Inspection·August 24, 2024

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observations, interviews, and record review, the facility failed to ensure all drugs and biologicals, were in locked compartments and inaccessible to unauthorized staff, visitors , and residents for 1 of 2 medication carts (Medication Cart #1) reviewed for medication storage. The facility failed to prevent Medication Cart #1 from 8:30 AM to 8:40 AM being unattended and unlocked on the 400 hall on 08/24/2024. This failure could allow residents unsupervised access to prescription and over-the-counter medications. Findings included: Observation on 08/24/2024 at 8:30 AM of Medication Cart #1, it was in front of Resident # 1's room. The medication cart was unlocked. Med-Aide A was in Resident #1's room with her back toward the door entering into Resident #1's room. Surveyor B opened and closed the top drawer of Medication Cart #1. Med-Aide A did not turn around to check on Medication Cart #1. Surveyor B opened the second drawer of Medication Cart #1 and Med-Aide A turned around and walked toward Medication Cart #1. Did not observe any residents in the hall. In an interview on 08/24/2024 at 8:45 AM Med-Aide A stated no one was to be opening the medication cart except nurses and med-aides. Med-Aide A stated she was under the assumption as long as the drawers were facing the resident room it was ok for the medication cart to be left unlocked. She stated she did not hear the top drawer opening and closing when she turned around and saw Surveyor B closing the second drawer in Medication Cart #1. Med-Aide A stated she had been in-serviced to lock the cart when not giving medications but she thought it was ok for the cart to be unlocked as long as the drawers were not facing the hall. She stated it would have been very easy for someone to open Medication Cart #1 and get the medications out of the cart before she knew it when standing in Resident #1's room. She stated she did have her back turned to the medication cart while talking to Resident #1. Med - Aide A stated Medication Cart #1 was not in her view when she was in Resident #1's room. She stated if a resident had ingested any medications a resident had a potential of dying from interaction of medications. Med-Aide A stated she had been in-serviced on medication administration and medication carts in July 2024, however, she did not recall all the information given during the in-service. In an interview on 08/24/2024 at 9:00 AM LVN C stated all medication carts were expected to be locked anytime a med-aide or a nurse was not standing at the cart administering medications. She stated (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: 675885 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 675885 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Caldwell 1022 Presidential Corridor Hwy 21 E Caldwell, TX 77836 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)