Inspection·November 11, 2025

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few finished the next day at 7:00am. CNA B stated, on 09/13/25 at about 5:10am she and CNA E were changing Resident #1 and getting her for the day. She said, while separating Resident #1's crossed legs, a skin tear occurred on her right lower leg from rubbing her left leg on the other leg, as her skin was sensitive even to mild pressure. CNA B stated Resident #1 was bleeding from the skin tears. She said as the bleeding was not stopping, she reported immediately to LVN A who was in the same hall administering medications. CNA B reported that LVN A told her that she was busy with administering medications and would go and assess Resident #1 once she completed administering medications to the residents in the hall. CNA B said she returned to Resident #1 and wrapped a towel around the wound to minimize further damage until LVN A's visit and intervention. CNA B stated she clocked out at about 7:20am and went home thinking Resident #1's bleeding was taken care of by LVN A. She said, at around noon she received a phone call at her home from LVN A asking her how severe Resident #1's wound was and stated she got busy with administering medications and had forgotten to take care of Resident #1's bleeding. CNA B stated on 09/15/25 she attended Inservice on abuse and neglect, reporting to the oncoming nursing team and competent nursing. A phone call made to RN C on 10/08/25 at 2:05pm and left a VM to call back and she returned the call on 10/10/25 at 11:06am. RN C stated on 09/13/25 she worked in the day shift. She said, at about 7:20am CNA D reported to her that Resident #1 was bleeding profusely in her bed. RN C stated she rushed to Resident #1's room to take care of her bleeding. RN C stated on arrival she noticed Resident #1 was bleeding heavily from 3 skin tears on her right lower leg from knee to ankle and the bed sheet was visibly wet with blood. RN C stated she had to change 3 bandages that were saturated with blood and eventually managed to contain the bleeding. RN C stated Resident #1 lost copious amount of blood from the bleeding. She said, neither she nor CNA D received any handover in the morning from the previous shift regarding Resident #1. RN C stated CNA D found out about the bleeding when she entered Resident #1's room for the routine check at the beginning of the shift. RN C stated Resident #1 was a fragile person and had a very sensitive vulnerable skin that could be easily torn with minor stresses on the skin. She stated Resident #1 was on her observation the whole day and her vitals were within normal range. RN C stated she attended an in-service related to the incident , few days after the incident and could not remember exactly what day it was. A phone call made to CNA E on 10/08/25 at 2:15pm and left a VM to call back. She returned the call on 10/10/25 at 3: 13pm. CNA E stated, on 09/13/25 early in the morning, she was helping CNA B in changing Resident #1. She stated since Resident #1 had contracted legs it was very difficult to change her. She stated in the process of separating her legs she had seen Resident#1 bleeding profusely from her right leg. CNA E said, CNA B rushed out of the room to report it to LVN A. She stated they wrapped a towel around Resident #1's leg to put some pressure on to stop the bleeding. She stated the bleeding was pretty bad and non-stopping. Since she was on duty in another hall and had other tasks to accomplish with her residents in her hall, she left Resident #1 with CNA B. When investigator asked about in services she attended, CNA B stated at the facility there were in services at least once a week. She stated she attended an in-service of reporting abuse and neglect and importance of reporting concerns related to residents in handover meetings. A phone call was made to CNA D on 10/08/25 at 1:50 pm and left a voice message to call back. No return call was received from CNA D, prior to the investigation exit. During an interview on 09/08/25 at 12:45pm the DON stated LVN A did not assess Resident #1 and perform interventions to stop the bleeding in a timely manner. She stated loss of excessive blood is a threat to Resident #1's life. She said RN C did the wound care to stop the bleeding at 7:20am immediately after she commenced her shift. The DON stated Resident #1 was under observation and her wound was assessed many times that day to ensure her safety. The DON stated LVN (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676035 If continuation sheet Page 2 of 6 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 676035 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Kingsland 3727 W Ranch Rd 1431 Kingsland, TX 78639 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 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete A and other staff were in- serviced regarding the importance of triaging nursing care and reporting issues that needed continuity of care, during handover at shift changes. The DON stated staff were observed and reviewed by the DON and ADON daily and issues if any were discussed during the daily staff meeting. During an interview on 09/08/25 at 12:30pm the ADM stated, on 09/13/25 in the afternoon the RP of Resident #1 met him at his office. He stated the RP was visibly upset and complained about the competency of LVN A . The ADM stated , the RP told him to terminate LVN A and demanded a drug test on her as she did nothing to stop Resident #1 from bleeding. The ADM stated LVN A did not do her job correctly. He said though she was busy with administering medications she should have triaged and prioritized assessing Resident #1 when CNA B reported to her about skin tears and bleeding. He stated he did a facility investigation on the incident . The ADM said, though LVN A had not done her job in a timely manner , Resident #1 was taken care of by RN C immediately after she commenced her shift and subsequent follow up throughout the day. When the investigator pointed out that although RN C attended to Resident#1 at 7:20am , Resident #1 was left unattended bleeding for about two hours until 7:20am, the ADM responded that LVN A should not have allowed that happened. He stated LVN A and other nurses received an in-service on preventing , recognizing and reporting abuse and neglect and expectations of reporting during shift changes. The ADM stated he included an employee disciplinary report in LVN A's file as well. The ADM stated they have an annual performance evaluation program for all the employees, in placeRecord review of facility in service revealed on 09/15/25 an in service conducted on the shift to shift report must be given to oncoming staff. Nurses and CNAs must be given a detailed report after every shift.' Record review of the in services revealed about 20 staff members attended the in service that was conducted on 9/15/25. Record review of facility policy staffing, sufficient and competent Nursing revised in August 2022 reflected: Our facility provides sufficient numbers of nursing staff with the appropriate skills and competency necessary to provide nursing and related care and services for all residents with resident care plans and the facility assessment.Staff must demonstrate the skills and techniques necessary to care for resident needs including (but not limited to) the following areas:a. Resident Rights .m. Identification of changes in condition .Licensed nurse and nursing assistance are trained and must demonstrate competency in identifying, documenting, reporting resident changes of condition consistent with their scope of practice and responsibilities . Event ID: Facility ID: 676035 If continuation sheet Page 3 of 6 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 676035 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Kingsland 3727 W Ranch Rd 1431 Kingsland, TX 78639 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record review, the facility failed to ensure that a resident receives treatment and care in accordance with professional standards of practice for 1 of 2 nurses (LVN A) reviewed for nursing services.The facility failed to ensure LVN A assessed and performed necessary interventions to stop Resident #1 from bleeding from skin tears on 09/13/25.This failure could place residents with wounds at risk for bleeding related complications.Findings included: Record review of Resident #1's face sheet dated 10/08/25 revealed a [AGE] year-old female admitted to the facility on [DATE]. Her diagnoses included shortness of breath, Alzheimer's disease, muscle weakness, chronic pain, hypertension and other abnormalities of gait and mobility. Record review of Resident #1's quarterly MDS dated [DATE] revealed that a BIMS interview could not be conducted as she rarely/never understood the interview questions. Record review of Resident #1's Care Plan dated 06/08/25 revealed Resident #1 had potential for impaired skin integrity and was at risk of bleeding. The relevant intervention was evaluating skin for integrity and impaired coagulation (Bruising, petechia (pinpoint red spots on skin from bleeding from capillaries) , bleeding from orifices) Record review of Resident #1's MAR of September 25 revealed Resident#1 was not blood thinners. Record review of physician's order reflected: Skin Tear to Right Distal Lower Leg: Cleanse with wound cleanser, dry, apply Xeroform, ABD pad, and wrap with Kerlixdaily and PRN. Everyday shift. Record review of the wound assessment profile revealed substantial improvement in healing. The dimensions of the wound during the assessment on 09/15/25 was 4cm L x 0.5cms W x 0.1cm D and on 10/06/25 it was 0.9cm L x 0.4cm W x UTD A phone call made to LVN A on 10/08/25 at 11:20am and left to VM to call back. No return call was received as on 10/08/25 at 5:00pm. During an interview on 10/08/25 at 12:30pm the RP stated she visited Resident #1 almost every day. She said Resident #1 was on prednisone (An anti-inflammatory drug) for a very long time and due to that she had very vulnerable skin ( as side effect of prednisone medication) with bilateral edema (swelling on both legs). The RP said Resident #1's skin was prone to skin tears very easily . The RP reported on 09/13/25 early in the morning CNAs who took care of Resident #1 noticed she was bleeding from newly developed skin tears on her left leg. The RP said CNA B who noticed the bleeding threw a towel on the wound to stop the bleeding and reported to LVN A however she did not do any interventions and let Resident #1 bleed until a nurse from the next shift came and fixed it. She said LVN A left the facility without even look at Resident#1 to see what was going on. The RP stated Resident #1's condition is stable currently and there was no further complication from the wound and bleeding. During an observation on 10/08/25 at 1:15pm she was in her room in her wheelchair and napping. She appeared calm and relaxed without any distress. The wound was covered by dressing. She could not answer any of the interview questions and responded with unrelated answers. During a phone interview on 10/08/25 at 1:33pm CNA B stated she was the night CNA who worked on the night shift on 09/12/25 and finished the next day at 7:00am. CNA B stated, on 09/13/25 at about 5:10am she and CNA E were changing Resident #1 and getting her for the day. She said, while separating Resident #1's crossed legs, a skin tear occurred on her right lower leg from rubbing her left leg on the other leg, as her skin was sensitive even to mild pressure. CNA B stated Resident #1 was bleeding from the skin tears. She said as the bleeding was not stopping, she reported immediately to LVN A who was in the same hall administering medications. CNA B reported that LVN A told her that she was busy with administering medications and would go and assess Resident #1 once she completed administering medications to the residents in the hall. CNA B said she returned to Resident #1 and wrapped a towel around the wound to minimize further damage until LVN A's visit and intervention. CNA B stated she clocked out at about 7:20am and went Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676035 If continuation sheet Page 4 of 6 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 676035 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Kingsland 3727 W Ranch Rd 1431 Kingsland, TX 78639 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 0684 Level of Harm - Actual harm Residents Affected - Few home thinking Resident #1's bleeding was taken care of by LVN A. She said, at around noon she received a phone call at her home from LVN A asking her how severe Resident #1's wound was and stated she got busy with administering medications and had forgotten to take care of Resident #1's bleeding. CNA B stated on 09/15/25 she attended Inservice on abuse and neglect, reporting to the oncoming nursing team and competent nursing. A phone call made to CNA E on 10/08/25 at 2:15pm and left a VM to call back. She returned the call on 10/10/25 at 3: 13pm. CNA E stated, on 09/13/25 early in the morning, she was helping CNA B in changing Resident #1. She stated since Resident #1 had contracted legs it was very difficult to change her. She stated in the process of separating her legs she had seen Resident#1 bleeding from her right leg. CNA E said, CNA B rushed out of the room to report it to LVN A. She stated they wrapped a towel around Resident #1's leg to put some pressure on to stop the bleeding. She stated the bleeding was pretty bad and non-stopping. Since she was on duty in another hall and had other tasks to accomplish with her residents in her hall, she left Resident #1 with CNA B. When investigator asked about in services she attended, CNA B stated at the facility there were in services at least once a week. She stated she attended an in-service of reporting abuse and neglect, and importance of reporting concerns related to residents in handover meetings. A phone call was made to CNA D on 10/08/25 at 1:50 pm and left a voice message to call back. No return call was received from CNA D, prior to the investigation exit. A phone call made to RN C on 10/08/25 at 2:05pm and left a VM to call back and she returned the call on 10/10/25 at 11:06am. RN C stated on 09/13/25 she worked in the day shift. She said, at about 7:20am CNA D reported to her that Resident #1 was bleeding in her bed. RN C stated she rushed to Resident #1's room to take care of her bleeding. RN C stated on arrival she noticed Resident #1 was bleeding heavily from 3 skin tears on her right lower leg from knee to ankle and the bed sheet was visibly wet with blood. RN C stated she had to change 3 bandages that were saturated with blood and eventually managed to contain the bleeding. RN C stated Resident #1 lost copious amount of blood from the bleeding. She said, neither she nor CNA D received any handover in the morning from the previous shift regarding Resident #1. RN C stated CNA D found out about the bleeding when she entered Resident #1's room for the routine check at the beginning of the shift. RN C stated Resident #1 was a fragile person and had a very sensitive vulnerable skin that could be easily torn with minor stresses on the skin. She stated Resident #1 was on her observation the whole day and her vitals were within normal range. RN C stated she contacted MD and received an order for wound care. She stated attended an Inservice related to the incident a few days after the incident and could not remember exactly what day it was. During an interview on 10/08/25 at 2:30pm the WN stated she was not working on the day the incident occurred however she had done the wound care when she was back at work on Monday. She said the wound doctor who visited on that day had assessed Resident #1 and made no changes to the existing treatment plan as he found the wound was not significant enough to have a change in the treatment plan. During an interview on 09/08/25 at 12:45pm the DON stated LVN A did not assess Resident #1 and perform interventions to stop the bleeding in a timely manner. She stated loss of excessive blood is a threat to Resident #1's life. She said RN C did the wound care to stop the bleeding at 7:20am immediately after she commenced her shift. The DON stated Resident #1 was under observation and her wound was assessed many times that day to ensure her safety. The DON stated LVN A and other staff were in- serviced regarding the importance of triaging nursing care and reporting issues that needed continuity of care, during handover at shift changes. The DON stated staff were observed and reviewed by the DON and ADON daily and issues if any were discussed during the daily staff meeting. During an interview on 09/08/25 at 12:30pm the ADM stated, on 09/13/25 in the afternoon the RP of Resident #1 met him at his office. He stated the RP was visibly (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676035 If continuation sheet Page 5 of 6 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 676035 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Kingsland 3727 W Ranch Rd 1431 Kingsland, TX 78639 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 0684 Level of Harm - Actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete upset and complained about the competency of LVN A . The ADM stated, the RP told him to terminate LVN A and demanded a drug test on her as she did nothing to stop Resident #1 from bleeding. The ADM stated LVN A did not do her job correctly. He said though she was busy with administering medications she should have triaged and prioritized assessing Resident #1 when CNA B reported to her about skin tears and bleeding. He stated he did a facility investigation on the incident. The ADM said, though LVN A had not done her job in a timely manner, Resident #1 was taken care of by RN C immediately after she commenced her shift and subsequent follow up throughout the day. When the investigator pointed out that although RN C attended to Resident#1 at 7:20am, Resident #1 was left unattended bleeding for about two hours until 7:20am, the ADM responded that LVN A should not have allowed that happened. He stated LVN A and other nurses received an in-service on preventing, recognizing and reporting abuse and neglect and expectations of reporting during shift changes. The ADM stated he included an employee disciplinary report in LVN A's file as well. The ADM stated they have an annual performance evaluation program for all the employees, in place Record review of facility in service revealed on 09/15/25 an in service conducted on the shift to shift report must be given to oncoming staff. Nurses and CNAs must be given a detailed report after every shift'. Record review of the in services revealed about 20 staff members attended the in service that was conducted on 9/15/25. Record review of facility policy staffing, sufficient and competent Nursing revised in August 2022 reflected: Our facility provides sufficient numbers of nursing staff with the appropriate skills and competency necessary to provide nursing and related care and services for all residents with resident care plans and the facility assessment. 1. Competency is a measurable pattern of knowledge and skills abilities , behaviors, and other characteristics that an individual needs to perform work roles or occupational functions successfully . 2. All nursing staff must meet specific competency requirements of their respective licensure ad certification requirements defined by state law. 3. Staff must demonstrate the skills and techniques necessary to care for resident needs including (but not limited to) following areas: .Resident rights, person centered care, communication, Basic nursing skills, medication management, infection control , Skin, and wound care.Licensed nurse and nursing assistance are trained and must demonstrate competency in identifying, documenting, reporting resident changes of condition consistent with their scope of practice and responsibilities . Event ID: Facility ID: 676035 If continuation sheet Page 6 of 6