Inspection·September 19, 2023

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some admitted to the facility on [DATE] with the following diagnoses: orthopedic aftercare, displaced comminuted fracture of shaft of left femur (realignment of snapped thigh bone), type 2 diabetes mellitus (blood cells resisting sugars) without complications, (primary) hypertension (high blood pressure), cardiac murmur (uneven blood flow through the heart), nonrheumatic aortic (inflammation of heart valves) stenosis. Record review of Resident #2's Minimum Data Set (MDS) assessment, dated 08/16/2023, reflected a Brief Interview for Mental Status (BIMS) score of 13 out of 15 resulting in intact cognitive function. The MDS reflected Resident #2 required extensive assist with bathing and toileting with 1-person assist, and total dependency for bed mobility, transfers, and lower body dressing with 2-person assist. Resident #2 was always incontinent of bladder and required the use of pads and briefs and is bowel incontinent and required a colostomy bag. Record review of Resident #2's Care Plan dated 09/04/2023, reflected the following: Resident was incontinent of bladder and bowel with impaired mobility. Brief Use: The resident used disposable briefs. Incontinence: Check resident routinely as required for incontinence. Wash, rinse, and dry perineum (space between the anus and scrotum on a male). Change clothing PRN after incontinence episodes. Monitor and document intake and output as per facility policy. Goal: Resident was to remain free from skin breakdowns due to incontinence and brief use through the review date. The resident had a colostomy and to remain clean and free from odor thru next review. Resident was to be assisted in keeping skin around colostomy cleaned daily. Keep accurate record of bowel movement, color, and consistency of stool. Observe skin for breakdown. Replace colostomy according to policy. Record review of the Face Sheet for Resident #3 reflected a [AGE] year-old male initially admitted to the facility on [DATE] and readmitted on [DATE] with the following diagnoses: retention of urine, hyperlipidemia (fat buildup in the blood), constipation, generalized anxiety disorder, vitamin B-12 deficiency anemia, vitamin D deficiency, hypothyroidism (hormone deficiency), Parkinson's disease (brain condition causing uncontrollable movements), atherosclerotic heart disease of native coronary artery without angina pectoris (fat buildup in the blood), atrial fibrillation (irregular/rapid heart rate), hemiplegia (muscle weakness/paralysis one side of body), tremor, lack of coordination, muscle weakness, insomnia, unsteady on feet, cognitive communication deficit, and Todd's paralysis (seizure followed by temporary paralysis). Record review of Resident #3's MDS assessment, dated 08/16/2023, reflected a BIMS score of 13 out of 15 resulting in intact cognitive function. The MDS reflected Resident #3 required extensive assist with bed mobility, toileting, and personal hygiene with 1-person assist. Resident #3 required total dependency for transfers with 2-person assist. The MDS reflected Resident #3 was frequently incontinent of bladder with no toileting program currently being used to manage the resident's bowel continence. Record review of Resident #3's Care Plan dated 07/21/2023, reflected the following: Resident was incontinent of bladder and bowel and mobility and cognitive status. Goal: Resident will be assisted for toileting as needed and have no avoidable skin injuries. Interventions: Resident was to be checked every 2-hours and checked as needed. Observe patterns of incontinence, and initiate toileting schedule if indicated. Provide bedside pan or bedside commode. Provide peri care after each incontinence episode. Dependent on transfers, hoyer-lift. In an interview on 09/16/2023 at 10:21a.m. Resident #2 could provide any statements related to his peri care. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676066 If continuation sheet Page 2 of 6 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676066 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Houston 2310 S Eldridge Parkway Houston, TX 77077 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some In an interview on 09/16/2023 at 10:30 a.m. Resident #2's family member stated that the resident's colostomy bag was to be changed daily. She stated that the bag was not changed on 09/06/2023, 09/07/2023 and 09/08/2023. She stated she kept mentioning it to the staff (exact times, names, and titles unknown) that the bag needed changing before it bursts. On 09/09/2023, the resident's colostomy bag busted. She stated it made a huge mess all over the resident, his wheelchair, and the floor. She stated that staff had to come clean it up. She stated on 09/06/2023, 09/07/2023, 09/08/2023 and 09/09/2023 on or about 04:00 a.m. she pushed the call light for the resident to be changed, but no one came. She stated that she waited until 07:30 a.m. and finally changed the resident herself. She stated that the resident's brief was soaked through his clothes, bedsheet to the mattress. She stated that the family had to change his bed sheet 2-times a day from the resident being soaked with urine to the bed. In an interview on 09/16/2023 at 12:02 p.m. Resident #1 stated that he pressed the call bell at 04:00 a.m. today for a bowel change and no one came. He stated he called out for help and kept pushing the call light, but still no one came. He stated he then called his significant other, and she did not answer either and then became scared he was going to be left alone in his feces. He stated his significate other arrived at about 8:00 a.m. and changed his brief. He stated he could not remember the last time staff came in the room. He stated his significate other changed his brief when she came into the facility today. In an interview on 09/16/2023 at 12:05 p.m. Resident #1's family member stated that she changed the resident's brief on 09/15/2023 around 08:00 p.m. before she left from visiting. She stated that the resident called her phone several times between 4:00 and 8:00 a.m. (exact times unknown) on 09/16/2023 but did not answer because she was asleep and then had gotten ready to go to the facility. She stated she arrived at the facility around 7:30/8:00 a.m. and the resident was soaked in urine and feces. She stated that she disrobed the resident, changed his brief, wiped him down, and put a new shirt on him. She stated that his sheets were soaked, and she had to get new sheets and remade his bed. She stated that the resident had only been in the facility 5-days, and every day when she came in the mornings, she had to change the resident's-soaked brief. She stated that the staff do not get the resident up, do not change the resident's briefs, nor help wash his face or brush his teeth. In an interview on 09/19/2023 at 09:15 a.m. Resident #3 stated that he was changed for bed in the evenings (exact time differs). He stated he pushed the call bell at 05:00 a.m. every morning to have his brief changed, but no one came to check on him or change him until closer to 07:30 a.m. He stated it did not make him feel good to sit that long without anyone coming to see what he needed. In an interview on 09/19/2023 at 01:28 p.m. the DON stated staff on all shifts and during the night are to make resident rounds every two hours and perform incontinent care has needed. He stated that residents are to be changed every two hours even through the night unless it is care planned not to disturb a resident. He stated it is not acceptable for a resident to go all through the night and not have their brief changed. He stated that it is not acceptable for a resident to have to wait from 04:00 a.m. or 05:00 a.m. until 07:30 a.m. to have their brief changed. Residents sitting in briefs for long periods of times could increase the chance of infections and cause discomfort for the residents. He stated there were no complaints and he was not aware of any residents waiting long periods of time for peri care nor sitting in heavily soiled bedding as a result. In an interview on 09/19/2023 at 01:56 p.m. the Administrator stated that staff performed peri changes every 2 hours. He stated that monthly he made unannounced/undocumented visits to the facility between 10:00 p.m. and 06:00 a.m. and randomly checked residents to see if they were dry. He stated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676066 If continuation sheet Page 3 of 6 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676066 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Houston 2310 S Eldridge Parkway Houston, TX 77077 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some that he had found no issues. He stated routinely management made undocumented angel rounds, asking residents had they received the quality of care from staff. He stated there had been no complaints or grievances related to peri care. He stated if resident were being left in soiled briefs from bedtime until morning that would not be acceptable, and that would be an issue that would need to have been addressed immediately. He stated there were no complaints and he was not aware of any residents waiting long periods of time incontinent care or sitting in heavily soiled bedding. In an interview on 09/19/2023 at 02:06 p.m. CNA A stated that she worked 6:00 a.m. to 2:00 p.m. Monday Friday prn. She stated residents are to be checked every 2-hours. She stated she checked on her residents more than every 2-hours and when the residents pressed their call bells. She stated that residents who were incontinent were to be checked and changed every two hours as needed. She stated when she started her shift, she changed residents and began getting them ready for the day. She stated that they change the sheets and most of the time the bedsheets were dry. She cannot name anyone resident was repeatedly soaked through. In an interview on 09/19/2023 at 2:52 p.m. CNA B stated that she worked 6:00 a.m. to 2:00 p.m. 09/07/2023, 09/12/2023 and 09/16/2023. She stated that Resident #1, Resident #2 and Resident #3 were heavy wetters (brief always full). She stated that she performed rounds every 2-hours and as needed to check on residents. She stated if residents were incontinent, she would check and change the resident as needed. She stated sometimes residents would soak through their sheets, but there was not any particular resident on any particular shift that frequently soak through or had complaints about not being changed during rounds. In an interview on 09/28/2023 at 2:15 p.m. CNA C stated that she worked 10pm to 6am on 09/07/2023, 09/08/2023, 09/12/2023, and 09/14/2023. She stated when her shifts started at 10:00 p.m. she began taking resident vitals and checked to see what residents needed incontinent care and changed them. She stated she would check the residents again at 12:00 a.m., 2:00 a.m. and between 4:45 a.m. and 5:00 a.m. She stated that Resident #1, Resident #2, and Resident #3 are heavy wetters. Resident #1 was a quiet man and had no complaints related to incontinent care. Resident #2 was a quiet man. She stated she does not remember his family every being in the facility during her shift. She stated that he had a colostomy bag, no foley, was incontinent and was a heavy wetter. She stated she checked him when she came on shift during her 10:00 a.m. rounds, her 12:00 a.m. rounds, 2:00 a.m. rounds, and her 4:00 a.m. rounds. She stated sometimes she had to let air out his colostomy bag. She stated that his colostomy bag was never full, never came off, or needed to be changed on her shift. She stated if he had been, she would have to alert the nurse who would perform the change. She stated RN was the nurse on shift when she worked and female nurse whose name she did not know. Resident #3 was an intelligent and talkative man. She stated he would often be asleep when she came on shift. She stated at 12:00 a.m. most mornings he would press the call light for pain medication and to be changed. He would be wet again at the 2:00 a.m. and changed, and his last change would be between 4:45 a.m. and 5:00 a.m. before she left shift. In an interview on 09/28/2023 at 02:30 p.m. CNA D stated she worked the 10:00 p.m. to 6:00 a.m. shift on 09/09/2023, 09/12/2023, and 09/14/2023. She stated when she started her shifts at 10:00 p.m. she performed vital checks on the residents and checked to see if the residents needed incontinent care. She stated she did not change residents at that time because there was only one vital sign checking machine. She stated she performed resident vitals first, then passed it on to the next CNA, and then she went back to the residents who needed incontinent care to change their briefs. She stated that rounds took her about 2-hours to complete and rounds were roughly every two hours: 10:00 p.m., 12:00 a.m., 02:00 a.m., and 04:00 a.m. She stated Resident #1 incontinent and was a heavy wetter. She (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676066 If continuation sheet Page 4 of 6 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676066 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Houston 2310 S Eldridge Parkway Houston, TX 77077 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some stated sometimes she did not disturb him when he was asleep for incontinent care (exact dates and times unknown). She stated sometimes he would soak through his briefs onto his bed sheets, and she had to change the bedding (exact dates and times unknown). She stated that the family had called and complained that he was not being changed enough (exact date and time unknown). She stated thereafter the resident was moved to the other end of the hall (exact date and time unknown) and she no longer provided the resident care. She stated Resident #2 was incontinent and had a colostomy bag. She stated when he was first admitted (exact date and time unknown) she did not know he was a heavy wetter. She stated that during rounds she would ask him was he wet, and he would tell her no. She stated when she would come back on the next round, again he told her no when she asked was, he wet. She stated she would check him anyway and found that he had soaked through his brief and onto his bedding. She stated that he had done that on a few occasions (exact dates and times unknown) and realized that he may not know he is wet when she asked him. She stated moving forward (exact date and time unknown), when she checked in on him during her rounds, she changed his brief know matter if he said he was wet or not. She stated Resident #3 did not like to wait on his incontinent care. She stated sometimes when she was helping other residents he would yell out and would not stop yelling until she changed him. She stated that he would yell so loudly that he would awaken the other residents. She stated she would try and change him first to keep him from waiting too long. In an interview on 09/29/2023 at 08:56 a.m. the Administrator stated that were no blanket policy on ADL care. Record review of the signed staffing scheduled revealed that CNA B worked 6:00 a.m. to 2:00 p.m. on 09/07/2023, 09/12/2023, and 09/16/2023. CNA C worked 10pm to 6am on 09/07/2023, 09/08/2023, 09/12/2023, and 09/14/2023. CNA D worked 10:00 p.m. to 6:00 a.m. on 09/09/2023, 09/12/2023, and 09/14/2023. Record review of progress notes dated 09/11/2023 - 09/14/2023 revealed Resident #1 had no notes related to resident's peri care. There were no progress notes before 09/11/2023 and no notes after 09/14/2023. Record review of progress note dated 08/19/2023 at 08:45 p.m. revealed Resident #2's family reported swelling around colostomy bag with some discomfort. Progress note dated 08/20/2023 at 04:36 a.m. revealed colostomy bag changed, and resident made no complaints on that shift. Progress note dated 08/29/23 at 11:00 a.m. change of condition reported. Evaluation: abnormal pain, constipation or impaction observation, evaluation, and recommendation: Resident colostomy site swollen, painful, and stools looked hard. Provider response: Sent resident to hospital. Functional status evaluation: Needed more assistance with ADLs, resident had pain, resident constipated, and resident had not had a bowel movement in 3-days. Progress note dated 08/29/2023 at 11:18 a.m. revealed family at bedside, resident sent to hospital due to pain, and swelling around colostomy site. Record review of progress notes dated 09/07/2023 - 09/16/2023 revealed Resident #3 had no progress/nursing notes related to his peri care. Record review of Personal Care Policy Perineal Care revised date of February 2018 revealed: Purpose: The purpose of the procedure was to provide cleanliness and comfort to the resident, to prevent infections and skin irritation, and to observe the resident's skin condition. Preparation: 1. Review the resident's care plan to assess for any special needs of the resident. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676066 If continuation sheet Page 5 of 6 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676066 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Houston 2310 S Eldridge Parkway Houston, TX 77077 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 0690 Record review of facility grievances dated March 2023 - September 2023 revealed no incontinent care complaints or complaints related to Resident #1, #2, or #3. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676066 If continuation sheet Page 6 of 6