Health inspection·April 10, 2025

F 0552 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Seroquel (quetiapine) 150mg one tablet by mouth once a day for bipolar disorder with a start date of 11/15/24. Record review of Resident #13's medication administration record dated 04/01/25-04/10/25 indicated she had received Seroquel 150mg one tablet daily in the morning and Seroquel 300mg one tablet daily at bedtime. Record review of Resident #13's Consent for Antipsychotic or Neuroleptic Medication Treatment (Form 3713) dated 12/02/24, indicated Resident #13 was taking Seroquel for Bipolar Disorder. Resident #13 did not sign the consent acknowledging the consent to the prescribed antipsychotic medication. During an interview on 04/08/25 at 10:06 AM, Resident #13 said she was aware she was receiving Seroquel. Resident #13 said she consented to taking Seroquel but unable to recall if she signed a consent. During an interview on 04/09/25 at 2:33 PM, the ADON said Resident #13 should have signed the consent when the medication was ordered. The ADON said Resident #13 was her own responsible party and was aware she was taking Seroquel. The ADON said the consent should be signed by Resident #13 acknowledging the risks and benefits of the medication. The ADON said the DON and herself were responsible for ensuring the proper consents were completed. The ADON said failure to obtain a signed consent indicated Resident #13 did not know the risks of taking Seroquel and if something were to happen, she did not give consent to take it. During an interview on 04/09/25 at 2:49 PM, the Administrator said he expected all antipsychotic medication consents to be completed accurately. He said Resident #13 should have had a signed consent for her Seroquel indicating she was aware of the side effects. He said the DON or designee were responsible for ensuring the consent was completed accurately. Record review of the facility's policy Psychoactive Medications dated July 2024, indicated . Residents are not given psychotropic medications unless the drug is necessary to treat a specific condition, as diagnosed and documented in the clinical record, and the medication is beneficial to the resident, as demonstrated by monitoring and documentation of the resident's response to the medication . 9. Consent must be obtained from the resident or resident representative prior to administering a psychotropic medication (excluding an emergency). a. A consent form for antipsychotic/neuroleptic medication utilizing Texas form 3713 must be completed and signed by the resident or resident representative. Consent must be obtained in writing . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675668 If continuation sheet Page 2 of 21 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 675668 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Mineola 320 Greenville Highway Mineola, TX 75773 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 0584 Level of Harm - Minimal harm or potential for actual harm Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. Based on observation, interview, and record review, the facility failed to provide a safe, clean, and comfortable homelike environment for 1 of 2 shower rooms (B hall) reviewed for homelike environment. Residents Affected - Some The facility failed to ensure the shower room on B hall did not have black grime buildup on the walls and missing tiles on the floor. This failure could place the residents at risk for a decreased quality of life, an uncomfortable, unhomelike environment due to unsanitary conditions. Findings included: During an observation and interview on 04/09/2025 at 4:04 PM, an observation of the shower room on B hall revealed the shower was missing tiles on the floor, the walls of the shower room had thick black gunk on them. LVN A said it looked like the shower room had not been cleaned. LVN A said housekeeping should be cleaning the shower, but she had not seen them clean it recently. LVN A said it was important for the shower to be clean for hygiene purposes and cleanliness, and the tile missing could result in mildew. During an observation on 04/10/2025 at 8:38 AM, the shower on B hall had black gunk on the walls, a pink stain on the floor, and tiles on the shower floor were missing. During an interview on 04/10/2025 at 8:42 AM, CNA F said housekeeping was responsible for cleaning the showers. CNA F said he had seen one of the housekeepers cleaning the shower on B hall yesterday (04/09/2025). CNA F said the tile on the shower floor had been missing for about 40-45 days. CNA F said he did not know if the missing tile had been logged on the maintenance log for it to be repaired. CNA F said it was important for the shower to be clean for infection control and to prevent cross contamination. CNA F said it was important for the missing tile to be repaired because it could cut somebody, cause the shower chair to get stuck, and cause an accident. During an interview on 04/10/2025 at 8:48 AM, the Maintenance Director said he was aware that the shower on B hall had missing tiles on the floor, and it had been going on for a few months. The Maintenance Director said the repair was the next one in line to be done. The Maintenance Director said it was important for the shower room not to have missing tiles because nobody wanted a nasty shower, and it could cause a slight injury to the residents. During an interview on 04/10/2025 at 10:39 AM, Housekeeper L said she was not responsible for cleaning the shower on B hall. Housekeeper L said one of the other housekeepers was responsible, but she did not know who. Housekeeper L said the CNAs were responsible for cleaning the shower when they did their showers, and then the housekeeper cleaned it. During an interview on 04/10/2025 at 10:42 AM, the Housekeeping/Laundry Supervisor said the showers should be cleaned every day by the housekeepers. The Housekeeping/Laundry Supervisor said she was aware of the shower room on B hall having the black gunk on the walls. The Housekeeping/Laundry Supervisor said they had to scrub the walls to get them clean, but then every couple of days it would come back. The Housekeeping/Laundry Supervisor said Housekeeper M was responsible for cleaning the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675668 If continuation sheet Page 3 of 21 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 675668 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Mineola 320 Greenville Highway Mineola, TX 75773 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some shower on B hall. The Housekeeping/Laundry Supervisor said it was important for the showers to be clean because it can end up with germ buildup and infection could go through the roof and everybody will start getting sick. During an interview on 04/10/2025 at 10:51 AM, Housekeeper M said the showers should be cleaned every week. Housekeeper M said when she scrubbed the shower walls most of the black build up came off. Housekeeper M said the last time she cleaned the shower on B hall was Monday (04/07/2025). Housekeeper M said she had notified her supervisor about having difficulty removing the black build up on the walls of the shower. Housekeeper M said she had noticed the missing tiles on the floor of the shower but had not reported it to anybody because sometimes she got busy and forgot about it. Housekeeper M said it was important for the shower to be clean for the residents because it could make them sick if it was dirty. Housekeeper M said the missing tiles on the floor of the shower could cause the residents to fall. During an interview on 04/10/2025 at 11:22 AM, the Administrator said he was made aware of the condition of the shower on B hall that morning (the morning of 04/10/2025). The Administrator said housekeeping was responsible for cleaning the showers. The Administrator said the showers should be cleaned daily by housekeeping and then a deep clean was completed weekly by the Housekeeping/Laundry Supervisor. The Administrator said the shower room should be clean for cleanliness and because they did not want to deal with dirt, and it could affect the resident's psychological well-being. The Administrator said the shower missing tiles on the floor should be repaired because it was just a bumpy ride for the shower chair in or out, and it needed to look good. Record review of the Maintenance Log Work Order requests for the months of May 2024 through the Month of March 2025 did not indicate a work order for the shower on B hall. There were no work orders for the month of April 2025. Record review of the facility's policy titled, Resident Rights, revised February 2021, indicated, Federal and state laws guarantee certain basic rights to all residents of this facility. These rights include the resident's right to: a. a dignified existence; b. be treated with respect, kindness, and dignity . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675668 If continuation sheet Page 4 of 21 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 675668 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Mineola 320 Greenville Highway Mineola, TX 75773 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 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure prompt efforts were made to resolve grievances for 2 of 18 residents (Resident #3 and Resident #13) reviewed for grievances. 1. The facility did not ensure a grievance was filed for Resident #3's underwear that was part of the facility fire. 2. The facility did not ensure a grievance was filed for Resident #13's missing pants. These failures could place residents at risk for grievances not being addressed or resolved promptly. Findings included: 1. Record review of a face sheet dated 04/09/2025 indicated Resident #3 was a [AGE] year-old male initially admitted to the facility on [DATE] and re-admitted on 04/08//2024 with diagnoses which included dementia unspecified severity without behavioral disturbance, psychotic disturbance, mood disturbance (loss of memory, language, problem solving and other thinking abilities that were severe enough to interfere with daily life without behaviors), and anxiety and chronic obstructive pulmonary disease (chronic inflammatory lung condition that affects the respiratory system). Record review of the Quarterly MDS assessment dated [DATE] indicated Resident #3 understood others and was understood. The MDS assessment indicated Resident #3 had a BIMS score of 15, which indicated his cognition was intact. The MDS assessment indicated Resident #3 was independent for eating, required setup or clean-up assistance with toileting, dressing, and personal hygiene and partial to moderate assistance with showering/bathing self. During an interview on 04/08/2025 at 11:28 AM, Resident #3 said there had been a fire in the laundry department and all his underwear had been destroyed. Resident #3 said he had 3 sets left but was unable to report how many underwear he lost. Resident #3 said he had asked several of the CNAs, nurses, and the laundry about his underwear being destroyed and nobody knows nothing. 2. Record review of Resident #13's face sheet dated 04/08/25, indicated a [AGE] year-old female who admitted to initially admitted to the facility on [DATE] and readmitted on [DATE]. Resident #13 had diagnoses of personality disorder (mental health condition that involves long-lasting, disruptive patterns of thinking, behavior, mood and relating to others), bipolar disorder (a disorder associated with episodes of mood swings ranging from depressive lows to manic highs), major depression (mental health disorder characterized by persistently depressed mood or loss of interest in activities, causing significant impairment in daily life), and anxiety. Record review of Resident #13's Quarterly MDS assessment dated [DATE], indicated she was understood and understood others. The MDS assessment indicated Resident #13 had a BIMS score of 14, which indicated her cognition was intact. During an interview on 04/08/2025 at 10:06 AM, Resident #13 said she had lost her $40 pants and had been missing them for a while. Resident #13 said she reported it to the Administrator, and he did (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675668 If continuation sheet Page 5 of 21 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 675668 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Mineola 320 Greenville Highway Mineola, TX 75773 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 0585 not do anything. Resident #13 said her pants had not been found or replaced. Level of Harm - Minimal harm or potential for actual harm During an interview on 04/09/2025 at 3:12 PM, Laundry Aide H said she was aware Resident #3 lost some underwear in the fire. Laundry Aide H said when clothing was missing, she wrote down the item and went to look for it in the residents' rooms. Laundry Aide H said if the item was not located, she would notify the Administrator. Laundry Aide H said she had notified her manager about the clothes that were lost in the fire. She said there was not a lot of clothes lost because she had delivered majority of the clothes prior to the fire, but she knew Resident #3's underwear were not delivered. Laundry Aide H said most of the items lost in the fire were socks and underwear. Laundry Aide H said it was important for the residents clothing to be returned to them because it belonged to them, and it could be something personal to them that they really wanted. She said the facility was their home and it is where they stayed every day and they needed to feel safe and be happy where they were living. Residents Affected - Few During an interview on 04/09/2025 at 3:29 PM, Laundry Aide K said Resident #3 had told her he had lost some boxers in the fire. Laundry Aide K said the boxers had not been replaced, and she did not know if the clothes that were lost in the fire were going to be replaced. Laundry Aide K said if clothing was reported as missing by the residents to her, she would look for the clothes and if she could not find it, she would let the resident know she had not found the clothes. Laundry Aide K said she was not told if something was not found she needed to report it. Laundry Aide K said it was important for the residents clothing to be returned to them because that was the only thing they had, and they could not go to the store and get more. During an interview on 04/09/2025 at 3:33 PM, the Housekeeping/Laundry Supervisor said there were not that many clothes that were lost in the fire. The Housekeeping/Laundry Supervisor said when the fire occurred the only thing in the laundry were the dirties. The Housekeeping/Laundry Supervisor said she was aware some of the clothes were burned, but not all of it. The Housekeeping/Laundry Supervisor said Resident #3 lost some underwear. The Housekeeping/Laundry Supervisor said nobody had her to write a grievance, but she believed one was done. The Housekeeping/Laundry Supervisor said Resident #13 had been missing some sky blue pants for months, and they had searched everywhere for the pants, and she had no idea where they went. The Housekeeping/Laundry Supervisor said she had not been told to write a grievance when clothes were reported missing to her. The Housekeeping/Laundry Supervisor said if she received a grievance that clothes were missing, she would go look for it and if she was unable to find it in the laundry she would check the residents' rooms. The Housekeeping/Laundry Supervisor said she notified the Administrator, the nurses and the CNAs when clothing was missing. The Housekeeping/Laundry Supervisor said it was important for the residents clothing to be returned to them because it could affect them financially and emotionally. During an interview on 04/10/2025 at 11:14 AM, the Administrator said there were no clothes in the laundry when the fire happened. The Administrator said nobody had reported to him Resident #3 was missing underwear. The Administrator said if clothes were reported missing the Housekeeping/Laundry Supervisor would be notified and a search would be conducted to see if the clothes was in another resident's room. If the item was not found immediately a grievance would be completed. Any of the staff could complete a grievance for missing clothes. The Administrator said the staff should be aware they can complete a grievance. The Administrator said the Social Worker was responsible for the grievances. The Administrator said Resident #13 had not reported to him that she was missing any pants. The Administrator said it was important for a grievance to be filed for missing clothing because the residents could get upset and it would affect their psychological well-being. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675668 If continuation sheet Page 6 of 21 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 675668 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Mineola 320 Greenville Highway Mineola, TX 75773 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 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on 04/15/2025 at 11:37 AM, the Social Worker said she was responsible for the grievances. The Social Worker said if she was made aware of a grievance, she wrote it up. The Social Worker said after a grievance was written, she put it on her log, and notified the department head the grievance belonged to. The Social Worker said for missing clothes the grievance went to the Housekeeping/Laundry Supervisor. The Social Worker said she kept a copy of the grievances to follow up on them. The Social Worker said the problem was when things were not conveyed to her and any of the staff could write a grievance, but it did not happen. The Social Worker said she was not told about Resident #3's underwear or Resident #13's pants. The Social Worker said any grievance was important to be addressed for the resident's peace of mind for them to know that they were taken seriously. The Social Worker said it was important for the residents' clothes to be returned to them because it was theirs and it could make the residents upset. Record review of the grievances from September 2024-April 2025 did not indicate any grievances for Resident #3 or Resident #13. Record review of the facility's policy titled, Grievances, Recording and Investigating, revised 01/12/2023, indicated, All grievances filed with the facility will be investigated and corrective actions will be taken to resolve the grievance(s). 1. The facility will make information on how to file a grievance available to residents, family, and staff .The Administrator or designee will record and maintain all grievances in the Grievance Log. 5. The Resident Grievance Form will be filed with the Administrator or designee and the resolution will be identified within three (3) working days of the concern. 6. The resident, or person acting on behalf of the resident, will be informed of the findings of the investigation, as well as any corrective actions recommended, within 3 working days of the filing of the grievance . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675668 If continuation sheet Page 7 of 21 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 675668 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Mineola 320 Greenville Highway Mineola, TX 75773 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 8. Record review of a face sheet dated 04/09/2025 indicated Resident #6 was a [AGE] year-old male initially admitted to the facility on [DATE] and re-admitted on [DATE] with diagnoses which included diffuse traumatic brain injury with loss of consciousness (injury to the brain which results in loss of consciousness), bipolar disorder (a disorder associated with episodes of mood swings ranging from depression lows to manic highs), and schizophrenia (mental disorder characterized by delusions, hallucinations, disorganized thoughts, speech and behavior). Record review of the Comprehensive MDS assessment dated [DATE] indicated Resident #6 was understood and understood others. The MDS assessment indicated Resident #6 had a BIMS of 15, which indicated his cognition was intact. The MDS assessment indicated Resident #6 required substantial/maximal assistance with personal hygiene, supervision with bathing/showering, and he was independent with eating, toileting and dressing. The MDS assessment indicated Resident #6 did not exhibit physical or verbal behavioral symptoms towards others. Record review of Resident #6's Physician Order Report dated 03/09/2025-04/09/2025 indicated, May provide psychiatric and psychological services with a start date of 08/03/2023. Risperidone (used to treat mood disorders) 2 mg twice a day with a start date of 02/03/2023. Bupropion hydrochloride (used to treat depression) 100 mg twice a day with a start date of 10/10/2024. Lorazepam (medication used to treat anxiety) 0.5 mg twice a day. Record review of Resident #6's care plan revised 02/07/2025 indicated resident was struck on the head by another male resident during an argument with a goal of resident will be free from harm over the next 90 days and approaches for an assessment, neurological checks (evaluation to detect impairments in the nervous system), and a social worker consult. Record review of Resident #6's progress note dated 01/01/2025 indicated, This nurse heard screaming/cursing coming from Resident #9's room. Upon entering room noted Resident #6 sitting in wheelchair at the foot of bed and Resident #5 near the head of Resident #9's bed. As Resident #9 was resting in her bed. Both men were shouting/cursing at each other. CNA E came through bathroom and escorted Resident #5 out of room and into hallway. Resident #6 exited room in wheelchair upon entering hallway Resident#5 came from behind and hit Resident #6 3 times. Once in the left temple, then on left side of jaw, and again left back of head. Several staff members broke men apart. Resident #6 then self-propelled wheelchair to his friend's room. This nurse and another nurse, LVN P assessed Resident #6 with no visible injuries noted: No swelling, no broken skin, and no bleeding noted. Resident #6 did not hit Resident #5 at any time. Neuros initiated. Resident #6 refusing to go to ER for evaluation. Denies pain. Will continue to observe and provide care signed by LVN A. 9. Record review of a face sheet dated 04/09/2025 indicated Resident #5 was a [AGE] year-old male initially admitted to the facility on [DATE] and re-admitted on [DATE] with diagnoses which included traumatic cerebral edema with loss of consciousness (swelling of the brain), bipolar disorder (a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675668 If continuation sheet Page 8 of 21 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 675668 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Mineola 320 Greenville Highway Mineola, TX 75773 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some disorder associated with episodes of mood swings ranging from depression lows to manic highs), and schizoaffective disorder bipolar type (a condition that can make you feel detached from reality and can affect our mood). Record review of the Comprehensive MDS assessment dated [DATE] indicated Resident #5 was usually understood and usually understood others. The MDS assessment indicated Resident #5 had a BIMS score of 12, which indicated his cognition was moderately impaired. The MDS assessment indicated Resident #5 required supervision or touching assistance with showering/bathing, setup or clean-up assistance with eating, oral and personal hygiene, and was independent with dressing and toileting. The MDS assessment indicated Resident #5 did not exhibit physical or verbal behavioral symptoms towards others. Record review of Resident #5's Physician Order Report dated 03/09/2025-04/09/2025 indicated, May provide psychological and psychiatric services with a start date of 08/03/2023. Seroquel (medication used to treat mood disorders) 50 mg twice a day with a start date of 02/03/2023. Risperdal (medication used to treat mood disorders) 0.5 mg once a day with a start date of 04/17/2024. Record review of Resident #5's care plan revised 03/13/2025 indicated he was involved in a verbal argument with another resident, became angry, and hit the other residents on the head 3 times. The goal for Resident #5 was for him to refrain from acts of aggression towards others over the next 90 days, and the approaches included for an assessment, for psych to assess, and for the social worker to assess. Record review of Resident #5's progress notes dated 01/01/2025 indicated, This nurse heard screaming/cursing coming from Resident #9's room. Upon entering room noted Resident #6 sitting in wheelchair at the foot of bed and Resident #5 near the head of Resident #9's bed. As Resident #9 was resting in her bed. Both men were shouting/cursing at each other. CNA E came through bathroom and escorted Resident #5 out of room and into hallway. Resident #6 exited room in wheelchair upon entering hallway Resident#5 came from behind and hit Resident #6 3 times. Once in the left temple, then on left side of jaw, and again left back of head. Several staff members broke men apart. Resident #6 then self-propelled wheelchair to his friend's room. This nurse and another nurse, LVN P assessed Resident #6 with no visible injuries noted: No swelling, no broken skin, and no bleeding noted. Resident #6 did not hit Resident #5 at any time. Neuros initiated. Resident #6 refusing to go to ER for evaluation. Denies pain. Will continue to observe and provide care. Altercation occurred between this resident and another male resident. RP, NP, Administrator and DON notified. Police notified. Self- report filed with HHSC. Signed by the DON. Spoke to patient about going via EMS to hospital for a psych evaluation. Patient stated he would refuse to go even after talking to him about the benefits of him going. NP contacted. Received telephone order to give Ativan 1mg po NOW then do every 15 minute checks until a psych eval can be done. Signed by LVN V. Record review of the Provider Investigation Report incident date 01/01/2025 indicated, Resident #5 and Resident #6 were vising another resident when verbal altercation occurred then physical (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675668 If continuation sheet Page 9 of 21 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 675668 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Mineola 320 Greenville Highway Mineola, TX 75773 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some altercation with Resident #5 striking Resident #6 in the back of the head twice and once in the left temple area. The Police Department contacted, no charges were filed, and officer told Resident #5 to go pray about the situation. Resident #6 states it wasn't nothing he didn't hit me hard and we have talked since he is apologetic, we are still bro's Residents separated, physician notified, no new orders for Resident #6, Resident #5 order for Ativan. Resident placed on Q15 minute checks, no other issues, families notified, Safe surveys conducted, no other issues identified, Psychological referral sent, Neurological Checks performed nothing noted. LVN P did skin assessment, nothing noted, Social Services did emotional assessment no signs or symptoms or adverse effects. Interview with Resident #5 and Resident #6 both say it was nothing and it was stupid, Therefore we are unconfirming the allegation of abuse. Record review completed of Resident #5's psychological and psychiatry referral dated 01/02/2025. Record review completed of Resident #5's every 15-minute checks dated 01/01/2025-01/03-2025. Record review completed of the neurological checks completed for Resident #6 dated 01/01/2025-01/02/2025. Record review of Safe Surveys completed January 2025 with no issues. Record review completed of the in-service sign in sheet with topic, Abuse, regarding the Abuse Prevention Program, instructor the Administrator, dated 01/08/2025, indicated 15 staff signatures. During an interview on 04/08/2025 at 3:49 PM, Resident #5 said he had got into it with Resident #6, and he did not even know why. Resident #5 said he told Resident #6 what wrong with your friend, and Resident #6 told him what's going on with my friend. Resident #5 said they started fussing and fighting, and then CNA E (he thought was her name) grabbed him and took him to the other side of the bathroom. Resident #5 said he then went on the other side and started swinging. Resident #5 said he was mad, and CNA E was trying to calm him down, and he started crying. Resident #5 said he was taken to his room, and he got on his knees and started praying. Resident #5 said the police went to him and asked if he was okay. Resident #5 said he hit Resident #6, but he did not remember where he hit him. Resident #5 said he just remembered he swung at Resident #6. Resident #5 said Resident #6 was mad. Resident #5 said everything was all right and they have been cool. During an interview on 04/08/2025 at 5:55 PM, LVN A said Resident #5 was in Resident #9's room and Resident #6 had gone into the room, and then she heard a bunch of screaming and hollering and the CNAs and MA (she could not remember their names) went in through the other room (residents' rooms are connected by a shared bathroom) to get Resident #5. Resident #5 was removed from Resident #9's room through the shared bathroom. LVN A said she was trying to calm down Resident #6, and Resident #6 exited the room. When Resident #6 exited the room into the hallway, Resident #5 came up from behind and hit Resident #6 on his face. LVN A said CNA F attempted to break the residents up and was thrown and fell, and then the residents were separated. LVN A said Resident #6 did not have any injuries, and he was actually kind of laughing about it. LVN A said Resident #6 did not have any redness to his face or anything. LVN A said she notified the DON, ADON, and the Administrator. LVN A said neurological checks were conducted on Resident #6 and there were no abnormalities. LVN A said Resident #6 refused to go to the ER for evaluation. LVN A said Resident #5 and Resident #6 had not been in any altercations before, and they had not been involved in more altercations. LVN A was able to correctly identify the types of abuse, what steps to take if she witnessed abuse, and the abuse coordinator. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675668 If continuation sheet Page 10 of 21 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 675668 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Mineola 320 Greenville Highway Mineola, TX 75773 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During an interview on 04/08/2025 at 6:02 PM, Resident #6 said, everything is alright, and did not want to answer any further questions. During an interview on 04/08/2025 at6:04 PM, MA B said Resident #5 and Resident #6 were in Resident #9's room, and they were cursing. MA B said CNA E went into the room from the bathroom to get Resident #5 out of the room, and on his way out of the room Resident #5 picked up a pillow and threw it at Resident #6. MA B said Resident #5 was dragging both of them as they were trying to separate the residents. MA B said Resident #5 managed to get away from them and hit Resident #6 twice as hard as he could, and they were trying to break them up. MA B said there was a lot of cursing but Resident #6 did not retaliate. MA B said she had never seen Resident #5 act like that. MA B said she had not seen any injuries to Resident #6. MA B was able to correctly identify the types of abuse, what steps to take if abuse was witnessed, and who to report to. During an interview on 04/09/2025 at 1:04 PM, CNA E said she heard Resident #5 screaming in Resident #9's room, and Resident #5 and Resident #6 started getting heated. CNA E said they were screaming at each other, and they tried to separate them. CNA E said Resident #9 was not involved in the altercation. CNA E said the place where Resident #5 was standing in the room was close to the bathroom, so they pulled Resident # 5 out of the room through the bathroom to the hallway. CNA E said she thought they had gotten them separated when she brought Resident #5 out of the room, but Resident #5 ran away from her and MA B and hit Resident #6. CNA E said they got Resident #5 away and the police arrived. CNA E said Resident #5 hit Resident #6 on his left shoulder. CNA E said from the angle she was at it appeared to be Resident #6's shoulder. CNA E said CNA G, CNA F, LVN A, LVN P, and the ADON were the staff that attempted to intervene during the altercation. During an interview on 04/09/2025 at 1:22 PM, CNA F said he heard a lot of shouting, so he went to check, and it was Resident #5 and Resident #6 arguing. CNA F said it started inside the room and then continued into the hallway. CNA F said he tried to intervene and get in the middle of Resident #5 and Resident #6, but he got knocked down and was unable to intervene. CNA F said Resident #5 hit Resident #6 on the side of his head. CNA F said every month they were in-serviced on abuse. CNA F was able to correctly identify abuse, what to do if he witnessed abuse, and who to report to. During an interview on 04/09/2025 at 1:40 PM, CNA G said she heard Resident #5 and Resident #6 arguing in Resident #9's room. CNA G said she went in the room and separated them. CNA G said she got in front of Resident #6 and Resident #5 threw a pillow at Resident #6. CNA G said someone took Resident #5 through the bathroom and out of the room, and then she got Resident #6 out of the room into the hallway. Resident #5 came out of the other door and went and punched Resident #6. CNA G said when Resident #5 and Resident #6 were in the hallway CNA F tried to separate them, but he got knocked down. Resident #5 punched Resident #6 in the jaw. CNA G said she did not see any redness, bleeding, or any injuries. Resident #6 did not complain of pain. Resident #6 said Resident #5 hit like a wuss. CNA G said that was the first time she had seen Resident #5 do anything like that. CNA G said the ADON called the police. CNA G was able to identify the types of abuse, what to do if she witnessed abuse, and who to report to. 10. Record review of an undated face sheet indicated Resident #14 was a [AGE] year-old female initially admitted to the facility on [DATE] and re-admitted on [DATE] with diagnoses which included focal traumatic brain injury (injury to the brain) and schizoaffective disorder bipolar type (a condition that can make you feel detached from reality with mood swings). Record review of the Comprehensive MDS assessment dated [DATE] indicated Resident #14 was usually (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675668 If continuation sheet Page 11 of 21 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 675668 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Mineola 320 Greenville Highway Mineola, TX 75773 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some understood and usually understood others. The MDS assessment indicated Resident #14 had a BIMS score of 15, which indicated her cognition was intact. The MDS assessment indicated Resident #14 required substantial/maximal assistance with showering/bathing, dressing, and personal hygiene. The MDS assessment indicated Resident #14 did not exhibit physical or verbal behavioral symptoms towards others. Record review of Resident #14's care plan with a problem date of 12/08/2024 indicated Resident was propelling her wheelchair down the hallway and ran into a male resident who was sitting in his wheelchair at the nurse's station. She did not apologize to him. Instead, she told the other resident to get out of her way and laughed about running into his wheelchair. The goal was for the resident to refrain from aggressive behavior over the next 90 days. The approach was the resident was redirected by staff, resident with chronic behavioral issues, psychological services and NP notified of incident and medications were reviewed staff to continue to redirect as needed. Record review of Resident #14's orders dated 03/15/2025-04/15/2025 indicated, May provide psychological services and may provide psychiatric services with a start date of 08/03/2023. Lorazepam (anxiety medication) 0.5 mg every 8 hours with a start date of 10/03/2024. Fluoxetine (medication for depression) 20 mg 2 capsules once a day with a start date of 10/10/2024. Seroquel (medication to treat mood disorders) 150 mg take twice a day with a start date of 12/18/2024. Depakote sprinkles (used to treat mood disorders) 625 mg twice a day with a start date of 01/23/2025. 11. Record review of a face sheet dated 04/09/2025 indicated Resident #3 was a [AGE] year-old male initially admitted to the facility on [DATE] and re-admitted on 04/08//2024 with diagnoses which included dementia unspecified severity without behavioral disturbance, psychotic disturbance, mood disturbance (loss of memory, language, problem solving and other thinking abilities that were severe enough to interfere with daily life without behaviors), and anxiety and chronic obstructive pulmonary disease (chronic inflammatory lung condition that affects the respiratory system). Record review of the Quarterly MDS assessment dated [DATE] indicated Resident #3 understood others and was understood. The MDS assessment indicated Resident #3 had a BIMS score of 15, which indicated his cognition was intact. The MDS assessment indicated Resident #3 was independent for eating, required setup or clean-up assistance with toileting, dressing, and personal hygiene and partial to moderate assistance with showering/bathing self. The MDS assessment indicated Resident #3 did not exhibit physical or verbal behavioral symptoms towards others. Record review of Resident #3's Physician Order Report dated 03/09/2025-04/09/2025 indicated, May provide psychological and psychiatric services with a start date of 08/03/2023. Record review of Resident #3's care plan revised 04/08/2025 indicated he was involved in an altercation with another male resident, lost his temper, and hit the resident. Resident #3's right hand was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675668 If continuation sheet Page 12 of 21 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 675668 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Mineola 320 Greenville Highway Mineola, TX 75773 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 0600 Level of Harm - Minimal harm or potential for actual harm bruised and swollen. The goal for Resident #3 was for him to be free of altercations with other resident and for his injured right had to be healed within the next 90 days. The approach for Resident #3 was for the resident to be assisted back to his room for assessment, an x-ray of his right hand was done to rule out fracture, and resident was referred to social services to discuss incident. Residents Affected - Some Record review of Resident #3's progress notes indicated, 12/08/2024 5:47 PM Resident #3 was in the hall and Resident #14 ran over the patient with her wheelchair then laughed about it. She went down to cafeteria and Resident #3 came down there and she started screaming and cussing at him and then Resident #4 started screaming and cussing at him. Resident #4 then proceeded to spit in Resident #3's face and call him a bitch twice and Resident #3 then struck the patient in the back of the head causing a knot. Neuro and vitals were normal. Resident #4 stated he was not hurt. We assessed him and did first aid. Resident #3 then assessed, and he stated he was fine. We separated the two and then I called the DON to inform her so that she could take appropriate measures since this was an altercation. She stated she would contact administrator signed by LVN U. 12/09/2024 5:45 AM bruising noted to right hand from altercation with another resident signed by LVN W. 12/09/2024 8:00 AM bruising to right hand from previous altercation new order for x-ray of the right hand, resident denies any pain/discomfort signed by LVN P. 12/10/2024 12:31 PM, x-ray of right hand is negative for fracture signed by DON. Record review of Resident #3's x-ray of his right hand dated 12/9/2024 indicated no acute fracture or dislocation. 12. Record review of a face sheet dated 04/10/2025 indicated Resident # 4 was a [AGE] year-old male initially admitted to the facility on [DATE] and re-admitted on [DATE] with diagnoses which included hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side (weakness and paralysis of one site of the body following a stroke). Record review of the Comprehensive MDS assessment dated [DATE] indicated Resident #4 was understood and understood others. The MDS assessment indicated #4 had a BIMS score of 15, which indicated his cognition was intact. The MDS assessment indicated Resident #4 required setup or clean-up assistance with eating and substantial/maximal assistance with toileting, showering/bathing, and personal hygiene. The MDS assessment indicated Resident #4 did not exhibit physical or verbal behavioral symptoms towards others. Record review of Resident #4's care plan revised 01/30/2025 indicated he was in an altercation with another male resident in the dining room. The goal for Resident #4 was for him to refrain from altercations with other residents over the next 90 days. The approach was residents separated, resident assessed and received redirection by nurse, staff to continue to supervise and redirect as needed, and notified psychological services and the NP of the incident. Record review of Resident #4's Physician Order Report dated 03/09/2025-04/09/2025 indicated, Psychiatric and psychological services to evaluate and treat as needed with a start date of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675668 If continuation sheet Page 13 of 21 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 675668 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Mineola 320 Greenville Highway Mineola, TX 75773 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 0600 03/25/2021. Level of Harm - Minimal harm or potential for actual harm Record review of Resident #4's progress notes indicated, Residents Affected - Some 12/08/2024 5:39 PM, An altercation occurred in the dining room when resident accused another male resident of running his wheelchair over his friend's foot. He called the other male resident a punk ass bitch and spat in his face twice. The other resident responded by hitting him on the back of his head. Residents were separated and assessed for injury. NP and RP notified. Administrator notified. Signed by the DON. 12/09/2024 5:47 AM, Resident awake, alert. Raised bump noted to back of residents head from altercation with another resident. Denies pain or discomfort signed by the DON. Record review of the Provider Investigation Report dated 12/08/2024 indicated, Resident #14 was wheeling her wheelchair backwards down the hall too fast and ran her wheelchair into Resident #3, Resident #3 asked Resident #14 to slow down, Resident #14 got mad then went and told Resident #4 that Resident #3 ran over her foot, Resident #4 then approached Resident #3 in the dining room and cursed him and spit in his face twice, resident #3 retaliated by hitting Resident #4 in the back of the head. The residents were separated charge nurse did skin assessment on Resident #3 and Resident #4. Resident #4 had a knot on back of head, said he wasn't hurt. Neuros were normal, Resident #3 also stated he wasn't hurt but had some delayed bruising to right hand. The facility is unconfirming the allegation of abuse. Record review of Safe Surveys completed December 2024 indicated no issues. Record review of an in-service sign in sheet with the topic Abuse, regarding the Abuse Prevention Program, instructor the Administrator, date in-service initiated 12/13/2024 indicated 13 staff signatures. During an interview on 04/08/2025 at 11:17 AM, LVN U said Resident #14 backs her wheelchair everywhere she went (travels in reverse), and the day of the incident between Resident #3 and Resident #4 (12/08/2024) Resident #14 came flying down the hall and hit Resident #3. Resident #14 started cussing at Resident #3, and Resident #3 told her she need to stop because she ran over people. Resident #14 ended up going to the dining room, and then Resident #3 went to dining room to get coffee. Resident #14 had told Resident #4 what had happened with Resident #3. Resident #4 confronted Resident #3 and started cussing at him. LVN U said she did not witness when Resident #3 hit Resident #4, but she had assessed the residents after the incident. LVN U said she tried to deescalate and tell Resident #14 she needed to watch where she was going. LVN U said she told Resident #3 they would educate Resident #14 on going down the hall. LVN U said Resident #14 always went in reverse, but she was better about being more careful because it had caused so many issues. LVN U said Resident #14 had behaviors and they were working on her behaviors with the psychiatrist that went to visit her, and they had adjusted her medication. LVN U said Resident #4 had a bump to the back of his head after the incident, and Resident #3's hand was swollen. LVN U said they had obtained an x-ray of Resident #3's hand and the x-ray was negative. LVN U said the following day after the incident Resident #3 and Resident #4 were chit chatting like nothing had happened. During an interview on 04/08/2025 at 11:28 AM, Resident #3 said he and Resident #4 had an argument. Resident #3 said Resident #4 spit in my face and I hit him. Resident #3 said they had apologized to each other and we are good now. Resident #3 said he felt safe in the facility. Resident #3 said (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675668 If continuation sheet Page 14 of 21 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 675668 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Mineola 320 Greenville Highway Mineola, TX 75773 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some after he hit Resident #4 his knuckles had swollen up and were bruised a little bit, but they were fine now. Resident #3 said that he was aware Resident #4 did not have any injuries. During an interview on 04/08/2025 at 3:23 PM, Resident #4 said he had gotten into an argument with Resident #3 because he was trying to take up for Resident #14. Resident #4 said Resident #3 came up from behind me from nowhere and hit me on my head 5-6 times, but he didn't hit me hard. Resident #4 denied any injuries. Resident #4 said they were fine now, and they talked every day. During an interview on 04/08/2025 at 3:30 PM, Resident #14 said Resident #3 said to Resident #4 I'm going to kick your ass. Resident #14 said she did not remember everything that happened. Resident #14 said sometimes she accidentally ran into people while she was in her wheelchair. During an interview on 04/09/2025 at 8:54 AM, the Regional Nurse Consultant said the DON would not be at the facility and she would not be available for interview. During an attempted phone interview on 04/09/2025 at 08:59 AM, LVN V did not answer the phone. During an attempted phone interview on 04/09/2025 at 09:01 AM, LVN P did not answer the phone. During an interview on 04/09/2025 at 2:04 PM, the Social Worker said she was not in the facility when the incident between Resident #5 and Resident #6 happened, and she had not witnessed the incident between Resident #3 and Resident #4. The Social Worker said she had done emotional assessments on the residents after the incidents and there were no issues. The Social Worker said after a resident was involved in any incidents, she checked on them to make sure they were ok, and made referrals as needed. The Social Worker said Resident #5 was already receiving psychological services, but she had sent a referral for him to be seen again. During an interview on 04/09/2025 at 2:28 PM, the ADON said when Resident #5 and Resident #6 got into an altercation she was notified by the staff and when she was going down the hallway there were staff already there and Resident #5 was coming out of the room into the hallway and went and hit Resident #6. The ADON said Resident #5 hit Resident #6 on the face, but she could not remember on what side. The ADON said the police were called and Resident #6 did not want to file charges. The ADON said Resident #5 and Resident #6 did not have a history of aggression. The ADON said she was not in the facility when the altercation between Resident #3 and Resident #4 occurred. The ADON said Resident #3 and Resident #4 did not have a history of aggression. The ADON said they provided ongoing education to the staff on what abuse and neglect was, and if they had any doubts, they should notify a supervisor. The ADON said the Administrator was the abuse coordinator. The ADON said when allegations of abuse were made the staff was suspended, questioned, and the incident investigated. The ADON said the staff was educated to be proactive to prevent resident to resident altercations by redirecting the residents and keeping them busy. The ADON said if a resident did not get along with another resident, they kept them separated and respected the residents likes and dislikes. During an attempted phone interview on 04/10/2025 at 10:31 AM, LVN P did not answer the phone. During an attempted phone interview on 04/10/2025 at 10:36 AM, LVN V did not answer the phone. During an interview on 04/10/2025 at 11:01 AM, the Administrator said when Resident #3 and Resident #4 were in an altercation, Resident #3 had delayed bruising to his right hand and Resident # 4 had a knot on the back of his head. The Administrator said the residents were separated and placed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675668 If continuation sheet Page 15 of 21 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 675668 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Mineola 320 Greenville Highway Mineola, TX 75773 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some within eyesight and the family and physician was notified. The Administrator said he reported it to the state and psychological services was contacted. The Administrator said Resident #5 hit Resident #6, but there were no injuries. The Administrator said the residents were separated and Resident #5 was placed on 15 minutes checks and a referral to psychological services was made for evaluation. The Administrator said when a resident to resident altercation occurred they separated the residents and put them on checks and with any type of abuse they did safe surveys with the residents, depending on the resident they referred to psychological services for the doctor to review, in-services were conducted, the appropriate parties were notified, they investigated, took it for the quality assessment and assurance to review, they assessed for injuries and if staff were involved staff was suspended. Record review of the facility's policy titled, Abuse Prevention Program, revised 01/09/2023, indicated Our residents have the right to be free from abuse, neglect, misappropriation of resident property and exploitation. This includes but was not limited to freedom from corporal punishment, involuntary seclusion, verbal, mental, sexual, or physical abuse, and physical or chemical restraint not required to treat the resident's symptoms. Record review of the facility's policy titled, Abuse, Neglect, and Exploitation, revised 10/2023, indicated, .The facility will implement policies and procedures to prevent and prohibit all types of abuse, neglect, misappropriation of resident property, and exploitation that achieves .The identification, ongoing assessment, care planning for appropriate interventions, and monitoring of residents with needs and behaviors which might lead to conflict or neglect; E. Ensuring the health and safety of each resident regarding visitors such as family members or resident representatives, friends, or other individuals subject to the resident's right to deny or withdraw consent at any time and to reasonable clinical and safety restrictions .The facility will have written procedures to assist staff in identifying the different types of abuse - mental/verbal abuse, sexual abuse, physical abuse, and the deprivation by an individual of goods and services. This includes staff to resident abuse and certain resident to resident altercations .Possible indicators of abuse include but are not limited to 1. Resident, staff, or family report of abuse .Verbal abuse of a resid[TRUNCATED] FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675668 If continuation sheet Page 16 of 21 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 675668 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Mineola 320 Greenville Highway Mineola, TX 75773 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 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. 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 a resident who is unable to carry out activities of daily living receives the necessary services to maintain grooming and personal hygiene for 1 of 10 residents reviewed for ADLs. (Resident #35) Residents Affected - Few The facility failed to ensure Resident #12 received his shower as scheduled. This failure could place residents at risk of not receiving services/care, decreased quality of life, and decreased self-esteem. Findings included: Record review of Resident #12's face sheet dated 04/10/25, indicated an [AGE] year-old male who initially admitted to the facility on [DATE] and readmitted on [DATE]. Resident #12 had diagnoses of myocardial infarction (heart attack), essential hypertension (high blood pressure), muscle weakness, and chronic obstructive pulmonary disease (a group of lung diseases that block airflow and make it difficult to breathe). Record review of Resident #12's quarterly MDS assessment dated [DATE], indicated he was able to make himself understood and understood others. The MDS assessment indicated Resident #12 had a BIMS score of 15, which indicated his cognition was intact. Resident #12 did not refuse care and was independent with showers/baths. Record review of Resident #12's comprehensive care plan revised 04/09/25 indicated he had an ADL function/rehabilitation potential, at risk for further decline, and a failure to have needs met related to ADL self-performance deficit. The care plan interventions indicated he required bathing/hygiene assist x 1. The care plan also indicated Resident #12 needed assistance with ADLs with interventions he preferred to have his bath/shower on Tuesday, Thursday, Saturday by hall aide between 6:00 AM- 6:00 PM. Record review Resident #12's point of history report dated 04/01/25-04/09/25, indicated Resident #12 preferred to have his showers/baths on Tuesday, Thursday, Saturday between 6:00 AM - 6:00 PM. The report revealed the following: 04/01/25 shower was not provided. 04/02/25 shower completed at 3:26 AM by CNA DD. 04/03/25 shower completed at 2:31 AM by CNA Y. 04/04/25 shower completed at 2:05 PM by CNA CC. 04/05/25 shower completed at 2:20 AM by CNA AA, 4:31 PM by CNA BB and 10:03 PM by CNA Z. 04/06/25 shower completed at 8:23 AM and 8:21 PM by CNA Z. 04/07/25 shower completed at 11:39 AM by CNA D and 11:01 PM by CNA Y. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675668 If continuation sheet Page 17 of 21 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 675668 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Mineola 320 Greenville Highway Mineola, TX 75773 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 0677 04/08/25 shower completed at 11:45 AM by CNA D. Level of Harm - Minimal harm or potential for actual harm During an observation and interview on 04/08/25 at 10:30 AM Resident #12 was in his bed. He said he had not received a shower in over a week. He said his showers were scheduled for Tuesday, Thursday, Saturday. He said it made him feel bad not receiving his showers regularly. Residents Affected - Few During an interview on 04/09/25 at 11:35 AM, Resident #12 said he did not receive a shower yesterday (04/08/25). During an interview 04/09/25 at 11:43 AM, CNA D said she worked from 6a-6p on 04/08/25 and was assigned to Resident #12. CNA D said she did not give Resident #12 a shower on 04/08/25 because she did not have time. CNA D said she was busy answering call lights and residents needing this or that. CNA D said the last time she saw resident receive a shower was on Thursday of last week (04/03/25). CNA D said the CNAs were responsible for ensuring the residents received their showers as scheduled. She said failure to provide showers would place the residents at risk for skin breakdown and health issues. During an interview on 04/09/25 at 1:11 PM, CNA E said Resident #12's showers were scheduled on Tuesday, Thursday, and Saturday. CNA E said Resident #12 did not refuse his showers. CNA E said Resident #12 was usually assigned to her. CNA E said the last time she remembered Resident #12 receiving a shower was on Tuesday of last week (04/01/25). CNA E said she was off for a week after that. CNA E said CNAs and nurses were responsible for ensuring the residents received their showers as scheduled. She said failure to provide showers would place the residents at risk for wounds and infections. During an interview on 04/09/25 at 2:33 PM, the ADON said the shower documentation comes up daily for the aides to document and they were consistently telling them to please read what they were documenting. The ADON said the point of care documentation was monitored daily during their morning meeting and for the most part was accurate. The ADON said she has reminded the nurses to document any refusals . The ADON said Resident #12 was not one who refused his showers. The ADON said the CNAs were responsible for ensuring the residents received their showers as scheduled. She said failure to provide showers would place the residents at risk for skin issues. During an interview on 04/09/24 at 2:49 PM, the Administrator said he expected showers/baths to be provided as per the resident's preference. He said the charge nurse, DON or designee were responsible for ensuring the residents received their showers/baths. The Administrator said failure to provide showers/baths placed the resident at risk for smells. Record review of the facility's policy Bath, Shower/Tub revised February 2018, indicated . The purposes of this procedure are to promote cleanliness, provide comfort to the resident and to observe the condition of the resident's skin . Record review of the facility's policy Activities of daily Living, ADLs, Supporting revised March 2018, indicated . Residents will provided with care, treatment and services as appropriate to maintain or improve their ability to carry out activities of daily living (ADLs). Residents who are unable to carry out activities of daily living independently will receive the services necessary to maintain good nutrition, grooming and personal and oral hygiene . 2. Appropriate care and services will be provided for residents who are unable to carry out ADLs independently, with the consent of the resident and in accordance with the plan of care, including appropriate support and assistance with: a. Hygiene (bathing, dressing, grooming, and oral care) . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675668 If continuation sheet Page 18 of 21 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 675668 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Mineola 320 Greenville Highway Mineola, TX 75773 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 0925 Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to maintain an effective pest control program to keep the facility free from pests for 4 of 18 (Resident #3 Resident #4, Resident #9 and Resident #14) residents reviewed for pest control. Residents Affected - Some The facility did not maintain an effective pest control program to ensure the facility was free of roaches and water bugs. This failure could place residents at risk for an unsanitary environment and a decreased quality of life. Findings included: 1. Record review of a face sheet dated 04/09/2025 indicated Resident #3 was a [AGE] year-old male initially admitted to the facility on [DATE] and re-admitted on 04/08//2024 with diagnoses which included dementia unspecified severity without behavioral disturbance, psychotic disturbance, mood disturbance (loss of memory, language, problem solving and other thinking abilities that were severe enough to interfere with daily life without behaviors), and anxiety and chronic obstructive pulmonary disease (chronic inflammatory lung condition that affects the respiratory system). Record review of the Quarterly MDS assessment dated [DATE] indicated Resident #3 understood others and was understood. The MDS assessment indicated Resident #3 had a BIMS score of 15, which indicated his cognition was intact. During an interview on 04/08/2025 at 11:28 AM, Resident #3 said there were roaches and water bugs in the dining room and rooms. Resident #3 said the last time he had seen them was about 2 days ago. Resident #3 said he saw the roaches and water bugs in the mornings around 6 am by the area where the coffee was served in the dining room when he went and turned the lights on. Resident #3 said he had reported it to the housekeepers, the CNAs, and the nurses. Resident #3 said they told him they would report it and get it taken care of. 2. Record review of a face sheet dated 04/10/2025 indicated Resident # 4 was a [AGE] year-old male initially admitted to the facility on [DATE] and re-admitted on [DATE] with diagnoses which included hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side (weakness and paralysis of one site of the body following a stroke). Record review of the Comprehensive MDS assessment dated [DATE] indicated Resident #4 was understood and understood others. The MDS assessment indicated #4 had a BIMS score of 15, which indicated his cognition was intact. During an interview on 04/08/2025 at 3:23 PM, Resident #4 said there were huge water bugs and a lot of cockroaches everywhere and in the dining room by the coffee. Resident #4 said he had to be careful when he went to get coffee to make sure there was not a roach in his cup. 3. Record review of an undated face sheet indicated Resident #14 was a [AGE] year-old female initially admitted to the facility on [DATE] and re-admitted on [DATE] with diagnoses which included focal traumatic brain injury (injury to the brain) and schizoaffective disorder bipolar type (a condition (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675668 If continuation sheet Page 19 of 21 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 675668 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Mineola 320 Greenville Highway Mineola, TX 75773 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 0925 that can make you feel detached from reality with mood swings). Level of Harm - Minimal harm or potential for actual harm Record review of the Comprehensive MDS assessment dated [DATE] indicated Resident #14 was usually understood and usually understood others. The MDS assessment indicated Resident #14 had a BIMS score of 15, which indicated her cognition was intact. Residents Affected - Some During an interview on 04/08/2025 at 3:30 PM, Resident #14 said she had seen water bugs and roaches in her room, and she had reported it to the staff. 4. Record review of Resident #9's face sheet dated 04/08/2025, indicated a [AGE] year-old female who initially admitted to the facility on [DATE] with diagnoses of cerebral ischemia (insufficient blood flow to the brain), dementia (memory loss), major depression (mental health disorder characterized by persistently depressed mood or loss of interest in activities, causing significant impairment in daily life), and anxiety. Record review of Resident #9's annual MDS assessment dated [DATE], indicated she was usually understood and usually understood others. The MDS assessment indicated Resident #9 had a BIMS score of 12, which indicated her cognition was moderately impaired. During an interview on 04/08/2025 at 3:40 PM, Resident #9 said when she turned the light on in her room and bathroom the big bugs come out. Resident #9 said the staff were aware of the bugs in her room. During an interview on 04/09/2025 at 1:04 PM, CNA E said she had noticed roaches in the shower room about 2 weeks ago. During an interview on 04/09/2025 at 1:22 PM, CNA F said there were gigantic water bugs and house roaches everywhere. CNA F said they got on the ceilings and the residents complained about them. CNA F said he had seen some today (04/09/2025). CNA F said he did not log it in the pest control binder but he verbally told the Maintenance Director. During an interview on 04/10/2025 at 8:48 AM, the Maintenance Director said the staff was supposed to write in the pest control binder if they saw anything. The Maintenance Director said he had told the staff to write in the binder, but when he went to check the binders the staff also verbally told him. The Maintenance Director said the staff reported to him that they saw water bugs, but for a while he had not hear anything about roaches. The Maintenance Director said he did not have all the visits from the pest control, but there were binders on the east and west side of the building where the pest control person signed when he went to the facility. The Maintenance Director said it was important for there not to be any roaches or water bugs because nobody wanted the bugs, and it was important for the quality of life of the residents. During an interview on 04/10/2025 at 9:37 AM, the Pest Control Technician said he last visited the facility on 03/26/2025 and was going to the facility twice a month. The Pest Control Technician said the facility had American roaches and water bugs, and they were coming out of the plumbing areas in the residents' rooms. He said the kitchen had German roaches, but the German roaches were almost resolved. During an interview on 04/10/2025 at 10:51 AM, Housekeeper M said she saw roaches on the unit today (04/10/2025), and she had reported it to her supervisor. Housekeeper M said it was important for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675668 If continuation sheet Page 20 of 21 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 675668 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Mineola 320 Greenville Highway Mineola, TX 75773 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 0925 there not to be any roaches because they could get in the residents' clothes or get in the bed with them. Level of Harm - Minimal harm or potential for actual harm During an interview on 04/10/2025 at 11:18 AM, the Administrator said they had switched pest control companies in December 2024, and the pest control company had been perfect. The Administrator said he was not aware that the residents and staff were still seeing roaches and water bugs. The Administrator said he expected for the staff to document in the pest control book if they saw any roaches and water bugs so the facility could be treated accordingly. The Administrator said the facility staff were responsible for monitoring for any pests, and they should be documenting in the pest control books. The Administrator said having roaches and water bugs could affect the residents because it was nasty and dirty. Residents Affected - Some Record review of the east and west pest control binders for the building did not indicate any facility staff entries for pests sighted. Record review of the facility's policy titled, Pest Control, revised May 2008, indicated, Our facility shall maintain an effective pest control program .Maintenance services assist, when appropriate and necessary, in providing pest control services . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675668 If continuation sheet Page 21 of 21