Inspection·July 8, 2025

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few down button that raised the handle bars up for comfortability as the resident raised from a sitting to standing position. There was a seatbelt attached to a sling that she stated fit around the small of their back and the loops attached to the hooks on the machine. The belt had several knots that had been tied on it. CNA A stated that the knots had been tied on the belt because the belt was too big and the aides were trying to keep it from sliding. When asked if Resident #1 used the belt during transfers, she stated Resident #1 didn't need it because she was able to stand. CNA A could not recall how long the belt on the sit to stand lift had been broken and stated that she had only used it a few times because Resident #1 use to walk more. In an interview on 06/25/25 at 1:46 pm with Resident #1, she stated that when she used the sit to stand lift, she made sure her feet were secured and if they were not, she would ask one of the aides to help her. She explained that there was a burgundy belt attached to the hoyer's sling that was supposed to snap around her, however the buckle was not secured and needed some adjustment and this made her feel unsteady. She explained the aides usually tied it but they needed another belt so that it could be adjusted correctly. She stated that although she was not nervous using the sit to stand lift, she knew that it needed to be fixed. In an observation and interview on 06/25/25 at 2:59 pm, Resident #1 rolled herself into her room accompanied by CNA A and CNA B. Resident #1 lifted her legs out of the leg rests on her motorized wheelchair and placed them on the foot rest of the sit to stand hoyer lift. CNA A removed her glasses and the pouch she was wearing and strapped her legs into the lift. Resident #1 grabbed the handle bars and CNA attempted to fasten the buckle on the sling but it could not fit around Resident #1's body. She tried to buckle it but it would not stay. CNA A finished the transfer with Resident #1, safety lowering her back to a sitting position on the bed. When asked why did she use the seatbelt attached to the sling, she stated that one of the prongs were broken and it could not clasp. The investigator viewed the buckle and noticed that 1 out of the 3 prongs was missing. In an interview on 06/25/25 at 4:08 pm with the DON, he stated he honestly was not aware of the strap on the lift. The DON showed the investigator and email and explained that yesterday he made a request to Corporate Central Supply requesting new lifts at the facility. He stated his expectation was for staff to inform him of malfunctioned equipment and if he would have known, he would have gotten on it immediately. In an observation on 07/08/25 at 9:15 am, the sit to stand lift had been removed from the previous space across from Resident #1's room. The lift had been moved to a storage room and the attachable belt and sling had been removed from the lift. Review of the maintenance calibration displayed that the last service date was 04/25/25 and it was due for maintenance on 10/25/25. In an interview on 07/08/25 at 11:22 am, CNA C stated in the past, she had used the sit to stand lift with Resident #1 and she was aware the belt on the sling was broken. She stated at one point, the facility had ordered a new sling/belt, but it went missing, so staff had been utilizing the broken belt for about a year and a half. She stated t when equipment was not functional, staff were supposed to notify the DON, however, she did not let the DON know the belt was broken because the lift operated fine. CNA C recalled in a morning meeting a few months prior, administration was informed that aides needed new belts and slings. She also stated staff were instructed to no longer to use the sit to stand lift because it was dangerous to operate the machine with a broken belt. In an interview on 07/08/25 at 12:49 pm, Resident #1 stated she was not using the lift for transfers and she had been getting in an out of bed using the walker instead. She stated staff informed her that they would not use the sit to stand lift because the broken belt made it dangerous for transfers. Resident #1 explained she had also restarted therapy and felt she was getting stronger. In therapy she worked on walking, riding the bike, using the walker, and walking with the parallel bars. In an interview on 07/08/25 at 12:55 pm with PTA, she stated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675791 If continuation sheet Page 2 of 3 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 675791 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Golfcrest 7633 Bellfort Houston, TX 77061 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete that Resident #1 was picked up for physical therapy on 06/30/25. In PT, Resident #1 was working on her balance, functional goals, functional limitations, bed mobility, and weakness and balance deficient. PTA explained that since Resident #1 had just started, there were no progress notes entered in the system because they are to be completed every 4 weeks. In an interview on 07/08/25 at 1:02 pm, the MD stated that prior to the previous State visit on 06/25/25, no one had mentioned to him that the belt to the sit to stand lift was broken. He explained that if there was a problem with equipment, they should report it to the DON and log it into the maintenance log located at each nurse's station. On the evening of 06/25/25, he joined the DON, ADM, and other staff to discuss the sit to stand lift. The MD stated that they ordered new belts and slings for the hoyers from central supply, and he discarded the broken belt. In an interview on 07/08/25 at 1:27 pm, the DON stated that after the State visit on 06/25/25, a meeting was called and the first thing staff did was pull the sit to stand hoyer lift off of the floor. CNA's and nurses were immediately in serviced that before they use any equipment, they were to check it before use to satisfy that it was safe and there must always be two people. The DON also stated that he ordered new slings and belts in bulk for all the hoyers. He explained that he pulled it off the floor because he did not want it to be used and he was intentionally asking staff daily when was the last they used the sit to stand hoyer lift to makes sure staff were not sneaking to use it without permission. The DON explained Resident #1 used to walk with her walker and since she restarted therapy, she has been able to utilize the walker again for transfers. He stated that he could confidently say that since the last visit, no one at the facility had used the sit to stand hoyer. In an observation on 07/08/25 at 1:45 pm, a transfer was completed by Resident #1, CNA B, and CNA E. Resident #1 sat in her mobilized chair near the front wall of the room and aides went into the bathroom to wash their hands and put on gloves. CNA B and CNA E removed the cross pouch on Resident #1's body and they asked her to sit forward so that they could fasten the gait belt around her waist. Resident #1 let staff know that she has it, and she began to lift herself up from the chair to a standing position while aides stood close by. Using her walker, Resident #1 slowly walked herself from the chair to the bed. Aides helped Resident #1 pivot and she sat down on the bed. Record review revealed an in-service was completed 12/20/24 titled [mechanical]Lift: Proper Use; Do's and Don'ts when transferring resident's. Sign in sheet reflected that 16 nursing staff and CNA's were in attendance. Record review of facility in-services revealed that an inservice was completed on 06/29/25 titled safe transfer techniques and another in-service was completed on 06/30/25 titled Sit to Stand Lift, properly checking slings. Record review of the facility's policy titled Lifting Machine, Using Mechanical revised 07/2017 reflected that under the subsection Steps in the Procedure staff should:1) Make sure that all necessary conditions (slings, hooks, chains, straps, and supports) is on hand and in good condition.2) Double check the sling.3) Place the sling under the resident. Visually check the size to ensure it is not too large or too small.4) Lower the sling bar closer to the resident.5) Attach sling straps to sling bar, according to manufacturer's instructions. a) Make sure the sling is securely attached to the clips and that it is properly balanced.b) Check to make sure the resident's head, neck, and back are supported.c) Before resident is lifted, double check the security of the sling attachment.d) Examine all hooks, clips or fasteners.e) Check the stability of the straps.f) Ensure that the sling bar is securely attached and sound.Sling Care:a) Disinfect slings between residents (unless disposable).b) Discard any worn, frayed or ripped slings. Event ID: Facility ID: 675791 If continuation sheet Page 3 of 3