Health inspection·April 10, 2025

F 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to incorporate the PASRR level II recommendations into a resident's assessment and care planning to ensure that individuals with a mental disorder, intellectual disability or a related condition receives care and services in the most integrated setting appropriate to their needs for one (Resident #1) of three residents reviewed for PASRR (Preadmission Screening Resident Review) services. The facility failed to submit the Nursing Facility Specialized Services for SLP, PT, OT, and a customized wheelchair within 20 business days after the IDT meeting for Resident #1. This failure could place residents at risk of not receiving the needed care and services to attain or maintain their highest practicable physical, mental, and psychosocial well-being. Findings included: Review of Resident #1's undated face sheet reflected a [AGE] year-old male who was admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses including cerebral palsy (a group of disorders that affect movement and muscle tone or posture), epilepsy (seizures), unspecified intellectual disabilities, dysphagia (difficulty with swallowing), and weakness. Review of Resident #1's quarterly MDS assessment, dated 02/05/25, reflected a BIMS score of 00, indicating he had a severe cognitive impairment. Review of Resident #1's quarterly care plan, revised 10/09/24 reflected he had been identified as having PASRR positive status related to an intellectual disability and/or developmental disability with interventions of providing habilitative OT, PT, and SLP and a CMWC. Review of Resident #1's IDT Care Conference, dated 10/16/24, reflected the following summary: Annual PASSR meeting . Resident/RP has chosen to continue PASRR specialized services PT/OT/ST and Hab Co. Therapy arrange evaluation for CMWC. Review of Resident #1's Habilitation Service Plan, dated 10/23/24, reflected the following: Section 4, Habilitation Coordination Plan: [Resident #1] will receive habilitation coordination while the individual is residing in the (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 3 Event ID: 675797 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 675797 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Weston 2505 S 37th St Temple, TX 76504 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)