Health inspection·August 8, 2025

F 0584 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. Level of Harm - Actual harm Residents Affected - Few **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview, the facility failed to provide a safe, comfortable, and homelike environment, for daily living for three (Resident#1 room, Resident#2 room and Resident# 3 room) of sixteen resident rooms reviewed for environmental concerns. The facility failed to maintain Resident#1, Resident#2 and Resident#3 room at temperatures levels ranging of 71 F to 81 F. This failure could put residents at potential risk associated with temperature extremes, like hypothermia or overheating.Findings included: Resident #1Record review of Resident #1's admission record dated [DATE] revealed, he was a [AGE] year-old male, initially admitted on [DATE] and readmitted on [DATE] with diagnoses, which included but were not limited to: Parkinson's disease without Dyskinesia (the condition where individuals experience the symptoms of Parkinson's but do not exhibit the involuntary movements often associated with long-term treatment, particularly with levodopa), without mention of fluctuations, chronic pain syndrome ( long-term condition characterized by persistent pain that lasts for months or years, significantly affecting daily life.), and legal blindness, as defined in USA. Record Review of Resident#1 MDS dated [DATE] revealed, he had a BIMS of 13 indicates cognitively intact. Resident #2Record review of Resident #2's admission record dated [DATE] revealed, he was a [AGE] year-old male, admitted on [DATE] with diagnoses, which included but were not limited to schizoaffective disorder (hallucinations and delusions, and mood disorder symptoms), unspecified, chronic pain syndrome ( long-term condition characterized by persistent pain that lasts for months or years, significantly affecting daily life.), major depressive disorder (mood disorder that causes a persistent feeling of sadness and loss of interest.), recurrent, moderate and bipolar disorder (mental health condition characterized by extreme mood swings that include emotional highs (mania or hypomania) and lows (depression), current episode manic serve with psychotic features. Record Review of Resident#2's MDS dated [DATE] revealed, he had a BIMS of 12 indicates moderate cognitive impairment. Resident #3Record review of Resident #3's admission record dated [DATE] revealed, she was a [AGE] year-old female, admitted on [DATE] with diagnoses, which included but were not limited to Type 2 Diabetes Mellitus with Ketoacidosis without coma (characterized by high ketone levels and symptoms like excessive thirst and frequent urination), adjustment disorder with depressed mood, adjustment disorder with depressed mood (short-term symptoms that affect your thoughts, behaviors and emotions) and Personal history of Transient Ischemic Attack (TIA)- (a short period of symptoms similar to those of a stroke. It's caused by a brief blockage of blood flow to the brain), and cerebral infraction without residual deficits. Record Review of Resident#3's MDS dated [DATE] revealed, she had a BIMS of 13 indicates cognitively intact. Record review of maintenance logs dated, [DATE] to [DATE] reflected no documentation of room temperature checks or AC unit concerns. Observation of Initial Walk through of facility on [DATE] at 9:45 am revealed rm# 119, rm# 205, rm# 206, rm# 216, rm#223, rm# 229 had portable fans in rooms. Observed rm# 221 had window units in the Page 1 of 3 675840 675840 08/08/2025 Avir at Richland Hills 7146 Baker Blvd Richland Hills, TX 76118

F 0584 Level of Harm - Actual harm Residents Affected - Few room. Observed floor fan at the entrance of the facility and at the two nurse's station. Observation revealed playmates at both nursing station were full of ice. Interview and observation on [DATE] at 11:30 am with the MD revealed the facility had AC unit issues for the last 3 weeks. The MD stated he did not have an exact date. The MD and surveyor completed a walkthrough of the facility and checked the temperatures. The MD read the temperature for Resident#3 room at 86.3F. The MD read the temperature in Resident#1 room at 92 F on A side and 89 F for Resident#2 room on B side. Interview and observation on [DATE] at 12:00 pm, Resident #1 stated he was miserable, and his roommate was miserable. Observed both residents had portable fans facing them. Observed Resident#2 with no t-shirt on and sweating. Resident#2 stated he was hot. Resident#1 stated he was asked if he wanted to move rooms, and he told staff no. Resident#1 stated he did not want to be separated from Resident#2. Resident#1 stated he was not asked about a window unit. Interview on [DATE] at 1:56 pm, the AC/HT Technician stated he had to wait on the facility to get the curb order in. The AC/HT Technician stated he was due to return to the facility on Wednesday on [DATE] to complete the repairs. The AC/HT Technician stated it should take a full day to complete. Interviews on [DATE] between 2:00 pm to 3:00 pm, LVN A, LVN B, LVN C, CNA D, CNA E, CNA F, and CNA G stated residents on 200 hall south have complained of being hot and staff reported to the MD. The Staff reported the facility did get hot sometimes, but the floor fans help combat the heat. Staff stated Residents are offered more hydration throughout the day. Observation and interview on [DATE] at 3:30 pm with the MD revealed Resident#3 room temperature read 82.9. Observation revealed the facility added a window unit to Resident#3 room. The MD stated his digital thermometer was no longer working and needed to be charged. Observation on [DATE] at 5:00 pm the surveyor checked back with the MD to see if the digital thermometer would work and observed it was not turning on at that time. Interview on [DATE] at 5:30 pm with the Admin, the DON and the MD revealed the AC started going out two to three weeks ago and they did not have an exact date. The Admin stated estimate for repairs were completed and approved. The MD stated by the end of next week the repairs should be completed. The MD stated the curb was ordered and should be delivered by [DATE] or [DATE]. The MD stated AC/HT technician should be at the facility by [DATE] to complete repairs. The DON stated they offered to move Resident#1 and Resident#2 to another room, and they both declined. The Admin stated they offered to put in a window unit and Resident#1 declined. The DON stated residents are offered water throughout the day. Observation on [DATE] at 8:10 am, The surveyor and the MD did a walk through to check the room temperatures which revealed, Resident#3 room was in the safe temperature range of 71 F to 81 F. Observation of Resident#1 and Resident#2 room temperature read 82.5 F. Observed both Resident#1 and Resident#2 in the room sitting up in their beds. Interview on [DATE] at 8:45 am Resident#1 stated the room felt a lot better. Resident#2 stated he was ok. Review of AC/HT company invoice reflected, estimated date of [DATE] and expired on [DATE].Services reflected in part: Gas package unit change out 5 -ton, fresh air damper, [NAME] guards, and curb adapter. Review of website : https://www.hhs.texas.gov/provider-news/[DATE]/hhsc-reminds-nursing-facilities-importance-maintaining-hvac-equipment. Titled HHSC Reminds Nursing Facilities of the Importance of Maintaining HVAC Equipment dated [DATE] reflected, Nursing facilities initially licensed before Sept. 11, 2003, must have cooling systems that ensure the indoor air temperature is no warmer than 81 degrees in areas used by residents. Review of facility's policy titled Maintenance service, revised 12/2009, revealed in part the following: 1. The maintenance department is responsible for maintaining the buildings, grounds, and equipment in a safe operable manner at all times.2. Functions of maintenance personnel include but are not limited to: d. maintaining the heat/cooling system .in good working condition. Review of facility's policy titled Homelike Environment, revised 12/2009, revealed in 675840 Page 2 of 3 675840 08/08/2025 Avir at Richland Hills 7146 Baker Blvd Richland Hills, TX 76118

F 0584 part the following:2. The facility staff and management maximize, to the extent possible, the characteristics and personal needs and preference. H) comfortable and safe temperatures (71 F-81 F). Level of Harm - Actual harm Residents Affected - Few 675840 Page 3 of 3