Health inspection·June 23, 2023

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews, the facility failed to provide a safe, functional, sanitary, and comfortable environment for residents, staff, and the public for 1 of 1 (room [ROOM NUMBER]) rooms and the memory care unit reviewed for environment. The facility window blinds in resident room [ROOM NUMBER] and the common room in the memory care unit were inoperable and damaged. This failure could place residents at risk for diminished quality of life due to the lack of a well- kept environment. Findings included: Observation on 6/22/23 at 8:10 am revealed that in the common room of the memory care unit, the window blinds were damaged, broken blades, missing blades, cords in knots, inoperable, white 1-inch vinyl blinds. Interview on 6/22/23 at 8:30 am, the ADON stated he had noticed that the window blinds in the common room of the memory care unit were damaged, and it was that way for months and needed to be replaced. Observation on 6/22/23 revealed that in hall 100, room [ROOM NUMBER], the window blinds were damaged, blades bent, blinds unable to open or close properly, inoperable, white 1 inch medal blinds. Interview on 6/22/23 at 1:05 pm in room [ROOM NUMBER], Resident #4 stated he's been at facility for one month. Resident #4 stated the window blinds were damaged and inoperable when he arrived, 6/1/23. Resident #4 stated he wished that facility would fix the blinds, because it looks bad. Record review of Maintenance repair log for April through June 21, 2023, revealed no repair request was found for the damaged blinds in room [ROOM NUMBER] or memory care unit common room. Interview on 6/23/23 at 9:05 am, Maintenance Director stated that room [ROOM NUMBER] was the Administrator's office a few months ago and he said he was not aware of the blinds being damaged. Maintenance Director stated he had removed one damaged blind covering the exit door in the memory care unit common room but did not remove the other damaged blinds covering the window. Maintenance Director stated it was his department that is responsible for maintaining the building and equipment in a safe and operable manner at all times. (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 2 Event ID: 675881 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 675881 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Pecos 1819 Memorial Dr Pecos, TX 79772 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)