Health inspection·November 21, 2025

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few assessment dated [DATE] indicated he was understood and understood others. Resident #2 had a BIMS of 11, which indicated he had moderate cognitive impairment. The MDS indicated Resident #2 had physical behavioral symptoms directed toward others one to three days. The MDS did not indicate Resident #2 had behaviors. Resident #2 required supervision to moderate assistance for most ADLs but was independent with ambulation.Record review of Resident #2's undated Care Plan Report indicated he used psychotropic medication (medication that affects a person's mental state) for behavioral management and on 8/22/25 he was aggressive with staff, 10/03/25 hit a resident with a toy, and 10/09/25 was seen hitting another resident. Resident #2 was an elopement risk and was placed on the secured unit due to disruptive behaviors and would walk up to resident and start arguments. Record review of Resident #2's Progress Notes dated 10/09/25 indicated RN D was notified by CNA (not named in note) that Resident #2 and Resident #1 were in the dining room hitting each other. Resident #1 was sitting in his wheelchair wheeling himself into the dining room, Resident #2 was sitting in the chair at table right at the doorway and Resident #2 started hitting Resident #1. The resident was assessed, and no injuries were noted. During an interview on 11/06/25 at 9:06 AM, RN D said she had worked at the facility since June 2025 and normally worked the 6 AM - 2 PM shift until the facility changed to twelve-hour shifts. RN D said she usually was the nurse for 100 (Unit 1 Memory Care), 200 (Unit 2 Memory Care), and the left side of 300 hall. RN D said a few residents could be aggressive toward other residents, which included Resident #2. RN D said Resident #2 was pretty quiet and did his own thing. RN D said if they tried to redirect Resident #2, he could get mad and he would try to grab things in the air that were not there. RN D said he had been aggressive to other residents. RN D said CNA C came and got her and said Resident #1 was wheeling into the dining room and Resident #2 was sitting at the table just inside the door of the dining room. RN D said CNA C said Resident #2 just started hitting Resident #1. RN D said CNA C separated them. RN D said she called and reported the incident to the NP, DON, and RP. RN D said they kept both residents separated and had both on every 15-minute checks for 72 hours. RN D said when she assessed both residents, neither of them had any marks, bruising, no nothing. RN D said CNA C said they were hitting at each other but not hard. RN D said there were normally two staff members in the memory care units but thought it may have just been CNA C back there when the incident occurred. During an interview on 11/06/25 at 9:30 AM, CNA C said at the time of the altercation between Resident #1 and Resident #2, she was the only staff member in the memory care unit. CNA C said she was in another resident's room getting residents up and dressed for breakfast. CNA C said when she came out of a resident's room and was coming up the hall, she saw Resident #2 sitting in a chair just inside the dining room door and Resident #1 was wheeling himself into the dining room and they were swatting/slapping each other's hands. CNA C said she did not see Resident #1 get hit in the face and only saw them swatting/slapping each other's hands. CNA C said there were around nine or 10 residents in the men's memory care unit (Unit 2) at the time of the incident. CNA C said Resident #1 was already parked just inside the doorway of the dining room when she saw them and both residents were swatting/slapping at each other's hands. CNA C said she did not know how long they had been at it but did not think it had been long. CNA C said she did not see who started the incident, but she immediately intervened when she saw them and separated the residents, then notified the nurse and the nurse came and assessed both residents. CNA C said Resident #1 did not have any visible injuries. CNA C said there should be 2 staff present in the men's memory care unit (Unit 2) because of fights, incidents, and lots of residents that were combative and needed two people to deal with them. CNA C said if she had to take a resident to their room to perform incontinent care and change their brief, then there was no one to watch the other residents if there was only one staff (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676069 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 676069 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Texarkana 4925 Elizabeth St Texarkana, TX 75503 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few member in the memory care unit. CNA C said Resident #1 was able to wheel himself in his wheelchair, feed himself, transferred with assistance, and was able to use both arms. CNA C said Resident #2 was ambulatory.During an interview on 11/06/25 at 3:08 PM, the DON said his first day on the job was 10/09/25 and it was orientation day. The DON said the memory care units had residents that wandered, had dementia, and behaviors, such as outbursts, aggressive toward staff, and resident-to-resident altercations. The DON said there should be two staff in the memory care units, especially on the men's side (Unit 2 Memory Care). The DON said there should be two staff members for resident safety. The DON said there could be an altercation and if one staff member was showering or changing a resident they may not be able to get to them in time. The DON said he did not know if there were two staff members on the memory care unit at the time of the incident with Resident #1 and Resident #2 because he had just started that day. The DON said one staff member could not adequately supervise the residents if the one staff member was in another room or showering and something happened. The DON said the resident could be affected both emotionally, physically and feel unsafe if not adequately supervised. The DON said since he had been at the facility, he made sure there were two staff members on the memory care units, and they were trying to get a third person approved. The DON said he was unable to locate the sign-in staffing sheets for the date of the incident on 10/09/25.During an interview on 11/06/25 at 3:33 PM, Interim ADM F said he had initially been at the facility from 9/10/25 to 10/10/25 and then he came back 10/27/25 and 11/06/25 would be his last day. Interim ADM F said they have had a lot of staffing changes, and the previous DON had left without fulfilling her two-week notice. Interim ADM F said he had only been at the facility briefly, but knew they had residents in the memory care units that were rambunctious, elopement risks, had psychiatric issues, behaviors, aggressive residents, resident-to-resident altercations, and could get aggressive toward staff too. Interim ADM F said there were always two staff members on the memory care units. Interim ADM F said they were working on hiring someone for activities as a third person, specifically for the memory care units. Interim ADM F said there should be two staff members, especially in the men's unit, because they were typically bigger, louder, stronger and too much for one person to handle. Interim ADM F said he did not remember if there were two staff members at the time of the incident with Resident #1 and Resident #2, but he did not remember a time when they were not fully staffed. Interim ADM F said they were also utilizing agency staff to fill any gaps in coverage. Interim ADM F said he did not have an answer for what the risk to the residents would be if there was only one staff member in the memory care units. Interim ADM F said he would expect staff members to follow the policies and procedures of the facility.During an interview on 11/06/25 at 3:56 PM, the Regional Nurse Consultant said she started with the facility 10/01/25 and was probably in the building approximately a week or two later. The Regional Nurse Consultantsaid the memory care unit had residents with behaviors and they had to try to manage the behaviors with medications, supervision, and psychiatric services. The Regional Nurse Consultant said she thought there were two staff on the unit at the time of the incident with Resident #1 and Resident #2. She said the goal was to have two staff members in the memory care units. She said there should be two staff members so if one was providing care, the other could be monitoring and meeting the needs of the other residents. The Regional Nurse Consultant said the risk of not being supervised could result in increased risk of incident and accidents for the residents.Record review of the facility's Resident Roster dated 11/05/25 indicated there were 9 residents on Unit 2 Memory Care.Record review of the facility's policy titled Secure Unit, dated July 2025 indicated . The Secure Unit was designed to provide a safe and structured environment for residents who were at risk of elopement or harm due to cognitive impairment (such as dementia, Alzheimer's disease, or (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676069 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 676069 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Texarkana 4925 Elizabeth St Texarkana, TX 75503 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 other behavioral health concerns). This policy ensures that all residents' rights, safety, and dignity were protected while maintaining compliance with Federal and State regulations . Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676069 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 676069 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Texarkana 4925 Elizabeth St Texarkana, TX 75503 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety in the facility's only kitchen reviewed for food safety requirements.1. The facility failed to ensure Dishwasher A wore a facial covering to cover facial hair while serving food in the kitchen on 11/05/25.2. The facility failed to ensure Dishwasher A wore a hairnet and facial covering to cover his hair and facial hair while in the kitchen area on 11/06/25.3. The facility failed to ensure [NAME] B wore a facial covering to cover facial hair while preparing food in the kitchen on 11/06/25.These failures could place residents at risk for food contamination.Findings included:During initial tour observations and interview of the kitchen on 11/05/25 beginning at 4:35 PM, revealed [NAME] G was plating food and Dishwasher A was adding drinks and desserts to the meal tray and covered the food with a plate cover. Dishwasher A was noted to have facial hair above his upper lip and on his chin approximately 1/2 inch long and was not wearing facial covering to cover facial hair. [NAME] G said they did not have a Dietary Manager at this time. [NAME] G said they did have an Assistant Dietary Manager, [NAME] E. During an observation and interviews on 11/06/25 beginning at 2:24 PM, revealed [NAME] B was in the kitchen preparing food for the next meal service. [NAME] B was noted to have approximately 1/4 to 1/2 inch facial hair covering his lower face and was not wearing a facial covering to cover his facial hair. [NAME] B said all staff should be wearing hair nets and a facial covering if they had facial hair while in the kitchen, which included anything behind the two doors and he pointed at the kitchen door and dishwashing side door, to prevent hair from getting in the residents' food. The was a plastic bag with hair nets in it hung just outside of the dishwashing side of the kitchen. Dishwasher A was in the dishwashing side of the kitchen washing dishes. Dishwasher A was noted to have facial hair above his upper lip and chin and was not wearing a hairnet or facial covering to cover his hair or facial hair. Dishwasher A said he had been working at the facility for a couple of months. Dishwasher A said he had been educated to wear a hair net and facial covering when serving food, but he did not know he needed to wear them while washing dishes. Dishwasher A said he knew he should have been wearing facial covering yesterday (11/05/25) while serving food and just forgot. Dishwasher A said wearing hair nets and facial coverings were to keep hair out of the resident's food. Dishwasher A said if he was not wearing a hair net or facial covering in the kitchen, anything could happen, like hair could get in the residents' food. Dishwasher A said he did not know how it could affect the residents.On 11/06/25 at 2:49 PM and at 5:15 PM, Interim Dietary Manager H was called. There was no answer and unable to leave a voicemail.During an interview on 11/06/25 at 3:33 PM, the ADM F said he was the Interim ADM and had been at the facility since 10/27/25 this time. ADM F said the facility had gone through a lot of staffing changes and the facility did not have a Dietary Manager at the time, but they had an Interim Dietary Manager. ADM F said Interim Dietary Manager H was currently on leave. ADM F said staff should be wearing hairnets and facial coverings for facial hair when behind the kitchen doors to prevent food contamination. ADM F said he expected staff to follow the policies of the facility.During an interview on 11/10/25 at 9:20 AM, [NAME] E said she had worked at the facility for over 30 years. [NAME] E said everyone that entered the kitchen area, including the dishwashing side, should be wearing a hairnet and if they had facial hair, then they would need facial covering. [NAME] E said kitchen staff should be wearing hairnets/facial covering because hair could fall in anything and get in the resident's food. [NAME] E said hair could contaminate the resident's food.Record review of the facility's policy titled Food Preparation and Service dated revised November 2022, indicated . Food and nutrition services (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676069 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 676069 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Texarkana 4925 Elizabeth St Texarkana, TX 75503 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 0812 Level of Harm - Minimal harm or potential for actual harm employees prepare, distribute and serve food in a manner that complies with safe food handling practices . food preparation staff adhere to proper hygiene and sanitary practices to prevent the spread of foodborne illness . Food Distribution and Service . 8. Food and nutrition services staff wear hair restraints (hair net, hat, beard restraint, etc.) so that hair does not contact food . Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676069 If continuation sheet Page 6 of 6