Inspection·April 11, 2024

F 0602 1/31/24 Restaurant $4.32; Department store $10.01; Restaurant $15.18 Level of Harm - Minimal harm or potential for actual harm January Total: $345.76 2/1/24: Gas station $17.31; Grocery store $34.04. Residents Affected - Some 2/5/24: Restaurant $16.43; Gas station $20.00; Restaurant $26.14; Grocery store $44.49; ATM $300.00 ; Grocery store $161.58; ATM withdrawal $60.00; ATM withdrawal $300.00. 2/20/24: Department store $10.81; Restaurant $12.96; Department store $29.20; Grocery store $41.34; Department store $41.95; ATM withdrawal $100.00. 2/21/24 Gas station $20.00 2/22/24 $11.65; Restaurant $13.85; Department store $90.92 2/23/24: $33.51 Grocery store 2/26/24: Restaurant $29.71; Department store $31.68. 2/27/24: $140.00 ATM withdrawal. 2/28/24: SQ $6.06; Gas station $17.31; Restaurant $20.98; Department store $26.22; ATM withdrawal $260.00. February 2024 total: $1908.14 3/6/24: Gas station: $10.23; Grocery store $13.68; Restaurant $59.62 3/7/24 Department store $36.75 3/21/24 ATM withdrawal $200 3/22/24: Grocery store $57.04 March 2024 total: $377.32 Grand total: 345.76+$1908.14+$377.32=$2631.22 During an interview on 4/11/24 at 10:00 a.m., ADM stated the HR Coordinator was terminated on 3/25/24 before the facility became aware of the missing money from Resident #1's bank account. The ADM stated she was contacted by FM #1 on 3/27/24 about the missing money from Resident #1's account. The ADM stated the HR Coordinator was not authorized to do any shopping for residents or have access to their bank cards to make purchases for residents. The ADM stated FM #1 discovered there was approximately $2600 in charges on Resident #1's account and $400 in cash was missing as well. The ADM stated the HR Coordinator used Resident #1's bankcard at an ATM and took out $300 and gave him $100 but said the $300 was for his rent here at the facility. The ADM stated Resident #1 did not have any cash and there should have been $400 total in his wallet. The ADM stated the HR Coordinator was provided the bank card from Resident #1 to get him snacks at the store and that was when she would use his (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675646 If continuation sheet Page 2 of 7 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 675646 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Snyder 210 E 37th St Snyder, TX 79549 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 0602 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some debit card for herself. The ADM stated the HR Coordinator was previously married to Resident #1's nephew and was divorced. The ADM stated the HR Coordinator was not related to any other residents at the facility. The ADM stated the HR Coordinator did not returned calls or contacted her to provide a statement to the facility. The ADM stated the HR Coordinator did text FM#1 that she would pay the money back. The ADM stated the activity director was the only authorized staff member to do shopping for residents and must provide a receipt to the resident. The ADM stated Resident #1 was not provided receipts from the HR Coordinator. The ADM stated a PD report was made and the local police department interviewed Resident #1 who stated to the police he did not authorize the HR Coordinator to use his bank card for her own needs. The ADM stated the county DA was investigating this case. The ADM stated residents were interviewed, and it was determined that no other residents had missing money. The ADM stated the HR Coordinator should never have shopped for the resident, nor should she have taken his money for her own personal needs, and it was against policy. The ADM stated staff were in-serviced on ANE. During an interview on 4/11/24 at 11:16 a.m. with Resident #1, he stated FM #1 is in charge of his money. Resident #1 stated the HR Coordinator would bring him cokes and snacks but never brought any receipts. The HR Coordinator had his money in her office and would use those funds to purchase those items. Resident #1 stated that he never gave the HR Coordinator permission to use his debit card or cash for her own personal needs or wants. He stated FM #1 discovered several transactions that were made while he was in the facility, and he did not make them or authorize them. He stated he never received cash or asked for the HR Coordinator to take cash out of his account. He never asked or received any fast food from the HR Coordinator. The HR Coordinator was to purchase his snacks and cokes from Walmart. The HR Coordinator was supposed to purchase him a comforter for his bed he never got. Resident #1 stated the only stuff the HR Coordinator ever purchased from him came in grocery store bags and there were never any purchases from store The HR Coordinator never bought him anything. Resident #1 stated he never gave his permission to the HR Coordinator to use his debit card for ATM withdrawals or purchases for herself. Resident #1 stated he never authorized the HR Coordinator to do a spend down of his money for Medicaid authorization approval. Resident #1 stated the HR Coordinator was divorced from his nephew. Resident #1 stated he spoke to the police and told the officer he wanted to press charges against the HR Coordinator. Resident #1 stated he was upset the HR Coordinator took his money and now he did not have enough money to move back into his apartment and FM #1 was going to clean it out for him. During a phone interview on 4/11/24 at 12:18 p.m., FM #1 stated she has assisted Resident #1 with his finances and apartment. FM #1 stated she was a co-signer on Resident #1's bank account and personally visited the bank to pull out money to purchase him his requested items and to pay his apartment rent. FM #1 stated she lived several hours away and would visit Resident #1 at least once a month. FM #1 stated Resident #1 moved into the nursing home in January 2024 and the HR Coordinator was married to the resident's nephew previously. FM #1 stated the HR Coordinator stated it was her job to shop for the residents and she would lock up Resident #1's wallet and debit card in her office safe. FM #1 stated the HR Coordinator also stated she would get Resident #1 his snacks and cokes from grocery store FM #1 stated she had no concerns because she believed the HR Coordinator's job was to hold onto the resident wallets and to shop for them. FM #1 stated when she went to his bank and found out he had barely any money left, she reviewed the transaction record and found multiple transactions that were made with the debit card and ATM withdrawals totaling a few thousand dollars. FM #1 stated Resident #1 told her he did not eat food from any community restaurant and stated the HR Coordinator said she would buy him a comforter but never did. FM #1 stated Resident #1 stated he had no receipts for any snack or drink purchases from the HR (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675646 If continuation sheet Page 3 of 7 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 675646 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Snyder 210 E 37th St Snyder, TX 79549 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 0602 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Coordinator. FM #1 stated she notified the facility ADM of the missing money and transactions from the bank account, and she confronted the HR Coordinator who stated she had a rough time being a single Mom and she would pay the money back. FM #1 stated as of today, the HR Coordinator had returned $350 back to her and had promised she would make weekly payments back. FM #1 stated Resident #1 was able to make his own decisions and was in a nursing home due to a fall history in his apartment. FM #1 stated Resident #1 wanted to keep his apartment in town because he hoped to move back into it. FM #1 stated now there was not enough money to pay the rent and utilities due to the HR Coordinator using his bank account. FM #1 stated the HR Coordinator told her she used the debit card for her own purchases to help spend down Resident #1's money in order to qualify for Medicaid services. FM #1 stated Resident #1 was very upset the HR Coordinator took his money and wanted to press charges against her. FM #1 stated she had text messages from the HR Coordinator that show the HR Coordinator admitted to using the money for herself. FM #1 stated she would send the text messages to the HHSC State Surveyor state cell phone. During a phone interview on 4/11/24 at 12:56 p.m. with the HR Coordinator, she stated she no longer worked at the nursing facility. She stated Resident #1 was her ex-husband's uncle and she considered Resident #1 to be her family member. The HR Coordinator stated I was trying to do a spend down so Resident #1 would qualify for Medicaid. The HR Coordinator stated she had paid some of the money back to Resident #1's [FM #1]. The HR Coordinator stated she was not Resident #1's POA or RR and Resident #1 gave her his debit card and pin to do his shopping. The HR Coordinator stated she spent Resident #1's money on her own needs/wants but did not provide details . The HR Coordinator stated she had her children with her and could not talk at this time. The HR Coordinator stated she would call the HHSC State Surveyor back on 4/15/24 at 8:00 a.m. prior to the interview with the police investigator . During an interview on 4/11/24 at 1:51 p.m., the AD stated it was her job to complete shopping for residents. A resident would provide a list, she made the purchase and returned the receipt to the business office. The AD stated if a resident provided cash, she would sign for the cash, complete the shopping, and provide a receipt and change to the resident. The AD stated another staff member was present when the receipt and change was returned to the resident. The AD stated if a resident needed to spend down it was never done with resident cash, check or debit card. The AD stated a facility check was used to pay for the item(s) and the money was deducted from the resident trust account. The AD stated at no time should a staff member use resident funds to purchase items that were not for the resident. The AD stated all staff were trained on abuse, neglect and exploitation and were trained that they were not to take money or gifts from a resident. During an interview on 4/11/24 at 1:59 p.m., the LVN stated she was trained on abuse, neglect and exploitation that informed staff they were not permitted to take cash or gifts from residents and prohibited staff from using resident items for personal gain. The LVN stated the AD was assigned to shop for residents. The LVN stated she saw the HR Coordinator bring Resident #1 soda and snacks but had never seen the HR Coordinator bring Resident #1 fast food, clothing, bedding or anything besides sodas and snacks. The LVN stated it was against policy to take resident cash or debit cards. During an interview on 4/11/24 at approximately 2:25 p.m., the ADM stated the HR Coordinator was not authorized to do spend downs for any resident or Resident #1 that would allow for Medicaid approved services. The ADM stated the HR Coordinator stated when the HR Coordinator's office was cleaned out, Resident #1's wallet that included his ID and bank debit card were found in the HR Coordinator office. The ADM stated there was no cash found in Resident #1's wallet The ADM stated the HR Coordinator should not have had Resident #1's wallet. The ADM stated the HR Coordinator never provided any (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675646 If continuation sheet Page 4 of 7 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 675646 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Snyder 210 E 37th St Snyder, TX 79549 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 0602 receipts for purchased items for Resident #1. Level of Harm - Minimal harm or potential for actual harm During an interview on 4/12/24 at 8:35 a.m. with the local Police Department Officer revealed the investigation was now with the DA and was assigned to another Investigator. The PD Officer stated the HR Coordinator was interviewed and stated she had receipts for the purchases but has yet to provide them. The PD Officer stated the HR Coordinator had an interview with the DA Investigator on 4/15/24 to provide receipts. The PD officer stated Resident #1 was interviewed and stated he did not have food from two of the restaurants in question and the purchases were not made by him, and he did not authorize the HR Coordinator to make those purchases. The PD officer stated he would forward the HHSC State Surveyor's name and number to the DA Investigator . The PD officer stated he would send the completed PD report to the HHSC State Surveyor. Residents Affected - Some During an attempted phone interview on 4/15/24 at 8:10 a.m. with the HR Coordinator, the phone call was not answered, and a voicemail was left with request for a return call. Attempted interview via text Message sent on 4/15/24 at 9:08 a.m. to the HR Coordinator, was unsuccessful. During attempted phone interview on 4/15/2024 at 1:37 p.m., the HR Coordinator returned HHSC State Surveyor's call and stated she was at the sheriff department and would call the HHSC State Surveyor back once the interview was completed. During a phone interview on 4/15/24 at 2:35 p.m. with PD Sgt.; stated she completed her interview with the HR Coordinator today and at this time the HR Coordinator confessed she did use Resident #1's debit card for personal purchases and to withdraw money for herself. The Sgt. stated the HR Coordinator admitted she purchased items from a grocery store/department for herself or her kids and the PD would attempt to get the receipts from the store. The Sgt. stated she would send her completed police report with grocery store/department store receipts to the HHSC State Surveyor by the end of the week. Record review of a text message received on 4/15/24 at 4:33 p.m. from FM#1, stated there was a Venmo deposit made to her from the HR Coordinator on 2/2/24 at 10:55 a.m. for $150.00, When I went in February, she [HR Coordinator] told me her son had accidently took [Resident #1] card out of her purse and used it and spend his allowance. She said his card was in her purse because she was going to buy snacks for [Resident #1] that weekend. However, I had already done that. I made sure his wallet still had his money and his card and put it back in the safe in her office. I thought honest mistake and did not think to check the bank at that time. During an attempted phone interview on 4/16/24 at 8:07 a.m. with the HR Coordinator, phone call was not answered. HR Coordinator texted before voicemail could pick up with the following message: In a drs appt right now can I call you back. Record review of screen shot messages received from FM #1 on 4/11/24 reflected text messages between FM #1 and the HR Coordinator; dated 3/29/24 at 12:53 p.m.: FM #1 to the HR Coordinator: You said your boss had the receipts, and when I didn't hear back from your boss, I looked for her so I could contact her and find out where the receipts were. She doesn't have any of the receipts. HR Coordinator replied in part, Yes ma'am I understand, and I will send them. I was honestly trying to help anywhere I could so he would get approved .I'm an adult and I know right from wrong. I don't want you to think I went blowing money on myself because I didn't .I'm not asking for pity I just want to be (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675646 If continuation sheet Page 5 of 7 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 675646 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Snyder 210 E 37th St Snyder, TX 79549 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 0602 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some honest. I did get food when we had none and some things for the kids .I do have receipts for what was brought for [Resident #1] and for what isn't accounted for I'm going to replace in full. I thought if I just continued to get him things it would be ok. Or to always have cash for him handy. I went about it all the wrong way. And now I've gotten myself in some really really deep shit. With no one to blame but myself .My troubles should not have been anyone else's problem. I'm going to make this right .I truly thought what I was doing was helping. Meaning I did not want him to go private pay and the date was coming up too soon that he needed the Medicaid. However that's not an excuse and I'm not one to not own up to my own mistakes. Record review of FM#1 provided Venmo transaction receipt reflected on 2/2/24 at 10:55 a.m. FM#1 received $150.00 from the HR Coordinator entitled Payback. Record review of FM#1 provided Venmo transaction receipt reflected on 4/3/24 at 8:45 a.m. FM#1 received $200.00 from the HR Coordinator entitled Payback #1. Record review of emails provided by the ADM reflected the following: Email sent to the HR Coordinator on 3/13/24 from Corporate staff, [HR Coordinator]-can you touch base with [Resident #1] to see how he is going to pay? .$1049 is due for March. Or does he have a number where I can reach him to ask? Also, he does not have an admission agreement uploaded to Matrix. Response from HR Coordinator on 3/13/24, I have his admission agreement to upload now. He has cash that he can make the payment with. I have control of his finances, he's, my uncle. Like not POA but I do everything he asks me to do. Response from Corporate staff, Is he his own payee or does he have a RP. Response from HR Coordinator, He is his own. Record review of the HR Coordinator's employment file reflected: hire date 8/15/23. Record review of the HR Coordinator 's employment file contained the following signed documents dated 8/15/2023: -Employee Misconduct Registry employee notification that stated in part: If the Texas Department of Human Services received a report that an employee of a facility has abused, neglected of exploited a resident or consumer of the facility or misappropriated a resident's or consumer's property, DHS will investigate the report to determine whether the employee has committed an act of misconduct. If it is determined by DHS that the employee did in fact commit the reported misconduct, the employee will be placed on the Employee Misconduct Registry and will not be eligible for employment in this facility. -Abuse and Neglect Policy and Procedure in part: Misappropriation of Resident property-the deliberate misplacement, exploitation, or wrongful, temporary or permanent sue of a resident's belongings or money without the resident's consent. -Senate [NAME] 9 Statement of Nursing Home Policy and Employee Acknowledgement, Attachment E Resident Rights Under Federal Law, revealed in part: The facility shall protect and promote the rights of each resident, including the following rights: The resident has the right to exercise his or her legal rights, including a grievance with the State survey and certification agency concerning resident abuse, neglect, and misappropriation of the resident property in the agency. The resident has the right to manage his or her financial affairs. Attachment F Statement of Resident Rights, revealed in part: You have a right to: manage your own finances or to delegate that responsibility to another person; to access money and property you have deposited with the facility and to an accounting of your (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675646 If continuation sheet Page 6 of 7 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 675646 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Snyder 210 E 37th St Snyder, TX 79549 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 0602 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some money and property that are deposited to the facility and of all financial transactions made with or on behalf of you. To keep and use personal property, secure from theft or loss. Record review of the facility's, undated, policy, Abuse, Neglect, Exploitation and Misappropriation reflected in part: Exploitation defined as taking advantage of a resident for personal gain through use of manipulation, intimidation, threats, or coercion. Examples in part include: unknown charges to the resident's credit card, withholding information about the resident's finances, not placing a resident's money in a separate interest-bearing account. Misappropriation of Property defined as the deliberate misplacement, exploitation or wrongful, temporary, or permanent use of a resident's belongings or money with the resident's consent. Examples in part include: stealing or embezzling resident's money or personal property such as attempting to cash or cashing a check. Record review of the facility's provided Resident Rights policy, dated 2001, Med-Pass, revised February 2021 refleced in part: Federal and state laws guarantee certain basic rights to all residents in this facility. These rights include the resident's right to: be free from abuse, neglect, misappropriation of property and exploitation; manage his or her personal funds, or have the facility manage his or her funds (if he/she wishes). Orientation and in-service training programs are conducted quarterly to assist our employees in understanding our residents' rights. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675646 If continuation sheet Page 7 of 7