Health inspection·November 5, 2025

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few reflected a BIMS score of 06, indicating severe cognitive impairment. Section GG (Functional Abilities) reflected he was dependent on staff for toileting hygiene. Review of Resident #2's care plan, date initiated 07/23/2025, reflected he was at risk for harm: self-directed or other-directed with interventions that included: if resident poses a potential threat to injure self or others notify provider, utilize calming touch, and if safe, allow resident personal space. Review of Resident #2's care plan, dated 07/23/2025, reflected he was at risk for ADL self-care deficit with an intervention of providing assistance with ADLs/IADLs as needed.During an interview on 10/14/2025 at 1:04 PM, Resident #2 stated the care provided to him was alright. Resident #2 stated someone hurt him but was unable to provide a name or further information. Resident #2 then began asking for his mother.During a phone interview on 10/15/2025 at 09:23 AM, FM #2 stated Resident #2 had a history of physical abuse, though she was unsure of the details of the history of abuse. FM #2 stated Resident #2 is confused with short-term memory loss and some long-term memory loss. She stated she did not have any concerns related to staff taking care of Resident #2 and thought, when he stated someone hurt him, he was referring to his history of abuse prior to his admission to the facility. FM #2 stated Resident #2 had refused care and had increasing agitation but that started several months prior. She stated she didn't notice any changes in demeanor over the past couple of weeks. FM #2 stated she had no concerns for Resident #2's safety or the care provided to him. During a phone interview on 10/15/2025 at 11:24 AM, NA B stated she had worked at the facility for the past 5 months. She stated she witnessed, on an unknown date, CNA A place soap directly on Resident #1's face in a manner that would cause the soap to run directly into Resident #1's eyes. NA B stated CNA A then handed Resident #1 a washcloth with soap on it for Resident #1 to wipe her face and eyes with. NA B stated at that time she obtained a clean, dry washcloth and handed it to Resident #1. NA B stated she did not report the incident to the abuse coordinator (ADM) immediately. She stated that she had not noticed any changes in demeanor in Resident #1, but when NA B approached Resident #1 to give her a shower, Resident #1 will ask if NA B or the mean one is going to give her a shower. NA B stated, on an unknown date, she assisted CNA A and NA C with providing pericare to Resident #2. NA B stated Resident #2 was in bed when she entered the room. NA B stated Resident #2 had a history of agitation and being combative, but that day was worse than normal for him. NA B stated that while she was placing a brief under Resident #2, he punched CNA A. NA B stated she suggested to CNA A moving the bed away from the wall and raising it up to make it easier to finish applying the brief to him. NA B stated after moving the bed, she was holding Resident #2's hand and it slipped from her grip. She stated Resident #2 then punched CNA A in the chest really hard while NA C was attempting to pull up Resident #2's pants. NA B stated CNA A reacted by lifting her knee and placing it across Resident #2's arm and chest pinning his arm to the bed. NA B stated CNA A used one hand to hold Resident #2's other arm that was not secured with her knee then placed her other hand around the front of Resident #2's throat. NA B stated Resident #2's face turned red, his voice became strained, and he kept repeating, stop, stop and then stated, just kill me already. NA B stated CNA A told Resident #2, mother f*****, I'm the boss here, I'm going to show you, you are not going to beat the f*** out of me. NA B stated after NA C secured Resident #2's brief and pulled up his pants, the bed was lowered, and all staff left the room. NA B stated at the time she was concerned for the safety of Resident #2 and was in shock at the events she witnessed when leaving the room. NA B stated she did not report the witnessed incident to the abuse coordinator (ADM) immediately. NA B stated she checked on Resident #2 later that shift and he was calmer. NA B stated he had no changes in his demeanor since she witnessed the incident and she thought he had forgotten about the incident. NA B stated she did not report the incidents immediately to the abuse (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676044 If continuation sheet Page 2 of 24 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 676044 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Magnolia 1105 N Magnolia Luling, TX 78648 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 - Few coordinator because she feared CNA A. She stated CNA A bragged about how she had her FM beat people up and how CNA A had her FM come up to the facility to fight someone. NA B stated she was trained to report all suspicions of abuse to the abuse coordinator right away. NA B listed relevant examples and types of abuse. NA B stated she should have reported both incidents immediately to the abuse coordinator. NA B stated she talked to the ADM on 09/23/2025 about CNA A but did not mention either incident. NA B stated she reported both incidents to the ADM on 09/26/2025. NA B confirmed that they are to report all allegations to ADM immediately.During a phone interview on 10/15/2025 at 01:49 PM, CNA A stated she had worked at the facility for about a year. She stated she was currently suspended pending an investigation involving her and 2 separate incidents of abuse. CNA A stated she had been trained on abuse and neglect. She stated she had not showered Resident #1 in close to 2 months. CNA A stated Resident #1 always requested a dry washcloth that she then placed over her face after getting in the shower. CNA A stated Resident #1 would not take a shower without the dry washcloth on her face. CNA A denied ever putting soap directly on Resident #1's face or putting soap on a washcloth for Resident #1 to wash her face. CNA A stated Resident #1 needed assistance with washing her hair, back and waist down. She stated Resident #1 washed the remainder of her body herself. CNA A stated she was informed the second incident involved her putting her knee across Resident #2's chest, physically restraining him, and cussing at him. CNA A stated on 09/18/2025 she had worked with Resident #2, and he was more combative than usual. She stated Resident #2 had feces all over his bed, brief, clothes and body. CNA A stated she was paired with NA C to work that day. CNA A stated she was providing peri-care to Resident #2, with the assistance of NA C, Resident #2 hit her right hip with a closed fist. CNA stated that she requested NA C find another staff member to assist with completing peri-care. NA C left room and returned with NA B. CNA A stated that she then held Resident #2's arms while he was positioned on his right side while NA B performed peri-care. She stated they then turned Resident #2, and he hit CNA A in the stomach. CNA A stated they were able to finish peri-care, put a sheet under him, and secure his brief. CNA A stated she notified the nurse working that day that Resident #2 was combative during peri-care. CNA A stated Resident #2 would frequently cuss at staff when he was receiving care. CNA A denied Resident #2 told her to stop while performing care to him that day. CNA A stated she completed her shift that day, including providing peri-care for Resident #2 and getting him up into his wheelchair prior to leaving for the day. She stated when she got him up into his wheelchair, he was calm and cooperative. CNA A was informed by the ADM that one of the allegations was she placed her knee on Resident #2's chest and held his hands. CNA A stated There is no way. I am 5 foot. She stated that when the bed is raised to provide peri-care she could not lift her leg high enough to put her knee on Resident #2's chest while he was in bed. CNA A stated she was trained in handling combative residents. She stated she was trained to give them space, allow them time to calm down, and reapproach, but she stated she could not leave Resident #2 covered in his own feces. CNA A denied all allegations related to abuse.During a phone interview on 10/15/2025 at 2:29 PM, FM #1 stated he had no concerns with staff, or the care provided at the facility for Resident #1. He stated that he had not noticed a change in Resident #1's demeanor over the last couple of months. He stated that Resident #1 has a cell phone and sends him texts often. He stated that Resident #1 had not talked to or texted him with any concerns related to the way staff treat her, or the care provided to her. FM #1 stated that any concerns he had brought up to management had been addressed appropriately in a timely manner. FM #1 stated he felt Resident #1 was safe in the facility and he was satisfied with the care provided to her. Interview on 10/15/2025 at 2:51 PM, NA D stated she works on the secured unit and trained on abuse. NA D is giving examples of abuse and further stated that (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676044 If continuation sheet Page 3 of 24 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 676044 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Magnolia 1105 N Magnolia Luling, TX 78648 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 - Few all abuse is reported to ADM.Interview on 10/15/2025 at 3:01 PM, RN A stated she is a charge nurse, Last in-serviced on Friday (10/10/25) related to ANE. Topics included: what is abuse, definition of ANE, report ANE to ADM. Interview on 10/15/2025 at 3:23 PM, CNA B stated she is also a med aide. CNA B stated she was last trained on ANE and in-serviced last week. CNA B stated the topics included: signs of ANE, what to do if witnessed, who to speak with or hear about it.Interview on 10/15/2025 at 3:23 PM, RN B Worked here for 6 to 7 years. RN B stated she was trained on ANE and last in-serviced last week. RN A stated the topics included: to report any concerns or suspicion of abuse to the ADM immediately, such as yelling, neglect, not changing the resident, hitting. RN B stated the negative effects are residents being withdrawn, stop eating, decline in condition, bruising. RN B stated she never witnessed any form of abuse in the facility and feels the residents are safe here. RN B stated she has 2 family members living here and can comfortably report any allegations of ANE. During a phone interview on 10/15/2025 at 4:09 PM, NA C stated she had worked at the facility since July 2025. She stated she had been trained on abuse and neglect. NA C stated she was trained to report any suspected or witnessed abuse to the abuse coordinator (ADM) immediately. NA C was able to provide an explanation of appropriate types and examples of abuse and neglect. NA C stated on an unknown date in August 2025 she witnessed CNA A in the shower room with Resident #1. She stated CNA A put soap directly on Resident #1's forehead. NA C stated Resident #1 then started yelling my eyes, they are burning. She stated that CNA A waited about a minute before using the shower head to roughly rinse Resident #1 face and eyes. She stated that Resident #1 calmed down after her face and eyes were rinsed. NA C stated that later that (unknown) day Resident #1 complained of irritation to her eyes. She stated she did not report the incident to anyone that day because she was scared of CNA A. NA C stated she had not noticed a change in demeanor for Resident #1 since the day of the incident. NA C stated on an unknown date while working with CNA A she was assisting with providing pericare to Resident #2 because he was being combative. She stated she requested NA B to assist as well due to Resident #2's behaviors. NA C stated she and NA B transferred Resident #2 into bed. NA C stated Resident #2 became combative after transferring to bed. She stated while she was holding Resident #2 arm to prevent him from hitting another staff member her grip slipped, and CNA A grabbed both of Resident #2's arms while he was laying on his back. NA C stated CNA A then crossed Resident #2's arms and held his hand with her on the resident's upper chest where the collarbones meet. NA C stated that CNA A then placed her left knee on Resident #2's chest at the bottom of his ribs. NA C stated CNA A asked Resident #2 who's the boss now to which Resident #2 responded stop, you are as his face was turning red. NA C stated CNA A then immediately released Resident #2 and left room. NA C stated the bed was raised to her waist level at the time of the events. NA C stated she continued to provide care to Resident #2 for the remainder of the day. NA C stated she had not witnessed Resident #2 be combative since that day. NA C stated she did not report the incident that day because the ADM was not in her office and NA C did not have the ADM phone number to call her. She stated she did not feel comfortable talking to the charge nurse or the ADON that day about the incident because CNA A was friends with them. NA C stated she talked to the ADM about the incident the next day. NA C stated she was scared of CNA A because CNA A is known to go after someone if they report her. She stated other staff members are no longer talking to her because she reported CNA A. She stated CNA A has also been known to threaten to hurt people in the past. NA C stated she would immediately report the incident to the ADM if she were to witness any abuse, neglect, or exploitation occurring.Observation on 10/16/2025 at 09:33 AM, revealed Resident #1 in the shower room getting in her shower chair with assistance from staff. Resident #1 did not appear to exhibit any anxiety or emotional distress while in the shower. During a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676044 If continuation sheet Page 4 of 24 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 676044 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Magnolia 1105 N Magnolia Luling, TX 78648 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 - Few phone interview on 10/16/2025 at 10:36 AM, the MD stated he was notified of the allegations related to Resident #2 while performing his scheduled rounds but could not recall the allegations related to Resident #1. He stated Resident #2 was being followed by the psychiatrist due to aggressive behaviors. He stated Resident #2 was difficult and pretty aggressive. MD stated he performed an assessment on Resident #2 and did not observe any abnormal bruising. He stated he had not noticed a change in Resident #2's demeanor over the previous 2 weeks. The MD stated Resident #1 had a history of dementia (a disease that causes a general decline in cognitive abilities that can affect the ability to perform everyday activities, memory loss, and poor judgment) with some disorientation. The MD stated he felt all the residents were safe at the facility. He stated the facility had enough staff providing care to the residents when he did his rounds. He stated he had not witnessed any abuse or neglect at the facility. The MD stated he had good communication with the staff in the facility.During an interview on 10/16/2025 at 11:39 AM, the DON stated she had worked at the facility for 4 years but had only been in the DON position since 10/2/2025. She stated she had been trained on abuse, neglect, and exploitation. The DON stated she expected staff to report any concerns related to abuse, neglect or exploitation immediately to the abuse coordinator (ADM). The DON stated not reporting the incident immediately to the ADM could affect the investigation and the outcome of the investigation, especially if you have a resident with cognitive issues and staff turnover. The DON stated she had never witnessed any abuse occurring at the facility. She stated she felt the residents were safe at the facility. The DON stated CNA A had worked in the facility for approximately the past 2 years though most of that was working through a staffing agency. She stated the facility stopped using the staffing agency and CNA A decided to apply for a full-time job with the facility. The DON stated she felt CNA A was a good CNA and provided really good patient care and the DON would frequently recommend CNA A to orient and train other staff members. The DON stated she never had any indication CNA A was disliked by anyone or that CNA A would instigate drama or conflict until recently when an issue outside of work on social media appeared involving some staff. She stated she was not sure of the entire details of the social media post, only that another staff member, who no longer worked at the facility, felt threatened by CNA A's FM after making a random post on [social media] that did not even have anything to do with work. The DON stated she was unsure what day CNA A worked last. The DON stated NA B had worked at the facility for the past few months and was a little resistant to learning and training. She stated she changed her approach to training NA B and NA B was more receptive to critique and learning. She stated she was unaware of any other allegations made by NA B. The DON stated she knew NA B and NA C received the training related to abuse, neglect and exploitation but was unsure if they received any additional training. During an interview on 10/16/2025 at 1:41 PM, the ADM stated she had worked at the facility for the past 8 years and she was also the abuse coordinator. She stated she had received training on abuse, neglect and exploitation. The ADM stated the definition of abuse was the intentional infringement of adverse effects that produces a negative outcome. She stated she expected staff to report any concerns or suspicions of abuse to her immediately. The ADM stated if she is not in her office then she expected staff to call her phone. She stated she gave out her phone number to all staff members time and time again and her phone number was posted in the employee break room. The ADM denied ever witnessing any form of abuse in the facility and felt the residents were safe. The ADM stated she was also an RN, and she would monitor for abuse by performing frequent rounds and even going into a resident's room to assist the CNAs with providing care to the residents. The ADM stated she monitored allegations of abuse by repeatedly going back to the resident to monitor, observe, and talk in long conversations with the resident listed in the allegation. The (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676044 If continuation sheet Page 5 of 24 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 676044 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Magnolia 1105 N Magnolia Luling, TX 78648 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 - Few ADM stated she would also go with staff or the wound care provider to perform skin assessments after an incident. The ADM stated she was notified on 09/26/2025 at 2:00 PM by NA B about allegations of abuse to Resident #1 and Resident #2 by CNA A. The ADM stated she was informed by NA B that CNA A purposefully allowed soap to go into Resident #1's eyes during a shower and was slow to react and physically restrained Resident #2 with her body while providing pericare in his bed. The ADM stated at that time she collected a brief statement from NA B, but NA B was unable to provide a date or time for either one of the incidents that occurred. The ADM stated she asked NA B why she did not report the incident immediately to her like she had been trained to do. The ADM stated, NA B reported she was scared of CNA A due to a [social media] post from another, previously employed, staff member in which CNA A's FM threatened to bust out the previous staff member's windows. The ADM stated she had seen the social media comments under the social media's post threatening violence, but she never saw the actual social media post, and the language used in the comments was slang and she was unable to understand what was being said. The ADM stated CNA A did not make a comment on the social media post. The ADM stated she immediately started her investigation, a quick assessment of Resident #2's chest and neck and no abnormalities were noted and a quick assessment of Resident #1. The ADM stated she spoke with NA C related to allegations on 09/26/2025 around 03:00 PM and received her statement. The ADM denied receiving any reports prior to 09/26/2025 with allegations of abuse involving CNA A from NA C. She stated that NA C stated she was scared of CNA A due to a previous incident of cyber-bullying on social media involving a staff member that no longer worked at the facility. The ADM stated she suspended CNA A on 09/26/2025 at around 4:00 PM and collected her statement later through a text message. She stated she provided 1:1 in-service with NA B and NA C related to reporting expectations. The ADM stated she received further detailed witness statements from NA B and NA C on 10/2/2025 and both NAs continued to state they did not report the concerns for abuse immediately after the witnessed incident due to fear of CNA A. The ADM stated she spoke with another staff member during her investigation that wished to remain anonymous that stated NA C told her she really did not witness the alleged abuse by CNA A, but NA B had convinced her to make the report. The ADM stated she did not confront NA C with the statement because she did not want to breach the trust of the other staff member. She stated that she felt the other staff member was impartial to all other staff. The ADM stated she in-serviced all staff about cyber-bullying. She stated she terminated CNA A on 10/14/2025 due to concerns with cyber-bullying. She stated after talking with the anonymous staff member, looking at the bed height in relation to the length of CNA A's legs, the safety surveys and both Resident #1 and Resident #2 repeatedly stating no one at the facility had hurt them, her findings were unfounded for the allegation of abuse. The ADM stated she provided in-services on abuse, reporting guidelines for abuse, and sensitivity training to all staff. She stated she also implemented for two staff members to assist Resident #2 any time patient care is provided. A telephone interview with the PNP was attempted on 10/26/2025 at 05:22 PM. A voicemail was left requesting a return phone call. A returned phone call was not received prior to exit. Review of CNA A's employee file, on 10/17/2025, reflected a background check had been performed and revealed no convictions that would make CNA A unemployable. Review of CNA's employee file reflected the facility also performed and EMR and NAR search and no concerns were revealed. CNA A's hire date was officially 03/01/2025. Review reflected CNA A received training on Abuse, Neglect, and Exploitation as well as Texas Senate [NAME] 9 on 07/01/2025. Review of CNA A's employee file reflected CNA A's last day worked was 09/26/2025 and was terminated on 10/13/2025 with reason for termination listed as allegation of abuse with no circled next to Had the employee received any prior warning?.Review of facility in-services reflected in-services dated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676044 If continuation sheet Page 6 of 24 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 676044 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Magnolia 1105 N Magnolia Luling, TX 78648 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 - Few 03/02/2025, 03/04/2025 and 03/16/2025 related to Abuse, Neglect, and Exploitation with CNA A's signature which indicated her attendance to the in-services.Review of facility records reflected Safe surveys were conducted from a date range of 9/26/2025 to 10/4/2025, no findings. Review of NA B's witness statement reflected the following: On 09/26/2025 [NA B] states [CNA A] put soap in [Resident #1]'s eyes that was on a washcloth when she was washing her face and placed her hands on [Resident #2]'s chest to hold him down when they were providing him care and signed by NA B.Review of NA B's witness statement, dated 10/02/2025, reflected the following: [CNA A], and [NA C], were changing [Resident #2]. [NA C] had called because they needed help. I was watching him being changed and he was being combative. I joined in to help and we were able to turn him toward the wall. I put the brief on him and we turned him back to the other side so I could do the tab on his brief. He started hitting and he kicked me in the arm, (no bruising) and he hit [CNA A] in the chest. He hit her hard. [CNA A] started cursing but I don't think it was at him. After that I decided to pull the bed out and I was on the right arm and [CNA A] was on the other arm. He was able to get his arm loose from me and he hit [CNA A] again. I grabbed his arm back gently and [CNA A] had her knee on his chest and her right arm was holding him and her left arm was at the bottom of his neck and his face began to turn red. [Resident #2] was saying stop it over and over again. [CNA A] was calling him bad names and [CNA A] was telling him mother****** I am the boss and she would beat the s*** out him. [Resident #2] then got off him and he did not fight anymore after that.[Resident #1] had asked me to take her in the shower room and we put her in the shower chair. [Resident #1] asked for a wash rag and [CNA A] squirted the soap in her face and it got into her eyes. [Resident #1] kept say my eyes; you got soap in my eyes and then [Resident #1] asked me for a wash rag and I went and go the wash rag. Before I gave it to [Resident #1], [CNA A] put more soap on the wash rag and [CNA A] took the wash rag and washed her face with it. After she took the wash rag and did her face [Resident #1] kept saying wash rag, wash rag and I said to [CNA A] that she just wants a wash rag. [CNA A] did not say anything to me. I gave the wash rag to [Resident #1]. [CNA A] was rinsing [Resident #1]'s body. I left the shower room after that. This happened about two and a half weeks ago. I was worried to report because I was scared of the posts on [social media]. Signed by NA B.Review of NA C's undated witness statement reflected the following: [NA B] and I were assisting [CNA A] changing [Resident #2] and he was being very combative so [CNA A] took one of her arms and held onto his arm and then her other arm was on his chest. [Resident #2] was asking for [CNA A] to stop. I think she was using her body to hold him.[NA B] and I were watching [CNA A] because we were new when she was caring for [Resident #2]. [Resident #2] did not want to transfer and [CNA A] was picking at him like taking her fingers and putting them on his body. [Resident #2] can pivot on one leg and [CNA A] was getting him up and she transferred him onto the bed out of his wheelchair. [Resident #2] was aggressive and [CNA A] was taking her fingers and placing them on different parts of his face. [Resident #2] continued to be very combative. [Resident #2]'s hands were folded and she took her hands and placed them on top of his hands. She kept her hands there until [Resident #2] said ok you win you are the boss. She stopped.When I went to school I was taught that you do not put soap on a washcloth when you are washing a resident's face. [CNA A] took the soap bottle and poured soap on [Resident #1]s hair and it ran into her eyes and she let the soap stay like this for a full minute. After the minute was up she took the sprayer and sprayed towards her face. [Resident #1] took the water and used it and washed the soap off of her face.I feel [CNA A] is a good aide. She needs some training on compassion. Signed by NA C.Review of NA C's witness statement, dated 10/02/2025, reflected the following: Addendum to statement:[CNA A] was cussing but I am not sure what she was cussing about. She was just cussing. [Resident #2] was very angry (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676044 If continuation sheet Page 7 of 24 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 676044 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Magnolia 1105 N Magnolia Luling, TX 78648 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 - Few FORM CMS-2567 (02/99) Previous Versions Obsolete and fighting us when we were trying to change him. We always have two people and both of us have to try to care for him. He is combative everytime we try to change him and we have to hold him down. I feel he gets worse at night but also in the mornings he is very very bad. On this day I think he was worse than most days. When we were trying to hold him he was very strong and kept getting away from us. Wherever we were holding him he was able to get away from us. [CNA A] had her knee on [Resident #2] to hold him down to. We have to get him up and he will not try to get out of bed if he up[sic?]. If he is up he is calm. Signed by NA C.Review of unsigned, undated, witness statement reflected the following: On September 18, 2025, [CNA A] stated she remembered the day when they had trouble with [Resident #2] and the day was Thursday and [LVN E] was the nurse. In the beginning [NA C] and she were cleaning up [Resident #2]. They had raised the bed to [CNA A]'s hip which was approximately 23 inches above the floor. With the bed raised to hip level it would be 25 inches from the ground. [Resident #2] was being combative, and [CNA A] stated they texted [NA B] to come and help them. When [NA B] came to the room [CNA A] stated [NA B] was holding [Resident #2]'s hands and [NA C] was trying to keep him from kicking [NA B] and herself. [CNA A] and [NA B] switched positions because [NA B] could not turn his upper body. [NA B] stated she got both hands and held them on his left shoulder with one hand and turned him with the hand[sic?] while [NA B] finished cleaning the BM from his right side which was difficult since they had him turned on this right side facing the wall. [NA C] was holding his leg and [CNA A] stated they struggled to push the sheets under him and then they turned him on his bed. They were able to get his brief on and then they were only able to put a draw sheet under him. [CNA A] stated they then positioned him in the bed so that he could eat breakfast and then they all walked out. [CNA A] stated she remembered that day clearly because [Resident #2] had never been that combative before or hit her like that before.Per [CNA A] via textReview of in-service dated 09/27/2025, with subject Abuse/Neglect/Abuse Prevention coordinator is [ADM] and her cell is [###-###-####]. If not at the facility notify her on her cell for any allegations of abuse/neglect/exploitation. When a resident is combative walk away from the resident and go and get your charge nurse. Sometimes a resident will get care from someone else. Also remember the change in personality is the disease process reflected 36 of the 98 staff members attended the in-service. Review of the facility policy titled Identifying Types of Abuse, dated 2001 and revised September 2022, reflected the following: Policy StatementAs part of the abuse prevention strategy, volunteers, employees and contractors Event ID: Facility ID: 676044 If continuation sheet Page 8 of 24 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 676044 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Magnolia 1105 N Magnolia Luling, TX 78648 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 - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews, the facility failed to ensure that alleged violations involving abuse were reported immediately, but not later than 2 hours after the allegations are made to the abuse coordinator for two (Resident #1 and Resident #2) of five residents reviewed for abuse. The facility failed to notify the abuse and neglect coordinator (ADM) of the alleged abuse by CNA A towards Resident #1 and Resident #2 so it could be investigated and handled appropriately to ensure the residents' safety. The noncompliance was identified as PNC. The IJ began on 09/26/2025 and ended on 10/13/2025. The facility had corrected the noncompliance before the survey began on 10/14/2025. These failures could place residents at risk of abuse, neglect, trauma, and psychosocial harm. Findings included:Review of Resident #1's admission record, dated 10/14/2025, reflected a [AGE] year-old female who was admitted to the facility on [DATE] with diagnoses including depression (a mood disorder with persistent feelings of sadness and loss of interest), dementia (a disease that causes a general decline in cognitive abilities that can affect the ability to perform everyday activities, memory loss, and poor judgment), epilepsy (a neurological disorder causing seizures), blindness in one eye (inability to see out of one eye), conductive hearing loss (when sound cannot reach the inner ear due to issues in the outer or middle ear) and cognitive communication deficit (a problem with communication caused by cognition rather than a language or speech deficit). Review of Resident #1's Quarterly MDS assessment, dated 08/27/2025, reflected a BIMS score of 07, indicating moderate cognitive impairment. Section GG (Functional Abilities) reflected she required substantial/maximal assistance for showering/bathe self.Review of Resident #1's care plan, dated 05/06/2025, reflected she was at risk for ADL self-care deficit with an intervention of providing assistance with ADLs/IADLs as needed. During an interview on 10/14/2025 at 12:20 PM, Resident #1 stated the facility and care provided to her was fine. Resident #1 stated no staff member had intentionally been mean to her or attempted to cause her harm. Resident #1 stated she felt safe in the facility.Review of Resident #2's admission record, dated 10/15/2025, reflected a [AGE] year-old male who was originally admitted to the facility on [DATE] and most recent readmission on [DATE] with diagnoses including hemiplegia and hemiparesis (paralysis and weakness on one side of the body), dementia severe with mood disturbance (a disease that causes a general decline in cognitive abilities that can affect the ability to perform everyday activities, memory loss, and poor judgment causing behaviors), seizures, type 2 diabetes mellitus (a condition that affects the way the body processes blood sugar), depression (a mood disorder with persistent feelings of sadness and loss of interest), cerebral infarction (a blood clot blockage that impairs blood flow through the brain artery), dysphagia (difficulty swallowing), and cognitive communication deficit (a problem with communication caused by cognition rather than a language or speech deficit).Review of Resident #2's Quarterly MDS assessment, dated 08/21/2025, reflected a BIMS score of 06, indicating severe cognitive impairment. Section GG (Functional Abilities) reflected he was dependent on staff for toileting hygiene. Review of Resident #2's care plan, date initiated 07/23/2025, reflected he was at risk for harm: self-directed or other-directed with interventions that included: if resident poses a potential threat to injure self or others notify provider, utilize calming touch, and if safe, allow resident personal space. Review of Resident #2's care plan, dated 07/23/2025, reflected he was at risk for ADL self-care deficit with an intervention of providing assistance with ADLs/IADLs as needed.During an interview on 10/14/2025 at 1:04 PM, Resident #2 stated the care provided to him was alright. Resident #2 stated someone hurt him but was unable to provide a name or further information. Resident #2 then began asking for his mother.During a phone interview (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676044 If continuation sheet Page 9 of 24 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 676044 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Magnolia 1105 N Magnolia Luling, TX 78648 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 - Few on 10/15/2025 at 09:23 AM, FM #2 stated Resident #2 had a history of physical abuse, though she was unsure of the details of the history of abuse. FM #2 stated Resident #2 is confused with short-term memory loss and some long-term memory loss. She stated she did not have any concerns related to staff taking care of Resident #2 and thought, when he stated someone hurt him, he was referring to his history of abuse prior to his admission to the facility. FM #2 stated Resident #2 had refused care and had increasing agitation but that started several months prior. She stated she didn't notice any changes in demeanor over the past couple of weeks. FM #2 stated she had no concerns for Resident #2's safety or the care provided to him. During a phone interview on 10/15/2025 at 11:24 AM, NA B stated she had worked at the facility for the past 5 months. She stated she witnessed, on an unknown date, CNA A place soap directly on Resident #1's face in a manner that would cause the soap to run directly into Resident #1's eyes. NA B stated CNA A then handed Resident #1 a washcloth with soap on it for Resident #1 to wipe her face and eyes with. NA B stated at that time she obtained a clean, dry washcloth and handed it to Resident #1. NA B stated she did not report the incident to the abuse coordinator (ADM) immediately. She stated that she had not noticed any changes in demeanor in Resident #1, but when NA B approached Resident #1 to give her a shower, Resident #1 will ask if NA B or the mean one is going to give her a shower. NA B stated, on an unknown date, she assisted CNA A and NA C with providing peri-care to Resident #2. NA B stated Resident #2 was in bed when she entered the room. NA B stated Resident #2 had a history of agitation and being combative, but that day was worse than normal for him. NA B stated that while she was placing a brief under Resident #2, he punched CNA A. NA B stated she suggested to CNA A moving the bed away from the wall and raising it up to make it easier to finish applying the brief to him. NA B stated after moving the bed, she was holding Resident #2's hand and it slipped from her grip. She stated Resident #2 then punched CNA A in the chest really hard while NA C was attempting to pull up Resident #2's pants. NA B stated CNA A reacted by lifting her knee and placing it across Resident #2's arm and chest pinning his arm to the bed. NA B stated CNA A used one hand to hold Resident #2's other arm that was not secured with her knee then placed her other hand around the front of Resident #2's throat. NA B stated Resident #2's face turned red, his voice became strained, and he kept repeating, stop, stop and then stated, just kill me already. NA B stated CNA A told Resident #2, mother f*****, I'm the boss here, I'm going to show you, you are not going to beat the f*** out of me. NA B stated after NA C secured Resident #2's brief and pulled up his pants, the bed was lowered, and all staff left the room. NA B stated at the time she was concerned for the safety of Resident #2 and was in shock at the events she witnessed when leaving the room. NA B stated she did not report the witnessed incident to the abuse coordinator (ADM) immediately. NA B stated she checked on Resident #2 later that shift and he was calmer. NA B stated he had no changes in his demeanor since she witnessed the incident and she thought he had forgotten about the incident. NA B stated she did not report the incidents immediately to the abuse coordinator because she feared CNA A. She stated CNA A bragged about how she had her FM beat people up and how CNA A had her FM come up to the facility to fight someone. NA B stated she was trained to report all suspicions of abuse to the abuse coordinator right away. NA B listed relevant examples and types of abuse. NA B stated she should have reported both incidents immediately to the abuse coordinator. NA B stated she talked to the ADM on 09/23/2025 about CNA A but did not mention either incident. NA B stated she reported both incidents to the ADM on 09/26/2025. NA B confirmed that they are to report all allegations to ADM immediately.During a phone interview on 10/15/2025 at 01:49 PM, CNA A stated she had worked at the facility for about a year. She stated she was currently suspended pending an investigation involving her and 2 separate incidents of abuse. CNA A stated she had been trained on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676044 If continuation sheet Page 10 of 24 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 676044 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Magnolia 1105 N Magnolia Luling, TX 78648 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 - Few abuse and neglect. She stated she had not showered Resident #1 in close to 2 months. CNA A stated Resident #1 always requested a dry washcloth that she then placed over her face after getting in the shower. CNA A stated Resident #1 would not take a shower without the dry washcloth on her face. CNA A denied ever putting soap directly on Resident #1's face or putting soap on a washcloth for Resident #1 to wash her face. CNA A stated Resident #1 needed assistance with washing her hair, back and waist down. She stated Resident #1 washed the remainder of her body herself. CNA A stated she was informed the second incident involved her putting her knee across Resident #2's chest, physically restraining him, and cussing at him. CNA A stated on 09/18/2025 she had worked with Resident #2, and he was more combative than usual. She stated Resident #2 had feces all over his bed, brief, clothes and body. CNA A stated she was paired with NA C to work that day. CNA A stated was providing peri-care to Resident #2, with the assistance of NA C, Resident #2 hit her right hip with a closed fist. CNA stated that she requested NA C find another staff member to assist with completing peri-care. NA C left room and returned with NA B. CNA A stated that she then held Resident #2's arms while he was positioned on his right side while NA B performed peri-care. She stated they then turned Resident #2, and he hit CNA A in the stomach. CNA A stated they were able to finish peri-care, put a sheet under him, and secure his brief. CNA A stated she notified the nurse working that day that Resident #2 was combative during peri-care. CNA A stated Resident #2 would frequently cuss at staff when he was receiving care. CNA A denied Resident #2 told her to stop while performing care to him that day. CNA A stated she completed her shift that day, including providing pericare for Resident #2 and getting him up into his wheelchair prior to leaving for the day. She stated when she got him up into his wheelchair, he was calm and cooperative. CNA A was informed by the ADM that one of the allegations was she placed her knee on Resident #2's chest and held his hands. CNA A stated There is no way. I am 5 foot. She stated that when the bed is raised to provide pericare she could not lift her leg high enough to put her knee on Resident #2's chest while he was in bed. CNA A stated she was trained in handling combative residents. She stated she was trained to give them space, allow them time to calm down, and reapproach, but she stated she could not leave Resident #2 covered in his own feces. CNA A denied all allegations related to abuse.During a phone interview on 10/15/2025 at 2:29 PM, FM #1 stated he had no concerns with staff, or the care provided at the facility for Resident #1. He stated that he had not noticed a change in Resident #1's demeanor over the last couple of months. He stated that Resident #1 has a cell phone and sends him texts often. He stated that Resident #1 had not talked to or texted him with any concerns related to the way staff treat her, or the care provided to her. FM #1 stated that any concerns he had brought up to management had been addressed appropriately in a timely manner. FM #1 stated he felt Resident #1 was safe in the facility and he was satisfied with the care provided to her. Interview on 10/15/2025 at 2:51 PM, NA D stated she works on the secured unit and trained on abuse. NA D is giving examples of abuse and further stated that all abuse is reported to ADM.Interview on 10/15/2025 at 3:01 PM, RN A stated she is a charge nurse, Last in-serviced on Friday (10/10/25) related to ANE. Topics included: what is abuse, definition of ANE, report ANE to ADM. Interview on 10/15/2025 at 3:23 PM, CNA B stated she is also a med aide. CNA B stated she was last trained on ANE and in-serviced last week. CNA B stated the topics included: signs of ANE, what to do if witnessed, who to speak with or hear about it.Interview on 10/15/2025 at 3:23 PM, RN B Worked here for 6 to 7 years. RN B stated she was trained on ANE and last in-serviced last week. RN A stated the topics included: to report any concerns or suspicion of abuse to the ADM immediately, such as yelling, neglect, not changing the resident, hitting. RN B stated the negative effects are residents being withdrawn, stop eating, decline in condition, bruising. RN B stated she never witnessed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676044 If continuation sheet Page 11 of 24 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 676044 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Magnolia 1105 N Magnolia Luling, TX 78648 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 - Few any form of abuse in the facility and feels the residents are safe here. RN B stated she has 2 family members living here and can comfortably report any allegations of ANE. During a phone interview on 10/15/2025 at 4:09 PM, NA C stated she had worked at the facility since July 2025. She stated she had been trained on abuse and neglect. NA C stated she was trained to report any suspected or witnessed abuse to the abuse coordinator (ADM) immediately. NA C was able to provide an explanation of appropriate types and examples of abuse and neglect. NA C stated on an unknown date in August 2025 she witnessed CNA A in the shower room with Resident #1. She stated CNA A put soap directly on Resident #1's forehead. NA C stated Resident #1 then started yelling my eyes, they are burning. She stated that CNA A waited about a minute before using the shower head to roughly rinse Resident #1 face and eyes. She stated that Resident #1 calmed down after her face and eyes were rinsed. NA C stated that later that (unknown) day Resident #1 complained of irritation to her eyes. She stated she did not report the incident to anyone that day because she was scared of CNA A. NA C stated she had not noticed a change in demeanor for Resident #1 since the day of the incident. NA C stated on an unknown date while working with CNA A she was assisting with providing pericare to Resident #2 because he was being combative. She stated she requested NA B to assist as well due to Resident #2's behaviors. NA C stated she and NA B transferred Resident #2 into bed. NA C stated Resident #2 became combative after transferring to bed. She stated while she was holding Resident #2 arm to prevent him from hitting another staff member her grip slipped, and CNA A grabbed both of Resident #2's arms while he was laying on his back. NA C stated CNA A then crossed Resident #2's arms and held his hand with her on the resident's upper chest where the collarbones meet. NA C stated that CNA A then placed her left knee on Resident #2's chest at the bottom of his ribs. NA C stated CNA A asked Resident #2 who's the boss now to which Resident #2 responded stop, you are as his face was turning red. NA C stated CNA A then immediately released Resident #2 and left room. NA C stated the bed was raised to her waist level at the time of the events. NA C stated she continued to provide care to Resident #2 for the remainder of the day. NA C stated she had not witnessed Resident #2 be combative since that day. NA C stated she did not report the incident that day because the ADM was not in her office and NA C did not have the ADM phone number to call her. She stated she did not feel comfortable talking to the charge nurse or the ADON that day about the incident because CNA A was friends with them. NA C stated she talked to the ADM about the incident the next day. NA C stated she was scared of CNA A because CNA A is known to go after someone if they report her. She stated other staff members are no longer talking to her because she reported CNA A. She stated CNA A has also been known to threaten to hurt people in the past. NA C stated she would immediately report the incident to the ADM if she were to witness any abuse, neglect, or exploitation occurring. Observation on 10/16/2025 at 09:33 AM, revealed Resident #1 in the shower room getting in her shower chair with assistance from staff. Resident #1 did not appear to exhibit any anxiety or emotional distress while in the shower. During a phone interview on 10/16/2025 at 10:36 AM, the MD stated he was notified of the allegations related to Resident #2 while performing his scheduled rounds but could not recall the allegations related to Resident #1. He stated Resident #2 was being followed by the psychiatrist due to aggressive behaviors. He stated Resident #2 was difficult and pretty aggressive. MD stated he performed an assessment on Resident #2 and did not observe any abnormal bruising. He stated he had not noticed a change in Resident #2's demeanor over the previous 2 weeks. The MD stated Resident #1 had a history of dementia (a disease that causes a general decline in cognitive abilities that can affect the ability to perform everyday activities, memory loss, and poor judgment) with some disorientation. The MD stated he felt all the residents were safe at the facility. He stated the facility had enough staff providing care to the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676044 If continuation sheet Page 12 of 24 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 676044 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Magnolia 1105 N Magnolia Luling, TX 78648 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 - Few residents when he did his rounds. He stated he had not witnessed any abuse or neglect at the facility. The MD stated he had good communication with the staff in the facility.During an interview on 10/16/2025 at 11:39 AM, the DON stated she had worked at the facility for 4 years but had only been in the DON position since 10/2/2025. She stated she had been trained on abuse, neglect, and exploitation. The DON stated she expected staff to report any concerns related to abuse, neglect or exploitation immediately to the abuse coordinator (ADM). The DON stated not reporting the incident immediately to the ADM could affect the investigation and the outcome of the investigation, especially if you have a resident with cognitive issues and staff turnover. The DON stated she had never witnessed any abuse occurring at the facility. She stated she felt the residents were safe at the facility. The DON stated CNA A had worked in the facility for approximately the past 2 years though most of that was working through a staffing agency. She stated the facility stopped using the staffing agency and CNA A decided to apply for a full-time job with the facility. The DON stated she felt CNA A was a good CNA and provided really good patient care and the DON would frequently recommend CNA A to orient and train other staff members. The DON stated she never had any indication CNA A was disliked by anyone or that CNA A would instigate drama or conflict until recently when an issue outside of work on social media appeared involving some staff. She stated she was not sure of the entire details of the social media post, only that another staff member, who no longer worked at the facility, felt threatened by CNA A's FM after making a random post on [social media] that did not even have anything to do with work. The DON stated she was unsure what day CNA A worked last. The DON stated NA B had worked at the facility for the past few months and was a little resistant to learning and training. She stated she changed her approach to training NA B and NA B was more receptive to critique and learning. She stated she was unaware of any other allegations made by NA B. The DON stated she knew NA B and NA C received the training related to abuse, neglect and exploitation but was unsure if they received any additional training.During an interview on 10/16/2025 at 1:41 PM, the ADM stated she had worked at the facility for the past 8 years and she was also the abuse coordinator. She stated she had received training on abuse, neglect and exploitation. The ADM stated the definition of abuse was the intentional infringement of adverse effects that produces a negative outcome. She stated she expected staff to report any concerns or suspicions of abuse to her immediately. The ADM stated if she is not in her office then she expected staff to call her phone. She stated she gave out her phone number to all staff members time and time again and her phone number was posted in the employee break room. The ADM denied ever witnessing any form of abuse in the facility and felt the residents were safe. The ADM stated she was also an RN, and she would monitor for abuse by performing frequent rounds and even going into a resident's room to assist the CNAs with providing care to the residents. The ADM stated she monitored allegations of abuse by repeatedly going back to the resident to monitor, observe, and talk in long conversations with the resident listed in the allegation. The ADM stated she would also go with staff or the wound care provider to perform skin assessments after an incident. The ADM stated she was notified on 09/26/2025 at 2:00 PM by NA B about allegations of abuse to Resident #1 and Resident #2 by CNA A. The ADM stated she was informed by NA B that CNA A purposefully allowed soap to go into Resident #1's eyes during a shower and was slow to react and physically restrained Resident #2 with her body while providing pericare in his bed. The ADM stated at that time she collected a brief statement from NA B, but NA B was unable to provide a date or time for either one of the incidents that occurred. The ADM stated she asked NA B why she did not report the incident immediately to her like she had been trained to do. The ADM stated, NA B reported she was scared of CNA A due to a [social media] post from another, previously employed, staff member in which CNA A's FM (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676044 If continuation sheet Page 13 of 24 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 676044 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Magnolia 1105 N Magnolia Luling, TX 78648 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 - Few threatened to bust out the previous staff member's windows. The ADM stated she had seen the social media comments under the social media's post threatening violence, but she never saw the actual social media post, and the language used in the comments was slang and she was unable to understand what was being said. The ADM stated CNA A did not make a comment on the social media post. The ADM stated she immediately started her investigation, a quick assessment of Resident #2's chest and neck and no abnormalities were noted and a quick assessment of Resident #1. The ADM stated she spoke with NA C related to allegations on 09/26/2025 around 03:00 PM and received her statement. The ADM denied receiving any reports prior to 09/26/2025 with allegations of abuse involving CNA A from NA C. She stated that NA C stated she was scared of CNA A due to a previous incident of cyber-bullying on social media involving a staff member that no longer worked at the facility. The ADM stated she suspended CNA A on 09/26/2025 at around 4:00 PM and collected her statement later through a text message. She stated she provided 1:1 in-service with NA B and NA C related to reporting expectations. The ADM stated she received further detailed witness statements from NA B and NA C on 10/2/2025 and both NAs continued to state they did not report the concerns for abuse immediately after the witnessed incident due to fear of CNA A. The ADM stated she spoke with another staff member during her investigation that wished to remain anonymous that stated NA C told her she really did not witness the alleged abuse by CNA A, but NA B had convinced her to make the report. The ADM stated she did not confront NA C with the statement because she did not want to breach the trust of the other staff member. She stated that she felt the other staff member was impartial to all other staff. The ADM stated she in-serviced all staff about cyber-bullying. She stated she terminated CNA A on 10/13/2025 due to concerns with cyber-bullying. She stated after talking with the anonymous staff member, looking at the bed height in relation to the length of CNA A's legs, the safety surveys and both Resident #1 and Resident #2 repeatedly stating no one at the facility had hurt them, her findings were unfounded for the allegation of abuse. The ADM stated she provided in-services on abuse, reporting guidelines for abuse, and sensitivity training to all staff. She stated she also implemented for two staff members to assist Resident #2 any time patient care is provided. A telephone interview with the PNP was attempted on 10/26/2025 at 05:22 PM. A voicemail was left requesting a return phone call. A returned phone call was not received prior to exit. Review of CNA A's employee file, on 10/17/2025, reflected a background check had been performed and revealed no convictions that would make CNA A unemployable. Review of CNA's employee file reflected the facility also performed and EMR and NAR search and no concerns were revealed. CNA A's hire date was officially 03/01/2025. Review reflected CNA A received training on Abuse, Neglect, and Exploitation as well as Texas Senate [NAME] 9 on 07/01/2025. Review of CNA A's employee file reflected CNA A's last day worked was 09/26/2025 and she was terminated on 10/13/2025 with reason for termination listed as allegation of abuse with no circled next to Had the employee received any prior warning?.Review of facility in-services reflected in-services dated 03/02/2025, 03/04/2025 and 03/16/2025 related to Abuse, Neglect, and Exploitation with CNA A's signature which indicated her attendance to the in-services.Review of NA B's witness statement reflected the following: On 09/26/2025 [NA B] states [CNA A] put soap in [Resident #1]'s eyes that was on a washcloth when she was washing her face and placed her hands on [Resident #2]'s chest to hold him down when they were providing him care and signed by NA B.Review of facility records reflected Safe surveys were conducted from a date range of 9/26/2025 to 10/4/2025, no findings. Review of NA B's witness statement, dated 10/02/2025, reflected the following: [CNA A], and [NA C], were changing [Resident #2]. [NA C] had called because they needed help. I was watching him being changed and he was being combative. I joined in to help and we were able to turn him toward the wall. I put the brief on him and we (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676044 If continuation sheet Page 14 of 24 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 676044 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Magnolia 1105 N Magnolia Luling, TX 78648 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 - Few turned him back to the other side so I could do the tab on his brief. He started hitting and he kicked me in the arm, (no bruising) and he hit [CNA A] in the chest. He hit her hard. [CNA A] started cursing but I don't think it was at him. After that I decided to pull the bed out and I was on the right arm and [CNA A] was on the other arm. He was able to get his arm loose from me and he hit [CNA A] again. I grabbed his arm back gently and [CNA A] had her knee on his chest and her right arm was holding him and her left arm was at the bottom of his neck and his face began to turn red. [Resident #2] was saying stop it over and over again. [CNA A] was calling him bad names and [CNA A] was telling him mother****** I am the boss and she would beat the s*** out him. [Resident #2] then got off him and he did not fight anymore after that.[Resident #1] had asked me to take her in the shower room and we put her in the shower chair. [Resident #1] asked for a wash rag and [CNA A] squirted the soap in her face and it got into her eyes. [Resident #1] kept say my eyes; you got soap in my eyes and then [Resident #1] asked me for a wash rag and I went and go the wash rag. Before I gave it to [Resident #1], [CNA A] put more soap on the wash rag and [CNA A] took the wash rag and washed her face with it. After she took the wash rag and did her face [Resident #1] kept saying wash rag, wash rag and I said to [CNA A] that she just wants a wash rag. [CNA A] did not say anything to me. I gave the wash rag to [Resident #1]. [CNA A] was rinsing [Resident #1]'s body. I left the shower room after that. This happened about two and a half weeks ago. I was worried to report because I was scared of the posts on [social media]. Signed by NA B. Review of NA C's undated witness statement reflected the following: [NA B] and I were assisting [CNA A] changing [Resident #2] and he was being very combative so [CNA A] took one of her arms and held onto his arm and then her other arm was on his chest. [Resident #2] was asking for [CNA A] to stop. I think she was using her body to hold him. [NA B] and I were watching [CNA A] because we were new when she was caring for [Resident #2]. [Resident #2] did not want to transfer and [CNA A] was picking at him like taking her fingers and putting them on his body. [Resident #2] can pivot on one leg and [CNA A] was getting him up and she transferred him onto the bed out of his wheelchair. [Resident #2] was aggressive and [CNA A] was taking her fingers and placing them on different parts of his face. [Resident #2] continued to be very combative. [Resident #2]'s hands were folded and she took her hands and placed them on top of his hands. She kept her hands there until [Resident #2] said ok you win you are the boss. She stopped.When I went to school I was taught that you do not put soap on a washcloth when you are washing a resident's face. [CNA A] took the soap bottle and poured soap on [Resident #1]s hair and it ran into her eyes and she let the soap stay like this for a full minute. After the minute was up she took the sprayer and sprayed towards her face. [Resident #1] took the water and used it and washed the soap off of her face.I feel [CNA A] is a good aide. She needs some training on compassion. Signed by NA C.Review of NA C's witness statement, dated 10/02/2025, reflected the following: Addendum to statement:[CNA A] was cussing but I am not sure what she was cussing about. She was just cussing. [Resident #2] was very angry and fighting us when we were trying to change him. We always have two people and both of us have to try to care for him. He is combative everytime we try to change him and we have to hold him down. I feel he gets worse at night but also in the mornings he is very very bad. On this day I think he was worse than most days. When we were trying to hold him he was very strong and kept getting away from us. Wherever we were holding him he was able to get away from us. [CNA A] had her knee on [Resident #2] to hold him down to. We have to get him up and he will not try to get out of bed if he up[sic?]. If he is up he is calm. Signed by NA C.Review of unsigned, undated, witness statement reflected the following: On September 18, 2025, [CNA A] stated she remembered the day when they had trouble with [Resident #2] and the day was Thursday and [LVN E] was the nurse. In the beginning [NA C] and she were (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676044 If continuation sheet Page 15 of 24 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 676044 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Magnolia 1105 N Magnolia Luling, TX 78648 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 - Few FORM CMS-2567 (02/99) Previous Versions Obsolete cleaning up [Resident #2]. They had raised the bed to [CNA A]'s hip which was approximately 23 inches above the floor. With the bed raised to hip level it would be 25 inches from the ground. [Resident #2] was being combative, and [CNA A] stated they texted [NA B] to come and help them. When [NA B] came to the room [CNA A] stated [NA B] was holding [Resident #2]'s hands and [NA C] was trying to keep him from kicking [NA B] and herself. [CNA A] and [NA B] switched positions because [NA B] could not turn his upper body. [NA B] stated she got both hands and held them on his left shoulder with one hand and turned him with the hand[sic?] while [NA B] finished cleaning the BM from his right side which was difficult since they had him turned on this right side facing the wall. [NA C] was holding his leg and [CNA A] stated they struggled to push the sheets under him and then they turned him on his bed. They were able to get his brief on and then they were only able to put a draw sheet under him. [CNA A] stated they then positioned him in the bed so that he could eat breakfast and then they all walked out. [CNA A] stated she remembered that day clearly because [Resident #2] had never been that combative before or hit her like that before.Per [CNA A] via text Review of in-service dated 09/27/2025, with subject Abuse/Neglect/Abuse Prevention coordinator is [ADM] and her cell is [###-###-####]. If not at the facility notify her on her cell for any allegations of abuse/neglect/exploitation. When a resident is combative walk away from the resident and go and get your charge nurse. Sometimes a resident will get care from someone else. Also remember the change in personality is the disease process reflected 36 of the 98 staff members attended the in-service.Review of the facility policy titled Abuse, Neglect, Exploitation or Misappropriation - Reporting and Investigating, dated 2001 and last revised 09/2022, reflected the following: .1. If resident abuse, neglect, exploitation, misappropriation of resident property or injury of unknown source is suspected, the suspicion m Event ID: Facility ID: 676044 If continuation sheet Page 16 of 24 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 676044 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Magnolia 1105 N Magnolia Luling, TX 78648 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 0610 Respond appropriately to all alleged violations. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to, in response to allegations of abuse, neglect, exploitation, or mistreatment, have evidence that all alleged violations are thoroughly investigated and report the report the results of all investigations to the state survey agency within five working days of the incident for two of five residents (Resident #1 and Resident #2) reviewed for abuse and neglect. The facility failed to thoroughly investigate two allegations of abuse regarding Resident #1 and Resident #2 to identify a timeframe of when alleged abuse occurred and failed to notify the local law enforcement. This deficient practice placed residents at risk of abuse due to not having a thorough investigation done for facility reported incidents. Findings included:Review of Resident #1's admission record, dated 10/14/2025, reflected a [AGE] year-old female who was admitted to the facility on [DATE] with diagnoses including depression (a mood disorder with persistent feelings of sadness and loss of interest), dementia (a disease that causes a general decline in cognitive abilities that can affect the ability to perform everyday activities, memory loss, and poor judgment), epilepsy (a neurological disorder causing seizures), blindness in one eye (inability to see out of one eye), conductive hearing loss (when sound cannot reach the inner ear due to issues in the outer or middle ear) and cognitive communication deficit (a problem with communication caused by cognition rather than a language or speech deficit). Review of Resident #1's Quarterly MDS assessment, dated 08/27/2025, reflected a BIMS score of 07, indicating moderate cognitive impairment. Section GG (Functional Abilities) reflected she required substantial/maximal assistance for showering/bathe self.Review of Resident #1's care plan, dated 05/06/2025, reflected she was at risk for ADL self-care deficit with an intervention of providing assistance with ADLs/IADLs as needed. During an interview on 10/14/2025 at 12:20 PM, Resident #1 stated the facility and care provided to her was fine. Resident #1 stated no staff member had intentionally been mean to her or attempted to cause her harm. Resident #1 stated she felt safe in the facility.Review of Resident #2's admission record, dated 10/15/2025, reflected a [AGE] year-old male who was originally admitted to the facility on [DATE] and most recent readmission on [DATE] with diagnoses including hemiplegia and hemiparesis (paralysis and weakness on one side of the body), dementia severe with mood disturbance (a disease that causes a general decline in cognitive abilities that can affect the ability to perform everyday activities, memory loss, and poor judgment causing behaviors), seizures, type 2 diabetes mellitus (a condition that affects the way the body processes blood sugar), depression (a mood disorder with persistent feelings of sadness and loss of interest), cerebral infarction (a blood clot blockage that impairs blood flow through the brain artery), dysphagia (difficulty swallowing), and cognitive communication deficit (a problem with communication caused by cognition rather than a language or speech deficit).Review of Resident #2's Quarterly MDS assessment, dated 08/21/2025, reflected a BIMS score of 06, indicating severe cognitive impairment. Section GG (Functional Abilities) reflected he was dependent on staff for toileting hygiene. Review of Resident #2's care plan, date initiated 07/23/2025, reflected he was at risk for harm: self-directed or other-directed with interventions that included: if resident poses a potential threat to injure self or others notify provider, utilize calming touch, and if safe, allow resident personal space. Review of Resident #2's care plan, dated 07/23/2025, reflected he was at risk for ADL self-care deficit with an intervention of providing assistance with ADLs/IADLs as needed.Review of facility's self-reporting template, dated 06/26/2025, reflected NA B alleged on an unknown date and time CNA A put soap in Resident #1's eyes and on an unknown date and time CNA A placed her hands on Resident #2's chest to hold him down while providing care. The template also reflected the local law enforcement was not notified.Review of facility's Provider Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676044 If continuation sheet Page 17 of 24 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 676044 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Magnolia 1105 N Magnolia Luling, TX 78648 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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Investigation Report, signed on 10/02/2025, reflected Incident Date: Unknown and Time of Incident: __:__ o a.m. o p.m. The report also reflected that the police were notified but there was no case number or documentation provided. During an interview on 10/14/2025 at 1:04 PM, Resident #2 stated the care provided to him was alright. Resident #2 stated someone hurt him but was unable to provide a name or further information. Resident #2 then began asking for his mother.During a phone interview on 10/15/2025 at 09:23 AM, FM #2 stated Resident #2 had a history of physical abuse, though she was unsure of the details of the history of abuse. FM #2 stated Resident #2 is confused with short-term memory loss and some long-term memory loss. She stated she did not have any concerns related to staff taking care of Resident #2 and thought, when he stated someone hurt him, he was referring to his history of abuse prior to his admission to the facility. FM #2 stated Resident #2 had refused care and had increasing agitation but that started several months prior. She stated she didn't notice any changes in demeanor over the past couple of weeks. FM #2 stated she had no concerns for Resident #2's safety or the care provided to him. During a phone interview on 10/15/2025 at 11:24 AM, NA B stated she had worked at the facility for the past 5 months. She stated she witnessed, on an unknown date, CNA A place soap directly on Resident #1's face in a manner that would cause the soap to run directly into Resident #1's eyes. NA B stated CNA A then handed Resident #1 a washcloth with soap on it for Resident #1 to wipe her face and eyes with. NA B stated at that time she obtained a clean, dry washcloth and handed it to Resident #1. NA B stated she did not report the incident to the abuse coordinator (ADM) immediately. She stated that she has not noticed any changes in demeanor in Resident #1, but when NA B approaches Resident #1 to give her a shower, Resident #1 will ask if NA B or the mean one is going to give her a shower. NA B stated, on an unknown date, she assisted CNA A and NA C with providing peri-care to Resident #2. NA B stated Resident #2 was in bed when she entered the room. NA B stated Resident #2 had a history of agitation and being combative, but that day was worse than normal for him. NA B stated that while she was placing a brief under Resident #2, he punched CNA A. NA B stated she suggested to CNA A moving the bed away from the wall and raising it up to make it easier to finish applying the brief to him. NA B stated after moving the bed, she was holding Resident #2's hand and it slipped from her grip. She stated Resident #2 then punched CNA A in the chest really hard while NA C was attempting to pull up Resident #2's pants. NA B stated CNA A reacted by lifting her knee and placing it across Resident #2's arm and chest pinning his arm to the bed. NA B stated CNA A used one hand to hold Resident #2's other arm that was not secured with her knee then placed her other hand around the front of Resident #2's throat. NA B stated Resident #2's face turned red, his voice became strained, and he kept repeating, stop, stop and then stated, just kill me already. NA B stated CNA A told Resident #2, mother f*****, I'm the boss here, I'm going to show you, you are not going to beat the f*** out of me. NA B stated after NA C secured Resident #2's brief and pulled up his pants, the bed was lowered, and all staff left the room. NA B stated at the time she was concerned for the safety of Resident #2 and was in shock at the events she witnessed when leaving the room. NA B stated she did not report the witnessed incident to the abuse coordinator (ADM) immediately. NA B stated she checked on Resident #2 later that shift and he was calmer. NA B stated had no changes in his demeanor since she witnessed the incident and she thought he had forgotten about the incident. NA B stated she did not report the incidents immediately to the abuse coordinator because she feared CNA A. She stated CNA A bragged about how she had her FM beat people up and how CNA A has had her FM come up to the facility to fight someone. NA B stated she was trained to report all suspicions of abuse to the abuse coordinator right away. NA B listed relevant examples and types of abuse. NA B stated she should have reported both incidents immediately to the abuse coordinator. NA B (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676044 If continuation sheet Page 18 of 24 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 676044 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Magnolia 1105 N Magnolia Luling, TX 78648 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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few stated she talked to the ADM on 09/23/2025 about CNA A but did not mention either incident. NA B stated she reported both incidents to the ADM on 09/26/2025.During a phone interview on 10/15/2025 at 01:49 PM, CNA A stated she had worked at the facility for about a year. She stated she was currently suspended pending an investigation involving her and 2 separate incidents of abuse. CNA A stated she had been trained on abuse and neglect. She stated she had not showered Resident #1 in close to 2 months. CNA A stated Resident #1 always requested a dry washcloth that she then placed over her face after getting in the shower. CNA A stated Resident #1 would not take a shower without the dry washcloth on her face. CNA A denied ever putting soap directly on Resident #1's face or putting soap on a washcloth for Resident #1 to wash her face. CNA A stated Resident #1 needed assistance with washing her hair, back and waist down. She stated Resident #1 washed the remainder of her body herself. CNA A stated she was informed the second incident involved her putting her knee across Resident #2's chest, physically restraining him, and cussing at him. CNA A stated on 09/18/2025 she had worked with Resident #2, and he was more combative than usual. She stated Resident #2 had feces all over his bed, brief, clothes and body. CNA A stated she was paired with NA C to work that day. CNA A stated while she was providing peri-care to Resident #2, with the assistance of NA C, Resident #2 hit her right hip with a closed fist. CNA stated that she requested NA C find another staff member to assist with completing peri-care. NA C left room and returned with NA B. CNA A stated that she then held Resident #2's arms while he was positioned on his right side while NA B performed peri-care. She stated they then turned Resident #2, and he hit CNA A in the stomach. CNA A stated they were able to finish peri-care, put a sheet under him, and secure his brief. CNA A stated she notified the nurse working that day that Resident #2 was combative during peri-care. CNA A stated Resident #2 would frequently cuss at staff when he was receiving care. CNA A denied Resident #2 told her to stop while performing care to him that day. CNA A stated she completed her shift that day, including providing peri-care for Resident #2 and getting him up into his wheelchair prior to leaving for the day. She stated when she got him up into his wheelchair, he was calm and cooperative. CNA A was informed by the ADM that one of the allegations was she placed her knee on Resident #2's chest and held his hands. CNA A stated There is no way. I am 5 foot. She stated that when the bed is raised to provide peri-care she could not lift her leg high enough to put her knee on Resident #2's chest while he was in bed. CNA A stated she was trained in handling combative residents. She stated she was trained to give them space, allow them time to calm down, and reapproach, but she stated she could not leave Resident #2 covered in his own feces. CNA A denied all allegations related to abuse.During a phone interview on 10/15/2025 at 2:29 PM, FM #1 stated he had no concerns with staff, or the care provided at the facility. He stated that he had not noticed a change in Resident #1's demeanor over the last couple of months. He stated that Resident #1 has a cell phone and sends him texts often. He stated that Resident #1 has not talked to or texted him with any concerns related to the way staff treat her, or the care provided to her. FM #1 stated that any concerns he had brought up to management had been addressed appropriately in a timely manner. FM #1 stated he felt Resident #1 was safe in the facility and he was satisfied with the care provided to her. During a phone interview on 10/15/2025 at 4:09 PM, NA C stated she had worked at the facility since July 2025. She stated she had been trained on abuse and neglect. NA C stated she was trained to report any suspected or witnessed abuse to the abuse coordinator (ADM) immediately. NA C was able to provide an explanation of appropriate types and examples of abuse and neglect. NA C stated on an unknown date in August 2025 she witnessed CNA A in the shower room with Resident #1. She stated CNA A put soap directly on Resident #1's forehead. NA C stated Resident #1 then started yelling my eyes, they are burning. She stated that CNA A waiting about a minute (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676044 If continuation sheet Page 19 of 24 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 676044 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Magnolia 1105 N Magnolia Luling, TX 78648 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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few before using the shower head to roughly rinse Resident #1 face and eyes. She stated that Resident #1 calmed down after her face and eyes were rinsed. NA C stated that later that (unknown) day Resident #1 complained of irritation to her eyes. She stated she did not report the incident to anyone that day because she was scared of CNA A. NA C stated she had not noticed a change in demeanor for Resident #1 since the day of the incident. NA C stated on an unknown date while working with CNA A she was assisting with providing peri-care to Resident #2 because he was being combative. She stated she requested NA B to assist as well due to Resident #2's behaviors. NA C stated she and NA B transferred Resident #2 into bed. NA C stated Resident #2 became combative after transferring to bed. She stated while she was holding Resident #2 arm to prevent him from hitting another staff member her grip slipped, and CNA A grabbed both of Resident #2's arms while he was laying on his back. NA C stated CNA A then crossed Resident #2's arms and held his hand with her on the resident's upper chest where the collarbones meet. NA C stated that CNA A then placed her left knee on Resident #2's chest at the bottom of his ribs. NA C stated CNA A asked Resident #2 who's the boss now to which Resident #2 responded stop, you are as his face was turning red. NA C stated CNA A then immediately released Resident #2 and left room. NA C stated the bed was raised to her waist level at the time of the events. NA C stated she continued to provide care to Resident #2 for the remainder of the day. NA C stated she had not witnessed Resident #2 be combative since that day. NA C stated she did not report the incident that day because the ADM was not in her office and NA C did not have the ADM phone number to call her. She stated she did not feel comfortable talking to the charge nurse or the ADON that day about the incident because CNA A was friends with them. NA C stated she talked to the ADM about the incident the next day. NA C stated she was scared of CNA A because CNA A is known to go after someone if they report her. She stated other staff members are no longer talking to her because she reported CNA A. She stated CNA A has also been known to threaten to hurt people in the past. NA C stated she would immediately report the incident to the ADM if she were to witness any abuse, neglect, or exploitation occurring. Observation on 10/16/2025 at 09:33 AM, revealed Resident #1 in the shower room getting in her shower chair with assistance from staff. Resident #1 did not appear to exhibit any anxiety or emotional distress while in the shower. During a phone interview on 10/16/2025 at 10:36 AM, MD stated he was notified of the allegations related to Resident #2 while performing his scheduled rounds but could not recall the allegations related to Resident #1. He stated Resident #2 was being followed by the psychiatrist due to aggressive behaviors. He stated Resident #2 was difficult and pretty aggressive. MD stated he performed an assessment on Resident #2 and did not observe any abnormal bruising. He stated he had not noticed a change in Resident #2's demeanor over the previous 2 weeks. MD stated Resident #1 had a history of dementia (a disease that causes a general decline in cognitive abilities that can affect the ability to perform everyday activities, memory loss, and poor judgment) with some disorientation. MD stated he felt all the residents were safe at the facility. He stated the facility had enough staff providing care to the residents when he did his rounds. He stated he had not witnessed any abuse or neglect at the facility. MD stated he had good communication with the staff in the facility.During an interview on 10/16/2025 at 11:39 AM, the DON stated she had worked at the facility for 4 years but had only been in the DON position since 10/2/2025. She stated she had been trained on abuse, neglect, and exploitation. The DON stated she expected staff to report any concerns related to abuse, neglect or exploitation immediately to the abuse coordinator (ADM). The DON stated not reporting the incident immediately to the ADM could affect the investigation and the outcome of the investigation, especially if you have a resident with cognitive issues and staff turnover. The DON stated she had never witnessed any abuse occurring at the facility. She stated she (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676044 If continuation sheet Page 20 of 24 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 676044 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Magnolia 1105 N Magnolia Luling, TX 78648 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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few felt the residents were safe at the facility. The DON stated CNA A had worked in the facility for approximately the past 2 years though most of that was working through a staffing agency. She stated the facility stopped using the staffing agency and CNA A decided to apply for a full-time job with the facility. The DON stated she felt CNA A was a good CNA and provided really good patient care and the DON would frequently recommend CNA A to orient and train other staff members. The DON stated she never had any indication CNA A was disliked by anyone or that CNA A would instigate drama or conflict until recently when an issue outside of work on social media appeared involving some staff. She stated she was not sure of the entire details of the social media post, only that another staff member, who no longer worked at the facility, felt threatened by CNA A's FM after making a random post on [social media] that did not even have anything to do with work. The DON stated she was unsure what day CNA A worked last. The DON stated NA B had worked at the facility for the past few months and was a little resistant to learning and training. She stated she changed her approach to training NA B and NA B was more receptive to critique and learning. She stated she was unaware of any other allegations made by NA B. The DON stated she knew NA B and NA C received the training related to abuse, neglect and exploitation but was unsure if they received any additional training.During an interview on 10/16/2025 at 1:41 PM, the ADM stated she had worked at the facility for the past 8 years and she was also the abuse coordinator. She stated she had received training on abuse, neglect and exploitation. The ADM stated the definition of abuse was the intentional infringement of adverse effects that produces a negative outcome. She stated she expected staff to report any concerns or suspicions of abuse to her immediately. The ADM stated if she is not in her office then she expected staff to call her phone. She stated she gave out her phone number to all staff members time and time again and her phone number was posted in the employee break room. The ADM denied ever witnessing any form of abuse in the facility and felt the residents were safe. The ADM stated she was also a RN, and she would monitor for abuse by performing frequent rounds and even going into a resident's room to assist the CNAs with providing care to the residents. The ADM stated she monitored allegations of abuse by repeatedly going back to the resident to monitor, observe, and talk in long conversations with the resident listed in the allegation. The ADM stated she would also go with staff or the wound care provider to perform skin assessments after an incident. The ADM stated she was notified on 09/26/2025 at 2:00 PM by NA B about allegations of abuse to Resident #1 and Resident #2 by CNA A. The ADM stated she was informed by NA B that CNA A purposefully allowed soap to go into Resident #1's eyes during a shower and was slow to react and physically restrained Resident #2 with her body while providing pericare in his bed. The ADM stated at that time she collected a brief statement from NA B, but NA B was unable to provide a date or time for either one of the incidents that occurred. The ADM stated she asked NA B why she did not report the incident immediately to her like she had been trained to do. The ADM stated, NA B reported she was scared of CNA A due to a [social media] post from another, previously employed, staff member in which CNA A's FM threatened to bust out the previous staff member's windows. The ADM stated she had seen the social media comments under the social media's post threatening violence, but she never saw the actual social media post, and the language used in the comments was slang and she was unable to understand what was being said. The ADM stated CNA A did not make a comment on the social media post. The ADM stated she immediately started her investigation, a quick assessment of Resident #2's chest and neck and no abnormalities were noted and a quick assessment of Resident #1. The ADM stated she spoke with NA C related to allegations on 09/26/2025 around 03:00 PM and received her statement. The ADM denied receiving any reports prior to 09/26/2025 with allegations of abuse involving CNA A from NA C. She stated that NA C stated she was scared of CNA A due (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676044 If continuation sheet Page 21 of 24 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 676044 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Magnolia 1105 N Magnolia Luling, TX 78648 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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few to a previous incident of cyber-bullying on social media involving a staff member that no longer worked at the facility. The ADM stated she suspended CNA A on 09/26/2025 at around 4:00 PM and collected her statement later through a text message. She stated she provided 1:1 in-service with NA B and NA C related to reporting expectations. The ADM stated she received further detailed witness statements from NA B and NA C on 10/2/2025 and both NAs continued to state they did not report the concerns for abuse immediately after the witnessed incident due to fear of CNA A. The ADM stated she made a call to the police department to report the incident on 10/04/2025 but received no case number or follow-up. She stated the one of the regional compliance staff took the investigation report to the police department on 10/14/2025 and received the call for service number CFS-25-12418. The ADM stated after her investigation she was unable to determine the date and time of either alleged incident. The ADM stated she spoke with another staff member during her investigation that wished to remain anonymous. The ADM stated that the anonymous staff member stated NA C told her she really did not witness the alleged abuse by CNA A, but NA B had convinced her to make the report. The ADM stated she did not confront NA C with the statement because she did not want to breach the trust of the other staff member. She stated that she felt the other staff member was impartial to all other staff. The ADM stated she in-serviced all staff about cyber-bullying. She stated after talking with the anonymous staff member, looking at the bed height in relation to the length of CNA A's legs, the safety surveys and both Resident #1 and Resident #2 repeatedly stating no one at the facility had hurt them, her findings were unfounded for the allegation of abuse. The ADM stated she terminated CNA A on 10/13/2025 due to allegations of abuse even though the investigation was unfounded. She stated with the previous concerns related to social media she did not want that tension returning to the facility. The ADM stated she provided in-services on abuse, reporting guidelines for abuse, and sensitivity training to all staff. She stated she also implemented for two staff members to assist Resident #2 any time patient care is provided. The ADM also stated she had set up an in-service to be performed by the local law enforcement related to cyber-bullying that was scheduled to occur the following week. A telephone interview with PNP was attempted on 10/26/2025 at 05:22 PM. A voicemail was left requesting a return phone call. A returned phone call was not received prior to exit. Review of CNA A's employee file, on 10/17/2025, reflected a background check had been performed and revealed no convictions that would make CNA A unemployable. Review of CNA's employee file reflected the facility also performed and EMR and NAR search and no concerns were revealed. CNA A's hire date was officially 03/01/2025. Review reflected CNA A received training on Abuse, Neglect, and Exploitation as well as Texas Senate [NAME] 9 on 07/01/2025. Review of CNA A's employee file reflected CNA A was terminated on 10/13/2025 with reason for termination listed as allegation of abuse with no circled next to Had the employee received any prior warning?.Review of facility in-services reflected in-services dated 03/02/2025, 03/04/2025 and 03/16/2025 related to Abuse, Neglect, and Exploitation with CNA A's signature which indicated her attendance to the in-services.Review of NA B's witness statement reflected the following: On 09/26/2025 [NA B] states [CNA A] put soap in [Resident #1]'s eyes that was on a washcloth when she was washing her face and placed her hands on [Resident #2]'s chest to hold him down when they were providing him care and signed by NA B.Review of NA B's witness statement, dated 10/02/2025, reflected the following: [CNA A], and [NA C], were changing [Resident #2]. [NA C] had called because they needed help. I was watching him being changed and he was being combative. I joined in to help and we were able to turn him toward the wall. I put the brief on him and we turned him back to the other side so I could do the tab on his brief. He started hitting and he kicked me in the arm, (no bruising) and he hit [CNA A] in the chest. He hit her hard. [CNA A] started cursing but I don't think (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676044 If continuation sheet Page 22 of 24 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 676044 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Magnolia 1105 N Magnolia Luling, TX 78648 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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few it was at him. After that I decided to pull the bed out and I was on the right arm and [CNA A] was on the other arm. He was able to get his arm loose from me and he hit [CNA A] again. I grabbed his arm back gently and [CNA A] had her knee on his chest and her right arm was holding him and her left arm was at the bottom of his neck and his face began to turn red. [Resident #2] was saying stop it over and over again. [CNA A] was calling him bad names and [CNA A] was telling him mother****** I am the boss and she would beat the s*** out him. [Resident #2] then got off him and he did not fight anymore after that.[Resident #1] had asked me to take her in the shower room and we put her in the shower chair. [Resident #1] asked for a wash rag and [CNA A] squirted the soap in her face and it got into her eyes. [Resident #1] kept say my eyes; you got soap in my eyes and then [Resident #1] asked me for a wash rag and I went and go the wash rag. Before I gave it to [Resident #1], [CNA A] put more soap on the wash rag and [CNA A] took the wash rag and washed her face with it. After she took the wash rag and did her face [Resident #1] kept saying wash rag, wash rag and I said to [CNA A] that she just wants a wash rag. [CNA A] did not say anything to me. I gave the wash rag to [Resident #1]. [CNA A] was rinsing [Resident #1]'s body. I left the shower room after that. This happened about two and a half weeks ago. I was worried to report because I was scared of the posts on [social media]. Signed by NA B. Review of NA C's undated witness statement reflected the following: [NA B] and I were assisting [CNA A] changing [Resident #2] and he was being very combative so [CNA A] took one of her arms and held onto his arm and then her other arm was on his chest. [Resident #2] was asking for [CNA A] to stop. I think she was using her body to hold him. [NA B] and I were watching [CNA A] because we were new when she was caring for [Resident #2]. [Resident #2] did not want to transfer and [CNA A] was picking at him like taking her fingers and putting them on his body. [Resident #2] can pivot on one leg and [CNA A] was getting him up and she transferred him onto the bed out of his wheelchair. [Resident #2] was aggressive and [CNA A] was taking her fingers and placing them on different parts of his face. [Resident #2] continued to be very combative. [Resident #2]'s hands were folded and she took her hands and placed them on top of his hands. She kept her hands there until [Resident #2] said ok you win you are the boss. She stopped.When I went to school I was taught that you do not put soap on a washcloth when you are washing a resident's face. [CNA A] took the soap bottle and poured soap on [Resident #1]s hair and it ran into her eyes and she let the soap stay like this for a full minute. After the minute was up she took the sprayer and sprayed towards her face. [Resident #1] took the water and used it and washed the soap off of her face.I feel [CNA A] is a good aide. She needs some training on compassion. Signed by NA C.Review of NA C's witness statement, dated 10/02/2025, reflected the following: Addendum to statement:[CNA A] was cussing but I am not sure what she was cussing about. She was just cussing. [Resident #2] was very angry and fighting us when we were trying to change him. We always have two people and both of us have to try to care for him. He is combative everytime we try to change him and we have to hold him down. I feel he gets worse at night but also in the mornings he is very very bad. On this day I think he was worse than most days. When we were trying to hold him he was very strong and kept getting away from us. Wherever we were holding him he was able to get away from us. [CNA A] had her knee on [Resident #2] to hold him down to. We have to get him up and he will not try to get out of bed if he up[sic?]. If he is up he is calm. Signed by NA C.Review of unsigned, undated, witness statement reflected the following: On September 18, 2025, [CNA A] stated she remembered the day when they had trouble with [Resident #2] and the day was Thursday and [LVN E] was the nurse. In the beginning [NA C] and she were cleaning up [Resident #2]. They had raised the bed to [CNA A]'s hip which was approximately 23 inches above the floor. With the bed raised to hip level it would be 25 inches from the ground. [Resident #2] was being combative, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676044 If continuation sheet Page 23 of 24 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 676044 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Magnolia 1105 N Magnolia Luling, TX 78648 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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete and [CNA A] stated they texted [NA B] to come and help them. When [NA B] came to the room [CNA A] stated [NA B] was holding [Resident #2]'s hands and [NA C] was trying to keep him from kicking [NA B] and herself. [CNA A] and [NA B] switched positions because [NA B] could not turn his upper body. [NA B] stated she got both hands and held them on his left shoulder with one hand and turned him with the hand[sic?] while [NA B] finished cleaning the BM from his right side which was difficult since they had him turned on this right side facing the wall. [NA C] was holding his leg and [CNA A] stated they struggled to push the sheets under him and then they turned him on his bed. They were able to get his brief on and then they were only able to put a draw sheet under him. [CNA A] stated they then positioned him in the bed so that he could eat breakfast and then they all walked out. [CNA A] stated she remembered that day clearly because [Resident #2] had never been that combative before or hit her like that before. Per [CNA A] via textDuring phone interview on 10/16/2025 at 01:25 PM, A representative from the local police department stated the police department received a call to service on 10/14/2025 at 01:26 PM from the facility related to a staff member abused a resident but no further information was provided regarding the staff member's name or the resident's name. She stated the call to service was cancelled on 10/14/2025 at 01:29 PM. She stated that no investigation by the police department was conducted. Review of the facility policy titled Abuse, Neglect, Exploitation or Misappropriation - Reporting and Investigating, dated 2001 and last revised 09/2022, reflected the following: Policy StatementAll reports of resident abuse (including injuries of unknown origin), neglect, exploitation, or theft/misappropriation of resident property are reported to local, state and federal agencies (as required by current regulations) and thoroughly investigated by facility management. Findi Event ID: Facility ID: 676044 If continuation sheet Page 24 of 24