Health inspection·October 27, 2022

F 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure residents who are fed by enteral means received the appropriate treatment and services to prevent complications of enteral feeding for 1 of 2 residents (Resident #77) reviewed for gastrostomy tube management. The facility failed to ensure Resident #77's head was elevated at a minimum of 30-degree angle during enteral feeding ( a way to deliver food directly to the stomach) via gastrostomy tube (G-tube) (A tube directly inserted through the skin to the stomach to deliver nutrition). This failure could place residents who receive enteral feedings by G-tube at risk for injury, aspiration into the lungs ( fluid or food enter the lungs accidently), decreased quality of life, hospitalization and decline in health. Findings include: Record review of Resident #77's clinical record revealed a [AGE] year-old-male admitted to the facility on [DATE]. His diagnoses included hemiplegia and hemiparesis following a cerebral infarction (paralysis to one side of the body following a stroke), tracheostomy (a hole made into the trachea in the neck for breathing), chronic respiratory failure, gastrostomy status (feeding tube directly into the stomach for delivery of food/ nutrition), and tachycardia (rapid heartbeat). Record review of Resident #77's MDS dated [DATE] revealed, the resident's BIMS score was unable to be scored. The resident's cognitive skills for daily decision making was coded as severely impaired. Resident #77 was total dependent on one staff for bed mobility. Nutritional approach indicated Resident #77 required a feeding tube. Record review of Resident #77's October Physician Order Summary dated 09/23/2022, revealed Enteral Feeding every shift for strict aspiration precautions elevate head of bed at least 45 degrees during enteral feedings, water flushes, medication administration and one hour after any of these procedures. Record review of Resident #77's Care Plan date initiated 10/17/2022 revealed: Focus: Resident #77 required tube feeding; Goal: Resident #77 will be free of aspiration. Intervention: The resident needed the head of the bed elevated 30 degrees during and 30minute after tube feeding. (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 2 Event ID: 675789 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 675789 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/27/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Arden Wood 8810 Long Point Dr Houston, TX 77055 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)