Health inspection·November 6, 2025

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few performing peri care and emptying the stool from Resident #1s colostomy bag. In an interview on 11/5/2025 at 10:30 AM with CNA A, he stated he did not always where a gown when providing care to Resident #1. He stated he was unable to explain enhanced barrier precautions. In an Interview 11/5/2025 at 10:32 AM with CNA B, she stated that she sometimes wore a gown when performing peri care but not always. When Surveyor and CNA B exited the room and Surveyor asked what the sign on the door meant, CNA B stated she did not see the sign before providing care to Resident #1. She stated she should have worn a gown when emptying the colostomy bag and providing peri care.In observation and interview on 11/5/2025 at 10:51 AM with CMA A, she entered the room and put on a gown and gloves and obtained Resident#1s blood pressure. She removed the PPE sanitized her hands and prepared medication following physician's order. CMA A then placed another gown and set of gloves on and assisted Resident #1 in taking her medications and ensured all medication were swallowed. She stated she wore the gown and gloves to provide any care to Resident #1 as she was on Enhanced barrier precautions. In a telephone interview on 11/6/2025 at 12:50 PM, with DON, she stated that she frequently inserviced staff on abuse, neglect and enhanced barrier precautions. She stated that if a resident is on enhanced barrier precautions she expects the staff to wear gowns and gloves when providing care to the residents.In an interview on 11/6/2025 at 12:54 PM with ADON, she stated that she knows they have reviewed EBP in July. She stated that anyone with a chronic wound, g tube, trach, or surgically opened areas in the body would require the resident to be placed on enhanced barrier precautions. She stated she expects staff to wear a gown and gloves during direct patient care. She stated that the PPE for enhanced barrier precautions should be worn to prevent infection. She stated she would expect staff to wear a gown and gloves when providing incontinent care in a resident with a colostomy as well as when they are emptying the colostomy bag. She denied that there have been reports that staff have not been utilizing proper PPE on a patient labeled as EBP. She was unable to provide the signed in-service where EBP was covered recently. She stated that the documents must be locked up in the DONs office and she is currently out of state.In an interview on 11/6/2025 at 1:20 PM with the Administrator he stated he expected the staff to wear PPE when providing care to residents on enhanced barrier precautions. He stated that ADON, DON and himself have already established a plan to further educate the staff on enhanced barrier precautions.Record review on 11/5/2025 of facility policy titled Enhanced Barrier Precautions dated 2001 MED-PASS, Inc. stated: Enhanced Barrier Precautions (EBP) refer to an infection control intervention designed to reducetransmission of multidrug-resistant organisms that employs targeted gown and glove use during highcontact resident care activities. Related Policy Interpretations and Implementation excerpts include: 1. Enhanced barrier precautions (EBPs) are used as an infection prevention and control intervention toreduce the transmission of multi-drug-resistant organisms (MDROs) to residents.2. EBPs employ targeted gown and glove use in addition to standard precautions during high contact resident care activities when contact precautions do not otherwise apply.a. Gloves and gown are applied prior to performing the high contact resident care activity (as opposed to before entering the room).b. Personal protective equipment (PPE) is changed before caring for another resident.c. Face protection may be used if there is also a risk of splash or spray.3. Examples of high-contact resident care activities requiring the use of gown and gloves for EBPs include:a. dressing;b. bathing/showering;c. transferring;d. providing hygiene;e. changing linens;f. changing briefs or assisting with toileting;g. device care or use (central line, urinary catheter, feeding tube, tracheostomy/ventilator, etc.);h. wound care (any skin opening requiring a dressing).5. EBPs are indicated (when contact precautions do not otherwise apply) for residents with wounds and/orindwelling medical devices regardless of MDRO colonization.a. Wounds generally include chronic wounds (i.e., (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675862 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 675862 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Park Bend 2122 Park Bend Dr Austin, TX 78758 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 FORM CMS-2567 (02/99) Previous Versions Obsolete pressure ulcers, diabetic foot ulcers, venous stasisulcers, and unhealed surgical wounds), not shorter-lasting wounds like skin breaks or skin tears.b. Examples of indwelling medical devices include, but are not limited to, central vascular catheters(including hemodialysis catheters, peripherally inserted central catheters (PICCs)), indwelling urinarycatheters, feeding tubes, and tracheostomy tubes. Peripheral IV catheters are not considered anindwelling medical device for purposes of EBPs.10. Staff are trained prior to caring for residents on EBPs. 11. Signs are posted on the door or wall outside the resident room indicating the type of precautions and PPErequired.12. PPE for EBP's is available outside or inside of the residents' rooms. Event ID: Facility ID: 675862 If continuation sheet Page 3 of 3