Health inspection·February 24, 2024

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some understood and had the ability to understand others. The MDS indicated Resident #3 had unclear speech, adequate hearing, and adequate vision. The MDS indicated Resident #3 had a BIMS score of 13 which indicated intact cognition. The MDS indicated Resident #3 did not have psychosis, behavioral symptoms, or rejection of care. The MDS indicated Resident #3 required substantial/maximal assistance (helper does more than half the effort) for toileting hygiene, shower/bathe self, lower body dressing, personal hygiene, and partial/moderate assistance (helper does less than half the effort) for oral hygiene, upper body dressing and toilet transfer. The MDS indicated Resident #3 was occasionally incontinent for urine and frequently incontinent for bowel. Record review of Resident #3's care plan dated 06/12/22, edited on 01/11/24 indicated Resident #3 had potential for injury related to falls due to history of previous fall. Intervention included remind/encourage resident to use call light to gain assistance. During an interview on 02/15/24 at 12:04 p.m., Resident #3 said CNA B acted like she was better than him. He said CNA B said mean stuff to him all the time. He said CNA B did cuss at him and recently cussed him out after she helped him in the shower. He said CNA B made him feel like an outcast. 2. Record review of Resident #5's face sheet printed 02/15/24 indicated Resident #5 was a [AGE] year-old male and admitted on [DATE] with diagnoses including hemiplegia (is paralysis that affects only one side of your body) and hemiparesis (is weakness or the inability to move on one side of the body, making it hard to perform everyday activities like eating or dressing) following cerebral infarction affecting non dominant side, cerebral infarction (stroke), acquired absence of right leg below knee, and end stage renal disease (is a medical condition in which a person's kidneys cease functioning on a permanent basis leading to the need for a regular course of long-term dialysis or a kidney transplant to maintain life). Record review of Resident #5's quarterly MDS assessment dated [DATE] indicated Resident #5 was understood and had the ability to understand others. The MDS indicated Resident #5 had adequate hearing, clear speech, and adequate vision. The MDS indicated Resident #5 had a BIMS score of 15 which indicated intact cognition. The MDS indicated Resident #5 had functional limitation range of motion to lower extremities to one side. The MDS indicated Resident #5 required partial/moderate assistance (helper does less than half the effort) for oral and toileting hygiene, shower/bathe self, dressing, and personal hygiene, and substantial/maximal assistance for sit to stand, chair/bed-to-chair, toilet, and tub/shower transfer. The MDS indicated Resident #5 had frequent incontinence for urine and bowel. Record review of Resident #5's care plan dated 01/20/24 indicated Resident #5 had an ADL self-care performance deficit and limited physical mobility. Intervention included the resident required extensive assistance for bed mobility, toilet use and transfer. During an interview on 02/15/24 at 12:00 p.m., Resident #5 said CNA B was not easy to work with. He said the facility wanted CNA B to use the mechanical lift to transfer him, but she did not which made her pick him up from the wheelchair and push him on the bed. He said she sometimes acted like she was afraid to transfer him because she thought he would put poop on her. He said sometimes she put his coat in his wheelchair to sit on so he could poop on it instead of the facility's linen. He said CNA B did not want him eating his snacks because it made him have loose bowels. He said CNA B talked rough to him and kind of turned and cleaned him rough. He said he was not afraid of her. He said sometimes she tells him, Don't talk to me! He said CNA B did not know how to talk to people. He said CNA B put him in hospital gowns instead of shirts, which he would ask for, but was always told gowns (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675958 If continuation sheet Page 2 of 33 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 675958 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Citizens Trail 1008 Citizens Trail Texarkana, TX 75501 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some were easier. He said CNA B was not very nice to Resident #3, his roommate. He said she throws his clothes in the trash and talked rough to him. 3. Record review of Resident #7's face sheet printed on 02/15/24 indicated Resident #7 was a [AGE] year-old female and admitted on [DATE] and latest return on 02/15/24 with diagnoses including nontraumatic intracranial hemorrhage (brain bleed), flaccid hemiplegia affecting left side non dominant (the affected extremity exhibits decreased muscle tone and cannot be actively moved by the patient), legal blindness, muscle weakness, muscle wasting and atrophy (shortening), body mass index 50.0-59.9 (morbidly obese), major depressive disorder (a mental health disorder characterized by persistently depressed mood or loss of interest in activities, causing significant impairment in daily life), and anxiety disorder (persistent and excessive worry that interferes with daily activities). Record review of Resident #7's quarterly MDS assessment dated [DATE] indicated Resident #7 was understood and had the ability to understand others. The MDS indicated Resident #7 had adequate hearing, clear speech, and severely impaired vision. The MDS indicated Resident #7 had a BIMS score of 14 which indicated intact cognition. The MDS indicated Resident #7 had functional limitation in range of motion to her upper and lower extremities on one side. The MDS indicated Resident #7 required substantial/maximal assistance (helper does more than half the effort) for toileting hygiene, shower/bathe self, dressing, personal hygiene, roll left and right and dependent for chair/bed-to-chair transfer, toilet transfer, and tub/shower transfer. The MDS indicated Resident #7 was always incontinent for urine and bowel. Record review of Resident #7's care plan dated 06/10/22, edited 02/14/24 indicated Resident #7 had an ADL self-care performance deficit and limited physical mobility. Intervention included bed mobility, bathing and toilet use required extensive assistance and total assistance required for transfers. Record review of Resident #7's care plan dated 08/02/22, edited 02/14/24 indicated Resident #7 had demonstrated demanding behaviors towards others, yelling out for assistance when request for assistance is not answered immediately, desiring one on one constant help/assist from staff. Intervention included offer an outlet for resident to express feelings, wishes and frustrations. During an interview on 02/14/24 at 10:35 a.m., Resident #7 said she did not get along CNA B. She said CNA B jerked her arm and caused her pain when she got her up and called her fat. She said CNA B said things like I'm [CNA B] a buck 75 and you're [Resident #7] 300 pounds, so you need to help me or You [Resident #7] don't even try to help me [CNA B]. She said her left arm was bad so she could not help from that side. She said when CNA B said mean things to her, it made her sad. During an interview on 02/14/24 at 11:00 a.m., Resident #7's family member #1 said around December 2023, AE #1 called her at home and told her she needed to check on Resident #7 because CNA B was mistreating her. She said AE #1 told her she reported CNA B's mistreatment to the DON. She said when she filed the complaint on 12/26/23, she told the DON that CNA B said rude and hurtful things to her family member. She said she told the DON, CNA B always commented on Resident #7's weight. She said CNA B also told Resident #7, nobody cared if she told her family about things because if her family really cared about Resident #7, they would not have put her in nursing home. She said CNA B also said things like I don't have time to be doing this or I'm busy, so I ain't doing that. During an interview on 02/15/24 at 10:20 a.m., Resident #7's family member #2 said Resident #7 told her CNA B was rough, mean, and talked to her in a demeaning way. She said CNA B's behavior upset (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675958 If continuation sheet Page 3 of 33 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 675958 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Citizens Trail 1008 Citizens Trail Texarkana, TX 75501 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 0600 Resident #7 and when CNA B was not working, Resident #7 was happy and relieved. Level of Harm - Immediate jeopardy to resident health or safety During an interview on 02/15/24 at 11:00 a.m., Resident #7's family member #3 said Resident #7 complained CNA B was rude to her and does not treat her right. He said Resident #7 complained CNA B commented on her weight and told him I can't stand her! He said CNA B even mentioned private family matters to Resident #7 causing her to become upset. Residents Affected - Some 4. Record review of Resident #2's face sheet printed 02/15/24, indicated Resident #2 was an [AGE] year-old, female and admitted on [DATE] and 04/22/22 with diagnoses including unilateral primary osteoarthritis (is a chronic condition affecting the joints), depression (is a mood disorder that causes a persistent feeling of sadness and loss of interest), and generalized anxiety disorder (is a condition of excessive worry about everyday issues and situations). Record review of Resident #2's annual MDS assessment dated [DATE], indicated Resident #2 was understood and had the ability to understand others. The MDS indicated Resident #2 had adequate hearing, clear speech, and adequate vision. The MDS indicated Resident #2 had a BIMS score of 14 which indicated intact cognition. The MDS indicated Resident #2 required set-up or clean-up assistance for oral and toilet hygiene, shower/bathe self, and upper body dressing and supervision or touching assistance for lower body dressing, putting on/taking off footwear, transfers, and personal hygiene. The MDS indicated Resident #2 was occasionally incontinent of urine and bowel. Record review of Resident #2's care plan dated 03/01/22, edited on 01/30/24, indicated Resident #2 had potential for injury related to falls due to unsteady gait, attempted to stand unassisted, and lost balance easily. Intervention included resident educated on importance of using call light to gain assistance. During an interview on 02/14/24 at 12:45 p.m., Resident #2 said CNA B was verbally aggressive to her and other residents. She said the few times CNA B was verbally aggressive to her, it made her mad. 5. Record review of Resident #6's face sheet printed 02/15/24 indicated Resident #6 was an [AGE] year-old, female and admitted on [DATE] with diagnoses including age related cognitive decline (overall slowness in thinking and difficulties sustaining attention, multitasking, holding information in mind and word-finding), chronic obstructive pulmonary disease (a group of diseases that cause airflow blockage and breathing-related problems), and chronic kidney disease, stage 3 (is a type of kidney disease in which a gradual loss of kidney function occurs over a period of months to years). Record review of Resident #6's quarterly MDS assessment dated [DATE] indicated Resident #6 was understood and had the ability to understand others. The MDS indicated Resident #6 had adequate hearing, clear speech, and adequate vision. The MDS indicated Resident #6 had a BIMS score of 15 which indicated intact cognition. The MDS indicated Resident #6 required partial/moderate assistance for oral hygiene, upper body dressing, and personal hygiene and substantial/maximal assistance for toilet hygiene, shower/bathe self, lower body dressing, and putting on/taking off footwear. The MDS indicated Resident #6 was always incontinent of urine and bowel. During an interview on 02/15/24 at 10:03 a.m., Resident #6 said CNA B spoke to you a nasty way. She said when you asked CNA B for something, she would say, What you want? or Well, I [CNA B} ain't got no time for that! She said CNA B did not say those things in a joking manner. She said CNA B had smarted off at her and a bunch of folks. She said CNA B refused to change her and would get someone (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675958 If continuation sheet Page 4 of 33 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 675958 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Citizens Trail 1008 Citizens Trail Texarkana, TX 75501 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 0600 else to do it. She said CNA B's actions hurt her feelings and made her feel like she did something wrong. Level of Harm - Immediate jeopardy to resident health or safety 6. Record review of Resident #4's face sheet printed 02/15/24 indicated Resident #4 was a [AGE] year-old, male and admitted on [DATE] and 03/28/23 with diagnoses including multiple sclerosis (is a potentially disabling disease of the brain and spinal cord (central nervous system)), anxiety disorder (a mental health disorder characterized by feelings of worry, anxiety, or fear that are strong enough to interfere with one's daily activities), and muscle wasting and atrophy (shortening). Residents Affected - Some Record review of Resident #4's quarterly MDS assessment dated [DATE] indicated Resident #4 was understood and had the ability to understand others. The MDS indicated Resident #4 had adequate hearing, clear speech, and adequate vision. The MDS indicated Resident #4 had a BIMS score of 14 which indicated intact cognition. The MDS indicated Resident #4 required partial/moderate assistance for toileting hygiene, shower/bath self, and dressing. The MDS indicated Resident #4 was occasionally incontinent of urine and frequently incontinent of bowel. Record review of Resident #4's care plan dated 12/26/23, edited on 01/09/24 indicated Resident #4 had potential for injury related to falls due to history of previous falls. Intervention included encourage resident to participate in activities program that encourages exercise and physical activity for strengthening and improved mobility. During an interview on 02/14/24 at 1:15 p.m., Resident # 4 said CNA B intimated the poor, old ladies on her hall. He said CNA B was so mean to AR sometimes, AR would start shaking. He said about 1-2 weeks ago, he heard CNA B tell Resident #3, Now, take your a** back to your room after she helped him take a shower. He said LVN G was standing by the shower door, so he did not know how LVN G did not hear CNA B cussing at Resident #3. 7. During an interview and observation on 02/14/24 at 1:30 p.m., AR said he/she had been putting up with CNA B's behaviors for a while. AR said CNA B got a better attitude for a while then she went back to being bad. AR said she never hit her/him or anything, but CNA tells you to hurry up! AR said CNA B was always in a hurry and rough with cares. AR said she/he had pain in her/his arms and CNA B, who knew she/he had pain in the arms, would pull the arm up and yank her/his clothes off or pull on the hurt arm. AR said CNA B pushes you or throws you in the bed when she's transferring you. AR said she/he was afraid of CNA B. AR's body was shaking in the chair and increased as she/he talked. During an interview on 02/14/24 at 11:22 a.m., AE #1 said CNA B was mean and aggressive with cares. AE #1 said CNA B picked on Resident #7 all the time. AE #1 said CNA B made Resident #7 cry sometimes because of how bad she [CNA B] talked about her [Resident #7]. AE #1 said Resident #7 had behaviors of throwing herself out of the bed or wheelchair, but it was because she [Resident #7] was so mad and frustrated with CNA B picking on her all day long. AE #1 said she/he heard CNA B say things like, wipe your own a**! AE #1 said CNA B took Resident # 5's food away from him after he got back from dialysis, because sometimes he would be hungry and eat a lot of food since he did not eat at dialysis. AE #1 said she complained in front of Resident #5 if he ate too much, he was going to sh** everywhere. AE #1 said another resident [AR] complained CNA B was rude and rough with her/him, but the resident was too scared to report it because of retaliation. During an interview on 02/14/24 at 4:07 p.m., LVN G said she had worked at the facility for 22 years. She said she had never been told by a resident or staff CNA B was rough or rude to residents. She said she did not hear CNA B say cuss words to Resident #3. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675958 If continuation sheet Page 5 of 33 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 675958 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Citizens Trail 1008 Citizens Trail Texarkana, TX 75501 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some During an interview on 02/14/24 at 4:14 p.m., CNA E said she had worked at the facility for 5 years on the 2pm-10pm shift. She said she had heard residents being yelled at or staff refusing the resident care which she considered verbal abuse. She said it took the choices away from the resident making them feel helpless. She said she never saw who was verbally abusing the resident, just heard it. She said it happened on the 6am-2pm and 2pm-10pm shift. During an interview on 02/14/24 at 4:15 p.m., CNA B said she had been employed at the facility for a year. She said she normally worked the 2pm-10pm shift. She said she did not abuse any residents or was rough with cares. She said she did not have any issues with any of the residents. She said she did not have any issues with Resident #3, but she did try to take another person with her when she dealt with him. During an interview on 02/15/24 at 10:30 a.m., CNA J said she had been working for the facility since June 2022 but had previously worked at the facility for 4 years. She said she worked all shifts at the facility. She said she worked the middle hall (Rooms 201-216) and sometimes the B long hall (room [ROOM NUMBER]-228). She said several residents had complained about CNA B to her. She said Resident #3, Resident #5, Resident #7, and AR had complained about how CNA B talked to and treated them. She said CNA B's treatment of the residents made them feel like she did not like them. She said another resident told her CNA B cussed out Resident #3 and LVN G was there. She said when CNA B treats Resident #3 bad, he always says, I'm not putting with this sh**! During an interview on 02/15/24 at 11:22 a.m., CNA F said she had worked at the facility for 10 years on the 6am-2pm shift. She said she normally worked B long hall which were rooms 216-228. She said verbal and mental abuse was happening at the facility by CNA B. She said Resident #5 told her CNA B was too rough during cares and he was afraid of her. She said Resident #5 always asked the 6a-2pm shift to put him back to bed before they left because he did not want CNA B doing it. She said another resident reported to her CNA B was rough, talked harsh, and made them go to bed when she wanted them to. She said Resident #3 told her CNA B cussed at him and was ugly to him. She said the residents being abused probably felt sad, disgusted, or isolated themselves. During an interview on 02/15/24 at 1:20 p.m., the DON said she had known CNA B for a while and sometimes her tone was taken the wrong way. She said sometimes CNA B's tone and demeanor was aggressive. She said CNA B's aggressive tone or demeanor was not directed at the residents. She said it was just how CNA B was. She said she had done an in-service to all staff about their tone in November 2023. She said she had never done a 1:1 with CNA B about her tone and demeanor. She said CNA B had previous allegation of abuse last June (2023). She said staff had not recently told her of any residents complaining about CNA B's care or demeanor. She said recently Resident #3 told her CNA B and him had verbally got into, but he had called her a bit**. She said no formal disciplinary actions or report had been done on CNA B. During an interview on 02/15/24 at 2:09 p.m., the ADM said he was the abuse coordinator. He said CNA B had been verbally counseled a few times regarding how she spoke to residents. He said CNA B had been accused of abuse in June 2023. He said CNA B had employee disciplinary reports on file. He said CNA B had been monitored due to the previous abuse allegations by doing rounds. CNA B's employee disciplinary reports were requested during the interview and not received before exit. CNA B's employee disciplinary reports were received 6 days after exit. Record review of CNA B's proficiency dated 04/11/23 indicated .knowledge of abuse/neglect protocol .satisfactory .communication skills (respect/dignity) .satisfactory . (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675958 If continuation sheet Page 6 of 33 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 675958 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Citizens Trail 1008 Citizens Trail Texarkana, TX 75501 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Record review of CNA B's employee disciplinary report dated 02/02/24, indicated .CNA B .verbal counseling .Resident #3 complained that CNA B talked to him disrespectfully while attempting to provide care .reminded CNA B that this was the 2nd complaint regarding her tone with Resident #3 .another complaint would result in her suspension and/or termination .CNA B reported that she was only trying to get Resident #3 to get up and take a shower .Resident #3 needed to be cleaned up and was refusing .signature of supervisor presenting EDR:ADM .employee refused to sign .ADM (supervisor initial) .to be retained in employee's personnel file . The employee disciplinary report did not reveal CNA B's signature or date received and a witness initials of CNA B's refusal to sign. Record review of the facility's 12/23 staff sign in sheet indicated CNA B worked 24 days, 2pm-10pm shift on the hall where Resident #3, Resident #5, and Resident #7 resided. Record review of a facility's Be mindful of your tone and how you say things to and around the residents in-service dated 11/14/23 reflected CNA B's signature was noted on the attendance roster. Record review of a facility's Abuse, Neglect, and reportable events in-service dated 01/30/24 indicated .all resident have the right to be free from abuse, neglect .residents should not be subjected to abuse by anyone .it is everyone's responsibility to recognize, report, and promptly investigate actual or alleged abuse, neglect .and situations that may constitute abuse or neglect to any resident in the facility . CMA L, LVN G, LVN H, CNA E, CNA F signature was noted on the attendance roster. CNA B signature was not noted on the attendance roster. Record review of a facility's Abuse/Reportable Events policy dated 01/17 indicated .all residents have the right to be free from abuse, neglect .residents should not be subjected to abuse by anyone .it is everyone's responsibility to recognize, report, and promptly investigate actual or alleged abuse, neglect .and situations that may constitute abuse or neglect to any resident in the facility .abuse: the willful infliction of injury .intimidation .pain or mental anguish .it included verbal abuse, sexual abuse, physical abuse, and mental abuse .mental abuse .includes, but not limited to humiliation, harassment, threats of punishment or deprivation .verbal abuse .any use of oral, written or gestured language that willfully disparaging and derogatory terms to resident . This was determined to be an Immediate Jeopardy (IJ) on 02/23/24 at 3:10 p.m. The facility Administrator, and DON were notified. The Administrator was provided with the IJ template on 02/23/24 at 3:10 p.m. 2/24/2024 Plan of Removal - F 600 Immediate Action Taken Resident Specific CNA B was suspended pending investigation on 2/15/2024 at 3:30pm. CNA B was terminated on 2/21/2024 at 2:21pm. CNA B did not work in the facility after allegations of verbal abuse were brought to the Administrator, by the HHSC surveyor on 2/15/2024. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675958 If continuation sheet Page 7 of 33 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 675958 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Citizens Trail 1008 Citizens Trail Texarkana, TX 75501 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 0600 Residents #3, #5, and #7 were interviewed by the Administrator on 2/15/2024. Level of Harm - Immediate jeopardy to resident health or safety Residents #3, #5, and #7's Responsible Parties notified of the verbal abuse allegation on 2/15/2024. Residents Affected - Some MD notified of the IJ on 2/23/2024 at 4:48pm by Administrator, no new orders received. Residents #3, #5, and #7 had head to toe assessments performed by the Treatment Nurse on 2/15/2024. System Changes All interviewable residents were interviewed by Administrator regarding abuse, safety, who to report concerns to, and complaint resolution on 2/23/2024. All non-interviewable residents received a head-to-toe skin assessment, to assess for any injuries or evidence of abuse, by Charge Nurses, Director of Nursing and Treatment Nurse on 2/23/2024. All residents in the facility received head to toe skin assessments, to assess for any injuries or evidence of abuse, by Charge Nurses, Director of Nursing and Treatment Nurse on 2/23/2024. Direct care staff interviewed on 2/24/2024 by Administrator regarding abuse and whether they have witnessed any abuse. All resident care plans revised to include being at risk for mental/emotional distress on 2/23/2024 by Regional Reimbursement Consultant. Abuse/Reportable Event policy reviewed on 2/23/2024 at 5:15pm by Administrator, Regional Nurse, and Director of Nursing. No changes made to policy at this time. Education Director of Nursing provided education to all staff regarding the Abuse/Reportable Event Policy, including types of abuse, definition of verbal and mental abuse, reporting requirements. All staff present in the facility were educated on 2/23/2024, at 6pm. Staff not present for the education will receive the education prior to their next shift. Director of Nursing provided education to all staff regarding the Grievance Policy, including how to file a grievance, timely resolution, and that residents are able to voice grievances without fear of reprisal or discrimination. All staff present in the facility were educated on 2/23/2024, at 6pm. Staff not present for the education will receive the education prior to their next shift. Regional Clinical Consultant provided education to Administrator and Director of Nursing regarding the Abuse/Reportable Event Policy on 2/23/2024 at 5:45pm. Regional Clinical Consultant provided education to Administrator and Director of Nursing regarding the Grievance Policy on 2/23/2024 at 5:45pm. On 02/24/24 a surveyor confirmed the facility implemented their plan of removal sufficiently to remove the IJ by: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675958 If continuation sheet Page 8 of 33 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 675958 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Citizens Trail 1008 Citizens Trail Texarkana, TX 75501 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Record review of CNA B's termination letter. CNA B was suspended immediately and was officially terminated by telephone on 02/21/24. Record review of an Abuse Pre/Post test. The administrator said this was the test used for educational purposes concerning the staff. The test consisted of 20 questions covering the different types of abuse and reporting of allegations. There was a situation question at the end of the test. Residents Affected - Some Record review of an In-Service Form indicated an in-service for the Administrator and the DON was held on 02/23/24. The in-service was presented by the Regional Clinical Consultant. The topic was the Grievance Voicing and Resolution facility policy. The policy included how to file a grievance and promptly attempting to resolve grievances. Record review of an In-Service Form indicated an in-service for the Administrator and the DON was held on 02/23/24. The in-service was presented by the Regional Clinical Consultant The topic was Abuse/Neglect and reportable events. The In-service included definitions of abuse, screening of personnel, training of personnel, prevention of abuse, identification of abuse, reporting, and protection of the residents. Record review of an In-Service Form indicated an in-service for all staff was held on 02/23/24. The in-service was presented by the DON. The topic was the Grievance - Voicing and Resolution facility policy. The policy included how to file a grievance and promptly attempting to resolve grievances. Record review of an In-Service Form indicated an in-service for all staff was held on 02/23/24. The in-service was presented by the DON. The topic was Abuse/Neglect and reportable events. The In-service included definitions of abuse, screening of personnel, training of personnel, prevention of abuse, identification of abuse, reporting, and protection of the residents. Record review of Employee Disciplinary Reports for CNA E, CNA F, LVN G, and CNA J dated 02/24/24 indicated they received verbal counseling for failing to report an allegation of abuse/neglect to the Abuse Coordinator. The report indicated the employees were re-educated on the abuse/reportable events policy/procedure. Each employee had signed their report. During interviews and observations conducted on 2/24/24 beginning at 1:30 p.m. through 2:00 p.m., 12 of 51 residents were observed and they showed no signs of untimely care and there were no signs of abuse. Out of the 12 residents observed, 7 were interviewable. Each said they had been educated in the last 24 hours concerning abuse and who to report any abuse to. Each of the 7 residents denied abuse of any kind. The also said they had been assessed by a nurse. (Residents interviewed and observed were Resident #8, Resident #9, Resident #10, Resident #11, Resident #12, Resident #13, and Resident #14) (Non-interviewable observed were Resident #15, Resident #16, Resident #17, Resident #18, and Resident #19). Record review of the observed residents indicated each had been assessed by a nurse. There were skin assessments dated 2/23/24 for each of the 12 residents. Each of the 12 residents' care plan had been revised to include being at risk for mental/emotional distress on 2/23/2024. During interviews conducted on 02/24/24 beginning at 2:00 p.m. through 3:38 p.m., 19 of 33 of all staff in-serviced (including staff across all shifts that were the Administrator, the DON, the Treatment Nurse, CNAs, LVNs, RNs, Dietary Manager, Medical Records/Housekeeping Supervisor, and Activity (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675958 If continuation sheet Page 9 of 33 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 675958 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Citizens Trail 1008 Citizens Trail Texarkana, TX 75501 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Director) were interviewed. All staff said they received education on signs and symptoms of abuse, who and when to report abuse, types of abuse, reporting requirements, how to file a grievance, timely resolution, and resident being able to voice grievances without fear of reprisal or discrimination. The Treatment nurse said she had assisted in completing the head-to-toe assessments and skin assessments of each resident on 02/23/24. CNA E, CNA F, LVN G and CNA J said they had received verbal counseling on reporting abuse to the abuse coordinator immediately if they became Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675958 If continuation sheet Page 10 of 33 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 675958 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Citizens Trail 1008 Citizens Trail Texarkana, TX 75501 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 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. Level of Harm - Immediate jeopardy to resident health or safety **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to develop and implement written policies and procedures that prohibit mistreatment, neglect, and abuse of residents, and misappropriation of resident property and establish policies and procedures to report and investigate such allegations, for 6 of 7 residents (Resident #3, Resident #5, Resident #7, Resident #2, Resident #6, Anonymous Resident) reviewed for abuse/neglect. Residents Affected - Some The facility failed to follow the facility's policy to ensure CNA B did not verbally and mentally abuse Resident #7, Resident #5, Resident #3, and Anonymous Resident. The facility failed to follow the facility's policy to ensure CNA B did not cause Resident #7 and Anonymous Resident pain when providing ADL care. The facility failed to follow the facility's policy to ensure Resident #2 did not experience verbally aggressive behaviors from CNA B. The facility failed to follow the facility's policy to ensure Resident #6 did not experience emotional distress when CNA B would refuse to change her or speak to her in an unprofessional manner. The facility failed to ensure when Resident #3 filed a complaint/grievance on 02/09/24 indicating CNA B treated him like trash, it was investigated by the facility's ADM/ Abuse Preventionist within 24 hours of the complaint/grievance per the facility's policy. The facility ADM/ Abuse Preventionist had not completed the investigation process until surveyor entrance on 02/14/24. The facility failed to ensure when Resident #3 filed a complaint/grievance on 02/09/24 indicating CNA B treated him like trash, it was reported to HHSC within 2 hours of allegation by the facility's ADM/ Abuse Preventionist per the facility's policy. The facility ADM/ Abuse Preventionist had not reported alleged allegations of abuse until surveyor entrance on 02/14/24. The facility failed to ensure the ADM/Abuse Preventionist, followed the facility's policy to identify, correct, and intervene in situations for possible abuse or mistreatment by CNA B when Resident #4 filed a complaint/grievance on 02/09/24 indicating CNA B was mean and he had overhead a CNA being ugly to another resident. The facility failed to ensure the ADM/Abuse Preventionist, CNA E, CNA J, CNA F, LVN G and AE #1, followed the facility's policy to implement measures to protect residents from harm during and following alleged allegations of abuse by CNA B. The facility failed to ensure CNA E, CNA J, CNA F, LVN G and AE #1 immediately verbally reported allegations of abuse and mistreatment to the ADM/Abuse Preventionist per the facility's policy. The facility failed to ensure AR was not afraid of retaliation for reporting abuse by CNA B. An Immediate Jeopardy (IJ) situation was identified on 02/23/24 at 3:10 p.m. while the IJ was removed on 02/24/24 at 3:45 p.m., the facility remained out of compliance at a potential for actual harm with a scope of pattern with a potential for more than minimal harm, due to the facility's need to evaluate the effectiveness of the corrective systems. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675958 If continuation sheet Page 11 of 33 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 675958 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Citizens Trail 1008 Citizens Trail Texarkana, TX 75501 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 0607 These failures could place residents at risk of abuse, neglect, and decreased quality of life. Level of Harm - Immediate jeopardy to resident health or safety Findings included: Residents Affected - Some Record review of a facility's Abuse/Reportable Events policy dated 01/17 indicated .all residents have the right to be free from abuse, neglect .residents should not be subjected to abuse by anyone .it is everyone's responsibility to recognize, report, and promptly investigate actual or alleged abuse, neglect .and situations that may constitute abuse or neglect to any resident in the facility .abuse: the willful infliction of injury .intimidation .pain or mental anguish .it included verbal abuse, sexual abuse, physical abuse, and mental abuse .mental abuse .includes, but not limited to humiliation, harassment, threats of punishment or deprivation .verbal abuse .any use of oral written or gestured language that willfully disparaging and derogatory terms to resident .mistreatment: means inappropriate treatment or exploitation of a resident .all reports or suspicion of abuse/neglect .will investigated as facility protocol .investigations will be reviewed by the facility administrator and/or Abuse Preventionist within 24 hours of complaint .appropriate notification to state and home office will be the responsibility of the administrator .the facility will be responsible to identify, correct, and intervene in situations of possible abuse/neglect .facility employees must report all allegations of abuse, neglect, exploitation, mistreatment of residents .to the facility administrator .the facility administrator or designee will report the allegation to HHSC .if allegations involve abuse or result in serious bodily injury, the report is to be made within 2 hours of the allegation .comprehensive investigations will be the responsibility of the administrator and/or Abuse Preventionist .the facility will take necessary measure to protect residents and employees from harm during and following an abuse, neglect, exploitation, mistreatment of resident . Record review of the facility's Grievance/Complaint log dated 02/24 indicated .02/09/24 .Resident: Resident#3 .Person filing report: Resident #3, Date of Incident: 2/9/24 .Person Investigating: ADM .Date Resident/Family Informed of Findings: 2/9/24 .Disposition of Complaint: CNA treat him like trash . Record review of Resident #3 's Grievance/Complaint Investigation Report dated 02/09/24 indicated .Describe the incident as provided by the resident/individual: Res [Resident #3] states that CNA B treat him like trash .Recommendations/corrective action taken .CNA B have been counseled regarding their care administration and how they address Resident #3 . There was no documented date of when the recommendations/corrective action taken was done. There was no documentation noted for, Describe your findings of the incident, Was grievance/complaint resolved to the satisfaction of all concerned, Date resident/individual received report of findings, or .I, blank, certify that I have received a copy of the documents surrounding the grievance/complaint filed on . Record review of the facility's Grievance/Complaint log dated 02/24 indicated .02/09/24 Resident: Resident #4 .Person filing report: Resident #4 .Date of Incident: 2/9/24 . Person Investigating: ADM .Date Resident/Family Informed of Findings: 2/9/24 .Disposition of Complaint: CNA 's mean . Record review of Resident #4's Grievance/Complaint Investigation Report dated 02/09/24 indicated .Describe the incident as provided by the resident/individual: Res [Resident #4] state CNA's .CNA B .are mean .Res [Resident #4] has overheard CNA being ugly to other Res . There was no documentation noted for, Describe your findings of the incident, Recommendation/corrective action taken, Was grievance/complaint resolved to the satisfaction of all concerned, Date resident/individual received report of findings, or .I, 'blank', certify that I have received a copy of the documents surrounding the grievance/complaint filed on . (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675958 If continuation sheet Page 12 of 33 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 675958 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Citizens Trail 1008 Citizens Trail Texarkana, TX 75501 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 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some 1. Record review of Resident #3's face sheet printed 02/15/24 indicated Resident #3 was a [AGE] year-old male and admitted on [DATE] with diagnoses including schizoaffective disorder (is a mental health condition), generalized anxiety disorder (is a condition of excessive worry about everyday issues and situations), cognitive communication (problems with communication that have an underlying cause in a cognitive deficit), and muscle wasting and atrophy (shortening). Record review of Resident #3's quarterly MDS assessment dated [DATE] indicated Resident #3 was understood and had the ability to understand others. The MDS indicated Resident #3 had unclear speech, adequate hearing, and adequate vision. The MDS indicated Resident #3 had a BIMS score of 13 which indicated intact cognition. The MDS indicated Resident #3 did not have psychosis, behavioral symptoms, or rejection of care. The MDS indicated Resident #3 required substantial/maximal assistance (helper does more than half the effort) for toileting hygiene, shower/bathe self, lower body dressing, personal hygiene, and partial/moderate assistance (helper does less than half the effort) for oral hygiene, upper body dressing and toilet transfer. The MDS indicated Resident #3 was occasionally incontinent for urine and frequently incontinent for bowel. Record review of Resident #3's care plan dated 06/12/22, edited on 01/11/24 indicated Resident #3 had potential for injury related to falls due to history of previous fall. Intervention included remind/encourage resident to use call light to gain assistance. During an interview on 02/15/24 at 12:04 p.m., Resident #3 said CNA B acted like she was better than him. He said CNA B said mean stuff to him all the time. He said CNA B did cuss at him and recently cussed him out after she helped him in the shower. He said CNA B made him feel like an outcast. 2. Record review of Resident #5's face sheet printed 02/15/24 indicated Resident #5 was a [AGE] year-old male and admitted on [DATE] with diagnoses including hemiplegia (is paralysis that affects only one side of your body) and hemiparesis (is weakness or the inability to move on one side of the body, making it hard to perform everyday activities like eating or dressing) following cerebral infarction affecting non dominant side, cerebral infarction (stroke), acquired absence of right leg below knee, and end stage renal disease (is a medical condition in which a person's kidneys cease functioning on a permanent basis leading to the need for a regular course of long-term dialysis or a kidney transplant to maintain life). Record review of Resident #5's quarterly MDS assessment dated [DATE] indicated Resident #5 was understood and had the ability to understand others. The MDS indicated Resident #5 had adequate hearing, clear speech, and adequate vision. The MDS indicated Resident #5 had a BIMS score of 15 which indicated intact cognition. The MDS indicated Resident #5 had functional limitation range of motion to lower extremities to one side. The MDS indicated Resident #5 required partial/moderate assistance (helper does less than half the effort) for oral and toileting hygiene, shower/bathe self, dressing, and personal hygiene, and substantial/maximal assistance for sit to stand, chair/bed-to-chair, toilet, and tub/shower transfer. The MDS indicated Resident #5 had frequent incontinence for urine and bowel. Record review of Resident #5's care plan dated 01/20/24 indicated Resident #5 had an ADL self-care performance deficit and limited physical mobility. Intervention included the resident required extensive assistance for bed mobility, toilet use and transfer. During an interview on 02/15/24 at 12:00 p.m., Resident #5 said CNA B was not easy to work with. He said the facility wanted CNA B to use the mechanical lift to transfer him, but she did not which (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675958 If continuation sheet Page 13 of 33 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 675958 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Citizens Trail 1008 Citizens Trail Texarkana, TX 75501 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 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some made her pick him up from the wheelchair and push him on the bed. He said she sometimes acted like she was afraid to transfer him because she thought he would put poop on her. He said sometimes she put his coat in his wheelchair to sit on so he could poop on it instead of the facility's linen. He said CNA B did not want him eating his snacks because it made him have loose bowels. He said CNA B talked rough to him and kind of turned and cleaned him rough. He said he was not afraid of her. He said sometimes she tells him, Don't talk to me! He said CNA B did not know how to talk to people. He said CNA B put him in hospital gowns instead of shirts, which he would ask for, but was always told gowns were easier. He said CNA B was not very nice to Resident #3, his roommate. He said she throws his clothes in the trash and talked rough to him. 3. Record review of Resident #7's face sheet printed on 02/15/24 indicated Resident #7 was a [AGE] year-old female and admitted on [DATE] and latest return on 02/15/24 with diagnoses including nontraumatic intracranial hemorrhage (brain bleed), flaccid hemiplegia affecting left side non dominant (the affected extremity exhibits decreased muscle tone and cannot be actively moved by the patient), legal blindness, muscle weakness, muscle wasting and atrophy (shortening), body mass index 50.0-59.9 (morbidly obese), major depressive disorder (a mental health disorder characterized by persistently depressed mood or loss of interest in activities, causing significant impairment in daily life), and anxiety disorder (persistent and excessive worry that interferes with daily activities). Record review of Resident #7's quarterly MDS assessment dated [DATE] indicated Resident #7 was understood and had the ability to understand others. The MDS indicated Resident #7 had adequate hearing, clear speech, and severely impaired vision. The MDS indicated Resident #7 had a BIMS score of 14 which indicated intact cognition. The MDS indicated Resident #7 had functional limitation in range of motion to her upper and lower extremities on one side. The MDS indicated Resident #7 required substantial/maximal assistance (helper does more than half the effort) for toileting hygiene, shower/bathe self, dressing, personal hygiene, roll left and right and dependent for chair/bed-to-chair transfer, toilet transfer, and tub/shower transfer. The MDS indicated Resident #7 was always incontinent for urine and bowel. Record review of Resident #7's care plan dated 06/10/22, edited 02/14/24 indicated Resident #7 had an ADL self-care performance deficit and limited physical mobility. Intervention included bed mobility, bathing and toilet use required extensive assistance and total assistance required for transfers. Record review of Resident #7's care plan dated 08/02/22, edited 02/14/24 indicated Resident #7 had demonstrated demanding behaviors towards others, yelling out for assistance when request for assistance is not answered immediately, desiring one on one constant help/assist from staff. Intervention included offer an outlet for resident to express feelings, wishes and frustrations. During an interview on 02/14/24 at 10:35 a.m., Resident #7 said she did not get along CNA B. She said CNA B jerked her arm and caused her pain when she got her up and called her fat. She said CNA B said things like I'm [CNA B] a buck 75 and you're [Resident #7] 300 pounds, so you need to help me or You [Resident #7] don't even try to help me [CNA B]. She said her left arm was bad so she could not help from that side. She said her family member filed a grievance about CNA B treatment of her. She said the ADM and DON were aware of CNA B's being mean and saying hurtful things to her. She said when CNA B said mean things to her, it made her sad. She said the DON and CNA B were friends, and nothing seemed to happen when you complained about CNA B. During an interview on 02/14/24 at 11:00 a.m., Resident #7's family member #1 said she complained (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675958 If continuation sheet Page 14 of 33 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 675958 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Citizens Trail 1008 Citizens Trail Texarkana, TX 75501 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 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some to the DON and ADM about CNA B being mean to Resident #7, but nothing happened. She said the first time she reported CNA B was probably in November 2023. She said the DON told her CNA B would not be Resident #7's CNA. She said as time went on CNA B still was Resident #7's aide. She said the family kind of dealt with CNA B still being Resident #7's aide because the facility was short staffed. She said around December 2023, AE #1 called her at home and told her she needed to check on Resident #7 because CNA B was mistreating her. She said AE #1 told her she reported CNA B's mistreatment to the DON. She said when she filed the complaint on 12/26/23, she told the DON that CNA B said rude and hurtful things to her family member. She said she told the DON, CNA B always commented on Resident #7's weight. She said CNA B also told Resident #7, nobody care is she told her family about things because if her family really cared about Resident #7, they would not have put her in nursing home. She said CNA B also said things like I don't have time to be doing this or I'm busy, so I ain't doing that. She said the family had been pretty much just accepting any care that was given from CNA B, because nothing was being done. She said CNA N and the DON were pretty cool with each other so maybe that was why nothing happened. During an interview on 02/15/24 at 10:20 a.m., Resident #7's family member #2 said Resident #7 told her CNA B was rough, mean, and talked to her in a demeaning way. She said CNA B behavior upset Resident #7 and when CNA B was not working, Resident #7 was happy and relieved. During an interview on 02/15/24 at 11:00 a.m., Resident #7's family member #3 said Resident #7 complained CNA B was rude to her and does not treat her right. He said Resident #7 complained CNA B commented on her weight and told him I can't stand her! 4. Record review of Resident #2's face sheet printed 02/15/24, indicated Resident #2 was an [AGE] year-old, female and admitted on [DATE] and 04/22/22 with diagnoses including unilateral primary osteoarthritis (is a chronic condition affecting the joints), depression (is a mood disorder that causes a persistent feeling of sadness and loss of interest), and generalized anxiety disorder (is a condition of excessive worry about everyday issues and situations). Record review of Resident #2's annual MDS assessment dated [DATE], indicated Resident #2 was understood and had the ability to understand others. The MDS indicated Resident #2 had adequate hearing, clear speech, and adequate vision. The MDS indicated Resident #2 had a BIMS score of 14 which indicated intact cognition. The MDS indicated Resident #2 required set-up or clean-up assistance for oral and toilet hygiene, shower/bathe self, and upper body dressing and supervision or touching assistance for lower body dressing, putting on/taking off footwear, transfers, and personal hygiene. The MDS indicated Resident #2 was occasionally incontinent of urine and bowel. Record review of Resident #2's care plan dated 03/01/22, edited on 01/30/24, indicated Resident #2 had potential for injury related to falls due to unsteady gait, attempted to stand unassisted, and lost balance easily. Intervention included resident educated on importance of using call light to gain assistance. During an interview on 02/14/24 at 12:45 p.m., Resident #2 said CNA B was verbally aggressive to her and other residents. She said the few times CNA B was verbally aggressive to her, it made her mad. She said she had not reported CNA B to the ADM because when she was admitted 2 years ago, other residents told her not to talk to the state or corporate people because the staff would retaliate. She said, so I've kept my mouth shut. 5. Record review of Resident #6's face sheet printed 02/15/24 indicated Resident #6 was an [AGE] (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675958 If continuation sheet Page 15 of 33 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 675958 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Citizens Trail 1008 Citizens Trail Texarkana, TX 75501 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 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some year-old, female and admitted on [DATE] with diagnoses including age related cognitive decline (overall slowness in thinking and difficulties sustaining attention, multitasking, holding information in mind and word-finding), chronic obstructive pulmonary disease (a group of diseases that cause airflow blockage and breathing-related problems), and chronic kidney disease, stage 3 (is a type of kidney disease in which a gradual loss of kidney function occurs over a period of months to years). Record review of Resident #6's quarterly MDS assessment dated [DATE] indicated Resident #6 was understood and had the ability to understand others. The MDS indicated Resident #6 had adequate hearing, clear speech, and adequate vision. The MDS indicated Resident #6 had a BIMS score of 15 which indicated intact cognition. The MDS indicated Resident #6 required partial/moderate assistance for oral hygiene, upper body dressing, and personal hygiene and substantial/maximal assistance for toilet hygiene, shower/bathe self, lower body dressing, and putting on/taking off footwear. The MDS indicated Resident #6 was always incontinent of urine and bowel. During an interview on 02/15/24 at 10:03 a.m., Resident #6 said CNA B spoke to you a nasty way. She said when you asked CNA B for something, she would say, What you want? or Well, I [CNA B} ain't got no time for that! She said CNA B did not say those things in a joking manner. She said CNA B had smarted off at her and a bunch of folks. She said CNA B refused to change her and would get someone else to do it. She said CNA B's actions hurt her feelings and made her feel like she did something wrong. 6. Record review of Resident #4's face sheet printed 02/15/24 indicated Resident #4 was a [AGE] year-old, male and admitted on [DATE] and 03/28/23 with diagnoses including multiple sclerosis (is a potentially disabling disease of the brain and spinal cord (central nervous system)), anxiety disorder (a mental health disorder characterized by feelings of worry, anxiety, or fear that are strong enough to interfere with one's daily activities), and muscle wasting and atrophy (shortening). Record review of Resident #4's quarterly MDS assessment dated [DATE] indicated Resident #4 was understood and had the ability to understand others. The MDS indicated Resident #4 had adequate hearing, clear speech, and adequate vision. The MDS indicated Resident #4 had a BIMS score of 14 which indicated intact cognition. The MDS indicated Resident #4 required partial/moderate assistance for toileting hygiene, shower/bath self, and dressing. The MDS indicated Resident #4 was occasional incontinent of urine and frequently incontinent of bowel. Record review of Resident #4's care plan dated 12/26/23, edited on 01/09/24 indicated Resident #4 had potential for injury related to fall due to history of previous falls. Intervention included encourage resident to participate in activities program that encourages exercise and physical activity for strengthening and improved mobility. During an interview on 02/14/24 at 1:15 p.m., Resident # 4 said CNA B intimated the poor, old ladies on her hall. He said CNA B was so mean to AR sometimes, AR would start shaking. He said about 1-2 weeks ago, he heard CNA B tell Resident #3, Now, take your a** back to your room after she helped him take a shower. He said LVN G was standing by the shower door, so he did not know how LVN G did not hear CNA B cussing at Resident #3. He said he had filed a grievance at the beginning of the month about CNA behavior. He said it did not really do any good to report stuff because nothing happened. 7. During an interview and observation on 02/14/24 at 1:30 p.m., AR said he/she had been putting up with CNA B's behaviors for a while. AR said CNA B got a better attitude for a while then she went back to being bad. AR said she never hit her/him or anything, but CNA tells you to hurry up! AR said (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675958 If continuation sheet Page 16 of 33 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 675958 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Citizens Trail 1008 Citizens Trail Texarkana, TX 75501 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 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some CNA B was always in a hurry and rough with cares. AR said she/he had pain in her/his arms and CNA B, who knew she/he had pain in the arms, would pull the arm up and yank her/his clothes off or pull on the hurt arm. AR said CNA B pushes you or throws you in the bed when she's transferring you. AR said she/he was afraid of CNA B. AR body was shaking in the chair and increased as she/he talked. During an interview on 02/14/24 at 11:22 a.m., AE #1 said CNA B was mean and aggressive with cares. AE #1 said CNA B picked on Resident #7 all the time. AE #1 said CNA B made Resident #7 cry sometimes because of how bad she [CNA B] talked about her. AE #1 said Resident #7 had behaviors of throwing herself out of the bed or wheelchair, but it was because she [Resident #7] was so mad and frustrated with CNA B picking on her all day long. AE #1 said she/he heard CNA B say things like, wipe your own a**! AE #1 said CNA B took Resident # 5's food away from him after he got back from dialysis, because sometimes he would be hungry and eat a lot of food since he did not eat at dialysis. AE #1 said she [CNA B] complained in front of Resident #5 if he ate too much, he was going to sh** everywhere. AE #1 said another resident [AR] complained CNA B was rude and rough with her/him, but the resident was too scared to report it because of retaliation. AE #1 said the resident [AR #5] was so scared about reporting CNA B, the resident [AR] was literally shaking from the fear of CNA B. AE #1 said she/he reported the resident [AR] complaint about CNA B's treatment to a nurse and the nurse said CNA B was being investigated. AE #1 said she/he did not want to disclose the nurse's name. During an interview on 02/14/24 at 4:07 p.m., LVN G said she had worked at the facility for 22 years. She said she had not heard or seen any abuse at the facility. She said she had never been told by a resident or staff CNA B was rough or rude to residents. She said she did not hear CNA B say cuss words to Resident #3. She said she knew to report abuse and neglect to DON or ADM immediately. During an interview on 02/14/24 at 4:14 p.m., CNA E said she had worked at the facility for 5 years on the 2pm-10pm shift. She said she had heard residents being yelled at or refusing staff the resident care which she considered verbal abuse. She said it took the choices away from the resident making them feel helpless. She said she never saw who was verbally abusing the resident, just heard it. She said it happened on the 6am-2pm and 2pm-10pm shift. She said she knew she was supposed to report abuse allegation but felt it was pointless because nothing happened to the person. She said not reporting abuse risked the abuse to keep happening. She said the verbal abuse made the residents defensive and not ask for help from staff. During an interview on 02/14/24 at 4:15 p.m., CNA B said she had been employed at the facility for a year. She said she normally worked the 2pm-10pm shift. She said she had recently received abuse training. She said she did not abuse any residents or was rough with cares. She said she did not have any issues with any of the residents. She said she did not have any issues with Resident #3, but she did try to take another person with her when she dealt with him. During an interview on 02/15/24 at 10:30 a.m., CNA J said she had been working for the facility since June 2022 but had previously worked at the facility for 4 years. She said she worked all shifts at the facility. She said she worked the middle hall (Rooms 201-216) and sometimes the B long hall (room [ROOM NUMBER]-228). She said several residents had complained about CNA B to her. She said Resident #3, Resident #5, Resident #7, and AR had complained about how CNA B talked to and treated them. She said she had reported the complaints, in the last 1-2 months, to the DON. She said CNA B's treatment of the residents made them feel like she did not like them. She said another resident told her CNA B cussed out Resident #3 and LVN G was there. She said when CNA B treats Resident #3 bad, he always said, I'm not putting with this sh**! (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675958 If continuation sheet Page 17 of 33 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 675958 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Citizens Trail 1008 Citizens Trail Texarkana, TX 75501 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 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some During an interview on 02/15/24 at 11:22 a.m., CNA F said she had worked at the facility for 10 years on the 6am-2pm shift. She said she normally worked B long hall which were rooms 216-228. She said verbal and mental abuse was happening at the facility by CNA B. She said Resident #5 told her CNA B was too rough during cares and he was afraid of her. She said Resident #5 always asked the 6a-2pm shift to put him back to bed before they left because he did not want CNA B doing it. She said another resident reported to her CNA B was rough, talked harsh, and made them go to bed when she wanted them to. She said Resident #3 told her CNA B cussed at him and was ugly to him. She said she had reported the resident's complaint to LVN G, and she said CNA B treatment to resident had been reported. She said the residents being abused probably felt sad, disgusted, or isolated themselves. She said she had abuse training and knew the ADM was the abuse coordinator. During an interview on 02/15/24 at 1:20 p.m., the DON said she had known CNA B for a while and sometimes her tone was taken the wrong way. She said sometimes CNA B's tone and demeanor was aggressive. She said CNA B's aggressive tone or demeanor was not directed at the residents. She said it was just how CNA B was. She said staff had not recently told her of any residents complaining about CNA B's care or demeanor. She said recently Resident #3 told her CNA B and him had verbally got into, but he had called her a bit**. She said no formal disciplinary actions or report had been done on CNA B. She said she did not know if a safe survey had been done recently because the SW did those. She said staff should first report abuse allegations to the ADM and then her (DON). She said staff should report abuse allegation to the ADM or DON, immediately. During an interview on 02/15/24 at 2:09 p.m., the ADM said he was the abuse coordinator. He said CNA B had employee disciplinary reports on file. He said CNA B had been monitored due to the previous abuse allegations by doing rounds. He said he expected staff to immediately notify him of any allegation of abuse. He said staff were told in orientation and in-serviced on the abuse policy. He said residents were educated on reporting abuse allegations in resident council meetings and he had an open-door policy. He said he had communicated with staff and resident that retaliation would not occur if they reported allegations of abuse. CNA B's employee disciplinary reports were requested during the interview and not received before exit. CNA B's employee disciplinary reports were received 6 days after exit. During an interview on 02/15/24 at 2:26 p.m. the SW said she was responsible for documenting resident's grievances on the grievance/complaint log and report. She said the grievance then went to department heads the complaint was related to. She said she did not remember receiving a complaint/grievance about abuse from a resident. She said she had received a complaint from Resident #4, but it was a CNA but not CNA B. During an interview on 02/15/24 at 2:30 p.m., the ADM said CNA B had been mentioned in February 2024 grievances by Resident #4. He said he had not given February's grievance report when requested at entrance because he was still investigating the allegations. During an interview on 02/23/24 at 3:26 p.m., the ADM said typically Social Services wrote up any grievance or complaints and brought them to him to be resolved. He said he then went to the appropriate department heads for resolution. He said he was working through the grievances and there were 3 - 4 that had not been resolved at the time of the initial complaint investigation. He said it had only been 2 - 3 days since he had received the grievances when the initially investigation started on 02/14/24. Record review of CNA B's proficiency dated 04/11/23 indicated .knowledge of abuse/neglect protocol (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675958 If continuation sheet Page 18 of 33 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 675958 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Citizens Trail 1008 Citizens Trail Texarkana, TX 75501 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 0607 .satisfactory .communication skills (respect/dignity) .satisfactory . Level of Harm - Immediate jeopardy to resident health or safety Record review of CNA B's employee disciplinary report dated 02/02/04, indicated .CNA B .verbal counseling .Resident #3 complained that CNA B talked to him disrespectfully while attempting to provide care .reminded CNA B that this was the 2nd complaint regarding her tone with Resident #3 .another complaint would result in her suspension and/or termination .CNA B reported that she was only trying to get Resident #3 to get up and take a shower .Resident #3 needed to be cleaned up and was refusing .signature of supervisor presenting EDR:ADM .employee refused to sign .ADM (supervisor initial) .to be retained in employee's personnel file . The employee disciplinary report did not reveal CNA B's signature or date received and a witness initials of CNA B's refusal to sign. Residents Affected - Some Record review of the facility's 12/23 staff sign in sheet indicated CNA B worked 24 days, 2pm-10pm shift on the hall where Resident #3, Resident #5, and Resident #7 resided. Record review of a facility's Be mindful of your tone and how you say things to and around the residents[TRUNCATED] FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675958 If continuation sheet Page 19 of 33 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 675958 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Citizens Trail 1008 Citizens Trail Texarkana, TX 75501 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 0609 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. Based on interview and record review, the facility failed to ensure all alleged violations involving mistreatment, neglect, abuse, or misappropriation of resident property were reported immediately, but not later than 2 hours after the allegation is made, if the event that cause the allegation involved abuse to the administrator of the facility and to other officials (including to the State Agency) for 2 of 7 residents (Resident #3 and Resident #4) and 6 of 9 staff members (ADM, CNA E, CNA J, CNA F, LVN G, and AE #1) reviewed for reporting of abuse, neglect and mistreatment. The facility failed to ensure when Resident #3 filed a complaint/grievance on 02/09/24 indicating CNA B treated him like trash, it was reported to HHSC within 2 hours of allegation by the facility's ADM/ Abuse Preventionist. The facility ADM/ Abuse Preventionist had not reported alleged allegations of abuse by CNA B. The facility failed to ensure when Resident #4 filed a complaint/grievance on 02/09/24 indicating CNA B was mean and he had overhead a CNA being ugly to another resident it was reported to HHSC within 2 hours of allegation by the facility's ADM/ Abuse Preventionist. The facility ADM/ Abuse Preventionist had not reported alleged allegations of abuse by CNA B . The facility failed to ensure CNA E reported to the ADM when she heard staff verbally abusing residents. CNA E did not report verbal abuse because it was pointless because nothing would happen. The facility failed to ensure CNA J reported to the ADM when she received multiple complaints of abuse and mistreatment from CNA B. The facility failed to ensure CNA F reported to the ADM when she received multiple complaints of abuse from CNA B. CNA F only informed LVN G of the allegations of abuse and mistreatment from CNA B. LVN G informed CNA F, CNA B's mistreatment to the residents had been reported. The facility failed to ensure LVN G reported to the ADM when CNA F reported allegations of abuse and mistreatment from CNA B. The facility failed to ensure AE #1 reported to the ADM when she received complaints of abuse and witnessed verbal/mental abuse from CNA B. An Immediate Jeopardy (IJ) situation was identified on 02/23/24 at 3:10 p.m. while the IJ was removed on 02/24/24 at 3:45 p.m., the facility remained out of compliance at a potential for actual harm with a scope of pattern with a potential for more than minimal harm, due to the facility's need to evaluate the effectiveness of the corrective systems. These failures could place residents at risk for continued alleged violations, diminished quality of life and harm. Findings included: Record review of the facility's Grievance/Complaint log dated 02/24 indicated .02/09/24 .Resident: Resident #3 .Person filing report: Resident #3, Date of Incident: 2/9/24 .Person Investigating: ADM .Date Resident/Family Informed of Findings: 2/9/24 .Disposition of Complaint: CNA treat him like (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675958 If continuation sheet Page 20 of 33 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 675958 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Citizens Trail 1008 Citizens Trail Texarkana, TX 75501 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 0609 trash . Level of Harm - Immediate jeopardy to resident health or safety Record review of the facility's Grievance/Complaint log dated 02/24 indicated .02/09/24 Resident: Resident#4 .Person filing report: Resident #4 .Date of Incident: 2/9/24 . Person Investigating: ADM .Date Resident/Family Informed of Findings: 2/9/24 .Disposition of Complaint: CNA 's mean . Residents Affected - Some During an interview on 02/14/24 at 11:22 a.m., AE #1 said CNA B was mean and aggressive with cares. AE #1 said she/he reported the resident [AR] complaint about CNA B's treatment to a nurse, not the ADM, and the nurse said CNA B was being investigated. AE #1 said she/he did not want to disclose the nurse's name. AE #1 said she/he did not report the incident to the ADM because she/he was told it was being investigated. During an interview on 02/14/24 at 4:07 p.m., LVN G said she had never been told by a resident or staff CNA B was rough or rude to residents. She said she did not hear CNA B say cuss words to Resident #3. She said she knew to report abuse and neglect to DON or ADM immediately. During an interview on 02/14/24 at 4:14 p.m., CNA E said she had heard residents being yelled at or staff refusing the resident care which she considered verbal abuse. She said she knew she was supposed to report abuse allegations but felt it was pointless because nothing happened to the person. She said not reporting abuse risked the abuse to keep happening. During an interview on 02/15/24 at 10:30 a.m., CNA J said several residents had complained about CNA B to her. She said she had reported the complaints, in the last 1-2 months, to the DON, not the ADM. During an interview on 02/15/24 at 11:22 a.m., CNA F said verbal and mental abuse was happening at the facility by CNA B. She said another resident reported to her CNA B was rough, talked harsh, and made them go to bed when she wanted them to. She said she had reported the resident's complaint to LVN G but not the DON or ADM, and she said CNA B's treatment to residents had been reported. She said which was why she did not report the complaints to the DON and ADM. She said she had abuse training and knew the ADM was the abuse coordinator. Unable to interview AE #1 due to AE #1 calling from an undisclosed phone number. During an interview on 02/15/24 at 1:20 p.m., the DON said staff had not recently told her of any residents complaining about CNA B's care or demeanor. She said staff should first report abuse allegations to the ADM and then her (DON). She said staff should report abuse allegations to the ADM or DON, immediately. During an interview on 02/15/24 at 2:09 p.m., the ADM said he was the abuse coordinator. He said he expected staff to immediately notify him of any allegation of abuse. He said abuse allegation had been reported to him a couple months ago in November or December 2023. He said he did not recall the resident and staff involved in the allegation, but he had made a self-report. He said CNA B had been verbally counseled a few times regarding how she spoke to residents. He said CNA B had been accused of abuse during full book survey in June 2023. He said he did not know the results of investigation but if CNA B was guilty, she would not still be working at the facility. He said CNA B had employee disciplinary reports on file. He said CNA B had been monitored due to the previous abuse allegations by doing rounds. He said staff were told in orientation and in-serviced on the abuse policy. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675958 If continuation sheet Page 21 of 33 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 675958 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Citizens Trail 1008 Citizens Trail Texarkana, TX 75501 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 0609 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some During an interview on 02/23/24 at 2:50 p.m., LVN G said the abuse coordinator was the ADM. She said any abuse of any kind should be reported to him immediately. She said any staff could get in trouble for not reporting abuse to the Abuse Coordinator. She said not reporting abuse could hurt a resident. During an interview on 02/23/24 at 2:57 p.m., CNA F said the DON was the Abuse Coordinator. She said if she saw anything wrong, she would tell the whole thing. She said, We are there to take care of them. She said she would report any abuse immediately. During an interview on 02/23/24 at 3:17 p.m., CNA E said the ADM was the Abuse Coordinator. She said she would report any kind of abuse to him. This included verbal abuse, financial abuse, physical abuse, and sexual abuse. She said any abuse should be reported immediately. She said not reporting abuse could cause residents to have mood changes and/or depression. During an interview on 02/23/24 at 3:26 p.m., the ADM said typically Social Services wrote up any grievance or complaints and brought them to him to be resolved. He said he then went to the appropriate department heads for resolution. He said he was working through the grievances and there were 3 - 4 that had not been resolved at the time of the initial complaint investigation. He said it had only been 2 - 3 days since he had received them. During an interview on 02/23/24 at 3:40 p.m., CNA J said the ADM and DON were the Abuse Coordinators. She said she would report any form of abuse. She said abuse could be physical, financial, sexual, or verbal. She said she would report anything concerning that was going on with the resident. She said not reporting abuse puts the residents in danger and would make her as bad at the one giving the abuse. Record review of a facility's Abuse, Neglect, and reportable events in-service dated 01/30/24 indicated .it is everyone's responsibility to recognize, report, and promptly investigate actual or alleged abuse, neglect . LVN G, CNA E, and CNA F's signatures were noted on the attendance roster. CNA J's signature was not noted on the attendance roster. Record review of a facility's Abuse/Reportable Events policy dated 01/17 indicated .all resident have the right to be free from abuse, neglect . it is everyone's responsibility to recognize, report, and promptly investigate actual or alleged abuse, neglect . facility employees must report all allegations of abuse, neglect, exploitation, mistreatment of residents .to the facility administrator .the facility administrator or designee will report the allegation to HHSC .if allegations involve abuse or result in serious bodily injury, the report is the be made within 2 hours of the allegation . This was determined to be an Immediate Jeopardy (IJ) on 02/23/24 at 3:10 p.m. The facility Administrator, and DON were notified. The Administrator was provided with the IJ template on 02/23/24 at 3:10 p.m. 2/24/2024 Plan of Removal - F 609 Immediate Action Taken Resident Specific (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675958 If continuation sheet Page 22 of 33 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 675958 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Citizens Trail 1008 Citizens Trail Texarkana, TX 75501 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 0609 Allegations of verbal abuse brought to the Administrator on 2/15/2024 at 3:30pm. Level of Harm - Immediate jeopardy to resident health or safety Allegations of verbal abuse reported to HHSC by the Administrator on 2/15/2024 at 4:00pm. Residents Affected - Some CNA B was terminated on 2/21/2024 at 2:21pm. CNA B was suspending pending investigation on 2/15/2024 at 3:30pm. CNA B did not work in the facility after allegations of verbal abuse were brought to the Administrator, by the HHSC surveyor on 2/15/2024. Residents #3, #5, and #7 were interviewed by the Administrator on 2/15/2024. Residents #3, #5, and #7's Responsible Parties notified of the verbal abuse allegation on 2/15/2024. Residents #3, #5, and #7 had head to toe assessments performed by the Treatment Nurse on 2/15/2024. MD notified of the IJ on 2/23/2024 at 4:48pm by Administrator, no new orders received. CNA E, CNA J, CNA F, and LVN G were given 1:1 in-service regarding abuse reporting - who to report to and when to report, on 2/24/2024 by Director of Nursing. CNA E, CNA J, CNA F, and LVN G were given documented verbal disciplinary action for failing to follow the facility's abuse policy, on 2/24/2024 by Administrator. System Changes All interviewable residents were interviewed by Administrator regarding abuse, safety, who to report concerns to, and complaint resolution on 2/23/2024. All non-interviewable residents received a head-to-toe skin assessment, to assess for any injuries or evidence of abuse, by Charge Nurses, Director of Nursing and Treatment Nurse on 2/23/2024. All residents in the facility received head to toe skin assessments, to assess for any injuries or evidence of abuse, by Charge Nurses, Director of Nursing and Treatment Nurse on 2/23/2024. All resident care plans revised to include being at risk for mental/emotional distress on 2/23/2024 by Regional Reimbursement Consultant. Abuse/Reportable Event policy reviewed on 2/23/2024 at 5:15pm by Administrator, Regional Nurse, and Director of Nursing. No changes made to policy at this time. Education Director of Nursing provided education to all staff regarding signs and symptoms of abuse, and who/when to report it on 2/23/2024, at 6pm. Staff not present for the education will receive the education prior to their next shift. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675958 If continuation sheet Page 23 of 33 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 675958 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Citizens Trail 1008 Citizens Trail Texarkana, TX 75501 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 0609 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Director of Nursing provided education to all staff regarding the Abuse/Reportable Event Policy, including types of abuse, definition of verbal and mental abuse, reporting requirements. All staff present in the facility were educated on2/23/2024, at 6pm. Staff not present for the education will receive the education prior to their next shift. Director of Nursing provided education to all staff regarding the Grievance Policy, including how to file a grievance, timely resolution, and that residents are able to voice grievances without fear of reprisal or discrimination. All staff present in the facility were educated on2/23/2024, at 6pm. Staff not present for the education will receive the education prior to their next shift. Director of Nursing provided education to all staff regarding Examples of Mental/Verbal Abuse, how to report those allegations, and that retaliation should never occur. All staff present in the facility were educated on 2/24/2024, at 11:30am. Staff not present for the education will receive the education prior to their next shift. Regional Clinical Consultant provided education to Administrator and Director of Nursing regarding the Abuse/Reportable Event Policy including types of abuse, definition of verbal and mental abuse, and reporting requirements to HHSC, on 2/23/2024 at 5:45pm. Regional Clinical Consultant provided education to Administrator and Director of Nursing regarding the Grievance Policy including how to file a grievance, their responsibility to investigate, assess and resolve, timely resolution of the grievance, and that residents are able to voice grievances without fear of reprisal or discrimination on 2/23/2024 at 5:45pm. On 02/24/24 a surveyor confirmed the facility implemented there plan of removal sufficiently to remove the IJ by: Record review of CNA B's termination letter. CNA B was suspended immediately and was officially terminated by telephone on 02/21/24. Record review of an Abuse Pre/Post test. The administrator said this was the test used for educational purposes concerning the staff. The test consisted of 20 questions covering the different types of abuse and reporting of allegations. There was a situation question at the end of the test. Record review of an In-Service Form indicated an in-service for the Administrator and the DON was held on 02/23/24. The in-service was presented by the Regional Clinical Consultant. The topic was the Grievance Voicing and Resolution facility policy. The policy included how to file a grievance and promptly attempting to resolve grievances. Record review of an In-Service Form indicated an in-service for the Administrator and the DON was held on 02/23/24. The in-service was presented by the Regional Clinical Consultant The topic was Abuse/Neglect and reportable events. The In-service included definitions of abuse, screening of personnel, training of personnel, prevention of abuse, identification of abuse, reporting, and protection of the residents. Record review of an In-Service Form indicated an in-service for all staff was held on 02/23/24. The in-service was presented by the DON. The topic was the Grievance - Voicing and Resolution facility policy. The policy included how to file a grievance and promptly attempting to resolve grievances. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675958 If continuation sheet Page 24 of 33 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 675958 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Citizens Trail 1008 Citizens Trail Texarkana, TX 75501 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 0609 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Record review of an In-Service Form indicated an in-service for all staff was held on 02/23/24. The in-service was presented by the DON. The topic was Abuse/Neglect and reportable events. The In-service included definitions of abuse, screening of personnel, training of personnel, prevention of abuse, identification of abuse, reporting, and protection of the residents. Record review of Employee Disciplinary Reports for CNA E, CNA F, LVN G, and CNA J dated 02/24/24 indicated they received verbal counseling for failing to report an allegation of abuse/neglect to the Abuse Coordinator. The report indicated the employees were re-educated on the abuse/reportable events policy/procedure. Each employee had signed their report. During interviews and observations conducted on 2/24/24 beginning at 1:30 p.m. through 2:00 p.m., 12 of 51 residents were observed and they showed no signs of untimely care and there were no signs of abuse. Out of the 12 residents observed, 7 were interviewable. Each said they had been educated in the last 24 hours concerning abuse and who to report any abuse to. Each of the 7 residents denied abuse of any kind. The also said they had been assessed by a nurse. (Residents interviewed and observed were Resident #8, Resident #9, Resident #10, Resident #11, Resident #12, Resident #13, and Resident #14) (Non-interviewable observed were Resident #15, Resident #16, Resident #17, Resident #18, and Resident #19). Record review of the observed residents indicated each had been assessed by a nurse. There were skin assessments dated 2/23/24 for each of the 12 residents. Each of the 12 residents' care plan had been revised to include being at risk for mental/emotional distress on 2/23/2024. During interviews conducted on 02/24/24 beginning at 2:00 p.m. through 3:38 p.m., 19 of 33 of all staff in-serviced (including staff across all shifts that were the Administrator, the DON, the Treatment Nurse, CNAs, LVNs, RNs, Dietary Manager, Medical Records/Housekeeping Supervisor, and Activity Director) were interviewed. All staff said they received education on signs and symptoms of abuse, who and when to report abuse, types of abuse, reporting requirements, how to file a grievance, timely resolution, and resident being able to voice grievances without fear of reprisal or discrimination. The Treatment nurse said she had assisted in completing the head-to-toe assessments and skin assessments of each resident on 02/23/24. CNA E, CNA F, LVN G and CNA J said they had received verbal counseling on reporting abuse to the abuse coordinator immediately if they became aware of any abuse. During an interview on 2/24/24 at 3:27 p.m., the DON said she conducted the initial in-service on 02/23/24 and another on the morning of 02/24/24. She said she planned to in-service every shift as they come on duty, until ever staff member was in-serviced. She said she had in-serviced not just nursing staff but all staff in the facility. She said in-services were about the grievance policy, the abuse and neglect policy, reporting of abuse, and signs and symptoms of abuse. The DON said she was by the Regional Nurse Consultant. She said she was in-serviced on the different types of abuse and reporting abuse. She said the Administrator was the Abuse Coordinator. The DON said she was in-serviced on grievance and following up on them. She said grievances should be followed up on immediately and at least within 24 hours. She said all abuse should be report immediately. During an interview on 2/24/24 at 3:34 p.m., Regional Clinical Consultant said she in-serviced the Administrator and DON on the evening of 2/23/24. She said she in-serviced them on abuse and the reporting abuse. She said she in-serviced them on reporting abuse immediately. She said she in-serviced them on grievances being taken very seriously and following up on them immediately. She said they focused on verbal abuse and mental abuse but did discuss all types of abuse including physical, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675958 If continuation sheet Page 25 of 33 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 675958 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Citizens Trail 1008 Citizens Trail Texarkana, TX 75501 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 0609 financial, and sexual abuse. They also discussed neglect. Level of Harm - Immediate jeopardy to resident health or safety During an interview on 2/24/24 at 3:38 p.m., the Administrator said he was in-serviced the evening of 2/23/24 by Regional Nurse Consultant. He was in-serviced on abuse policy, grievance policy and reporting abuse. He said they went through the whole thing the different types of abuse, reporting of abuse, and following up timely on grievances. Residents Affected - Some The Administrator was informed the Immediate jeopardy was removed on 02/24/24 at 3:45 p.m. the facility remained out of compliance at a severity level of potential harm with a scope of a pattern due to the facility's need to evaluate the effectiveness of the corrective systems that were put into place. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675958 If continuation sheet Page 26 of 33 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 675958 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Citizens Trail 1008 Citizens Trail Texarkana, TX 75501 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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 observation, interview and record review, the facility failed to develop and implement a comprehensive person-centered care plan to meet each resident's medical, nursing, mental and psychosocial needs for 1 of 4 residents reviewed for care plans. (Resident# 7) The facility failed to place Resident #7's bed in the lowest position per her care plan, after she had recently returned (02/15/24) from the hospital after a fall with injury (02/09/24). This failure could place residents at risk of not having individual needs met and cause residents not to receive needed services. Findings included: Record review of Resident #7's face sheet printed on 02/15/24 indicated Resident #7 was a [AGE] year-old female and admitted on [DATE] and latest return on 02/15/24 with diagnoses including nontraumatic intracranial hemorrhage (a brain bleed), flaccid hemiplegia affecting left side non dominant (the affected extremity exhibits decreased muscle tone and cannot be actively moved by the patient), legal blindness, and laceration to right foot. Record review of Resident #7's quarterly MDS assessment dated [DATE] indicated Resident #7 was understood and had the ability to understand others. The MDS indicated Resident #7 had adequate hearing, clear speech, and severely impaired vision. The MDS indicated Resident #7 had a BIMS score of 14 which indicated intact cognition. The MDS indicated Resident #7 had functional limitation in range of motion to her upper and lower extremities on one side. The MDS indicated Resident #7 required substantial/maximal assistance (helper does more than half the effort) for toileting hygiene, shower/bathe self, dressing, personal hygiene, roll left and right and dependent for chair/bed-to-chair transfer, toilet transfer, and tub/shower transfer. Record review of Resident #7's care plan dated 06/26/22, edited 02/15/24 indicated Resident #7 has potential for injury related to falls due to unsteady gait, history of previous fall, visual deficits, attempt to stand unassisted, and loses balance easily. Intervention included may have low bed (12/10/23) and place bed in lowest position while resident is in bed (12/13/23). During an observation on 02/15/24 at 9:25 a.m., Resident #7 was sitting up in bed with her bed not low to the ground. The right side of her bed was on the wall with a positioning bar attached. During an observation and interview on 02/15/24 at 9:40 a.m., Resident #7 was sitting up in bed with her bed not low to the ground. The right side of her bed was on the wall with a positioning bar attached. The DON arrived in Resident #7's and stated, Resident #7 your bed needs to be lowered. The DON looked around for the bed controller and had to move the bed to reach it. The bed controller was behind the bed on the floor. The DON lowered the bed to the floor with the bed controller. Resident #7 said she was blind and could not tell when her bed was not low to the floor. During an interview on 02/15/24 at 10:30 a.m., CNA J said she had been working for the facility since June 2022 but had previously worked at the facility for 4 years. She said she worked all shifts at the facility. She said she worked the middle hall (Rooms 201-216) and sometimes the B long hall (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675958 If continuation sheet Page 27 of 33 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 675958 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Citizens Trail 1008 Citizens Trail Texarkana, TX 75501 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few (room [ROOM NUMBER]-228). She said she worked with Resident #7 and was assigned to her today (02/15/24). She said Resident #7 was a fall risk and the facility interventions to prevent falls were putting the call light near her hand, fall mat, and her bed in lowered position. She said when she started her shift at 6am, Resident #7's bed was not low to the ground. She said she had not lowered Resident #7's bed to the lowest position. She said if Resident #7's bed was not in the lowest position she could hurt herself. She said it was everyone's responsibility to make sure Resident #7's bed was low to the ground. During an interview on 02/15/24 at 10:47 a.m., LVN K said she had been working at the facility since 2021. She said she was prn and had worked all the halls. She said Resident #7 was a fall risk and her fall interventions were low bed, get her out of the bed as soon as possible and out her room to be watched, and a fall mat. She said everybody was responsible to make sure Resident #7's bed was in the lowest position. She said when her bed was not in the lowest position, it placed Resident #7 at risk for falls. She said when residents had falls, they could develop a brain bleed or fracture something. During an interview on 02/15/24 at 1:20 p.m., the DON said Resident #7 had returned to the facility this morning (2/15/24) from a hospital stay due to a fall. She said all staff had access to resident's care plan on the electronic charting system. She said new employees were taught in training and during orientation on how to access resident's care plans. She said she ensured care plans were followed by having care plan meetings and educating staff on how to access them. She said Resident #7 had a history of falling from her bed and wheelchair. She said the facility had tried different interventions to prevent falls for Resident #7. She said Resident #7's bed should be in the lowest position to prevent injury if she had a fall. She said when she went into Resident #7's room this morning her bed was not low to the ground. She said staff should ensure Resident #7's bed was in the lowest position. She said all staff had access to Resident #7's care plan to know her fall interventions. During an interview on 02/15/24 at 2:09 p.m., the ADM said he expected care plan interventions to be followed. He said when interventions were not followed it placed residents at risk for negative outcomes. He said charge nurses should make observations and when staff made rounds to ensure care plan interventions were followed. Record review of a facility's Falls-Evaluation and Prevention policy dated 12/2017 indicated .it is the policy of this home to evaluate residents for their fall risk and develop intervention for prevention .the goal is to prevent falls if possible and avoid any injury related to falls .intervention suggestions for fall prevention .place bed in lowest position and lock wheels . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675958 If continuation sheet Page 28 of 33 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 675958 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Citizens Trail 1008 Citizens Trail Texarkana, TX 75501 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 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Level of Harm - Actual harm Residents Affected - Few **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility has failed to ensure that the resident environment remains as free of accident hazards as possible and provide supervision to prevent avoidable accidents for 1 of 3 residents reviewed for accidents. (Residents #7) The facility failed to ensure CNA A provided Resident #7 incontinence care with staff assist x2 per the care plan, which resulted in a fall on 02/08/24. The facility failed to ensure CNA B provided Resident #7 a bed bath with staff assist x2 per the care plan, which resulted in a fall with a laceration to the right foot and probable fracture to the fifth toe on 02/09/24. The facility failed to ensure MR D was trained to operate the mechanical lift for Resident #7's transfer on 02/09/24. These failures could place residents at risk of injury from accident and hazards. Findings included: Record review of Resident #7's face sheet printed on 02/15/24 indicated Resident #7 was a [AGE] year-old female and admitted on [DATE] and latest return on 02/15/24 with diagnoses including nontraumatic intracranial hemorrhage (brain bleed), flaccid hemiplegia affecting left side non dominant (the affected extremity exhibits decreased muscle tone and cannot be actively moved by the patient), legal blindness, muscle weakness, muscle wasting and atrophy (shortening), body mass index 50.0-59.9 (morbidly obese) and laceration to right foot. Record review of Resident #7's quarterly MDS assessment dated [DATE] indicated Resident #7 was understood and had the ability to understand others. The MDS indicated Resident #7 had adequate hearing, clear speech, and severely impaired vision. The MDS indicated Resident #7 had a BIMS score of 14 which indicated intact cognition. The MDS indicated Resident #7 had functional limitation in range of motion to her upper and lower extremities on one side. The MDS indicated Resident #7 required substantial/maximal assistance (helper does more than half the effort) for toileting hygiene, shower/bathe self, dressing, personal hygiene, roll left and right and dependent for chair/bed-to-chair transfer, toilet transfer, and tub/shower transfer. The MDS indicated Resident #7 was always incontinent for urine and bowel. Record review of Resident #7's care plan dated 06/26/22, edited on 02/14/24 indicated Resident #7 has potential for injury related to falls due to unsteady gait, history of previous falls, visual deficits, attempt to stand unassisted, and loses balance easily. Interventions included staff to assist x2 with bed mobility, transfer, and incontinent care. Record review of Resident #7's care plan dated 06/10/22, edited 02/14/24 indicated Resident #7 had an ADL self-care performance deficit and limited physical mobility. Intervention included bathing and bed mobility required extensive assistance. Record review of Resident #7's care plan dated 08/02/22, edited 02/14/24 indicated Resident #7 had (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675958 If continuation sheet Page 29 of 33 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 675958 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Citizens Trail 1008 Citizens Trail Texarkana, TX 75501 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 impaired visual functioning and was at risk for decrease in ADL's and injuries. Intervention included alert resident for changes in environment, announce self by name, and call resident by name. Level of Harm - Actual harm Residents Affected - Few Record review of Resident #7's event report dated 02/08/24 at 7:57 a.m., completed by LVN C, indicated .aide [CNA A] was giving personal care to resident when she turned the resident to clean her back side up the resident and the mattress slid halfway to the floor with the resident. The event details, pain observation, body observation, neurological check, mental status, possible contributing factors, and interventions were not documented. Record review of Resident #7's event report dated 02/09/24 at 5:39 p.m., completed by LVN C, indicated .fall .resident room .laying in bed fixing to get a bed bath stated reached for a rail that is not there and rolled herself out of the bed .fall not witnessed .resident complain of right hip pain .moderate pain .right toes the three middle toes have lacerations to the bottom of the toes, complain of pain to right hip .laceration .alert wakefulness (perceives the environment clearly and responds appropriately to stimuli .clear speech . Record review of Resident #7's hospital record dated 02/09/24 indicated .patient [Resident #7] with fairly extensive laceration across the plantar aspect (sole) of the right foot directly where the toes join the foot .full-thickness (wounds that extend past the two layers of skin (dermis and epidermis) and extend into the subcutaneous tissue (fat and muscle)) and relatively deep .x-ray foot right 3 view .final result .probable fracture of the fifth proximal phalanx distal diaphysis(pinky toe) .x-ray hip left 2 view .no acute findings . operating room washout and closure of laceration . During an interview and observation in a local hospital, on 02/14/24 at 10:35 a.m., Resident #7 was sitting up in the hospital bed with her left arm contracted. She said CNA B was giving her a bed bath by herself and turned her on her side and left. She said the next thing she knew she was on the floor. She said she was trying to reach for the side rails, but CNA B said there were no side rails. During an interview on 02/14/24 at 3:18 p.m., LVN C said she had recently started at the facility. She said she worked the 6am-6pm shift. She said she was the nurse who worked the two days Resident #7 had falls. She said on Thursday morning (02/08/24), CNA A was providing incontinence care for Resident #7 by herself. She said 2 people are needed for Resident #7's care. She said when she arrived after the fall that involved CNA A, on 02/08/24, Resident #7 was on the right side of the bed with the bed mattress partially underneath her. She said CNA A must have moved Resident #7's bed from against the wall to provide care. She said Resident #7's fall mat was on the left side of the bed but thankfully when Resident #7 fell, the mattress partially slid with her. She said Resident #7 slid out of her wheelchair sometime after lunch on the same day. She said on Friday (02/09/24), she was told by CNA B, that her and another staff from laundry put the resident back to bed because Resident #7 was about to get a bed bath. She said CNA B said Resident #7 reached for the rail, which she did not have on her bed, and fell out of the bed. She said Resident #7 was blind and had learned Resident #7 had a history of falling. She said when she arrived after the fall, the mechanical lift pad was on the bed and Resident #7 was on the left side of the bed. She said Resident #7's was bleeding, and they could not figure out what caused the foot to bleed. During an interview on 02/14/24 at 3:45 p.m., CNA A said she had been working at the facility since 18th of last month (January 2024). She said she worked the 6am-2pm shift. She said she had provided incontinent care to Resident #7 alone. She said she thought Resident #7 required 2 people for incontinent care. She said Resident #7 was blind and needed to be directed where things were. She said Resident #7's right side of the bed was normally on the wall. She said she was turning Resident #7 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675958 If continuation sheet Page 30 of 33 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 675958 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Citizens Trail 1008 Citizens Trail Texarkana, TX 75501 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 - Actual harm Residents Affected - Few towards her right side to change her, and she reached out for the rail and fell. She said Resident #7's body when she fell made the mattress partially fall with her. She said Resident #7's right side of the bed was away from the wall. She said after the incident Resident #7 complained of shoulder pain but refused to go the emergency room. She said Resident #7 just wanted her pain medication. She said turning Resident #7 to the right side was hard but her left side was easier. She said she thought the care plans told staff what assistance the resident needed for ADLs. She said she had not seen Resident #7's care plan to know the amount of assistance she required. She said she had not been shown how to access the care plans on the facility's electronic charting system. She said when she started working at the facility, she was not told the amount of assistance Resident #7 required. She said having the right number of staff members for ADL care prevented falls. She said falls risked the resident passing away, hitting their head, bleeding, or hurting something. During an interview on 02/14/24 at 4:07 p.m., LVN G said she had worked at the facility for 22 years. She said Resident #7 required 2 people for turning and changing. She said she observed staff to ensure the correct amount of assistance was provided to residents. She said if 2 CNAs were not available to assist, she offered to help. She said not having the correct amount of assistance for ADL care could cause injuries and kill them. During an interview on 02/14/24 at 4:14 p.m., CNA E said she had worked at the facility for 5 years on the 2pm-10pm shift. She said Resident #7 required 2 people to put her back to bed but 1 person for changing. She said sometimes Resident #7 could help on one side. She said she did not know what Resident #7's care plan said her assistance was for ADLs. She said she had access to Resident #7's care plan on the electronic charting system. She said not having enough assistance for ADL care could cause falls. She said falls could result in injuries. During an interview on 02/14/24 at 4:35 p.m., LVN H said she had been working at the facility since May 2023. She said Resident #7 required 1 person for turning or changing on a good day. She said if Resident #7 had behaviors, she required 2 people. She said she believed Resident #7's care plan said she required 2 people. She said care plans were accessed on the electronic charting system. She said she made observations of CNAs to ensure they used the required number of staff for ADLs. She said if staff did not use the required number of staff for ADLs, falls could happen. She said the falls could result in injuries. During an interview on 02/14/24 at 4:14 p.m., CNA B said she had been employed at the facility for a year. She said she normally worked the 2pm-10pm shift. She said she was the CNA involved in Resident #7's fall on Friday (02/09/24). She said she and MR D transferred Resident #7 to her bed. She said MR D left the room to put the mechanical lift away and was coming back. She said she was getting supplies ready for Resident #7's bed bath. She said she turned her back on Resident #7 to put water in a basin. She said while she was putting water in the basin, she told Resident #7, do not roll over. She said suddenly Resident #7 was on the floor on the left side of her bed. She said she asked Resident #7 what happened, and Resident #7 said I was reaching for the rail. She said Resident #7 required 2 people for ADL care. She said not having the required staff placed residents at risk for falls and hurting themselves. During an interview on 02/15/24 at 10:30 a.m., CNA J said she had been working for the facility since June 2022 but had previously worked at the facility for 4 years. She said she worked all shifts at the facility. She said she worked the middle hall (Rooms 201-216) and sometimes the B long hall (room [ROOM NUMBER]-228). She said Resident #7 required 2 people assistance with cares. She said not having the required staff placed residents at risk to hurt themselves. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675958 If continuation sheet Page 31 of 33 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 675958 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Citizens Trail 1008 Citizens Trail Texarkana, TX 75501 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 - Actual harm Residents Affected - Few During an interview on 02/15/24 at 10:47 a.m., LVN K said she had been working at the facility since 2021. She said she was prn and had worked all the halls. She said Resident #7 required 2 people for cares. She said her left arm was contracted and flaccid. She said Resident #7 was completely blind and staff had to tell her where things were placed and push her in the wheelchair. She said the required number of staff needed for ADLs was in the care plan. She said all staff had access to resident's care plans. She said without the required number of staff, there was a risk of residents falling or rolling out of the bed. She said residents could develop brain bleeds or fractures from falls or rolling out of the bed. She said nurses, ADON, and DON should monitor the CNAs to ensure they used the required number of staff. During an interview on 02/15/24 at 10:57 a.m., MA L said she had worked at the facility for a year and half. She said she worked the 6am-2pm shift on all the halls. She said MR D was not a CNA and normally only passed out food trays. She said she did not think she should be using the mechanical lift. During an interview on 02/15/24 at 11:00 a.m., Resident #7's family member #3 said when Resident #7 mentioned rails, she was referring to the bed frame. Family member #3 said Resident #7 had been blind since her stroke 10 years ago. Family member #3 said Resident #7 grabbed the bed frame when she was turned. During an interview on 02/15/24 at 11:35 a.m., MR D said she worked in medical records and was not a CNA. She said she helped CNA B put Resident #7 back to bed last Friday (02/09/24). She said she had not been trained to operate the mechanical lift. She said she pushed the buttons on the mechanical lift controller and CNA B guided Resident #7's body during the transfer. She said after she helped place Resident #7 in the bed, she left the room with no intention to return to help with the bed bath. She said immediately after helping CNA B transfer Resident #7, she clocked out to go home for a family emergency. She said as she clocked out, she heard a splat then heard CNA B scream out Resident #7 fell out the bed. She said she heard CNA B say, I told you not to move! During an interview on 02/15/24 at 1:20 p.m., the DON said Resident #7 required 2 persons assistance with cares per her care plan. She said all staff had access to resident's care plan on the electronic charting system. She said new employees were taught in training and during orientation on how to access resident's care plans. She said she ensured care plans were followed by having care plan meetings and educating staff on how to access them. She said residents could get hurt when the care plan was not followed. She said she did not know all the details related to Resident #7's falls on 02/08/24. She said a note was written about the incident on 02/08/24 but not an incident report. She said she needed to contact LVN C about the report. She said she also did not know all the details about Resident #7's fall on 02/09/24. She said family member #1 saw her in the hallway and told her about it. She said from what she gathered, CNA B was about to give Resident #7 a bed bath and was getting stuff ready for it. She said she was told CNA B told Resident #7 not to turn but she did anyway. She said she was told Resident #7 was grabbing a rail. She said Resident #7's left side was weak, but she had witnessed her turning herself left to right without assistance. She said Resident #7 possibly could have been turned on her left side before she fell. She said she would have rather not had CNA B step away from Resident #7, if she was on her side, when she was alone in the room. She said the risk of 2 people not being in the room with Resident #7 was a fall and deep laceration in her foot. She said MR D was not trained to use the mechanical lift nor was she a CNA. She said she did not know if both people operating the mechanical lift had to be trained. She said she would have rather both people operating the mechanical lift on 02/09/24 were trained. She said staff members operating the mechanical lift without training could hurt someone. She said CNAs and nurses knew only trained (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675958 If continuation sheet Page 32 of 33 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 675958 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Citizens Trail 1008 Citizens Trail Texarkana, TX 75501 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 staff should us the mechanical lift for transfers. Level of Harm - Actual harm During an interview on 02/15/24 at 2:09 p.m., the ADM he did not know the details about Resident #7's falls, he was just notified she went to the hospital. He said he expected care plan intervention to be followed such as 2 people for cares. He said when interventions were not followed it placed residents at risk for negative outcomes. He said charge nurses should make observations and when staff made rounds to ensure care plan interventions were followed. He said only direct care staff such as nurses and CNAs should operate the mechanical lift. He said staff were trained or checked off during annual competencies and returned demonstration. He said if MR D was not a CNA, then she should not have been using the mechanical lift. He said if untrained staff used the mechanical lift, negative outcomes could happen. He said the CNAs should be observed and monitored to ensure only trained staff operated the mechanical lift. A policy on mechanical lift was requested and received. A policy on accident, hazards, and supervision was requested but not received prior to or after exit. Residents Affected - Few During an interview on 02/15/24 at 2:20 p.m., the DON said she just spoke to therapy and Resident #7 did not require two people for bed mobility. During an interview on 02/15/24 at 2:39 p.m., COTA N said Resident #7 was on occupational therapy services 01/31/24-02/09/24. She said Resident #7's OT plan of care worked on grooming, self-feeding, sit/balance time, and upper body strength. She said she could not definitely say what type of ADL assistance such as bed mobility, Resident #7 needed because PT worked on that not OT. She said Resident #7 could maintain her balance on her side, in the center of the bed, but she would not be able to self-correct if something happened during cares. Record review of Resident #7's Occupational Therapy Discharge summary dated [DATE] indicated .start date 01/31/23 .discharge date [DATE] .balance/coordination .prior status .poor .maximal assist to maintain position standing balance in order to complete ADLS while .current .the patient will demonstrate balance in order to while .Strength .prior status .fair bilateral upper extremities strength in order the complete ADLs .current . fair bilateral upper extremities strength in order the complete ADLs .self-care .personal hygiene .significant functional progress gains due to improved strength . The discharge summary did not indicate mobility or rolling left, and right being worked on during therapy sessions. Record review of a facility's Mechanical lift policy dated 12/2017 did not reveal who could or could not operate a mechanical lift. Record review of a facility's Falls-Evaluation and Prevention policy dated 12/2017 indicated .it is the policy of this home to evaluate residents for their fall risk and develop intervention for prevention .the goal is to prevent falls if possible and avoid any injury related to falls . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675958 If continuation sheet Page 33 of 33