Health inspection·February 1, 2024

F 0584 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Record review of Resident #2's admission Record, dated 01/30/24, revealed a [AGE] year-old female who was admitted to the facility on [DATE]. The resident's diagnoses included Parkinson's disease (brain disorder that causes involuntary movements), psychosis (conditions in the mind that results in difficulties determining what is real and what is not real), muscle weakness, lack of coordination, and cognitive communication deficit (difficulty with communication). Record review of Resident #2's Quarterly MDS assessment, dated 12/14/23, revealed a BIMS score of 0, indicating severe cognitive impairment. Record review of Resident #2's undated care plan revealed the following: resident had impaired cognitive function, ADL self-care performance deficit and required one-person supervision for transfers and one-person supervision as needed for bed mobility and walking. She had impaired thought processes, a communication problem related to neurological symptoms related to Parkinson's and dementia and was at risk for falls related to decreased safety awareness, gait/balance problems, impaired mobility, and psychoactive drug use. Observation on 01/30/24 at 7:38 a.m., revealed Resident #1 and Resident #2's bedroom door, located in the memory care unit, did not open when the state surveyor attempted to enter their bedroom. The state surveyor notified Nurse A and asked her if she could open the door. Nurse A went to the bedroom door an attempted to open the door but was unsuccessful. Nurse A called out to CNA A who walked over to the door and said she thought the bathroom door was wedged behind the bedroom door which was preventing it from opening. CNA A and Nurse A took turns knocking on the bedroom door and calling out for Resident #2 asking her to open the door. CNA A said Resident #1 was Spanish speaking and did not understand what they were saying. Nurse B went to the residents' door and attempted to open the door and called out for Resident #2 by name. CNA A, Nurse A, and Nurse B were unable to get the residents bedroom door open. The Floor Tech was notified, and he tried to get the door open but was unable. The Floor Tech left and returned shortly with a metal tool that he slid through the door and used to close the bathroom door. Resident #1 and #2's bedroom door was opened at approximately 7:50 a.m. Observation on 01/30/24 at 7:51 a.m., revealed Resident #2 appeared to be asleep in her bed an unaware of what happened. Resident #1 was lying in bed, awake, and unaware of what happened. In an interview on 01/30/24 at 8:35 a.m., CNA A said she had been working at the facility for approximately 20 years. She said she was working the 6:00 a.m. to 2:00 p.m. shift today and clocked in at approximately 6:30 a.m. She said she checked on Residents #1 and #2 at approximately 7:00 a.m. but when she went to open their bedroom door, she noticed the bathroom door was wedged behind the bedroom door preventing it from opening. She said she let Nurse A know the door would not open at approximately 7:05 a.m. She said Nurse A and she took turns trying to open the door. She said they also knocked on their bedroom door and called out to Resident #2 many times to open the door. She said Nurse A was also not able to open the door. She said the Floor Tech went and tried to open the door but could not get it to open. She said the Floor Tech went and got equipment to open the door and was able to get the residents bedroom door opened. She said she thinks Resident #2 went to the bathroom, left the restroom door open too far, and then went back to bed. She said if there was any type of emergency, she would not think twice and would go outside to the patio, break the windows, and climb in to get to them and/or get them out of the building. She said she believed it would take approximately 5 minutes for her to do this. She said Resident's #1 and #2 walked without assistance and did not use any assistive devices. She said this was the first time this happened and had not happened before to any other residents. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675789 If continuation sheet Page 2 of 13 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 02/01/2024 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)

F 0584 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few In an interview on 01/30/24 at 10:17 a.m., Nurse A said she had been working at the facility since October 2023. She said she was working the 6:00 a.m. to 2:00 p.m. shift today and arrived at the facility at approximately 6:20 a.m. She said she was at the nurse's station when CNA A told her that Resident #1 and #2's bedroom door would not open. She said she went to the bedroom door and tried to open it, but it would not open. She said she called Resident #2's name, and the resident said huh. She said she told Resident #2 to open the door many times, but she did not open the door. She said she told Nurse B that Resident #2's door would not open. She said she thought maybe something was caught on the door because when she pushed the door it would not open. She said she went to get the Maintenance Director but saw the Floor Tech when she was leaving the memory care unit. She said the Floor Tech called the Maintenance Director, and she told him that the bedroom door would not open when they tried to open it. She said the Maintenance Director told her to give the phone back to the Floor Tech so he could tell him what to do. She said when she gave the phone back to the floor Tech, he walked away and then came back with a tool and opened the door. She said if there was a medical emergency, she would call for another nurse, call 911, call the nursing director, run outside to the back where the residents' bedroom window was located, and break the window if needed, and try to attend to the patient to see what the emergency was . In an interview on 01/30/2024 at 11:12 a.m., the Maintenance Director said he had been working at the facility for approximately 3 years. He said he received a phone call this morning at approximately 7:52 a.m. from the Floor Tech. He said the Floor Tech told him that the restroom door and bedroom door to Resident #1 and 2's room were closed together and would not let the other one open. He said he told him he had to go to the closet and get a metal door opener to get the doors opened. He said this morning, when he received the phone call, was the first time he found out that the bathroom door was not working properly. He said all facility doors were checked monthly. He said in case of an emergency, they would call him, and he would instruct staff on what to do, and if needed he would go to the facility. He said the department heads and some of the facility staff submitted work orders through their online system. He said the other method was by writing a request in the maintenance log located at each nurse's station. He said the bathroom doors had a spring, not a pin, that need to be taken out and readjusted so the bathroom door would shut back on its own faster than the bedroom door opened . In an interview on 01/30/24 at 12:02 p.m., the Floor Tech said he had been working at the facility for approximately 2 years. He said the nurse (could not recall their name) told him Resident #1 and #2's bedroom door could not be opened. He said he called the Maintenance Director who told him to go get a metal tool from the closet located outside. He said he used the metal tool to get the door to open. He said today was the first time he was told that the bathroom door was not working properly . In an interview on 01/30/23 at 4:11 p.m., the Administrator said she had been working at the facility since 12/15/23. She said to her knowledge this type of incident had not happened in the past. She said the Maintenance Director showed her the bathroom door and told her the hinge had gotten off balance/dropped. She said the Maintenance Director showed her that he fixed the door and told her he checked the other doors to make sure it was not happening with any of the other bathroom doors. She said she asked the Maintenance Director if the doorknob could be switched to another shaped doorknob that the resident could still open. She said the Maintenance Director was going to talk to his supervisor about coming up with a solution. She said in case of a medical emergency, her expectation would be for staff to call 911, notify manager, notify maintenance, take the door knob off, and continue to make entry into the room until emergency personnel arrived on scene. She said the fire department was approximately 1 to 2 blocks away and would arrive to the facility quickly . (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675789 If continuation sheet Page 3 of 13 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 02/01/2024 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)

F 0584 Level of Harm - Immediate jeopardy to resident health or safety In a follow-up interview on 02/01/24 at 1:38 p.m., CNA A said if staff were unable to access a resident in case of an emergency or incident it could potentially lead to the resident tripping, falling, hitting their head, or cause them to become scared because they were in an unfamiliar place . This was determined to be an Immediate Jeopardy (IJ) on 01/30/24 at 5:25 p.m. The Administrator was notified and provided with the IJ template on 01/30/24 at 5:25 p.m. Residents Affected - Few The following Plan of Removal submitted by the facility was accepted on 01/31/24 at 11:11 a.m. and included: PLAN OF REMOVAL Name of facility: [ ] Date: 1-30-24 IMMEDIATE ACTION:

F921: Safe/Functional/Sanitary/Comfortable Environment The Maintenance Director was contacted by phone and made aware of the situation with the door handle hardware for Residents #1 and #2's room at approximately 7:40 am and instructed the floor tech assigned to the 300 hall to free the adjoining door handles from each other and he was successful. The residents inside the room were found to be safe and in no distress. The medical director was notified. Residents were assessed head to toe. Charge nurse completed the assessment on 1-30-24. Families of residents #1 and #2 were notified by charge nurse on 1-30-24. All resident room doors throughout the facility were inspected to ensure there were no issues. All doors were functioning properly. Inspection completed by maintenance director on 1-30-24. The maintenance Director and Regional Director of Physical Facilities were notified of the issue with the door handle hardware for Resident #1 and #2's room and instructed to change all door handles on the bathroom door to doorknobs to ensure that they do not latch on to each other under any circumstances. 23 door handles in total were replaced. Completion date 1-30-24. The maintenance director arrived at the facility to inspect the door and made adjustments to the door hinge to re-align the door so that the door handles do not get caught on each other. An inspection of all doors in the Memory care unit were then inspected to ensure there were no issues to any other doors. All doors were functioning properly. Completion date 1-31-24 Staff in-service initiated on 1-30-24 on what to do in the event of a resident room entry blocked and not able to enter the room in an emergency and non-emergency situation. Initial training conducted by Regional Nurse on 1-30-24 with management team. Staff will receive training in staff meeting by Administrator held on 1-31-24. Completion date will be 1-31-24. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675789 If continuation sheet Page 4 of 13 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 02/01/2024 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)

F 0584 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few On 1-31-24 the management team will conduct a Standards of Care and QAPI ad hoc meeting with the Medical Director to discuss the findings and recommendations will be made and followed through if necessary. A monthly preventative maintenance inspection of resident living area doors and hardware will be implemented effective 1-31-24. This inspection will be conducted by the maintenance director or designee to ensure doors are functioning properly. Following the acceptance of the facility's Plan of Removal (POR), the facility was monitored from 01/31/24 through 02/01/24. Monitoring of the POR included: Observation on 01/31/24 at 2:14 p.m. revealed all door handles on the bathroom doors located inside the resident(s) room, in the memory care unit, were changed to doorknobs. A total of 23 door handles were changed. Observation on 01/31/24 at 5:10 p.m. revealed all bathroom doors located inside the resident(s) room opened and closed without becoming wedged with the bedroom door. During interviews on 01/31/24 and 02/01/24, the following Nurses and CNAs were able to verbalize an understanding of the steps to take if a resident's room was blocked from entry: Nurses A and B, CNAs A, B, C, D, E and, F . Record review of in-service training titled Steps to Take if Resident Room is Blocked from Entry held with department managers and staff, dated 01/30/24 and 01/31/24, revealed 128 signatures. Record review of Resident #1 and Resident #2's progress notes, dated 01/30/24, revealed they were assessed, and their families were contacted about the incident. Record review of the Foundations of Care Meeting Action Plan, dated 01/31/24, revealed the Medical Director and Nursing Staff were present and no further recommendations were made. The Administrator was notified the Immediate Jeopardy was removed on 02/01/24 at 4:01 p.m. The facility remained out of compliance at a severity level of no actual harm and a scope of isolated due to the facility's need to evaluate the effectiveness of the corrective systems that were put into place. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675789 If continuation sheet Page 5 of 13 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 02/01/2024 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)

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 and interview, the facility failed ensure a resident who is unable to carry out activities of daily living receives the necessary services to maintain good nutrition, grooming, and personal and oral hygiene for 2 of 2 residents (Resident #3 and #4) reviewed for activities of daily living. Residents Affected - Few -The facility failed to provide incontinence care timely to Resident #3 and #4. These failures could place residents who were dependent on staff for ADL care at risk for infections, and a decreased quality of life. The findings included: Resident #3 Record review of Resident #3's admission Record, dated 01/31/24, revealed a [AGE] year-old female who was admitted to the facility on [DATE]. The resident's diagnoses included dementia, urinary tract infection, and hydronephrosis (excess urine accumulation in kidney(s) that causes swelling of kidneys). Record review of Resident #3's Significant Change MDS assessment, dated 01/15/24, revealed a BIMS score of 2, indicating severe cognitive impairment. Record review of Resident #3's undated care plan revealed the following: -Resident had bladder incontinence. Interventions included incontinent care at least every 2 hours. -Resident had bowel incontinence. Interventions included checking resident every two hours and assisting with toileting as needed and providing peri-care after each incontinent episode. -Resident had an ADL self-care performance deficit. She required one-person extensive assistance with bed mobility and one-person total dependence with toileting and transferring. -Resident had a potential for uncontrolled pain. Observation and interview on 01/31/2024 at 11:45 a.m., revealed Resident #3 was lying in bed naked and had a pervasive odor of urine. The resident's left leg was contracted and had no pillow/separation/device in-between her thighs. The resident had a soiled brief with urine and feces. The resident's bed linen was stained with a large brown ring, and her blankets, gown, and pants were soiled with urine through to the mattress. CNA G said she last changed the resident at 8:40 a.m. and that she always changed her every two hours and as needed. In an interview on 01/31/2024 at 12:13 p.m., CNA G said not doing this could result in more infection and said she had in-services on incontinent care in December 2023 . Resident #4 Record review of Resident #4's admission Record, dated 01/30/24, revealed a [AGE] year-old female (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675789 If continuation sheet Page 6 of 13 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 02/01/2024 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)

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few who was admitted to the facility on [DATE]. The resident's diagnoses hydronephrosis (excess urine accumulation in kidney(s) that causes swelling of kidneys), overactive bladder, irritable bowel syndrome (common disorder that affects the stomach and intestines) with diarrhea, and muscle weakness. Record review of Resident #4's Quarterly MDS assessment, dated 01/20/24, revealed a BIMS score of 8, indicating moderate cognitive impairment. Record review of Resident #4's undated care plan revealed the following: -Resident had a communication problem related to intermittent confusion. -Resident was at risk for impaired skin integrity related to intermittent incontinence, decreased mobility, thin/fragile skin. Interventions included incontinence care after each episode and applying moisture barrier and notifying nurse immediately of any new areas of skin breakdown. -Resident has impaired cognitive function and impaired thought processes related to dementia. -Resident was at risk for infections related to intermittent urine incontinence. Interventions included checking her at least every 2 hours for incontinence, wash, rinse, and dry soiled area as needed. -Resident was at risk for ADL self-care performance deficit related to dementia. Interventions included extensive one-person assistance with bed mobility, personal hygiene, toileting, and weekly skin inspection. Observation and interview on 01/31/2024 at 9:10 a.m., revealed Resident #4 was sitting up in bed, awake, alert, and responding to questions. She said she was left sitting or lying in her soiled brief every day. She said she was last changed at 5:00 a.m., nobody had been in her room to change her, and it happened all the time since she came back to the facility. The resident's family members were at her bed side and both family members complained about the resident lying in her urine and feces all the time. Observation and interview on 01/31/2024 at 9:20 a.m., CNA H said she worked 6:00 a.m. to 2:00 p.m. for 7 years. She said she always checked her incontinent residents every 2 hours. She said she was in a meeting this morning and that was why she had not checked on her residents. In an interview on 01/31/24 at 5:15 p.m., the DON said the failure could cause skin breakdown, urinary tract infections, odors in the room, skin infections, and affect the resident's dignity. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675789 If continuation sheet Page 7 of 13 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 02/01/2024 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)

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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 observation, interview, and record review, the facility failed ensure a resident who is incontinent of bladder receives appropriate treatment and services to prevent urinary tract infections and to restore continence to the extent possible for 2 of 2 residents (Resident #3 and #4) reviewed for urinary incontinence. -CNA G did not practice proper technique while providing incontinent care for Resident # 3. -CNA H did not practice proper technique while providing incontinent care for Resident # 4. This deficient practice could place residents at risk for infection and skin breakdown due to improper care practices. The findings included: Resident #3 Record review of Resident #3's admission Record, dated 01/31/24, revealed a [AGE] year-old female who was admitted to the facility on [DATE]. The resident's diagnoses included dementia, urinary tract infection, and hydronephrosis (excess urine accumulation in kidney(s) that causes swelling of kidneys). Record review of Resident #3's Significant Change MDS assessment, dated 01/15/24, revealed a BIMS score of 2, indicating severe cognitive impairment. Record review of Resident #3's undated care plan revealed the following: -Resident had bladder incontinence. Interventions included incontinent care at least every 2 hours. -Resident had bowel incontinence. Interventions included checking resident every two hours and assisting with toileting as needed and providing peri-care after each incontinent episode. -Resident had an ADL self-care performance deficit. She required one-person extensive assistance with bed mobility and one-person total dependence with toileting and transferring. -Resident had a potential for uncontrolled pain. Observation and interview on 01/31/2024 at 11:45 a.m., revealed Resident #3 was lying in bed naked and had a pervasive odor of urine. The resident had a soiled brief with urine and feces. CNA G performed incontinence care. She took off the soiled brief, used wet wipes, cleaned the perineal area twice but did not open the labia to clean. She cleaned the bowel movement in between the buttocks several times, but did not clean around the buttocks. She put a clean brief on the resident and transferred her to her wheelchair and propelled her to the nurse's station. In an interview on 01/31/2024 at 12:13 p.m., CNA G said she did not do well with incontinence care and that she forgot to open and clean the labia, clean the buttocks, and wipe down the mattress. She said not doing this could result in more infection and said she had in-services on incontinent care (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675789 If continuation sheet Page 8 of 13 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 02/01/2024 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)

F 0690 in December 2023 . Level of Harm - Minimal harm or potential for actual harm Resident #4 Residents Affected - Few Record review of Resident #4's admission Record, dated 01/30/24, revealed a [AGE] year-old female who was admitted to the facility on [DATE]. The resident's diagnoses hydronephrosis (excess urine accumulation in kidney(s) that causes swelling of kidneys), overactive bladder, irritable bowel syndrome (common disorder that affects the stomach and intestines) with diarrhea, and muscle weakness. Record review of Resident #4's Quarterly MDS assessment, dated 01/20/24, revealed a BIMS score of 8, indicating moderate cognitive impairment. Record review of Resident #4's undated care plan revealed the following: -Resident had a communication problem related to intermittent confusion. -Resident was at risk for impaired skin integrity related to intermittent incontinence, decreased mobility, thin/fragile skin. Interventions included incontinence care after each episode and applying moisture barrier and notifying nurse immediately of any new areas of skin breakdown. -Resident has impaired cognitive function and impaired thought processes related to dementia. -Resident was at risk for infections related to intermittent urine incontinence. Interventions included checking her at least every 2 hours for incontinence, wash, rinse, and dry soiled area as needed. -Resident was at risk for ADL self-care performance deficit related to dementia. Interventions included extensive one-person assistance with bed mobility, personal hygiene, toileting, and weekly skin inspection. Observation and interview on 01/31/2024 at 9:10 a.m., revealed Resident #4 was sitting up in bed, awake, alert, and responding to questions. She said she was left sitting or lying in her soiled brief every day. The resident's family members were at her bed side and voiced concerns about the resident having repeated urinary tract infections. Observation and interview on 01/31/2024 at 9:20 a.m., CNA H said she always checked her incontinent residents every 2 hours. She placed Resident #4 in a lying position, and removed her soiled brief with large bowel movement. She cleaned the perineal area twice with wet wipes but did not open the labia to clean. During the cleaning, the resident was saying ouch, ouch, and grimacing. The perineal area was very raw and red. CNA H positioned the resident to her right side and cleaned in-between the buttocks several times but did not clean around the buttocks. The resident's buttocks were very raw and red. The resident was moaning while CNA H was cleaning and said it was due to a sore on her buttock. At 9:42 a.m. CNA H put a clean brief on the resident, but the state surveyor stopped her as she was about to fasten the resident's brief and asked her to clean the resident's labia. A head to toes assessment was done (excoriation to perineal, groin, and buttocks) and there was no further skin break down noted. In an interview on 01/31/24 at 10:30 a.m., CNA H said she did not do a good job with incontinence care. She said she forgot to open and clean the labia and clean the buttocks. She said not cleaning (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675789 If continuation sheet Page 9 of 13 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 02/01/2024 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)

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few the labia and buttocks could result in more infections. She said she had an in-service on incontinence care in December 2023 . In an interview on 01/31/24 at 5:15 p.m., the DON said she expected staff to do proper incontinence care, clean from front to back, open the labia, and clean the buttocks. She said the failure could cause skin breakdown, urinary tract infections, odors in the room, skin infections, and affect the resident's dignity. Record review of the facility's policy titled Perineal Care, revised October 2018, read in part .Steps in Procedure .For a female resident: .b. wash perineal area . (1) Separate labia and wash area .e. Wash the rectal area thoroughly, wiping from the base of the labia towards and extending over the buttocks. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675789 If continuation sheet Page 10 of 13 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 02/01/2024 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)

F 0880 Provide and implement an infection prevention and control program. 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 maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 2 of 2 residents (Resident #3 and #4) reviewed for infection control. Residents Affected - Few -The facility failed to use proper infection control precautions when providing incontinence care to Resident #3 and #4. These failures could place residents at risk for cross contamination, infections, delay in treatment, and hospitalization. The findings included: Resident #3 Record review of Resident #3's admission Record, dated 01/31/24, revealed a [AGE] year-old female who was admitted to the facility on [DATE]. The resident's diagnoses included dementia, urinary tract infection, and hydronephrosis (excess urine accumulation in kidney(s) that causes swelling of kidneys). Record review of Resident #3's Significant Change MDS assessment, dated 01/15/24, revealed a BIMS score of 2, indicating severe cognitive impairment. Record review of Resident #3's undated care plan revealed the following: -Resident had bladder incontinence. Interventions included incontinent care at least every 2 hours. -Resident had bowel incontinence. Interventions included checking resident every two hours and assisting with toileting as needed and providing peri-care after each incontinent episode. -Resident had an ADL self-care performance deficit. She required one-person extensive assistance with bed mobility and one-person total dependence with toileting and transferring. -Resident had a potential for uncontrolled pain. Observation and interview on 01/31/2024 at 11:45 a.m., revealed Resident #3 was lying in bed naked and had a pervasive odor of urine. The resident's left leg was contracted and had no pillow/separation/device in-between her thighs. The resident had a soiled brief with urine and feces. The resident's bed linen was stained with a large brown ring, and her blankets, gown, and pants were soiled with urine through to the mattress. CNA G performed incontinence care, she washed her hands, donned clean gloves, adjusted the bed, and took off the soiled brief. Using wet wipes, CNA G cleaned the perineal area twice but did not open the labia to clean. She changed gloves, went to the restroom, used hand sanitizer, donned clean gloves, positioned Resident #3 to her right side, cleaned the bowel movement in between the buttocks several times, but did not clean around the buttocks. CNA G changed her gloves and then donned a clean pair of gloves without washing her hands first. She put a clean brief on the resident and transferred her to her wheelchair and propelled her to the nurse's station. CNA (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675789 If continuation sheet Page 11 of 13 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 02/01/2024 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)

F 0880 Level of Harm - Minimal harm or potential for actual harm G said she last changed the resident at 8:40 a.m. and that she always changed her every two hours and as needed. Observation on 01/31/2024 at 12:10 p.m., revealed CNA G did not clean Resident #3's mattress that was soiled with urine before putting on the clean bed linen. Residents Affected - Few In an interview on 01/31/2024 at 12:13 p.m., CNA G said she did not do well with incontinence care and that she forgot to open and clean the labia, clean the buttocks, wipe down the mattress, and perform hand hygiene between glove change. She said not doing this could result in more infection and said she had in-services on incontinent care in December 2023 . Resident #4 Record review of Resident #4's admission Record, dated 01/30/24, revealed a [AGE] year-old female who was admitted to the facility on [DATE]. The resident's diagnoses hydronephrosis (excess urine accumulation in kidney(s) that causes swelling of kidneys), overactive bladder, irritable bowel syndrome (common disorder that affects the stomach and intestines) with diarrhea, and muscle weakness. Record review of Resident #4's Quarterly MDS assessment, dated 01/20/24, revealed a BIMS score of 8, indicating moderate cognitive impairment. Record review of Resident #4's undated care plan revealed the following: -Resident had a communication problem related to intermittent confusion. -Resident was at risk for impaired skin integrity related to intermittent incontinence, decreased mobility, thin/fragile skin. Interventions included incontinence care after each episode and applying moisture barrier and notifying nurse immediately of any new areas of skin breakdown. -Resident has impaired cognitive function and impaired thought processes related to dementia. -Resident was at risk for infections related to intermittent urine incontinence. Interventions included checking her at least every 2 hours for incontinence, wash, rinse, and dry soiled area as needed. -Resident was at risk for ADL self-care performance deficit related to dementia. Interventions included extensive one-person assistance with bed mobility, personal hygiene, toileting, and weekly skin inspection. Observation and interview on 01/31/2024 at 9:10 a.m., revealed Resident #4 was sitting up in bed, awake, alert, and responding to questions. She said she was left sitting or lying in her soiled brief every day. She said she was last changed at 5:00 a.m., nobody had been in her room to change her, and it happened all the time since she came back to the facility. The resident's family members were at her bed side and both family members complained about the resident lying in her urine and feces all the time and had raw skin from front to back. The resident and family members voiced concerns about the resident having repeated urinary tract infections . Observation and interview on 01/31/2024 at 9:20 a.m., CNA H said she worked 6:00 a.m. to 2:00 p.m. for 7 years. She said she always checked her incontinent residents every 2 hours. She said she was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675789 If continuation sheet Page 12 of 13 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 02/01/2024 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)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few in a meeting this morning and that was why she had not checked on her residents. She washed her hands, donned clean gloves, pulled privacy curtains, placed Resident #4 in a lying position, and removed her soiled brief with large bowel movement. She cleaned the perineal area twice with wet wipes but did not open the labia to clean. During the cleaning, the resident was saying ouch, ouch, and grimacing. The perineal area was very raw and red. CNA H doffed the soiled gloves, washed her hands, donned clean gloves, and positioned resident to her right side. She cleaned in-between the buttocks several times but did not clean around the buttocks. The resident's buttocks were very raw and red. The resident was moaning while CNA H was cleaning and said it was due to a sore on her buttock. At 9:42 a.m. CNA H put a clean brief on the resident, but the state surveyor stopped her as she was about to fasten the resident's brief and asked her to clean the resident's labia. A head to toes assessment was done (excoriation to perineal, groin, and buttocks) and there was no further skin break down noted. CNA applied barrier treatment cream. In an interview on 01/31/24 at 10:30 a.m., CNA H said she did not do a good job with incontinence care. She said she forgot to open and clean the labia and clean the buttocks. She said not cleaning the labia and buttocks could result in more infections. She said she had an in-service on incontinence care in December 2023 . In an interview on 01/31/24 at 5:15 p.m., the DON said she expected staff to do proper incontinence care, clean from front to back, open the labia, and clean the buttocks. She said she expected staff to wash and/or use hand sanitizer with glove change during incontinence care. She said the failure could cause skin breakdown, urinary tract infections, odors in the room, skin infections, and affect the resident's dignity. Record review of the facility's policy titled Perineal Care, revised October 2018, read in part .Steps in Procedure .For a female resident: .b. wash perineal area . (1) Separate labia and wash area .e. Wash the rectal area thoroughly, wiping from the base of the labia towards and extending over the buttocks. Record review of the facility's policy titled Handwashing/Hand Hygiene, revised August 2019, read in part .7. Use an alcohol-based hand rub containing at least 62% alcohol; or, alternatively, soap (antimicrobial or non-antimicrobial) and water for the following situations: .m. After removing gloves . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675789 If continuation sheet Page 13 of 13