Health inspection·October 24, 2024

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few perpendicular to the bed and locked the wheelchair. Resident #1's feet did not touch the ground. CNA A placed the gait belt around Resident #1's waist and made sure it was tight enough. CNA A slid Resident #1 from the bed into the wheelchair while holding the gait belt. CNA A explained to Resident #1 what she was doing in Spanish the entire time. Interview on 10/24/24 at 4:05 p.m. CNA A stated Resident #1 could not bear weight and even when she did stand, she bent over completely. CNA A said Resident #1 was not a two-person transfer because she felt she could safely transfer Resident #1 on her own and there were times it was only her on the floor. CNA A stated she had told people she needed help and sometimes the nurses would help. CNA A said there were times she told the nurses that Resident #1 was non- weight bearing but nothing changed. Interview on 10/24/24 at 5:09 p.m. LVN B stated Resident #1 was non weight bearing. LVN B stated she thought one person could safely transfer Resident #1. LVN B stated she has performed a one-person transfer with Resident #1 in the past Interview on 10/24/24 at 5:27 p.m. the DON stated Resident #1 was weight bearing and was able to pivot. The DON stated a resident who was non-weight bearing was not safe to transfer with one person. The DON stated residents were assessed for transfer needs on admission, re-admission, and when the aides told the nurses that there was a change with residents ADL needs. The DON said they relied on the aides to tell the staff what a proper transfer was. The Regional Consultant who also present stated residents were assessed on admission, readmission, change of condition, and then usually when the MDS was done assessment needs were looked at. The Regional Consultant added they looked at transfer ability on therapy's recommendation and family request. The Regional Consultant stated the transfer ability was formally on the admission/re-admission assessment but nowhere else. The Regional Consultant stated there was not a form for a transfer ability assessment. Interview on 10/24/24 at 7:01 p.m. the MDS Coordinator stated Resident #1 was not weight bearing and as far as she knew Resident #1 was a one-person transfer. The MDS Coordinator stated she was unaware of a formal transfer assessment that the facility used. The Treatment Nurse who was also present stated she worked at the facility 20 years and was unaware of a formal transfer assessment they were just asked on admission and re-admission. Review of the facility's policy and procedure of Safe Lifting and Movement of Residents, revised February 2014, revealed: In order to protect the safety and well-being of staff and residents, and to promote quality care, this facility uses appropriate techniques and devices to lift and move residents. Resident safety, dignity, comfort, and medical condition will be incorporated into goals and decisions regarding the safe lifting and moving of residents. Nursing staff, in conjunction with the rehabilitation staff, shall assess individual residents' needs for transfer assistance on an ongoing basis. Staff will document resident transferring and lifting needs in the care plan. Such assessments shall include: Resident's mobility (degree of dependency) (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675881 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 675881 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/24/2024 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)

F 0689 - Level of Harm - Minimal harm or potential for actual harm Resident's size - Residents Affected - Few Weight bearing ability Cognitive status Safe lifting and movement of residents is part of an overall facility employee health and safety program, which: Involves employees in identifying problem areas and implementing workplace safety and injury-prevention strategies. Continually evaluates the effectiveness of workplace safety and injury-prevention strategies. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675881 If continuation sheet Page 3 of 3