Health inspection·December 2, 2025

F 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few the ability to use suitable items to clean teeth. CR #2 was dependent - helper does all of the effort for CR #2's toileting hygiene and did not have the ability to maintain perineal hygiene, adjust clothing before and after voiding or having a bowel movement, including wiping the opening but not managing equipment. CR #2 was dependent - helper does all of the effort for CR #2's shower/bathe self and did not have the ability to bathe self, including washing, rinsing, and drying self (excludes washing of back and hair), including transferring in/out of tub/shower. CR #2 was dependent - helper does all of the effort for CR #2's upper body dressing and did not have the ability to dress and undress above the waists, including fasteners on clothing. CR #2 was dependent - helper does all of the effort for CR #2's lower body dressing and did not have the ability to dress and undress below the waits; including fasteners. CR #2 was dependent - helper does all of the effort for CR #2's placing on/taking off footwear and did not have the ability to put on and take off socks and shoes or other footwear that was appropriate for safe mobility; including fasteners, if applicable. CR #2 was dependent - helper does all of the effort for CR #2's personal hygiene and did not have the ability to maintain personal hygiene, including combing hair, shaving, applying makeup, washing/drying face and hands. Section GG - Functional Abilities - at discharge. GG0170. Mobility (Assessment period was the last 3 days of the stay). Discharge performance: CR #2 required Supervision or touching assistance for sitting to lying: The ability to move from sitting on side of bed to laying flat on the bed with verbal cues and/or touching/steadying and/or contact guard assistance from helper as resident completed activity. (Assistant may be provided thought the activity or intermittently.) CR #2 required Supervision or touching assistance for Lying to sitting on side of bed: The ability to move from lying on the back to sitting on the side of the bed and with no back support. CR #2 required Supervision or touching assistance for Sit to stand: The ability to come to a standing position from sitting in a chair, wheelchair, or on the side of the bed. CR #2 required Supervision or touching assistance for Chair/bed-to-chair transfer: The ability to transfer to and from a bed to a chair (or wheelchair). CR #2 required supervision or touching assistance for toilet transfer: The ability to get on and off a toilet or commode. CR #2 required Supervision or touching assistance for tub/shower transfer: The ability to get in and out of a tub/shower. CR #2 required supervision or touching assistance for walking 10/50/150 feet making two turns, on uneven or sloping surfaces (indoor or outdoor), such as turf or gravel. CR #2 required supervision or touching assistance for 1 step (curb): the ability to go up and down a curb and/or up and down one step. CR #2 required supervision or touching assistance for picking up objects, bending/stooping from a standing position to pick up a small object, such as a spoon, from the floor. CR #2 was independent (completes the activity by themselves with no assistance from a helper) with use of a wheelchair and/or scooter, wheeling 50/150 feet with two turns once seated in wheelchair/scooter in a corridor or similar space. Section GG0130 Self-Care (Assessment period is the Assessment Reference Date (ARD) plus 2 previous calendar days). A. CR #2 required substantial/maximal assistance (helper does more than half the effort) with eating and had the ability to use suitable utensils to bring food and/or liquid to the mouth and swallow food and/or liquid once the meal is placed before the resident. Substantial/maximal assistance (Helper does MORE THAN HALF the effort).B. CR #2 required substantial/maximal assistance (helper does more than half the effort) with oral hygiene: Section H - Bladder and Bowel. Section H0200 indicated CR #2 was not on a urinary toileting program. Section H0300 Urinary Continence: Frequently incontinent (had 7 or more episodes of urinary incontinence, but at least one episode of continence voiding). Section H0400 Bowel Continence indicated CR #2 had frequent incontinent (2 or more episodes of bowel incontinence, but at least one continence bowel). Section H0500 indicated CR #2 was not on a bowel toileting program. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676066 If continuation sheet Page 2 of 16 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 12/02/2025 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 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Section I - Active Diagnoses indicated CR #2's primary medical condition that best describes the primary reason for admission was stroke/metabolic/ hyperlipidemia (high cholesterol (a waxy, fat-like substance vital for cell function) in the blood, increasing heart disease risk by forming artery-clogging plaque)/ hypercholesterolemia (excess of cholesterol in the bloodstream) and neurological/hemiplegia (paralysis affecting one side of the body, typically caused by brain or spinal cord damage, often from a stroke) or hemiparesis (weakness on one side of the body, affecting the arm, leg, and sometimes the face, resulting from neurological damage, most commonly a stroke). Section J - Health Condition indicated that CR #2 had no presence of pain. Section K - Swallowing/Nutritional Status indicated CR #2 had Complains of difficulty or pain with swallowing., and loss of liquids/solids from mouth when eating or drinking. Section K0100. Swallowing Disorder indicated CR #2 had signs and symptoms of possible swallowing disorder to include: Loss of liquids/solids from mouth when eating or drinking and complaints of difficulty or pain with swallowing. Section K0520: Nutritional Approaches indicated that while CR #2 was a resident he required a mechanically altered diet - required change in texture of food or liquids (e.g., pureed food, thickened liquids). Section N - Medications indicated that CR #2 was taking antiplatelet (medications that stop platelets (small blood cells) from sticking together to form dangerous blood clots) pharmacological classification/high risk drug class mediation during the last 7 days of admission. Record review of CR #2's Letter of Agreement (LOA) dated 04/23/2025 from hospital agreeing to pay facility $360 a day for CR #2's stay until 07/31/20 25. Record review of CR #2's Clinical Progress Note dated 04/23/2025 at 09:15 p.m. LVN K reflected CR #2 arrived at the facility with a stroke diagnosis and right-side weakness. A head-to-toe assessment was completed finding CR #2's skin intact. CR #2 was incontinent of bowel and bladder and identified as a fall risk and noted to be on regular diet. CR #2 was homeless and had difficulty communicating but could use gestures and pictures to communicate. Record review of CR #2's Clinical Progress Note dated 04/24/2025 at 8:30 a.m. NP A reflected CR #2 transferred to the facility from an acute care hospital. ***Chief Complaint*** Post-stroke evaluation and management. CR # 2 was recently hospitalized for acute onset of mutinous (sudden/rapped development of symptoms) and had a computed tomography (CT) of the brain showing M1 occlusion (major blood vessel in the brain). CT of the CR #2's head showed ischemic infarct (type of stroke resulted from lack of blood flow) to the middle cerebral artery (MCA) area of the brain. CR #2 had right side weakness and difficulty with word finding but was able to answer some questions with yes or no. A physical exam showed dysarthria and aphasia (communication disorders caused by brain damage), right hemiplegia (one-sided paralysis or weakness of the face, arm or leg) some sensitive to touch on right side. Record review of CR #2's Clinical Progress Note dated 04/23/2025 at 11:06 p.m. LVN K reflected CR #2 had a [NAME] monitor (small, wearable device that records the heart's rhythm) in place on the left chest for continuous cardiac monitoring. Record review of text messages from SW A to HSM A on 07/28/2025 at 03:59 p.m. reflected that SW A informed HSM A that she had a homeless patient planning to arrive on 07/31/2025 who was previously homeless in [NAME], TX. On 07/31/2025 at 03:07 p.m. HSM A asked was CR #2 disabled and able to climb on a top bunkbed. SW A stated that CR #2 was recovering from a stroke. Had weakness, walked with a quad cane, able to do all self-care tasks, with no assistance, but could not climb on a top [NAME]. HSM A agreed for CR #2's arrival and stated he had a bottom bunkbed for CR #2. Record review of CR #2's Clinical Progress Note dated 07/30/2025 at 11:30 a.m. reflected CR #2 had a recent functional assessment showing steady improvement with mobility and progressing from contact guard assistance to independent ambulation with a cane. Discharge planning had been finalized for CR #2 to transfer to a homeless shelter on 07/31/2025. CR #2 admits to poor hydration (not accepting substantiate fluids). SW B had (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676066 If continuation sheet Page 3 of 16 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 12/02/2025 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 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few difficulties finding a homeless shelter due to need for assistance with ADLs. CR #2 was to have likely transfer to a homeless shelter towards the end of the month with social support from Family #2 and Family #3. Record review of CR #2's Clinical Progress Note dated 07/31/2025 at 10:45 a.m. NP A reflected CR #2's discharge date of Service: 2025-07-31 10:45 a.m. Visit Type: Discharge Summary - NP A Discharge To: Home - Home with *NO Home Health* services (Home) ***Chief Complaint*** Post-stroke rehabilitation discharge. CR #2 seen for discharge from the skilled nursing facility. CR #2 currently stable. CR #2 denies any pain, fever, or chills. NP noted after discussion with the SW B, CR #2 will be transferring to a homeless shelter later today as planned. The patient has demonstrated significant functional improvement during his stay at facility. He has progressed from requiring contact guard assistance to achieving independent ambulation with a cane. A quad cane was previously ordered to support his continued mobility independence post-discharge. CR #2's course has been complicated by aphasia following cerebral infarction, with communication occurring through visual aids and binary responses. His pain has been well-controlled on Tylenol Extra Strength, and he was provided with a 90-day supply of medications in preparation for discharge. Record review of CR #2's Clinical Progress Note dated 07/31/2025 12:12 p.m. SW B reflected CR #2 received wide base quad cane (WBQC) provided by acute care hospital this week. CR #2 prepared to discharge men's homeless shelter 07/31/2025 due to letter of agreement (LOA) with acute care hospital community based transitional care program (CBTCP) ending on 07/31/2025. SW notified shelter on last week and earlier this week of pending arrival. CR #2 earlier on 07/31/2025 ambulating from the dining area to his room with WBQC. CR #2 voiced readiness to discharge from the facility. SW will contact Family B to inform her of shelter's address. CR #2 informed SW last week that Family B had not visited only Family C. Printed prescriptions will be provided to CR #2 in addition to list of homeless resources. Transportation was arranged on 07/31/2025. SW will continue to follow-up PRN. CR #2 was still pending disability determination for benefits. Record review of CR #2's Clinical Progress Note dated 07/31/2025 at 05:34 p.m. reflected CR #2 left the facility at about 05:15 p.m. in company of emergency medical services to homeless shelter in good condition. discharged instructions and face sheet given to CR #2. Record review of admissions transfers discharge log dated 07/31/2025 reflected CR #2 discharged on 07/31/2025 at 05:44 p.m. to a private home/apartment with no home health services. Record review of CR #2's Clinical Progress Note dated 08/04/2025 at 11:42 a.m. reflected Social Worker (SW) reflected Family B called regarding CR #2's recent discharge. SW provided details of CR #2's discharge and level of function at the time of discharge. No additional concerns noted. Record review of text messages from SW A to HSM A on 08/05/2025 at 5:11 p.m. reflected SW A asked HSM A if there were any issues with CR #2. HSM A responded, Yes. CR #2 stated he wants to return to the facility as he could not shower by himself, and it was very difficult to function at the shelter. SW A stated unfortunately, CR #2 could not return to the facility because the acute care hospital would no longer pay. She stated she informed Family B that CR #2 would need to go to the emergency room if Family B could not pick him up. HSM A stated he would let CR #2 know and asked what the hospital would do if CR #2 went. SW A stated, Basically, nothing unless something medical was going on. SW A stated that Family B was calling saying, The shelter had put him out (based on information Family B received from CR #2). HSM A stated that they had not put CR #2 out as he seen CR #2 on 08/05/2025 at 3:00 p.m. Record review of CR #2's discontinued orders reflected he received, Atorvastatin Calcium (treats high cholesterol and reduce the risk of heart attack, stroke, and other cardiovascular diseases) 80mg. Give 1 tablet by mouth in the evening for Cholesterol. Start date 04/24/2025 to Discharge (D/C) date 09/29/2025. Record review of CR #2's discontinued orders reflected that he received, Tylenol extra strength oral tablets 500 milligrams (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676066 If continuation sheet Page 4 of 16 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 12/02/2025 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 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few (mg )(Acetaminophen). Give 2 tablets by mouth 2 times a day for pain. Start date 05/07/2025 to D/C date of 09/29/2025. Record review of CR #2's discontinued orders reflected that he received, Aspirin EC oral tablet delayed release 18 mg (Aspirin). Give 1 tablet by mouth one time a day for pain. Start date 04/24/2025 to D/C date of 09/29/2025 In an interview on 11/11/2025 at 03:23 p.m. Family B stated that CR #2 was admitted to an acute care hospital after being found on a sidewalk unconscious. She stated CR #2 was med-flight from [NAME], Texas (TX) to an acute care hospital in Houston, TX where it was determined he had a stroke. She stated the stroke had affected the side of his brain that processes language. She stated in May of 2025, after the acute care hospital made payment arrangements for rehabilitation services, he was discharged to the facility. She stated she came to the facility and spoke with SW A trying to figure out where CR #2 would go upon discharge. She stated she informed SW B that she lived on 2nd floor housing unit with a spouse and children, which would not allow her to house CR #2 upon discharge from the facility and she stated that Family C was an elderly man that was also not in a position to take on the care of CR #2. She stated on 07/31/2025 she learned from CR #2 that he had been dropped off and dumped at a men's homeless shelter by the facility. She stated she reached out to the facility and SW B contacted her explaining that CR #2 was his own responsible party and met the discharge criteria to be released, now that he was able to walk. She stated CR #2 cannot bathe or dress himself and has the inability to use his right arm due to the stroke. She stated that CR #2 cannot communicate more than a few words and requires someone to translate his needs and wants as he points and even had confusion when trying to speak his needs. She stated it had been her understanding that SW A applied for Medicaid on behalf of CR #2 twice. She stated that she had no way of contacting CR #2 at the shelter, she had to wait for CR #2 to contact her. She stated that CR #2 had expressed fear that the shelter was going to require him to leave soon. She stated he was not doing well, was scared and fearful of where he could live the next day. She stated that CR #2 had been in perfect health prior to the stroke. She stated he had just purchased a bus ticket the day before the stroke to come to Houston to find work after finding himself homeless. In an interview on 11/14/2025 at 11:37 a.m. SW B stated that she had spoken with Family B regarding CR #2's discharge plans. She stated she received a call from Family B and explained to Family B that she had tried setting up home health care services, but CR #2 had no finances and no home to discharge into. She stated that the LOA ended from the hospital CR #2 discontinued his financial ability to stay at the facility and NP A cleared him medically to discharge. She stated that Family B explained their family was not in positions to take CR #2 into their homes. SW B stated therefore SW A had made plans for CR #2 to discharge to a homeless shelter. She stated in the meantime SW A had assisted CR #2 in applying for medical benefits. She stated that SW A set up CR #2's prescriptions and any medical equipment if any he would have needed. She stated at the time of discharge CR #2 was able to perform all his own ADLs. She stated that discharge process was then translated to CR #2 and he agreed to discharge to the shelter. She stated it had been her understanding from the beginning CR #2 would have been discharged to the shelter. She stated she had not personally met with CR #2 as SW A was his point of contact. In an interview on 11/14/2025 at 11:57 a.m. SW A stated that CR #2 was living on the street and found lifeless and had to be life flighted to the acute care hospital in Houston from [NAME]. She stated prior to his discharge he was cleared by NP A as CR #2 was able to walk with a 3-prong cane and perform all his own ADLs. She stated that she arranged for the CR #2 to discharge to a men's homeless shelter after finding he had no family that could provide him shelter. She stated a short time after CR #2 discharged ; Family B contacted her accusing her of putting him in a homeless shelter that only offered 30 days of housing and CR #2 was about to find himself back on the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676066 If continuation sheet Page 5 of 16 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 12/02/2025 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 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few streets unable to take care of himself. She stated that the shelter would not have allowed CR #2 to admit to the facility had he not been able to perform all his own ADLs as it was a mandatory requirement for admissions into the shelter. She stated she contacted the shelter on 08/05/2025 and learned from the homeless shelter manager (HSM) A that CR #2 was doing fine. She contacted HSM A again and learned that CR #2 wanted to return to the facility. She advised HSM A to send CR #2 to the hospital if he had been in need of medical care, but that he could not return without paying for his admission. SW A provided text message communication between HSM A and herself regarding CR #2. In an interview on 11/14/2025 at 04:21 p.m. Physical Therapy Assistant (PTA) stated that she had not provided CR #2, direct care but had been present in the therapy room when he came for services. She stated that CR #2 was able to walk towards the end of his stay at the facility with a hemi walker (4-prong cane). She stated CR #2 had weakness/worse or less movement on one side of his body and was unable to speak due to a stroke. In an interview on 11/14/2025 at 05:14 p.m. CNA D stated that she provided water to CR #2 who could walk with a hemi walker and roll with a wheelchair, but he could not speak only pointed after suffering a stroke. In an interview on 11/15/2025 at 03:21 p.m. RN B stated that she was the nurse for CR #2 who had come to the facility from the hospital after suffering a stroke. She stated at discharge the resident was not able to shower by himself without CNA 1-person assistance as a result of his right arm having no functional ability. In an interview on 11/15/2025 at 03:27 p.m. RN C stated that upon discharge CR #2 was walking with a cane, wheeling himself in the wheelchair, could communicate some of his needs and wants by pointing, but was unable to shower on his own as he needed assistance. In an interview on 11/17/2025 at 1:00 p.m. HSM A stated that he was the intake coordinator for the men's homeless shelter a organization that offers 30 days of emergency shelter for men. He stated as of that date CR #2 had been at the shelter for 106 days. He stated that HSM B was working with CR #2. He stated when men come to the shelter they were expected to read the rules and sign in acknowledgment that they understand and will abide by the rules. He stated when CR #2 arrived he had to be explained the rules of the shelter because he no longer had the ability to read, and HSM B had to sign on behalf of CR #2 because he had no abilities to read, write, or speak due to a stroke. He stated that CR #2 had shook his head in agreement to follow the rules. He stated that CR #2 had a limb and uses a cane to walk. He stated that CR #2 had not moved around too far because of the lack of usage of the [NAME] side of his body. He stated as long as CR #2 can kept up with basic hygiene and had not issues with showering he would have been allowed admission into the shelter. He stated the shelter offers showers seats to assist with showering. He stated that HSM B worked with him closely and would be better to share how CR #2 was doing. In an interview on 11/17/2025 at 01:25 p.m. HSM B stated that the men's shelter was a religious based entity offering 30-day emergency shelter to men along with classes to help them secure a job and then assistance with securing their own housing. He stated the men at the shelter must be able to follow the rules one of which is to keep up on their hygiene to include taking frequent showers. He stated CR #2 arrived at the facility on 08/01/2025 from a nursing facility where CR #2 had received therapy service after suffering a stroke. He stated that CR # 2 was a kind and quiet man, had weakness in his lower extremities, weakness on his right side, memory issues, and the inability to speak. He stated that the resident was able to feed himself for the most part but makes a bit of a mess as the food often missed CR #2's mouth. He stated that Family B had been helping him apply for Medicare and Medicaid services, but CR #2 had been denied, and it had been very frustrating for CR #2. He stated that the shelter had really been rallying for CR #2 who had shown signs and symptoms of emotional depression and had to check on him often. He stated that CR #2 needs help with living and functioning daily and does not have any (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676066 If continuation sheet Page 6 of 16 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 12/02/2025 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 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few help. He stated CR #2 was verbally unable to express needs and wants and would not make it on the street on his own. He stated he had to often assure CR #2 that the shelter would not thrown to the wolfs. He stated that CR #2 had not been able to cut his own fingernails nor accept help from others, especially during showers. They got him a health insurance card for health care services on site at the shelter. He could not work due to lack of comprehensive ability to read, or write, and communicate. He stated as for now CR #2 was at the shelter beyond the 30-day allowed time and can stay for now. In an interview on 11/17/2025 at 02:31 p.m. ADON stated she had been familiar with CR #2's discharge to the men's homeless shelter which was initiated by the previous ADM and DON She stated CR #2 had a stroke diagnosis but when it had been time to discharge, he wanted to leave and had not opposed to discharge. She stated she was not aware of any difficulties CR #2 had with ADLs/showering. She had heard that CR #2 wanted to return but had been advised to admit to the hospital if he had been in need of any medical services, because at this point, he had discharged and there was nothing they could do. She stated all residents must be cleared to discharge by their physician before they can complete a facility-initiated discharge and CR #2 was cleared by MD A. In an interview on 11/17/2025 at 03:07 pm. CR #2 and HSM B who assisted with translating for CR #2. HSM B stated that CR #2 stated when it was time for discharge, SW A told him he would be going to a men's shelter and he just went. HSM B stated that CR #2 stated he had not known he had a choice because he had not wanted to go to a shelter because he needed help with basic needs. HSM B stated that CR #2 stated CR #2 arrived with medication, was able to dress himself, but not able to shower well. HSM B stated that shelter does not allow other individuals to assist anyone with showering, nor do they offer that service. HSM B stated CR #2 just does the best he can. He stated that CR #2 was able to feed himself somewhat as food misses CR #2's his mouth and falls. HSM B stated CR #2 could not return to the nursing facility because he could not make payments for his stay and Family B was trying to help get better placement for CR #2. HSM B stated that the men's shelter only provided 30-day emergency services, however, they had an exception for CR #2 because they know he was not healthy enough to make it on his own if he left. HSM B further stated that CR #2 had been prescribed Fluvastatin 40 milliliter to prevent strokes. He stated however, CR #2 had memory issues and could not remember to take his medication nor keep up with its location. He stated that the men's shelter could not store or administer the medication for CR #2 therefore CR #2 has not been taking the medication consistently and he worried that without the medication CR #2 was at risk for another stroke. In an interview on 11/17/2025 at 07:14 p.m. ADM stated that he had not been working for the facility when CR #2 discharged . He stated it had been his understanding that as long as the residents agreed, they were able to walk without assistance, and perform their own ADLs, and the resident's physician cleared them for discharge residents could be discharged to homeless shelter, but he stated to refer to SW B for details. In an interview on 12/01/2025 at 02:14 p.m. NP A stated that he evaluated and cleared CR #2 for discharge. He stated at time of discharge CR #2 was right dominate due to a stroke and ambulated on his own with a quad cane. He stated he had observed CR #2 transition from hardwood to carpet with no issues. He stated he was unaware of any issues with his ability to shower himself or with feeding oneself and did not feel those were factors that would have hindered CR #2's discharge. He stated that CR #2 may have been unsteady on his feet, but he was at his baseline. He stated that he was aware that CR #2 had some issues with cognition, but CR #2 was able to address NP A by name, answer simple questions, and had been insistent on discharging up to the discharge date . He stated that CR #2 had good reasoning and from his understanding understood the medication instructions at discharge shared with him by the facility staff. He stated if CR# 2 had not taken his medication regularly, he would place himself (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676066 If continuation sheet Page 7 of 16 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 12/02/2025 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 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete at risk for future strokes. He stated that CR #2 had to have independence to enter the homeless shelter or he would not have been accepted. In an interview on 12/01/2025 at 03:37 p.m., Director of Rehab (DOR) stated he had been in his role with the facility for 2-years and scheduled and evaluated CR #2's occupational, physical, and speech therapy services. He stated that CR #2 came to the facility totally dependent on staff at the time of admission. He stated CR #2 had improved significantly and was functional for tasks of daily living resulting in the clearing for the discharge. He stated he had not been aware of limitations CR #2's MDS reflected and had seen CR #2 just before discharge walking up and down the hall with his quad cane. In an interview on 12/01/2025 at 03:47 p.m. MD A stated that CR #2 had come to the facility for therapy to improve his need for total assistance with care. She stated CR #2 had a low BIMS but believed that it should have been higher as when she asked questions of him, he had been able to answer correctly. She stated at discharge she had observed him ambulating in the hall on his own with a quad cane and was able to recall his last meals and the intake amounts of 100%. She stated he was able to rate his pain verbally after looking at the pain scale. She stated she had also seen him with a brochure which gave her the indication his cognition was intact and had the ability to read. She stated she had witnessed him in his room putting on joggers while he had some difficulties due to weakness on one side, he was able to get them on. She stated that she was not aware of his shower capability, nor could she recall what level of staff assistance was provided. She stated that CR #2 had to be totally independent for the homeless shelter to accept him. She stated at discharge CR #2 was given the written instructions for his prescriptions that outlined the name and dose frequency. She again stated she believed he had the mental capacity to administer his medication properly. She stated if the resident had not taken his medication regularly, he would place himself at risk for future strokes. In an interview on 12/01/2025 at 04:29 p.m. RN C stated that she had worked for the facility for 2-years and it had been her responsibility to complete CR #2's discharge MDS dated [DATE] and the MDS coding had been based on the direct CAN's ADL/care, supervision, assistance, and observations of CR #2 the last 3-days prior to discharge. She stated according to the coding CR #2 required supervision to walk 10 ft, up/over a curb, picking up objects. Required extensive assistant with eating required tray/food setup, limited; put the spoon to mouth assistance. Was dependent on helper/staff to perform all the work for personal hygiene care such as face washing, combing hair, and oral care/brushing of teeth. Required Event ID: Facility ID: 676066 If continuation sheet Page 8 of 16 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 12/02/2025 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 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Immediate jeopardy to resident health or safety **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to ensure a resident with pressure ulcer (injury/bedsore) is skin and tissue damage from prolonged pressure, friction, or shear) receives necessary treatment services consistent with professional standards of practice to promote healing, prevent infection, and prevent new pressure ulcers from developing for 1 of 4 closed record (CR) #1 reviewed for pressure ulcers in that: 1. The facility failed to prevent the development of a pressure ulcers to CR #1's 1-left foot measuring (Length x Width x Depth) 2x2x0 centimeters (cm).2. The facility failed to prevent the development of a pressure ulcers to CR #1's right lateral ankle measuring 1x1x1 cm.3. The facility failed to prevent the development of a pressure ulcers to CR #1's 1-left hip measuring 4x4x0 cm.4. The facility failed to prevent the development of a pressure ulcers to CR #1's-sacrum/sacral (a triangular bone in the lower back formed from fused vertebrae and situated between the two hipbones of the pelvis) measuring 10x15.5x0 resulting in CR #1 being transferred to a local acute care hospital 10/30/2025. 5. The facility failed to provide CR #1 with a pressure reducing mattress on 10/15/2025 resulting in CR #1 being without the mattress for 15-days resulting in the development of sacrum pressure wound. 6. The facility failed to provide CR #1 with pressure reducing heel boots for 11-days from 10/15/2025 to 10/26/2025 resulting in the resident acquiring. On 11/13/2025 at 02:41 p.m. an Immediate Jeopardy (IJ) was identified. While the IJ was removed on 11/15/2025 at 06:01 p.m., The facility remained out of compliance with the scope of pattern that was not actual harm with potential for more than the minimal harm that was not an immediate jeopardy due to the facility continuing to monitor the implementation and effectiveness of their Plan of Removal. These failures placed residents at risk for further skin breakdown, infections, and pain. Findings included: Record review of CR #1's facesheet dated 11/11/2025 reflected a [AGE] year-old male who admitted to the facility on [DATE] and discharged on 10/30/2025 with medical diagnoses including but not limited to fracture of fourth lumbar vertebra (supporting the upper body and connecting to the pelvis), injury to fourth lumbar (L4): vertebra in the lower back) level of lumbar spinal cord (refers to the nerve roots), traumatic subdural hemorrhage (excessive bleeding from a damaged blood vessel) without loss of consciousness, abrasion of right forearm, abrasion, left lower leg, lumbago with sciatica (a condition characterized by lower back pain that radiates down the buttocks and into one or both legs), and edema (swelling caused by fluid buildup in the body's tissues). Record review of CR #1's undated care plan reflected CR #1 required total assistance for all assistance of daily living (ADLs): (specify) mobility, transfers, dressing, eating, toileting, hygiene/grooming, bathing related to (r/t) clinical diagnosis (as listed above) initiated and revised on 08/17/2025. Goal: CR #1 will have all ADLs met by staff as evidenced by turning and repositioning and safe transfer initiated and revised on 08/17/2025. Interventions/Tasks: CR #1 required assistance with meals initiated on 08/17/2025 and revision on 09/01/2025. Have two-person transfer or mechanical lift as needed initiated on 08/17/2025. Record review of CR #1's hospital discharge records dated 08/04/2025 reflected that CR #1 discharged to the facility for recovery from a fall, head injury subdural hygroma (a collection of cerebrospinal fluid in the brain), fracture injury L4 superior endplate (the top surface of the vertebrate bones) compression fracture with 27 percent (%) loss of vertebral height and 2 millimeters retropulsion (disorder where a person tends to fall backward). Moderate spinal canal stenosis (narrows and puts pressure on the spinal cord) at this level after repeated falls withing a 3-day period beginning on 07/25/2025 while in CR #1's personal residence. Record review of CR #1's Comprehensive Minimum Data Set, dated [DATE] reflected the resident had a Brief Interview for Mental Status (BIMS) score of 03 indicating that the CR #1 had severe Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676066 If continuation sheet Page 9 of 16 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 12/02/2025 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 0686 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some cognitive impairment. Section M0100: Determination of the Pressure Ulcer/Injury Risk indicated that a formal assessment instrument/tool and clinical assessment were performed. Section M0150: Risk of Pressure Ulcers/Injuries indicated that the CR #1 was at risk for developing pressure ulcers/injuries. Section M0210: Unhealed Pressure Ulcers/Injuries indicated that the resident had not had one or more unhealed pressure ulcers/injuries. And had not had one or more unhealed pressure ulcers/injuries. Other Ulcers, Wounds and Skin Problems, none were present. M1040: Other Ulcers, Wounds and Skin Problems, none present. Foot problems. None were present. Section M - Skin Conditions M1200: Skin and Ulcer/Injury Treatments: Pressure reducing device for bed. Record review of CR #1's Predicting Pressure Sore Risk Scale assessment effective date: 08/15/2025 at 06:36 p.m. CR #1 was a Low Risk, sensory perception. Ability to respond meaningfully to pressure-related discomfort: No Impairment/Responds to verbal commands. Had no sensory deficit which would limit ability to feel or voice pain or discomfort. Moisture degree to which skin is exposed to moisture: Very Moist/Skin is often, but not always moist. Linen/bedsheets must be changed at least once a shift. Activity degree of physical activity: Chairfast/Ability to walk severely limited or non-existent. Cannot bear own weight and/or must be assisted into chair or wheelchair. Had no limitation or mobility/ability to change and control body position/ability to make major and frequent changes in position. Record review of CR #1's Clinical Record Progress Notes dated 8/15/2025 06:08 p.m. CR #1 was admitted into the facility from an acute care hospital for a fall with subdural hygroma and L4 compression fracture (spinal surgery for fractures) managed conservatively; urinary tract infection treated. Head to toe skin check done, redness noted to his buttock, bruise to his left side of his stomach, skin tear to his right upper arm. Record review of CR #1's Weekly Skin assessment dated : 08/16/2025 07:30 p.m. reflected MD A noted old trauma wounds, and old bruising. CR #1's skin color was normal, and temperature warm, equal, and dry. Integrity of skin intact. Further noted: Old bruising to right abdomen (Abd), old bruising to right arm, and old trauma wound to right arm. Record review of CR #1's Clinical Record Progress Notes dated 8/16/2025 at 01:13 p.m. reflected Licensed Vocational Nurse (LVN) A performed an observed CR #1 in room with on and off confusion noted and bed placed to lowest position. Further revealed noted during a head-to-toe skin assessed: Redness noted to sacral area/perineal the area of skin and tissue between the anus and the genitals) area. Applied barrier cream and will continue/encourage application. Record review of CR #1's Weekly Skin assessment dated [DATE]at 01:31 p.m. reflected MD A instructed LVN B to complete CR #1's weekly skin assessments. CR #1's skin color: Normal, with temperature equal, skin dry, and integrity of skin intact. Noted surgical wounds with old bruised, and no new wounds. Record review of CR #1's Orders dated 08/18/2025 at 08:22 a.m. reflected: MD A ordered Enhanced Barrier Precautions/barrier cream to bed added to CR #1's wounds. Record review of CR #1's Weekly Skin assessment dated [DATE] at 05:38 p.m. reflected MD A ordered LVN B to complete this weekly skin assessment. Full Assessment found that CR #1's skin color to be normal, with normal temperature warm, equal, and dry. Integrity of skin intact. Further assessment found old bruise to right Abd, old trauma scar to right arm. Record review of CR #1's Weekly Skin assessment dated [DATE] at 09:58 p.m. reflected MD A ordered LVN A to complete this weekly skin assessment. Full Assessment: Color normal, temperature warm, and integrity of skin intact. Record review of CR #1's Weekly Skin assessment dated [DATE] at 10:22 p.m. reflected MD A ordered LVN A to complete this weekly skin assessment. Full Assessment: Color normal, temperature warm, and integrity of skin intact.: Record review of CR #1's Weekly Skin assessment dated [DATE] at 06:13 p.m. reflected MD A complete this weekly skin assessment. Skin color normal, temperature warm, and integrity of skin intact. Record review of CR #1's Weekly Skin assessment dated [DATE] at 06:13 p.m. reflected MD A complete this weekly skin assessment. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676066 If continuation sheet Page 10 of 16 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 12/02/2025 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 0686 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Skin color normal, temperature warm, and integrity of skin intact. Record review of CR #1's Weekly Skin assessment dated [DATE] at 08:50 p.m. reflected MD A instructed LVN A to perform a full skin assessment. LVN A noted skin coloring normal and temperature warm. Record review of CR #1's Skin assessment dated [DATE] at 10:13 p.m. reflected MD A instructed LVN A to complete this weekly Skin Assessment. Skin Assessment found no alterations in skin integrity noted. Record review of CR #1's Communication Form/Situation, Background, Assessment, Recommendation (SBAR) dated 10/14/2025 at 12:00 a.m. The change in condition, symptoms, or signs observed and evaluated is/are: Skin wound or ulcer, change in skin color or condition This started on: 10/14/2025. This condition, symptom, or sign has occurred before: unknown. Background: CR #1 in the facility for: Long-Term Care. Skin evaluation found discoloration to wound. Review and Notify: to Primary Care Clinician Notified. Recommendations of Primary Clinicians (if any): Wound doctor to eval/see and treat wound discoloration as indicated. Record review of CR #1's Orders dated 10/14/2025 at 09:32 p.m. reflected MD A Ordered: Wound doctor to evaluate and treat sacrum wound and left foot wound. Order Type/Treatment Orders were: Evaluate and treat wounds one time a day for wounds for 2 days. Record review of CR #1's Skin assessment dated [DATE] at 09:33 p.m. reflected MD A instructed LVN A to complete this weekly Skin Assessment. Assessment finding blister to left (outer) ankle and blister to sacrum. Record review of CR #1's Clinical Record Progress Notes dated 10/14/2025 at 09:35 p.m. created by LVN B reflected, a change in condition/s reported: During CR #1's incontinent care an open wound to CR #1's sacrum, with redness, and swelling was discovered and blister likeness on his left foot. No signs/symptoms (s/s) of pain or any discomfort noticed or reported. Medical Doctor (MD) Recommended/Ordered for Wound Doctor (WD) consult. Record review of CR #1's Wound assessment dated [DATE] at 02:37 p.m. reflected WC received instructions from MD A to complete weekly wound assessments and complete wound assessment to be completed for each wound. Type of wound: Pressure ulcer, sacrum with date of onset 10/15/2025. Wound acquired within facility. Contributing factors: Pressure. Drainage - Character, serosanguinous (fluid that contains both blood and serum (the liquid part of blood), appearing as thin, watery, pinkish-red or light red drainage from a wound). Drainage amount light, with no odor, and wound edges pink. Support devices: Apply Positioning devices. Skin turgor (elasticity, its ability to change shape and snap back, tested by pinching it) fair. Current treatment: Cleanse with wound cleanser and apply wound gel (moist healing environment, control bacteria), and cover with bordered gauze (a sterile, multi-layer wound dressing with an adhesive border that secures it to the skin) daily and prescribed as needed (PRN). Record review of CR #1's Wound assessment dated [DATE] at 02:48 p.m. reflected MD A instructed WC to complete this weekly Skin Assessment for each of CR #1's wounds. Assessment: Pressure ulcer, site left foot, date of onset 10/14/2025, and acquired within the facility. Describe contributing factors: Pressure. Wound stage: deep tissue injury (DTI) Current treatment prepare skin by leaving open to air. Record review of CR #1's Orders dated: 10/15/2025 at 02:53 p.m. reflected MD A Ordered/Treatment Monitoring: Left foot one time a day. Monitor the treatment site for surrounding skin condition and pain status. If changes are observed, document signs with a progress note for further review. Record review of CR #1's Orders dated: 10/15/2025 at 02:57 p.m. reflected MD A Ordered/Treatment Order: provide skin care to left foot every shift. Record review of CR #1's Orders dated 10/15/2025 at 02:58 p.m. reflected MD A ordered description: Sacrum: Cleanse with wound cleanser/normal saline (NS) apply Wound gel and cover with bordered gauze daily and PRN. Order Type: Treatment Orders. Pharmacy Order Summary: Sacrum: Cleanse with wound cleanser/NS apply Wound gel and cover with bordered gauze daily and PRN/one time a day. Record review of CR #1's Skin assessment dated [DATE] at 04:52 p.m. MD A instructed WC to complete this weekly Skin Assessment for each of CR #1's wounds. Assessment (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676066 If continuation sheet Page 11 of 16 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 12/02/2025 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 0686 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some found a pressure wound to sacrum area and a DTI blister to left lower extremity. Record review of CR #1's Clinical Record Progress Notes dated 10/15/2025 at 05:15 p.m. Nurse Practitioner (NP) A reflected facility requested a follow up visit to evaluate CR #1's wound. Assessment performed with WC noting a new onset of a sacral ulcer, approximately the size of a baseball with mild redness to surrounding tissue and eschar (a thick, black, leathery layer of dead tissue (necrosis) that forms on the skin after a pressure sore to center of area). Also, noted a DTI to CR #1's left medial foot (the inner edge, running from the heel to the big toe, forming the high part of the arch (medial longitudinal arch) with bones like the talus, navicular, cuneiforms, first metatarsal, and big toe). The medial heel and medial foot (below greater/big toe) had ulcers approximately half dollar size. Further findings noted 2-other ulcers to medial foot are approximately the same size. Spoke with certified nursing aid (CNA) A who confirmed those ulcers were new. Review of CR #1's intake log indicates he does eat over 50% of most of his meals. NP A ordered Complete Blood Count (CBC) blood test (checks the proportion of red blood cells in your blood to help diagnose and monitor conditions like anemia, infections, and blood disorders), Basic Metabolic Panel (BMP) blood test (checks for fluid balance, metabolism, and kidney function, and to help diagnose and monitor various other conditions), and pre-albumin (blood test for measuring and assessing nutritional status. Low prealbumin levels can indicate malnutrition, liver disease, or inflammation), tomorrow. Also ordering air mattress and Prevalon (pressure-relieving heel protectors) boots to offload pressure. Consults to Dietitian and Wound Care MD have been placed. Record review of CR #1's Clinical Record Progress Notes dated 10/17/2025 at 10:00 a.m. reflected NP A's follow up visit with CR #1 noted pressure ulcers to sacrum and foot were examined and found to be relatively unchanged from earlier in the week. The sacral ulcer showed some improvement with approximately 10% granulation (new healthy) tissue now present. The wounds did not appear infected upon examination 10/17/2025. Laboratory studies from 10/16/2025 revealed white blood count (WBC) of 5.5 (normal), hemoglobin 9.2 (low, with a possible indication of anemia, which results from causes such as iron, B12, or folate deficiencies, chronic diseases, or blood loss), sodium 140 (normal range), potassium 4.5 (normal range), Blood Urea Nitrogen (BUN) 12 (normal range), creatinine 0.82 (normal range), and albumin (the most abundant protein in the blood, produced by the liver and essential for maintaining blood pressure and volume) 2.8 (low range). The low albumin level was consistent with protein calorie malnutrition. I discussed with the LVN E about ordering an air mattress and boots to offload pressure on the affected areas. Additionally, I am ordering nutritional supplements (boost shakes) twice a day and placing a consultation to the dietitian for further nutritional assessment and recommendations. Will continue to monitor wound healing progress. Record review of CR #1's Clinical Record Progress Notes dated 10/20/2025 at 01:36 p.m. reflected: NP B seen CR for Skin and Wound. Presents for initial evaluation and management of a non-healing open wound on the sacrum and bilateral lower extremities (BLE). CR #1's LVN A reports that the wound has been present for unknown amount of time as he was admitted to the facility with multiple pressure ulcers. They are currently using - dry dressing for the sacral wound care dressing and skin prep to the BLE ulcers. Offloading techniques in use included leg elevation on pillows. Pressure relief included frequent turning and repositioning. Counseled CR #1's nurse on wound care, diet/nutrition, and pressure relief. Risk factors that may contribute to wound formation and/or delay or poor wound healing: Impaired Functional Mobility, Risk of Malnutrition. Risk factors, diagnoses, and associated interventions have been noted in the CR #1's medical record and are managed by the facility care team. Wound: 3 Location: Sacrum Primary Etiology: Pressure Ulcer/Injury Stage/Severity: Unstageable procedures: A sharp debridement (the medical procedure of removing dead, damaged, or infected skin tissue) was not (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676066 If continuation sheet Page 12 of 16 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 12/02/2025 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 0686 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some performed today due to consent for procedure unable to be obtained. Pressure ulcer of sacral region, unstageable. Treatment Recommendations: 1. Cleanse with 0.125% Dakins solution. 2. apply Wound gel to base of the wound. 3. secure with bordered foam. 4. change daily, PRN. Assessment/Plan: The patient has a pressure injury. Recommend ongoing pressure reduction and turning/repositioning precautions per protocol, including pressure reduction to the heels and all bony prominences. All prevention measures were discussed with the staff at the time of the visit. Consider arterial doppler if wounds worsen or new wounds develop. CR #1 is incontinent of bowel and bladder. Use appropriate moisture barrier creams per formulary to provide thorough skin care with each incontinent episode. Use formulary briefs when indicated to manage moisture and assess often. Continue with turning and repositioning schedule per protocol for pressure prevention. Position CR #1 side to side as tolerated. Float heels while in bed with use of pillows. Follow up with MD A weekly. Record review of CR #1's Orders dated 10/21/2025 at 10:15 a.m. reflected MD A Ordered Standard Medication: SilverMed External Gel (Silver). Medication Class: Dermatological. Route of Administration: Topically order summary: Apply to sacrum topically one time a day for Wound Care. Record review of CR #1's Clinical Record Progress Notes dated 10/21/2025 at 12:15 p.m. reflected: MD A follow up for evaluation of CR #1's worsening pressure ulcers. MD A noted after discussion with the WC, it was noted that CR #1 has developed a new DTI to his right heel. This represents a concerning progression of CR #1's pressure-related wounds, which now affect both heels and his sacral region. To address these worsening wounds, MD A requested the staff to order an air mattress to reduce pressure on the sacral area and heel boots to protect both feet from further tissue damage. These interventions are essential to prevent further deterioration of the existing wounds and to promote healing. ***Medications*** Wound gel to be applied to sacrum one time a day for wound care. Record review of CR #1's Wound Assessment date: 10/22/2025 at 02:47 p.m. reflected MD A instructed WC to complete this weekly Skin Assessment for each of CR #1's wounds Assessment: Pressure ulcer skin tear, site sacrum, date of onset 10/20/2025, acquired within facility. Describe contributing factors: Pressure. Wound stage: unstageable. 10.5x7x0.5. 10.5 length by (x), 7 width x 0.5 depth (Length x Width x Depth). Drainage - Serosanguinous, moderate amount. Wound edges red. Granulation 100%, and skin turgor fair. Current treatment: Wound gel, cover with dry dressing. Record review of CR #1's Wound Assessment 10/22/2025 at 02:50 p.m. reflected MD A instructed WC to complete this weekly Skin Assessment for each of CR #1's wounds. Assessment: Pressure ulcer, site left foot scattered, date of onset 10/20/2025. Acquired within the facility. Describe contributing factors: Pressure. Suspected DTI. 10x16x0. Drainage, none, odor, none, and edges of wound red in color (usually a normal sign of the body's healing inflammation). Record review of CR #1's Wound assessment dated [DATE] at 02:52 p.m. reflected MD A instructed WC to complete this weekly Skin Assessment for each of CR #1's wounds. Assessment: Pressure ulcer, site right lateral ankle - date of onset 10/20/2025, acquired within the facility, unstageable. 2x2x0. Drainage, none. Support devices - positioning devices. Skin turgor fair. Record review of CR #1's Skin assessment dated [DATE] at 02:55 p.m. reflected MD A instructed WC to complete this weekly Skin Assessment for each of CR #1's wounds. Right ankle (inner) - pressure, sacrum pressure, and pressure left foot. Comments: open area to sacrum. DTI to right ankle and left foot. Record review of CR #1's Clinical Record Progress Notes dated 10/26/2025 at 09:38 p.m. created by LVN C reflected: CR #1 received heel boots for pressure ulcers at lower extremities/foot/heel. Record review of facility's delivery order summary for CR #1's air mattress dated 10/28/2025. Ordered On 10/28/2025 at 08:43 a.m. Received by the delivery company on 10/29/2025 at 3:02 p.m. Priority Next Business Day Fulfill Dated 10/29/2025. Record review of CR #1's Clinical Record Progress Notes dated 10/29/2025 at 02:30 p.m. reflected Skin and Wound evaluation (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676066 If continuation sheet Page 13 of 16 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 12/02/2025 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 0686 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some and management of a non-healing open wound on the sacrum and BLE on 10/28/2205 by NP B. Wound deterioration noted, advised hospitalization due to sacral necrosis (dead skin tissue in the sacral area). NP B noted if CR #1 does not go to the hospital he should receive x-rays, labs, wound culture (post debridement), wound healing supplements, low air loss (LAL) mattress, heel relief boots are advised. NP B to follow up weekly. Recommended sending CR #1 to the emergency room (ER). Record review of CR #1's Communication Form SBAR Situation dated 10/29/2025 at 3:00 p.m. reflected NP A noted change in condition of skin wound or ulcer started on 10/29/2025 and stayed the same. Recommendations: Wound Doctor consult order given. Record review of CR #1's Skin Assessment date 10/29/2025 at 03:10 p.m. reflected MD A instructed WC to complete this weekly Skin Assessment for each of CR #1's wounds. Assessment indicated alterations in skin integrity: Right ankle (outer) pressure, sacrum - pressure, and pressure left foot cluster. Record review of CR #1's Wound assessment dated [DATE] at 03:15 p.m. reflected MD A instructed WC to complete this weekly wound assessment and complete separate wound assessment each wound. Skin Prep/Assessment: Pressure ulcer, right lateral ankle. Date of onset 08/15/2025, wound acquired within the facility. Describe contributing factors pressure: 1x1x1 cm. No drainage, no odor, wound edges red, and skin turgor poor. Support devices: Heel protectors. Record review of CR #1's Skin assessment dated [DATE] at 04:42 p.m. reflected MD A instructed LVN A to complete CR #1's weekly skin assessments on each of CR #1's wounds. Left trochanter (hip), left pressure wound, right heel blister, and sacrum pressure comments: Treatment continues on this wound. No alterations in skin integrity noted. Record review of CR #1's Clinical Record Progress Notes dated 10/30/2025 at 02:45 p.m. reflected NP A noted: Discharge Summary. discharge date : [DATE]. CR #1 transfer out to acute care hospital - Leave. ***Chief Complaint*** Sacral ulcer requiring debridement ***Hospital Course*** CR #1 laying in bed, awake and alert. His multiple pressure ulcers remain unchanged compared to the 10/29/2025 examination. NP A spoke with the facility administrator (ADM) regarding CR #1's wound care. WC NP had attempted debridement earlier in the week but was unable to reach Family A to obtain consent. Given that the sacral ulcer will likely require surgical debridement, NP A recommended transferring CR #1 for this procedure. The nursing staff made two attempts to contact Family, unsuccessful. NP noted after discussion with the staff, will transfer CR #1 to acute care hospital for surgical debridement of his sacral ulcer. Patients were wearing Prevalon boots for pressure offloading. Record review of CR #1's Clinical Record Progress Notes dated 10/30/2025 reflected Pain. No pain other than this note: ***Vital Signs*** blood pressure (bp), 131/75, oxygen (O2) 96, Pain level 2 (0: none and 10 worse), Temp 97.5, Respiratory Rate 18, Heart Rate 69. Record review of CR #1's October 2025 (10/16/2025 - 10/30/2025) TAR reflected: Apply skin prep to left foot every shift. One time a day. Start Date 10/16/2025 08:00 a.m. Hold Date from 10/31/2025 09:51 a.m. to 11/01/2025 1200 a.m. D/C Date 11/10/2025 05:02 p.m. All treatments indicated as being received. Record review of CR #1's October 2025 (10/16/2025 - 10/30/2025) TAR reflected: Monitor dressing to sacrum site every shift. One time a day. Start Date 10/16/2025 08:00 a.m. Hold Date from 10/31/2025 09:51 a.m. to 11/01/2025 12:00 a.m. D/C Date 11/10/2025 05:02 p.m. All treatments indicated as being received. Record review of CR #1's October 2025 (10/21/2025 - 10/30/2025) TAR reflected: Right Lateral ankle skin prep daily. One time a day. Start Date 10/21/2025 08:00 a.m. Hold Date from 10/31/2025 09:51 a.m. to 11/01/2025 12:00 a.m. D/C Date 11/10/2025 05:02 p.m. All treatments indicated as being received. Record review of CR #1's October 2025 (10/16/2025 - 10/30/2025) TAR reflected: Sacrum: Clean with wound cleaner/NS apply Wound gel and cover with border gauze daily and PRN. One time a day. Start Date 10/16/2025 08:00 a.m. Hold Date from 10/31/2025 09:51 a.m. to 11/01/2025 12:00 a.m. D/C Date 11/10/2025 05:02 p.m. All treatments indicated as being received. Record review of CR #1's October 2025 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676066 If continuation sheet Page 14 of 16 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 12/02/2025 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 0686 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some (10/16/2025 - 10/30/2025) TAR reflected: Wound doctor to evaluate and treat as indicated. Sacrum wound and left foot wound. One time day for wound for 2 days. Start Date 10/15/2025 08:00 a.m. D/C Date 11/16/2025 12:30 p.m. All treatments indicated as being received. Record review of CR #1's hospital records dated 11/02/2025 reflected CR #1's current diagnosis, medical condition and poor overall outcome if surgical intervention will be done. Family A had been made aware of the unstageable infected nature of themultiple sacral wounds of CR, and surgery is not recommended. Any intervention due to CR #1's end stage dementia, poorquality of life and possible non healing large post operation wounds that may develop, and CR#1 was entirely bed bound. Family A understands the need for hospice placement as of this time and is looking at new long-term facility. Record review of CR #1's hospital records dated 11/05/2025 reflected CR #1 admitted with chief Complaint: infected sacral decubitus. Inpatient Diagnoses: open wound - primary - Onset: 10/30/2025. At some point, CR #1 developed a sacral ulcer which got infected leading to this admission. Assessment and Recommendations: [AGE] year-old man with immobility and failure to thrive who has a large sacral pressure ulcer that is infected. Traditionally one would recommend excisional debridement but in this case this would be futile. CR #1 has expressed to Family A that he does not want life-prolonging interventions. Risk was discussed with Family A of the infection becoming systemic and leading to sepsis/death. Suggestion was to use a palliative approach / hospice and Family A is willing to pursue this. Goals of care will be pain control and odor control if it becomes an isolating factor that would keep Family A from spending time with CR. Local antiseptics will not be of benefit as the odor comes from the necrotic (dead skin) tissue under the skin level. Should odor become very problematic then palliative debridement could be re-considered. Foot DTI and unstageable pressure ulcers are dry and can be left alone. He has also lesioned on feet and wrists. Exam/General: wasted-looking man in no distress. Skin/Wound Exam: Sacral ulcer with fully necrotic wound bed, boggy (skin texture abnormality characterized principally by a palpable sense of sponginess resulting from increased fluid content) and with foul odor. Peri-ulcer skin without signs of cellulitis. Right heel with dark discoloration, no skin breakdown. Right ankle with necrotic ulcers, dry, no drainage or signs of infection. Left heel intact. Left lateral hip ulcer with necrotic base and anasarca (severe, generalized swelling throughout the entire body caused by extensive fluid accumulation in tissues). Moderate-to-large sacral decubitus ulceration (skin injury from prolonged pressure) with no evidence osteomyelitis (painful bone infection/bacteria) involving the underlying sacrum or coccyx (small triangular bone at the base of the spinal column). In an interview on 11/11/2025 at 12:12 p.m. WC stated that she had begun working for the facility full time approximately two months ago Monday - Friday from 8 a.m. - 5 p.m. She stated she previously worked PRN weekends. She stated that she had not been familiar with CR #1 at the time of his admission, but mid to end of October 2025 received an order from the NP C to begin new wound treatment to his sacrum. She stated NP C ordered labs and put into place the following interventions: air mattress, heel protector, nutritional supplements, and increase repositioning as CR #1 had begun laying on one side more than the other. She stated CR #1 was incontinent, had what the facility called a regular mattress. She stated that CR #1 sat on his bottom around the clock making and believed that it made it difficult for the sacrum wound to improve. She stated that she educated the floor nurses and CNAs after each wound care treatment to ensure that they were performing frequent repositioning to assist with worsening wounds. She stated a short time later (week or so) pressure wounds developed on both of CR #1's heels. She stated that the CR #1 had not yet received his air mattress due to a backorder issue as indicated by Director of Nurse (DON) who was responsible for insuring were ordered and put into place. She stated that at some point the heel protectors were received and put into place. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676066 If continuation sheet Page 15 of 16 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 12/02/2025 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 0686 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete She stated at times, during skin assessments, and would care CR #1 would grunt and/or grimace when repositioned. She stated that CR #1 only communicated with a hello and a smile, but no full sentences and had not outright expressed pain during assessments. She stated on 10/28/2025 CR #1 was discharged to the hospital by the NP C for a gangrene (death of body tissue caused by a loss of blood supply) diagnosis to his sacrum wound. In an interview on 11/11/2025 at 12:41 p.m. DON stated that CR #1 was a confused patient who ate very little. She stated that CR #1 had a couple pressure wounds that NP A alluded to had progressed quickly. She stated that the progression could have contributed to the CR #1's low protein intake. She stated NP A placed an order for an air mattress for offloading weight pressure and boot for CR #1's heels. She stated that CR #1 discharged to the hospital recently for debridement to a sacrum wound. She stated that CR #1 was on the air mattress at the time he discharged . She stated LVN E and CNA A were most familiar with CR #1's care. In an interview on 11/11/2025 at 12:57 p.m. CNA E stated that he had worked for the facility for 5 plus years from 6 a.m. to 2p.m. He stated he had been responsible for CR #1's ADLs. He stated that CR #1 was verbal, lively, and often joked around. He stated that Family A would ask for assistance getting CR #1 dressed and into a chair for lunch during visits. He stated that Family A had expressed concerns of CR #1's wounds worsening and requested CR #1 receive an air mattress. He stated he informed LVN E who was unsuccessful locating an air mattress but found CR #1's boot protectors and placed them on his feet. He stated he placed pillows under the resident's legs to assist with offloading CR #1's weight. He stated that he was aware of CR #1's sacrum wound and t Event ID: Facility ID: 676066 If continuation sheet Page 16 of 16