Health inspection·November 18, 2025

F 0641 when he was sleeping since he was admitted to the facility. Level of Harm - Minimal harm or potential for actual harm During an interview on [DATE] at 10:25 a.m., the MDS nurse stated Resident #3's quarterly MDS was coded No to the question of Non-invasive Mechanical Ventilation – Bi-Pap in the section O (Special Treatment, Procedure, and Program) because when the resident was readmitted to the facility on [DATE], the resident's medical records did not reflect the resident's Bi-Pap. The MDS assessment should have been coded Yes because the resident had been using the Bi-Pap since he was admitted to the facility. The MDS nurse said she had responsibility for MDS accuracy, and there was no potential negative outcome because Resident #3 was receiving cares related to his Bi-Pap. Residents Affected - Few During an interview on [DATE] at 2:10 p.m., the DON stated the facility did not have policies regarding accuracy of MDS assessment, but the facility was following RAI. Record review of CMS's RAI version 3.0 Manual, dated 10/2024, revealed Code - yes: For Non-invasive Mechanical Ventilator, code any type of CPAP (Continuous Positive Airway Pressure) and BiPAP (bi-level positive airway pressure) respiratory support devices that prevent airway from closing by delivering slightly pressurized air through a mask or other device continuously or via electronic cycling throughout the breathing cycle. 2. Record review of Resident #74's face sheet, dated [DATE], revealed he was a [AGE] year-old male originally admitted to the facility on [DATE] with active diagnoses of Unspecified severe protein-calorie malnutrition, Dementia, and Depressive Disorder. Resident #74 was discharged on [DATE]. Record review of Resident #74's discharge MDS, dated [DATE], Section A, subsection A0310: Type of Assessment, question F: identifies Death in Facility. Section A, subsection A2105: Discharge Status indicated resident was discharge to Home/Community. Interview with the MDS nurse on [DATE] at 11:40 AM, revealed Resident #74 was discharged on [DATE] since he expired of natural causes in the facility. MDS nurse stated she was responsible for completion of discharge MDS. The MDS nurse stated when she completed the discharge MDS for Resident #74 Point Click Care automatically populated most of the information and she must have overlooked where Point Click Care indicated resident was discharged to home/community. The MDS nurse stated the error would have no impact on the residents. The MDS nurse stated the facility does not have a policy relating to MDS completion because they followed CMS RAI Manual. Interview with the DON on [DATE] at 11:47 AM, revealed Resident #74 passed away in the facility of natural causes. The DON stated a discharge MDS was completed by the MDS nurse, and it was the responsibility of the DON to ensure they were accurate. The DON stated the facility recently started using Point Click Care and they was still getting used to the program. The DON stated most of the information was populated in the discharge MDS and the error indicating resident was discharged to home/community was not identified. The DON stated the error would have no impact on the residents. The DON stated the facility does not have a policy relating to MDS completion because they followed CMS RAI Manual. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675656 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 675656 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Walnut Springs 1637 N King St 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)

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to ensure a resident who was incontinent of bladder and bowel received appropriate treatment and services to prevent urinary tract infections and to restore continence to the extent possible for 2 (Resident #4 and #52) of 4 residents reviewed for incontinence care. The facility failed to ensure while providing incontinent care: 1. CNAB did not clean the right buttock area for Resident #4. 2. CNAC did not separating the labia and thoroughly clean the vaginal area for Resident #52. This failure could place residents who required incontinence care at risk for cross contamination and the development of urinary tract infections. The findings included: 1. Record review of Resident #4's face sheet, dated 09/26/2025, revealed the resident was [AGE] years old male, originally admitted to the facility on [DATE], and re-admitted to the facility on [DATE] with diagnosis of severe protein-calorie malnutrition (a nutrition status in which reduced availability of nutrients leads to changes in body composition and function), pneumonia (infection in lungs caused by bacteria, viruses or fungi), cerebral palsy (a group of conditions that affect movement and posture), and muscle weakness. Record review of Resident #4's quarterly MDS assessment, dated 08/29/2025, revealed the resident's BIMS was 7 out of 15 which indicated the resident had severe cognitive impairment, and the resident was always incontinent of bladder and bowel. Record review of Resident #4's comprehensive care plan, dated 07/07/2025, revealed the resident was always incontinence to bladder and bowel. For intervention - Provide incontinent care after each incontinent episode. Observation on 09/25/2025 at 10:12 a.m., revealed CNAB removed the soiled brief from Resident #4, cleaned the resident's penis with circular motion, cleaned scrotum area, cleaned left and right groin areas, changed gloves after sanitizing hands, and turned the resident to right side, then cleaned the resident's rectal and left buttock area because the resident had bowel movement. CNAB took a new pad and brief and put them under Resident #4, made the resident supine position (lying horizontally, with the face and torso facing up), and closed the new brief without cleaning the resident's right buttock area. During an interview on 09/25/2025 at 10:29 a.m., CNAB stated when she cleaned Resident #4's penis, scrotum, left, and right groin area, she cleaned only Resident #4's left buttock area. CNAB said she did not clean Resident #4's right buttock area because she forgot it. CNAB said she should have cleaned Resident #4's right buttock area to prevent possible infection. Further interview with CNAB said she received skill check for peri care of male resident every year. During an interview on 09/25/2025 at 1:44 p.m., DON stated CNAB should have cleaned Resident #4's right buttock area to prevent possible infection or skin breakdown. 2. Record review of Resident #52's face sheet, dated 09/26/2025, revealed the resident was [AGE] years old female, originally admitted to the facility on [DATE] with diagnoses of atrial fibrillation (irregular and often very rapid heart rhythm), retention of urine (a condition where person cannot empty bladder), muscle weakness, and gastroparesis (slows or stops the movement of food from stomach to small intestine). Record review of Resident #52's quarterly MDS assessment, dated 09/19/2025, revealed the resident's BIMS score was 13 out of 15 indicating the resident's cognitive was intact and was always incontinent of bladder and bowel. Record review of Resident #52's comprehensive care plan, dated 07/30/2025, revealed the resident was always incontinent with bladder and bowel. For intervention -check resident frequently and give verbal reminders / cues toilet and provide incontinent care as needed. Observation on 09/25/2025 at 10:56 a.m., revealed CNAC removed Resident #52's soiled brief, and CNAC started cleaning the resident's suprapubic area, left groin, and right groin. When CNAC cleaned the vaginal area of Resident #52CNAC did not separate the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675656 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 675656 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Walnut Springs 1637 N King St 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)

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete resident's labia and thoroughly clean. , then rolled the resident to her left side and cleaned the resident's buttock area. During an interview on 09/25/2025 at 11:08 a.m., CNAC stated when she cleaned Resident #52's vaginal area, she did not separate the resident's labia, and she said she should have separated to prevent infection. CNAC said she was checked-off regarding female peri care every year. During an interview on 09/25/2025 at 1:44 p.m., the DON stated CNAC should have separated Resident #52's labia to clean inside when CNAC cleaned the resident's vaginal area to prevent possible infection. Record review of the facility's policy, titled Perineal Care, dated 2001, revealed Male - using a new wipe with each stroke clean from the upper parts of the leg to the hip, repeat on the other side and then once from hip bone to hip bone, and turn the resident over and repeat on the back side. Female - Separate the labia (clean to dirty). Event ID: Facility ID: 675656 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 675656 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Walnut Springs 1637 N King St 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)

F 0695 Provide safe and appropriate respiratory care for a resident when needed. 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 ensure that a resident who needed respiratory care, including tracheostomy care, was provided such care, consistent with professional standards of practice and the comprehensive person-centered care plan for one (Resident #70) of three residents who was reviewed for respiratory care. The facility failed to ensure Resident #70's suction Yankauer (suctioning tool used in medical procedures. It is typically a firm plastic suction tip with a large opening to allow effective suction in the mouth) which was attached to a suction machine was not covered in a plastic bag when the facility did not use it. This deficient practice could place residents who receive respiratory therapy and could contribute to respiratory distress, infections, pneumonia and an overall decline in their physical condition.The findings were: Record review of Resident #70's face sheet, dated 09/26/2025, revealed the resident was 78-years-old male who was admitted to the facility on [DATE] with diagnoses of Alzheimer's disease (progressive disease that destroy memories and other important mental functions), dementia (loss of memory and thinking ability), mycoses (fungal infection), and hyperlipidemia (elevated level of lipids). Record review of Resident #70's annual MDS assessment, dated 09/19/2025, revealed the resident's BIMS was 0 indicated the resident had severe cognitive impairment and was dependent on staff (Helper does ALL of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity) for all activities of daily living, such as bed mobility, chair to bed, and toilet transfer. Record review of Resident #70's hospice physician order, dated 08/20/2025, revealed suction machine with set up. Observation on 09/23/2025 at 10:41 a.m., revealed Resident #70 was on the bed and sleeping in his room, there was a suction Yankauer attached to a suction machine on the nightstand, the suction Yankauer was not covered in a plastic bag. During an interview on 09/23/2025 at 11:27 a.m., LVND stated Resident #70's suction Yankauer which was attached to a suction machine was not covered in a plastic bag when the facility did not use it, and the suction Yankauer should have been covered in a plastic bag when it was not used to prevent possible infection. During an interview on 09/25/2025 at 1:44 p.m., the DON said Resident #70's suction Yankauer attached the suction machine should have been covered in a plastic bag when it was not used to prevent possible infection, and the facility did not have specific policy regarding taking care of suction Yankauer and followed standard nursing care. Record review of the professional standard nursing care regarding taking care of suction Yankauer, website https://learn.medcareequipment.com/suction-machine/patient-instructions-suction-machine, titled Cleaning and disinfecting suction catheters/Yankauers, undated, revealed . 7. after the suction catheters/yankauers are dry, place each suction catheter/Yankauer in a clean bag and store until next use. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675656 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 675656 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Walnut Springs 1637 N King St 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)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 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 all drugs and biological were stored in locked compartments for 1 (stage 2 station medication room) of 1 medication room, 1 (stage 1 station medication aide cart) of 3 medication carts, and 1 resident (Resident #64) of 25 residents reviewed for storage, in that: The facility failed to ensure: 1. There was one bottle of Fish Oil 1200 mg found in stage 2 station medication room on 09/24/2025, and it expired 07/2025. 2. Resident #64's acetaminophen suppository was found in the refrigerator inside stage 2 station medication room on 09/24/2025, and it expired 08/2025. 3. There was one bottle of calcium citrate with vitamin D3 found in stage 1 station medication aide cart on 09/24/2025, and it expired 07/2025. This failure could place residents at risk of misappropriation of medications and not having the intended therapeutic effects.The findings were: 1. Observation on 09/24/2025 at 2:39 p.m., of the stage 2 station medication room revealed the surveyor and ADON-E saw that there was one bottle of Fish Oil 1200 mg , it expired 07/2025. During an interview on 09/24/2025 at 2:49 p.m., ADONE stated there was one bottle of Fish Oil 1200 mg found in stage 2 station medication room, and it was expired 07/2025. ADONE said all expired medication should have been removed from the medication room, and expired medications might not reach therapeutic effects. 2. Record review of Resident #64's face sheet, dated 09/26/2025, reveled the resident was 78-years-old female, originally admitted to the facility on [DATE], and re-admitted on [DATE] with diagnosis of hypothyroidism (thyroid gland does not produce enough thyroid hormone), dementia (loss of cognitive functioning-thinking, remembering, and reasoning-to such an extent that it interferes with a person's daily life and activities), atrial fibrillation (irregular and often very rapid heart rhythm), and pain in right and left shoulder. Record review of Resident #64's quarterly MDS assessment, dated 09/15/2025, revealed the resident's BIMS was 6 out of 15 indicating the resident had severe cognitive impairment, the resident was dependent (Helper does ALL of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity) to all activities of daily living, such as chair to bed and toilet transfer, and the resident received scheduled pain medication and PRN (as needed for pain) regimen. Record review of Resident #64's physician order, dated 09/19/2025, revealed the resident had the order of Acetaminophen 650 mg suppository insert one suppository rectally every 4 hours as needed for fever or pain. Observation on 09/24/2025 at 2:49 p.m., revealed Resident #64's acetaminophen suppository was found in the refrigerator inside stage 2 station medication room, and it expired 08/2025. During an interview on 09/24/2025 at 2:49 p.m., ADONE stated Resident #64's acetaminophen suppository found in the refrigerator inside stage 2 station medication room, and it expired 08/2025. ADONE said Resident #64 was the current resident of the facility and had the PRN (as needed for pain or fever) physician order regarding this medication, and all expired medication should have been removed from the medication room, and expired medications might not reach therapeutic effects. 3. Observation on 09/24/2025 at 3:14 p.m., revealed there was one bottle of calcium citrate with vitamin D3 found in stage 1 station medication aide cart, and it expired 07/2025. During an interview on 09/24/2025 at 3:14 p.m., ADONE stated there was one bottle of calcium citrate with vitamin D3 found in stage 1 station medication aide cart, and it expired 07/2025. ADONE said all expired medication should have been removed from a medication room, and expired medications might not reach therapeutic effects. During an interview on 09/25/2025 at 1:44 p.m., the DON said all expired medication should have been removed from a medication room and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675656 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 675656 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Walnut Springs 1637 N King St 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)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete carts, and expired medications might not reach therapeutic effects. The DON said she did not know what reason the expired medications were in the medication room and cart, the pharmacist usually checked every month, and nursing staff had responsibility for removing all expired medications from the medication room and carts. Record review of the facility policy, titled Medication Labeling and Storage, dated 2001, revealed . 3. If the facility has discontinued, outdated, or deteriorated medications or biologicals, the dispensing pharmacy is contacted for instructions regarding returning or destroying these items. Event ID: Facility ID: 675656 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 675656 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Walnut Springs 1637 N King St 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)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete 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 for 1 (stage 2 station medication room) of 2 medication rooms. The facility failed to ensure all prepared items in the refrigerator located inside the stage 2 station medication room was labeled and dated with the use by date. These failures could place residents at risk for food borne illness.The findings included: Observation of the facility's stage 2 station medication room on 09/24/2025 at 2:39 p.m., revealed there was two refrigerators in the medication room. One was for the medications, and the other was for the residents' food. There was 4 small containers with food found in the stage 2 station medication room, and the food containers did not have any labels or dates. During an interview on 09/24/2025 at 2:39 p.m., ADONE stated there was 4 small containers with food found in the stage 2 station medication room, and the food containers did not have any labels or dates. ADONE said the food looked like pudding from the facility kitchen but did not know exactly what kinds of food and when the food was put in the refrigerator because there were no labels and dates. ADONE said all food items that came from the facility kitchen should have labels and dates to prevent possible food borne illness. During an interview on 09/25/2025 at 1:44 p.m., the DON said all food items that came from the facility kitchen should have labels and dates to prevent possible food borne illness, and the DON said she did not know what reason the food items did not have any label and date. The nursing staff had responsibilities to write labels and dates on the food items. Record review of the facility policy, titled Foods and Snacks Kept on Nursing Units, revised 11/2022, revealed 1. All food items to be kept at or below 41 Fahrenheit are placed in the refrigerator located at the nurses' station and labeled with a use by date. Event ID: Facility ID: 675656 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 675656 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Walnut Springs 1637 N King St 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)

F 0813 Have a policy regarding use and storage of foods brought to residents by family and other visitors. 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 have a policy regarding use and storage of foods brought to residents by family and other visitors to ensure safe and sanitary storage, handling, and consumption, for 1 (Resident #21) of 25 residents reviewed, in that: Resident #21's personal refrigerator had unlabeled and undated food. The failure could place the resident at risk for food borne illness.The findings were: Record review of Resident #21's face sheet, dated 09/26/2025, revealed the resident was 85-years-old male and admitted to the facility on [DATE] with diagnoses of dementia (loss of cognitive functioning-thinking, remembering, and reasoning-to such an extent that it interferes with a person's daily life and activities), muscle wasting and atrophy (loss of skeletal muscle mass), type 2 diabetes mellitus (a condition where the body has trouble regulating blood sugar levels, leading to persistently high blood glucose levels), dysphagia (difficulty swallowing), and gastro-esophageal reflux disease (stomach acid flows back up into the esophagus and causes heartburn). Record review of Resident #21's quarterly MDS assessment, dated 09/01/2025, revealed the resident's BIMS was 15 out of 15 indicating the resident's cognitive was intact. The MDS indicated Resident #21 required Setup or clean-up assistance (Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity) to eating and Substantial/maximal assistance (Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort) to chair to bed and toilet transfer. Record review of Resident #21's comprehensive care plan, dated 07/01/2025, revealed the resident has an activities of daily living self-care performances deficit related to weakness and contractures to bilateral lower extremities. For intervention - Required eating: Resident requires supervision set up assist. Observation and interview on 09/23/2025 at 10:36 a.m., revealed Resident #21 had a personal refrigerator inside his room, and one food item with plastic container box without any label and date. Attempted interview with Resident #21, he covered his face with a blanket and did not say anything. During an interview on 09/23/2025 at 11:24 a.m., LVND stated Resident #21 had a personal refrigerator inside his room, and one food item with plastic container box was found without any label and date. LVND said the food looked like cake, the resident's family member brought it, and nurse should have labeled and dated to prevent possible food illness. During an interview on 09/25/2025 at 1:44 p.m., the DON said that all food items that came from resident's family members should have labels and dates to prevent possible food borne illness. The DON said she did not know what reason the food items did not have any label and date. The nursing staff had responsibilities to check a resident's refrigerator and write labels and dates on the food items. Record review of the facility policy, titled Food brought in from outside sources and personal food storage, dated 2021, revealed . 4. Foods and beverages brought in from outside sources that require refrigeration or freezing should be labeled with the patient/resident's name and date and stored in the refrigerator/freezer apart from facility food. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675656 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 675656 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Walnut Springs 1637 N King St 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)

F 0912 Level of Harm - Potential for minimal harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Provide rooms that are at least 80 square feet per resident in multiple rooms and 100 square feet for single resident rooms. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record reviews and interviews, the facility failed to ensure that 21 out of 21 resident rooms (401-405, 407, 410-414 and 501-510) provided a minimum of 80 square feet of floor space per resident. Twenty-one of the two-bed resident rooms measured less than the required 80 square feet per resident. This deficient practice could affect residents living in these rooms by restricting the amount of resident care equipment and resident's personal effects that could be accommodated in these rooms. The findings were: Per the facility Bed Classification Form 3740 dated 09/23/2025 as completed by facility Administrator revealed, Resident Rooms 401 through 405, 407, 410 through 414, and 501 through 510 were listed as two resident bedrooms. Observation on 09/24/2025 beginning at 1:15 p.m. of the measurements of resident bedrooms using a laser measuring tool by the Life Safety Code surveyor, revealed the following measurements: room [ROOM NUMBER]: 11.75 feet x 12.6 feet = 148.5 square feet (approximately 74.25 square feet per resident).room [ROOM NUMBER]: 11,75 feet x 12.75 feet = 149.81 (approximately 74.9 square feet per resident).room [ROOM NUMBER]: 11.75 feet x 12.75 feet = 149.81 (approximately 74.9 square feet per resident).room [ROOM NUMBER]: 11.75 feet x 12.75 feet = 149.81 (approximately 74.9 square feet per resident).room [ROOM NUMBER]: 11,75 feet x 12,75 feet = 149.81 (approximately 74.9 square feet per resident).room [ROOM NUMBER]: 11.75 feet x 12.75 feet = 149.81 (approximately 74.9 square feet per resident).room [ROOM NUMBER]: 11.25 feet x 12.66 feet = 142.42 (approximately 71 square feet per resident).room [ROOM NUMBER]: 11.66 feet x 12.66 feet = 147.61 (approximately 73.8 square feet per resident).room [ROOM NUMBER]: 11.66 feet x 12.66 feet = 147.61 (approximately 73.8 square feet per resident).room [ROOM NUMBER]: 11.75 feet x 12.75 feet = 149.81 (approximately 74.9 square feet per resident).room [ROOM NUMBER]: 11.75 feet x 12.66 feet = 147.61 (approximately 73.8 square feet per resident).room [ROOM NUMBER]: 13.5 feet x 10.9 feet = 147.15 (approximately 73.5 square feet per resident).room [ROOM NUMBER]: 10.75 feet x 13.5 feet = 145.12 (approximately 72.5 square feet per resident).room [ROOM NUMBER]: 10.83 feet x 13.5 feet = 145.8 (approximately 72.9 square feet per resident).room [ROOM NUMBER]: 13.5 feet x 10.9 feet = 147.15 (approximately 73.5 square feet per resident).room [ROOM NUMBER]: 13.5 feet x 10.9 feet = 147.15 (approximately 73.5 square feet per resident).room [ROOM NUMBER]: 10.83 feet x 13.5 feet = 146.2 (approximately 73.1 square feet per resident).room [ROOM NUMBER]: 10.9 feet x 13.5 feet = 147.15 (approximately 73.5 square feet per resident).room [ROOM NUMBER]: 10.83 feet x 13.5 feet = 146.2 (approximately 73.1 square feet per resident).room [ROOM NUMBER]: 10.9 feet x 13.5 feet = 142.15 (approximately 73.5 square feet per resident).room [ROOM NUMBER]: 10.9 feet x 13.5 feet = 142.15 (approximately 73.5 square feet per resident). During an interview on 09/26/2025 at 11:35 a.m., the Administrator confirmed the identified residents' rooms were 2-person rooms and did not provide a minimum of 80 square feet of floor space per resident. The Administrator requested a room size waiver for those resident rooms and completed Form 3762 Room Size Waiver for Facilities that reflected that all justification criteria for the wavier had been met which would not adversely affect the residents living in the rooms. Event ID: Facility ID: 675656 If continuation sheet Page 10 of 10