Health inspection·March 22, 2024

F 0839 Employ staff that are licensed, certified, or registered in accordance with state laws. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and record review the facility failed to ensure professional staff were licensed, certified, or registered in accordance with applicable State laws for 1 of 3 staff (Staff A) reviewed for staff qualifications. Residents Affected - Some The facility failed to ensure Staff A completed the appropriate educational requirements of a bachelor's degree in social work and was appropriately licensed to practice social work in the State of Texas. This failure could place residents at risk of not receiving care and services from staff who were properly trained and supervised. The findings included: Record review of staff Roster (undated) revealed Staff A had a job title listed as Social Services with a hire date of 07/01/2022. Record Review of a job description titled Social Service Director dated 7/02/2022 signed by Staff A revealed: Job Requirements: Education Experience: bachelor's degree in social work. During an interview on 3/21/2024 at 4:00 p.m., Staff A stated she was hired as the facility Social Worker approximately 1.5 years ago. She stated she had completed a bachelor's degree in psychology from a local university. She stated she did not have a degree in social work and was not licensed to work as a Social Worker. Staff A stated her job duties included: assessments, observations, referrals to community resources, liaison between staff, helping resident find community partners to meet their needs, resolving grievances, documentation, signing up residents for optometry, podiatry and dental services. She stated assessments included: social history, trauma informed cares, BIMS assessments and PHQ-9 assessments. She stated trauma informed care included understanding a resident's history and any traumatic experiences and how the facility served them while being conscious about the triggers that might affect them. She stated her training for trauma informed care had been online and not in a licensed social worker capacity. She stated she was trained to do social history, BIMS assessments and PHQ-9 assessments by shadowing another social worker at another facility for a few days when she was first hired. When asked if she performed counseling services, she stated she does speak with residents to help them talk through grievances and things that might have upset them or things that have brought them joy and they were happy about. She stated for residents who were having adjustment difficulties she meets with them when they arrive at the facility or the next day and help familiarize them with the building and surroundings. She stated if they were still having trouble adjusting in a month or two, she will ask them what they need and provide what she can. Staff A stated she helps develop care plans but not in a licensed sense. What asked what a licensed sense was she (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: 675641 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 675641 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Seguin 1215 Ashby Seguin, TX 78155 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)