Health inspection·April 23, 2024

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to ensure a resident who was unable to carry out activities of daily living received necessary services to maintain good personally hygiene for 4 out of 5 residents (#1, #3, #4, and #5) reviewed for ADL care. Residents Affected - Some The facility failed to provide timely incontinence care every two hours or as needed for Resident #1 on 4/22/24. The facility failed to provide timely incontinence care on a regular basis for residents #1, #3, #4, and #5. This failure could place residents at risk of skin breakdown, urinary tract infections, and loss of dignity. Findings included: 1) Record review of Resident #1's face sheet revealed a [AGE] year-old female, admitted on [DATE]. Diagnoses included: Blindness of right eye category 3, blindness of left eye category 5, ankylosing spondylitis (autoimmune disease that includes pain and stiffness in the spine and may affect other joints), atrophic disorder of skin (a reduction in epidermal and dermal thickness of skin), mild cognitive impairment, abnormalities of gait and mobility, rash and other skin disruption, stiffness of right hand, anxiety disorder, type 2 diabetes (a long term condition in which the body has trouble controlling blood sugar and using it for energy), sepsis due to Escherichia (strain of e. coli which can make you very sick), epilepsy (neurological disorder in the brain, causing seizures), muscle weakness, age related osteoporosis (deterioration in bone mass, with increasing risk to fragility fractures), and chronic kidney disease (long standing disease leading to renal failure). Record review of Resident #1's Quarterly MDS dated [DATE] revealed a BIMS score of 13 which indicated she was cognitively intact. Record review of Resident #1's Care Plan dated 2/27/24, showed resident has made allegations that staff do not change her in a timely manner. Also, .is at risk for pressure ulcer due to incontinence, bedfast. Furthermore, Resident is at risk for falls due to visual impairment. Record review of Resident #1's ADL care sheet revealed incontinent care was completed on 4/21/24 at 3 a.m., 12:12 p.m. and at 4:10 p.m. On 4/22/24, incontinent care was completed at 2:06 a.m., 12:05 (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 4 Event ID: 676120 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 676120 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/23/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Sherman 1000 Sara Swammy Dr Sherman, TX 75090 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)