Health inspection·November 20, 2024

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to develop and implement a comprehensive person-centered care plan for each resident, consistent with the resident rights, which included measurable objectives and time frames to meet a resident's medical, nursing, and mental and psychosocial needs for 3 (Resident #135, #79 and 72) 8 residents reviewed for comprehensive care plans. The facility failed to ensure Residents #135, #79, and #72's comprehensive care plans reflected the residents were at a high risk for wandering and them residing in the memory care unit. This deficient practice could place residents at risk for receiving improper care and services due to inaccurate care plans. Findings included: 1. Review of Resident # 135's face sheet dated 11/19/2024 revealed an [AGE] year-old female admitted on [DATE] with a readmission on [DATE]. Her diagnosis included Dementia in other Diseases classified elsewhere, moderate, with other behavioral disturbance (long-term brain disorder causing personality changes and impaired memory, reasoning, and social function), Arteriosclerotic heart disease (abnormal called lesions in the walls of arteries), and anxiety disorder (a group for mental disorders characterized by significant and uncontrollable feelings of anxiety). Review of Resident # 135's admission MDS assessment dated [DATE] revealed a BIMS score of 10 which can indicate she had moderate cognitive impairment. Section E - Behavior revealed the resident had verbal behavior occurred 1 to 3 days, and other behavioral symptoms not directed at others occurred 1 to 3 days, these behavioral symptoms did not put the resident or others are risk. The resident had wandering behavior that occurred 1 to 3 days with no impact of risk to resident or the privacy of others during the seven day look back period. Review of Resident # 135's Care plan dated 10/4/2024 revealed no indication of wandering behavior or interventions present. No indication in care plan for need for memory care unit or any interventions. Review of Resident #135's physician orders dated 10/08/2024 revealed admit to memory care unit. Review of Resident # 135's Memory Care Unit admission screening for placement dated 10/08/2024 revealed the resident has Alzheimer's of related dementia diagnosis; a habit of wandering, and was able to ambulate independently, and less restrictive alternative have been unsuccessful and will benefit (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 6 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 11/20/2024 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)