Health inspection·January 17, 2025

F 0676 Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. 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 provide, based on the comprehensive assessment of a resident and consistent with the resident's needs and choices, the necessary care and services to ensure that a resident's abilities in activities of daily living do not diminish unless circumstances of the individual's clinical condition demonstrate that such diminution was unavoidable for 3 of 8 resident (Residents #1, #2, and #3) reviewed for activities of daily living. Residents Affected - Some The facility failed to ensure Residents #1, #2, and #3 were provided care and services for hygiene. This failure could place residents at risk for poor self-esteem, infections, socialization, ADL decline and diminished quality of life. Findings included: Record review of Resident #1's face sheet dated 01/17/2025, revealed Resident #1 was a [AGE] year-old female admitted to the facility on [DATE]. Resident #1 was diagnosed with Encephalopathy, unspecified (a brain disorder that affects brain function or structure, but the cause is unknown), Aphasia (a language disorder that makes it difficult to understand or express language), Senile Degeneration of brain, not elsewhere classified (brain shrinkage that's not due to Alzheimer's disease or other specific conditions), need for assistance with Personal Care (when someone needs help with daily tasks and hygiene), Abnormalities of Gait and Mobility (unusual walking patterns that can be caused by injuries, medical conditions, or aging), unspecified Dementia, unspecified severity, with other Behavioral Disturbance (a diagnosis where a person is exhibiting symptoms of dementia, but the specific type of dementia cannot be determined, and the severity of the cognitive decline is also unclear, while also showing notable behavioral disturbances that aren't categorized as typical for a specific dementia type), Unsteadiness on feet (lack of balance or instability while standing or walking, often characterized by a feeling of swaying or potential to fall). Record review of Resident #1's quarterly MDS, dated [DATE] revealed; Resident #1 had a BIMS score of 07, which indicated severe impairment. Record review of Resident #1's care plan dated 10/08/24, revealed focus Resident #1 Problem Category: ADL functional Status/Rehabilitation Potential: Resident has self-care deficits d/t Impaired memories, disorientation to time, impaired mobility, and weakness. Long Term Target: Care needs will be met daily, and PRN and resident will maintain optimal level of functioning for care participation. Approach: Bathing/Hygiene amount of assist: 1. Resident prefer to take her showers on Tuesdays, Page 1 of 6 675587 675587 01/17/2025 Avir at Adams 3011 W Adams Ave Temple, TX 76504

F 0676 Thursdays, and Saturdays between 6 am to PM. The staff who provide showers will document skin issues. Level of Harm - Minimal harm or potential for actual harm Record review of Resident #1's shower sheet dated 1/1/2025 to 1/17/2025 reflected: 01/01/2025 @ 2:42pm Dependent; 2:43pm Not Applicable Residents Affected - Some 01/02/2025 @ 11:49 am Dependent 01/03/2025 @ 11:02 am Substantial/maximal assistance 01/04/2025 @ 10:46 am Dependent 01/05/2025 @ 4:09pm Not Applicable 01/06/2025 @ 10:13 am Dependent 01/07/2025 @ 10:53 am Supervision or touching assistance. 01/08/2025 @ 11:06 am Not applicable 01/09/2025 @ 8:43 am Dependent 01/11/2025 @ 2:38 am Dependent; 2:52pm Dependent 01/12/2025 @ 2:24pm Dependent 01/14/2025 @ 4:26 am Substantial/maximal assistance; 3:24pm Setup or clean-up assistance 01/15/2025 @ 1:35pm Not applicable 01/16/2025 @ 4:44pm Dependent Record review of Resident #2's face sheet dated 01/17/2025, revealed Resident#2 was a [AGE] year-old female admitted to the facility on [DATE]. Resident #2 was diagnosed with Personal history of Brain Injury (record of a previous traumatic brain injury), Unspecified Intracranial injury with loss of Consciousness or Unspecified duration, subsequent encounter (a patient is being seen for follow-up care after experiencing a head injury where the exact location and severity of the brain damage is unknown, but it is confirmed that they did lose consciousness for a period of time that cannot be precisely determined), Other Abnormalities of Gait and Mobility (deviations from normal walking patterns), Quadriplegia, unspecified (a medical condition that causes partial or total paralysis of all four limbs and the torso), Need for assistance with Personal Care (when someone needs help with daily tasks and hygiene). Record review of Resident #2's quarterly MDS, dated [DATE] revealed; Resident #2 had a BIMS score of 13, which indicated cognitively intact. Record review of Resident #2's care plan dated 11/21/24, revealed no documentation of Resident #2 ADL functional Status problem, goal, or approach. However, a shower sheet dated 01/07/2025 was 675587 Page 2 of 6 675587 01/17/2025 Avir at Adams 3011 W Adams Ave Temple, TX 76504

F 0676 Level of Harm - Minimal harm or potential for actual harm provided by the facility regarding Resident #2. The sheet revealed Resident #2 only wants showers on Tuesdays and Saturdays and on 01/07/2025 she was asked twice regarding taking a shower, but she refused. Record review of Resident#2's shower sheet dated 1/1/2025 to 1/17/2025 reflected: Residents Affected - Some 01/01/2025 @9:48pm Supervision or touching assistance. 01/02/2025 @ 11:00 am Dependent 01/03/2025 @1:38pm Partial/moderate assistance. 01/04/2025 @8:24 am Partial/moderate assistance. 01/05/2025 @8:26 am Setup or clean-up assistance 01/06/2025 @ 11:01 am Dependent 01/07/2025 @9:37 am Supervision or touching assistance; 4:07pm Resident Refused 01/08/2025 @ Substantial/maximal assistance 01/09/2025 @6:34 am Setup or clean-up assistance 01/10/2025 @11:43 am Supervision or touching assistance. 01/11/2025 @2:13pm Dependent 01/12/2025 @ 2:13pm Supervision or touching assistance. 01/13/2025 @10:14 am Resident Refused 01/14/2025 @2:33pm Resident Refused 01/15/2025 @ 10:59 am Dependent 01/16/2025 @ 8:52 am Dependent Record review of Resident #3's face sheet dated 01/17/2025, revealed Resident #3 was a [AGE] year-old male admitted to the facility on [DATE]. Resident #3was diagnosed with Spastic Hemiplegia affecting the right dominant side (neurological condition where the muscles on the right side of the body, which is considered the dominant side for most people, experience constant muscle stiffness and contraction, leading to impaired movement and difficulty controlling the affected limbs due to damage to the left side of the brain), Hemiplegia and Hemiparesis following nontraumatic intracerebral hemorrhage affecting right dominant side (condition where a person experiences either complete paralysis (hemiplegia) or partial weakness (hemiparesis) on the left side of their body due to a stroke caused by bleeding within the brain (intracerebral hemorrhage) on the right side), Difficulty in Walking not elsewhere classified (walking difficulties that can't be more specifically categorized), Other Abnormalities of Gait and Mobility (deviations from normal walking patterns), Need for assistance with 675587 Page 3 of 6 675587 01/17/2025 Avir at Adams 3011 W Adams Ave Temple, TX 76504

F 0676 Personal Care (when someone needs help with daily tasks and hygiene). Level of Harm - Minimal harm or potential for actual harm Record review of Resident #3's quarterly MDS, dated [DATE] revealed; Resident #3 had a BIMS score of 05, which indicated severe impairment. Residents Affected - Some Record review of Resident #3's care plan dated 12/09/24, revealed focus Resident #3 Problem Category and Start: ADL functional Status/Rehabilitation Potential: Resident has self-care deficits d/t Impaired memories, disorientation to time, impaired mobility, and weakness. Long Term Target: Care needs will be met daily, and PRN and resident will maintain optimal level of functioning for care participation. Approach: Bathing/Hygiene amount of assist: 1. Resident prefer to take her showers on Tuesdays, Thursdays, and Saturdays between 6 am to PM. Record review of Resident #3's shower sheet dated 1/1/2025 to 1/17/2025 reflected: 01/01/2025 @ 2:29pm Dependent 01/02/2025 @11:05 am Dependent 01/03/2025 @9:44 am Substantial/maximal assistance 01/04/2025 @9:00 am Dependent 01/05/2025 @3:57pm Not applicable 01/06/2025 @11:48 am Partial/moderate assistance 01/07/2025 @11:42 am Dependent 01/08/2025 @4:31pm Dependent 01/09/2025 @ 8:34 am Substantial/Maximal assistance 01/11/2025 @1;59 am Partial/moderate assistance; 2:38pm Dependent; 2:38pm Resident Refused. 01/12/2025 @1:36pm Dependent 01/13/2025 @7:34pm Not applicable 01/14/2025 @3:00pm Setup or Clean-up assistance 01/15/2025 @12:53pm Not applicable 01/16/2025 @ 9:40 am Dependent 01/17/2025 @8:15 am Setup or clean -up assistance Record Review of the facility's electronic health record did not reflect any documentation of ADL showers for residents. The DON provided a shower log for Residents #1, #2, and #3. The DON stated it was in their EHR, but access was not provided to the surveyor when upper management granted access. 675587 Page 4 of 6 675587 01/17/2025 Avir at Adams 3011 W Adams Ave Temple, TX 76504

F 0676 The shower log for the 3 residents did not reveal a clear understanding if the residents had showers or not. Level of Harm - Minimal harm or potential for actual harm During an observation and attempted interview with Resident #1, it was determined she was not interviewable. Residents Affected - Some During an interview of Resident #2 on 01/17/2025 at 10:09 am, she stated they don't help her shower her or wash her hair, and there are times that she does not get a shower at all. Resident #2 stated that her shower days was Tuesdays and Saturdays. Her last shower was Saturday 01/11/2025. She said that she didn't want a shower Tuesday 01/14/2025. She stated that she had been in the same cloths for three days. During an interview with Resident #3 on 01/17/2025 at 10:26 am, he refused to talk but when asked if he was receiving his showers regularly, he shook his head no. During an interview on 01/17/2025 at 3:10pm with CNA A, she stated she gave Resident #1 a shower on Wednesday 01/15/2025. She stated that day she came in to just helped with giving showers. She stated she advised a nurse to document the shower was given, but it was not done. Resident #1's shower sheet reflected not applicable on that date as Resident #1 shower days were Tuesday, Thursdays, and Saturdays. When given the shower sheet log and asked to explain if the resident had a shower or not, she was only able to acknowledge if the resident refused to take a shower or not applicable which could have meant that may not have been the resident shower day. During an interview on 01/17/2025 at 2:30pm with CNA B, he stated showers are given everyday except Sundays. He stated the even numbers of A bed showers are given on Mondays, Wednesday, and Friday mornings; even number B bed showers are given Tuesdays, Thursday, and Saturday mornings. Then odd numbers of B beds are given showers on Mondays, Wednesday, and Friday evening; odd number beds are given showers on Tuesday, Thursday, and Saturday evenings. He stated if the resident refused, they are to get the nurse and the scheduler involved to speak to the resident to regarding taking a shower. He stated he documented in their EHR and on the shower log. When given the shower sheet log and asked to explain if the resident had a shower or not, he stated he was not sure as to what all that meant but he was able to read and understand the resident refused to take a shower or not applicable meaning it was not the resident's day to shower. During an interview on 01/17/2025 at 2:10pm with CNA C, she stated sometimes the resident refused. She stated she works the day and night shift. She stated the next day residents will say no one gave them a shower but they will have refused. She stated she goes back and asked the resident 2 more times and then she will tell the nurse they refused and document it on the shower sheet and the EHR. When given the shower sheet log and asked to explain if the resident had a shower or not, she smirked and stated she did not understand it. CNA C attempted to explain it, but she stated she was not sure what it was. She read if a resident refused to take a shower but not applicable, she was confused. She stated if it was not a shower day, she would not document anything. During an interview on 01/17/2025 at 12:20pm with DON, she stated Resident #2 signed a shower sheet stating she only wanted showers twice a week, Tuesdays and Saturdays. DON stated that sometimes Resident #2 refused her showers, there are times that Resident #2 will help bathe herself and other times she needed assistance. The DON stated she provided a shower sheet log and all the dates had documentation by them. The DON was asked to explain why it showed residents had showers on days that weren't their shower days. The documentation appeared as if the residents received showers every day if 675587 Page 5 of 6 675587 01/17/2025 Avir at Adams 3011 W Adams Ave Temple, TX 76504

F 0676 Level of Harm - Minimal harm or potential for actual harm they did have not refused or someone marked not applicable. The DON tried to explain it but was not able to clearly explain. She was able to reveal the refused showers or the not applicable meant those were not their shower days. The DON could not provide a clear understanding. Residents Affected - Some 675587 Page 6 of 6