lifting devices. Mechanical lifting devices shall be used for heavy lifting, including lifting and moving residents when necessary. Review of the facility's policy and procedure on Using a Mechanical Lifting Machine, dated 7/2017, revealed: The purpose of this procedure is to establish the general principles of safe lifting using a mechanical lifting device. It is not a substitute for the manufacture's training or instructions. Mechanical lifts may be used for tasks that require: Transferring a resident from bed to chair. Lift design and operation vary across manufacturers. Staff must be trained and demonstrate competency using the specific machines or devices utilized in the facility. Make sure the lift is stable and locked. Event ID: Facility ID: 675522 If continuation sheet Page 5 of 10 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 07/29/2025 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 - Some FORM CMS-2567 (02/99) Previous Versions Obsolete 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure drugs and biologicals used in the facility were labeled with currently accepted professional principles, and included the appropriate accessory and cautionary instructions, and the expiration date when applicable for and 1 of 3 medication carts (Hall 100 and 200 nurse medication cart) and 1 out of 1 med room reviewed for medication storage. The facility failed to ensure the nurses cart #1 for 100 and 200 halls did not contain insulin, that were opened and not labeled with the open date. The medication room had an open vial of tuberculosis (a bacterial infection that affects the lungs and can spread to other organs) solution that was not labeled with an open date. Findings included:Observation on 07/28/25 at 4:30 PM revealed the nurse's medication cart #1 for 100 and 200 halls had the following opened medications with no open date labeled:1. Humalog insulin vials (Insulin is an essential hormone that helps the body turn food into energy and manage the blood sugar levels)2. Novolog insulin Kwik pensObservation on 7/29/2025 at 10:30 AM revealed the refrigerator in Medication room [ROOM NUMBER] had the following opened medications with no open date labeled:1. Aplisol Tuberculin solutionInterview on 07/28/25 at 4:31 PM with LVN D, she said once insulin, and tuberculosis solution were opened they needed to be dated with open dates. She said it was the responsibility for all nurses to check carts for labelling and dating every shift, but she did not check the whole cart that morning. She stated insulins and tuberculosis solutions were good for 28 days. She stated the risk of not having an open date was they would not be able to know when they expire, and they will not be effective. Interview on 07/29/25 at 12:36 PM the DON said insulin, and tuberculosis solution when opened should be dated. She stated it was the responsibility of nursing management to check and audit the carts after the nurses. The DON said the nurses were responsible for dating the medication when opened. She stated insulin and tuberculosis solution was good for 28 days and should be dated once the box or pen was opened. Interview on 07/29/25 at 3:02 PM the Administrator said the expectations were for nursing staff to date any medications with an open date after they were put into use. The Administrator said that was supposed to be done so that the staff would know when to discard the medication. Record review of the Recommended Medication Storage policy, dated 2/2023, reflected the following:Multi-dose vials that have been opened or accessed (e.g., needle punctured) are dated and discarded within 28 days unless the manufacturer specifies a shorter or longer date for the open vial. Event ID: Facility ID: 675522 If continuation sheet Page 6 of 10 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 07/29/2025 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety in 1 of 1 kitchen reviewed for kitchen sanitation and food storage. The facility failed to ensure foods were properly stored, labeled and dated.The facility failed to dispose of spoiled food items properly.The facility failed to prevent possible cross contamination.The facility failed to ensure dietary staff used hair restraints properly. These failures could place residents at risk for food borne illnesses.Findings included:Observation on 7/27/2025 at approximately 9:42 AM revealed [NAME] E touching the lid of a trash can to place paper towels in it after washing hands.Observation on 7/27/2025 at approximately 9:45 AM revealed a box with 5 bags of corn tortillas received 8/13/2024 did not have a use by date (UBD). The tortillas at the bottom of each bag were hard. Observation on 7/27/2025 at approximately 9:45 AM revealed 2 bags of crispy rice cereal removed from the original packaging, without a UBD.Observation on 7/27/2025 at approximately 9:45 AM revealed breadcrumbs in a sealed bin received 12/17/24, without a UBD.Observation on 7/27/2025 at approximately 9:55 AM revealed a bin of apples and oranges. Three of the oranges had fuzzy, green and white growth on them. Observation on 7/28/2025 at approximately 11:56 AM revealed the spoiled oranges were no longer in the bin.Observation on 7/28/2025 at approximately 11:59 AM revealed [NAME] E and Dietary Aide (DA) F were not wearing hair restraints correctly. Their hair was not restrained above the ears, at the nape of neck, and forehead. Observation on 7/28/2025 at approximately 12:15 PM revealed [NAME] E touched the food surface area of 3 serving utensils when she reached up to retrieve the utensils from an open-air hanging rack. Observation on 7/28/2025 at approximately 12:17 PM revealed [NAME] E touched the corn bread with a bare finger when dishing it from the pan to the first 6 plates.Observation on 7/28/2025 at approximately 12:17 PM - 12:43 PM revealed [NAME] E touched the rim and the food surface of plates with her bare hands while dishing food items.Observation on 7/28/2025 at approximately 12:43 PM revealed [NAME] E picked up a divided plate, used her thumb nail to flick something off the food surface of the plate then placed food items on the plate. During an interview on 7/29/2025 at 3:40 PM [NAME] E said she would not have used the corn tortillas. She said she used the bread/buns unless molded. Said she is not sure who should remove old products from dry storage. [NAME] E said the bags of cereal did not have a UBD because they were removed from the original box. [NAME] E said the staff did not use the step-open trash can at the hand sink because they never knew if it would have a bag in it. [NAME] E said they use the big rolling one next to it and must touch the lid to open it. [NAME] E said she was aware that hair nets must cover all hair. Said only one size is available at the facility. [NAME] E said she knows she is not supposed to touch the food surface of utensils, plates, or food with bare hands. [NAME] E said the divided plate she flicked something off was the last clean one. [NAME] E said she thinks it was something from the dishwasher. [NAME] E said she was not aware of touching the food surface of the plates while dishing food onto them. [NAME] E said all those things can cause residents to get sick. During an interview on 7/29/2025 at 4:10 PM the Administrator said the dietary staff knew all the rules/requirements. The Administrator said if the DM had been here, she feels like none of the findings would have been present. The Administrator said all dry storage items should have a received date and a UBD. The Administrator said the corn tortillas should not still be in the dry storage. Record review of the facility policy Food Receiving and Storage revised November 2022 revealed in part:- Dry foods and goods are handled and stored in a manner that maintains the integrity of the packaging until they are ready to use.- Dry foods that are stored in bins are removed from original packaging, labeled and dated (use by (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675522 If continuation sheet Page 7 of 10 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 07/29/2025 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete date). Such foods are rotated using a first in-first out system.Record review of the facility policy Food Preparation and Service revised November 2022 revealed in part:- Cross-contamination can occur when harmful substances. i.e., chemical or disease-causing microorganisms are transferred to food by hands (including gloved hands), food contact surfaces, sponges, cloth towels, or utensils that are not adequately cleaned. Cross-contamination can also occur when raw food touches or drips onto cooked or ready-to-eat foods.- Food preparation staff adhere to proper hygiene and sanitary practices to prevent the spread of foodborne illness.- Food and nutrition services staff, including nursing services personnel, wash their hands before serving food to residents. Employees also wash their hands after collecting soiled plates and food waste prior to handling food trays.- Bare hand contact with food is prohibited. Gloves are worn when handling food directly and changed between tasks.- Food and nutrition services staff wear hair restraints (hair net, hat, beard restraint, etc.) so that hair does not contact food.Record review of the Food Code, U.S. Public Health Service, U.S. FDA, 2022, U.S. Department of H&HS, revealed, 3-501.17 Ready-to-Eat/Time Temperature Control for Safety Food, Date Marking. (B) Except as specified in (E) - (G) of this section, refrigerated, ready-to-eat, time/temperature control for safety food prepared and packaged by a food processing plant shall be clearly marked, at the time the original container is opened in a food establishment and if the food is held for more than 24 hours, to indicate the date or day by which the food shall be consumed on the premises, sold, or discarded, based on the temperature and time combinations specified in (A) of this section and: (1) The day the original container is opened in the food establishment shall be counted as Day 1; and (2) The day or date marked by the food establishment may not exceed a manufacturer's use-by date if the manufacturer determined the use-by date based on food safety. Review of the Food Code, U.S. Public Health Service, U.S. FDA, 2022, U.S. Department of H&HS, revealed, 2-402 Hair Restraints, 2-402.11, Effectiveness., (A) Except as provided in paragraph (B) of this section, FOOD EMPLOYEES shall wear hair restraints such as hats, hair coverings or nets, beard restraints, and clothing that covers body hair, that are designed and worn to effectively keep their hair from contacting exposed FOOD; clean EQUIPMENT, UTENSILS, and LINENS; and unwrapped SINGLE-SERVICE and SINGLE-USE ARTICLES. Event ID: Facility ID: 675522 If continuation sheet Page 8 of 10 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 07/29/2025 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 help prevent the development and transmission of communicable diseases and infections for 1 of 5 staff (Medication Aide C) reviewed for infection control in that: -Medication Aide C did not sanitize or wash her hands before handling medication or in between administering medications to different residents. This failure could place residents at risk for infectious diseases. Findings Included: During an observation on 07/28/25 at 12:06 PM revealed Medication Aide C came out of a resident's room and proceeded to pour more medications without washing or sanitizing hands. Medication Aide C continued to not sanitize her hands in between the 12 residents she administered the med pass. During an interview on 07/28/25 at 12:07 PM, with Medication Aide C, she said she knew she was forgetting something. Medication Aide C said the facility policy and procedure was that all staff were required to conduct hand hygiene prior to handling and administering medication. During an observation on 07/28/25 at 12:15 PM revealed Medication Aide C administered medication to Resident #37, then prepared Resident #20's medications with no hand hygiene. Medication Aide C gave Resident #20's medications, left the room with no hand hygiene. Medication Aide C prepared Resident #46's medications with no hand hygiene, administered medications and left room with no hand hygiene. During an interview on 07/28/25 at 12:30 PM, the DON said based on the facility policy and procedure for infection control/hand hygiene, medication aides were required to conduct hand hygiene prior to handling medication, and she would expect medication aides to either wash their hands with soap and water before leaving a resident's room or use the hand sanitizer in the hallway. During an interview on 07/29/25 at 3:04 PM the Administrator said the expectations were for nursing staff to wash or sanitize their hands in between resident medication administration to prevent the spread of infections. Record review of the facility policy on Hand Hygiene revised October 2023, [NAME] Handwashing/Hand Hygiene reflected All Personnel shall follow the handwashing/Hand hygiene procedures to help prevent the spread of infection to other personnel, residents and visitors .Before preparing or Handling Medications .Perform hand hygiene before applying non-sterile gloves. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675522 If continuation sheet Page 9 of 10 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 07/29/2025 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 0908 Keep all essential equipment working safely. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and record review the facility failed to maintain all mechanical, electrical, and patient care equipment in safe operating condition for 1 of 1 kitchen reviewed for physical environment. The facility failed to ensure the refrigerator door adequately closed and sealed in the kitchen on 07/27/2025. This failure could place residents at risk of foodborne illnesses and potential for injury to residents and staff. Findings included:During an observation and interview on 07/27/2025 at 9:42 AM, 1 of 3 refrigerators observed in the kitchen revealed the door did not latch or seal. The refrigerator door stayed slightly open. [NAME] G said the door must be lifted and closed at the same time. [NAME] G demonstrated closing the door. [NAME] G said dietary staff were aware of the broken door and how to close it. During an interview with [NAME] E on 07/29/2025 at 3:40 PM, [NAME] E said the refrigerator door had been broken more than one year. [NAME] E said she thought the Dietary Manager (DM) reported it to the Administrator. [NAME] E said if the refrigerator was not sealed correctly the residents could get sick. During an interview on 07/29/2025 at 4:10 PM, the Administrator was made aware of the broken refrigerator door. The Administrator said the broken door was not reported to her by staff.Review of facility policy Sanitization, revised November 2022, revealed: All utensils, counters, shelves and equipment are kept cleaned, maintained in good repair and are free from breaks, corrosions, open seams, cracks and chipped areas that may affect their use or proper cleaning. Seals, hinges and fasteners are kept in good repair Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675522 If continuation sheet Page 10 of 10