Health inspection·September 28, 2023

F577 - Most Recent Survey/Inspection Results and Notice of Availability of Survey/Inspection (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 10 Event ID: 675946 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 675946 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Temple East 1511 Marlandwood Rd Temple, TX 76502 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 0577 Results Level of Harm - Minimal harm or potential for actual harm 42 CFR Section 483.10(g)(11) - An NF must: Residents Affected - Few Post in a place readily accessible to residents, family members, and legal representatives of residents, the results of the most recent survey of the facility. Have reports with respect to any surveys, certifications, and complaint investigations made respecting the facility during the three preceding years, and any plan of correction in effect with respect to the facility, available for any individual to review upon request. Post notice of the availability of such reports in areas of the facility that are prominent and accessible to the public. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675946 If continuation sheet Page 2 of 10 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 675946 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Temple East 1511 Marlandwood Rd Temple, TX 76502 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 0732 Post nurse staffing information every day. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review the facility failed to post nurse staffing information to include the facility name, current date, total number, and actual hours worked by registered nurses, licensed practical or licensed vocational nurses, certified nurse aides per shift and the resident census on a daily basis for one of two days (09/26/23) reviewed for nurse staffing information. Residents Affected - Few The facility did not post the required current nurse staffing information on 09/26/2023. This failure could place residents at risk of not having access to information regarding staffing data and the facility census. Findings include: Observation on 09/26/23 at 9:00AM., revealed the nurse staffing information form on the wall next to the facility's nursing station was not filled out. During an interview on 09/26/23 at 9:30 AM, the DON stated she would fill out the form immediately. Observation on 09/26/23 at 10:00AM revealed the nurse staffing information was posted however it did not have the component of the total number and actual hours worked by Registered Nurses. During an interview on 09/27/23 at 11:00AM, the corporate nurse stated the everyday nurse staffing information form used by the facility was incomplete and she would direct the facility to use the correct form that reflects the total number and actual hours worked by Registered Nurses (RNs), Licensed Vocational Nurses (LVNs) and Certified Nurse Aides (CNAs) Observation on 09/28/23 at 2:00PM revealed the nurse staffing information was posted however the Registered Nurse component was absent. During an interview on 09/28/23 at 3:00PM the DON stated she was responsible for making sure the posting of the nurse staffing and census data daily. She stated posting needed to be done by 6:00AM immediately after the shift change over meeting finished. When investigator asked about the relevance of the staffing posting, the DON said posting the daily census and nurse staffing information was important for the residents and facility visitors, to determine if the facility had adequate staffing. On 09/26/23 there was no policy available at the facility reflecting the requirement of posting daily, the nurse staffing information at a prominent place readily accessible and available to residents, employees, and visitors. Review of https://www.hhs.texas.gov/providers/long-term-care-providers/long-term-care-provider-resources/regulatory-services-facility accessed on 09/28/2023 reflected: 42 CFR Section 483.35(g) and 26 TAC Section 554.1001(b)(1)-(2) and Section 554.1921(e)(13) - An NF must conspicuously and prominently post the following information, in a clear and readable format and a prominent place readily accessible and available to residents, employees, and visitors, in accordance with Section 554.1921(e): (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675946 If continuation sheet Page 3 of 10 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 675946 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Temple East 1511 Marlandwood Rd Temple, TX 76502 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 0732 On a daily basis: Level of Harm - Minimal harm or potential for actual harm o Facility name Residents Affected - Few o Current date o Resident census o Specific shifts for the day At the beginning of each shift, the total number of hours and actual time of day to be worked by the following licensed and unlicensed nursing staff, including relief personnel directly responsible for resident care: o Registered nurses (RNs) o Licensed vocational nurses (LVNs) o Certified nurse aides (CNAs) In addition, the licensed NF must make the information required to be posted available to the public upon request. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675946 If continuation sheet Page 4 of 10 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 675946 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Temple East 1511 Marlandwood Rd Temple, TX 76502 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 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 observation, interview, and record review the facility failed to ensure storage and/ or label of medications used in the facility in accordance with currently accepted professional principles and include the appropriate expiration dates for 2 of 4( unit 300, and unit 500) medication carts reviewed for medication storage. -The facility failed to date Insulin Injections ( unit 100/200, ) when the product was first opened according to manufacture and professional standards. -The facility failed to ensure expired medications were removed from the medication carts ( unit 300, and unit 500). These failures could place residents at risk of not receiving the intended therapeutic effect of the medications or a contaminated medication. Findings Included: Observation on 09/26/2023 at 08:45 AM revealed the Unit 100 Medication cart with an Insulin Aspart 100 U/ ml injection with no open date. Observation on 09/26/2023 at 08:41 AM revealed the Unit 200 Medication cart with an Insulin Glargine 100 U/ ml injection with no open date. Observation on 09/26/2023 at 08:30 AM revealed the Unit 300 Medication cart with an Insulin Glargine 100 U/ ml injection with an open date of 08/17/2023. Observation on 09/26/2023 at 09:02 AM revealed the Unit 500 Medication cart with an Insulin Humalog 100 U/ ml injection with an open date of 08/05/2023. Observation on 09/26/2023 at 09:10 AM revealed the Unit 500 Medication cart with an Insulin Aspart 100 U/ ml injection with an open date of 08/17/23. In an interview on 09/26/2023 at 8:50 PM, LVN A stated insulin is supposed to be dated after opening to ensure medication does not expire. LVN A stated that insulin medication given after 28 days can impact the efficacy of the medication affecting treatment. In an interview on 09/26/2023 at 9:15 PM, LVN B stated the Nurse does not know how the insulin was overlooked. They should have been dated and the insulin that is passed 28 days should not be on the med cart. LVN B stated that insulin used passed the 28 days can lead to ineffective therapy. In an interview on 09/28/2023 at 2:00 PM, the DON stated Insulins should be dated as soon as they are removed from the refrigerator, staff are required to put the open date on them and keep them in the med cart for up to 28 days after opening them. The DON further stated Insulins have an expiration date and when given outside of the time allotted the potency can diminish and cause issues effecting residents' diabetes. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675946 If continuation sheet Page 5 of 10 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 675946 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Temple East 1511 Marlandwood Rd Temple, TX 76502 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete In an interview on 09/28/2023 at 2:15 PM, the ADMIN stated his expectations are that Insulins should be dated as soon as they are removed from the refrigerator, staff are required to put the open date on them and keep them in the med cart for up to 28 days after opening them to sustain the efficacy. Review of the facility's Policy Storage of Medications dated April 2022 reflected The facility should ensure the medications requiring refrigeration are stored appropriately. Event ID: Facility ID: 675946 If continuation sheet Page 6 of 10 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 675946 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Temple East 1511 Marlandwood Rd Temple, TX 76502 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 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview and record review, the facility failed to store and prepare food in accordance with professional standards for food safety in the facility's only kitchen. Residents Affected - Few 1. The facility failed to ensure food items in the refrigerator were dated, labeled, and sealed appropriately. 2. The facility failed to discard food stored in the refrigerator that should no longer be consumed. These failures could affect the residents who received their meals from the facility's only kitchen, by placing them at risk for food-borne illness and food contamination. Findings included: An observation of the facility's kitchen walk-in refrigerator, on 09/26/23 at 7:18 a.m., revealed the following: 1 10-pound roll of thawed hamburger meat, un-dated. 1 30-pound box of thawed slab bacon unsealed with date on outside of box 09/15/23. Record review of the Facility Storage and Retention Guide, undated, posted on the outside of walk-in refrigerator reflected that bacon, that is thawed, was to be retained up to 7 days . 1 5-pound clear bag of lettuce, turning brown, expiration dated 09/20/23. 1 of 2 boxes containing 7 cucumbers with 5 cucumbers spotted white mold. 2 of 2 boxes containing 4 cucumbers all spotted with white mold and black spots. Plastic bin with lid containing approximately 30 green bell peppers with 1 bell pepper turning a deep green color with white mold covering the fruit located in the center of remaining peppers. 1 box containing 16 tomatoes. One tomato with 4 black spots and a soft to the touch. 9 additional tomatoes soft to touch, dark red, and wrinkled and one with 3 spots of white mold on the top. 1 box of thawed breakfast sausage, unsealed. Interview on 09/28/23 with the ADA at 9:43 am, revealed that if residents consume food that is spoiled or gone bad, residents could become sick or might have to go to the hospital. Interview on 09/28/23 with the ADMIN at 3:38 p.m., revealed, after he was shown the photographs of the rotten tomatoes and cucumbers, revealed that if residents consumed food that is spoiled or gone bad, they could become sick or might go to the hospital. Review of facility policy title Food Storage dated 2018 revealed: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675946 If continuation sheet Page 7 of 10 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 675946 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Temple East 1511 Marlandwood Rd Temple, TX 76502 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 0812 Policy: to ensure that all food served by the facility is of good quality and safe consumption. Level of Harm - Minimal harm or potential for actual harm Refrigerators: Date, label and tightly seal all refrigerated foods. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675946 If continuation sheet Page 8 of 10 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 675946 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Temple East 1511 Marlandwood Rd Temple, TX 76502 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 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to maintain an Infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable disease and infection for 1 of 6 residents (Resident #44) reviewed for infection control, in that: Residents Affected - Few CNA A failed to wash or sanitize her hands or change gloves before touching the package of wipes and after cleaning Resident #44's buttock area. This deficient practice could place residents at-risk for infection due to improper care practices. Findings include: Record review Resident #44's face sheet, dated 09/28/2023, revealed an admission date 03/06/2020 and, a readmission date of 08/23/2022 with diagnoses including: Fracture right pubis, Dementia (decline in cognitive abilities), Hypertension (High blood pressure), Osteoarthritis, Muscle weakness, and a need for assistance with personal care. Record review of Resident #44's Quarterly MDS, dated [DATE], revealed the resident had a BIMS score of 2 indicating severe cognitive impairment. Resident #44 required extensive assistance, was always incontinent of bladder and bowel. Observation conducted on 9/27/2023 at 9:47 AM, revealed CNA A and CNA B conducted peri-care for Resident #44. CNA A cleansed Resident #44's bottom with multiple wipes and was pulling them directly out of the package. CNA A then removed more wipes from the package to cleanse Resident #44's peri area without changing gloves or conducting hand hygiene. In an interview on 09/28/23 at 09:10 AM, CNA A revealed she did not set up her station all the way during peri-care for Resident #44 by not removing the wipes from their package prior to providing peri-care. CNA A also stated the package of wipes became contaminated when she pulled more wipes while still wearing contaminated gloves. CNA A revealed she had received training on peri-care during CNA training at a nursing school, and in-servicing conducted in the facility. CNA A also revealed she felt remorseful about making the mistake and had become anxious with so many eyes watching the care. In an interview on 9/28/2023 at 2:30 PM, the DON stated a breach in infection control while providing resident care could cause an infection to develop. The DON's expectation for staff following Infection Control protocols during resident care included monthly training, and an expectation to conduct peri-care correctly. The DON further stated she would re-educate her staff on peri-care and hand hygiene during resident care. In an interview on 9/28/2023 at 2:45 PM, the ADMIN stated a breach in infection control could cause excoriation in the peri area, which could then lead to skin breakdown. The ADMIN's expectation was for staff to follow infection control protocol and proper handwashing techniques while providing resident care. Review of Policy and Procedures for Perineal Care dated October 2018 reflected, Always perform hand (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675946 If continuation sheet Page 9 of 10 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 675946 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Temple East 1511 Marlandwood Rd Temple, TX 76502 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 hygiene before and after glove use. Level of Harm - Minimal harm or potential for actual harm Review of Policy and Procedures for Infection Control dated October 2018 reflected, To maintain a safe, sanitary, and comfortable environment for personnel, residents, visitors, and the general public and To prevent, detect, investigate, and control infections in the facility. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675946 If continuation sheet Page 10 of 10