Inspection·January 15, 2026

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to maintain medical records, in accordance with accepted professional standards and practices, that were complete and accurately documented for 1 of 3 residents (Resident #1) reviewed for documentation. The facility failed to ensure Resident #1 had an accurately documented personal items inventory sheet for admission and discharge.This failure could place residents at risk of missing personal items at admissions, during stay, and at discharge.The findings include: Record review of Resident #1's face sheet, dated 1/15/26 reflected an 83 -year-old female who was admitted to the facility on [DATE] and discharged [DATE]. Resident #1 had diagnoses which included: Alzheimer's disease (a progressive brain disorder), Major Depressive Disorder, and anxiety. The RP was listed as: family member.Record review of Resident #1's quarterly MDS, dated [DATE], reflected a BIMS score of 99 (zero), indicative of severe impairment in cognition.Record review of Resident #1's Nurse Note dated 12/31/25 authored by the DON reflected the resident was discharged AMA per the RP's request. [The note provided no information on whether the resident's personal items were inventoried and sent home with the family.] Record review of facility's discharge list for the last 90 days, 10/1/25-1/15/26, reflected Resident #1 was discharged AMA on 12/31/25. Record review of R#1's D/C summary authored by LVN C dated 12/31/25 at 11:30 AM revealed: Resident family decided to take resident home against medical advice. MD notified and stated he did not feel resident was a safe discharge home. family decided to take her home against MD advice.[Timeline: From interview on 1/15/26 at 11:05 AM with the Administrator: 12/20/25 family informed of resident to move to a semi-private room (Family intended to take resident home AMA but relented). On the 12/31/25-resident discharged AMA, per RP request.] During an interview on 1/15/26 at 11:05 AM, the Administrator stated no residents had been given 30-day notice and no residents were discharged on an emergency basis. The Administrator stated Resident #1 was discharged AMA per request of the RP. The Administrator stated she was not certain whether an inventory sheet of the resident's personal items had been inventoried at admissions or discharge; but the family took all the resident's personal items home. During an interview on 1/15/26 at 1:20 PM, LVN A stated on 12/20/25 the RP was informed that Resident #1 needed to move to a semi-private room based on Medicaid payments, but the family refused and intended on executing an AMA. LVN A stated the RP delayed the AMA because they (RP) wanted to prepare another family for the resident going home and arranging medical care. LVN A stated on 12/31/25 Resident #1 was discharged home with community support. LVN A could not recall whether discharge arrangements involved an inventory of the resident's personal items. During an interview on 1/15/26 at 1:26 PM, CNA B stated she provided ADLs services to Resident #1 who was totally dependent for all ADLs (was bed bound). CNA B stated the RP agreed around 12/20/25 for a transfer to a semi-private room with someone compatible but a family member objected and wanted the resident discharged home. CNA B stated on 12/31/25 that the family member came with the approval of the (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: 675931 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 675931 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/15/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Camp Wood 710 Hwy 55 Camp Wood, TX 78833 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)