Health inspection·December 10, 2025

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few tubes noted in place, clean, dry, and intact, draining to gravity without complication. Ongoing wound care to coccyx continues per care plan. Call light within reach. Interview on 12/10/2025 at 10:00 AM with Physician J revealed Resident #1's change in condition was likely not the result of the facility's care or lack of care. He stated that she was only in the facility for a few days. He stated that he did not think the facility's care could cause her to have a change in condition in just a few days. He stated that 2 days would not cause a decline in her that fast. He stated that she had a large stroke prior to being admitted to the facility and it could sometimes cause continual chemical changes. When it happened, it could cause small bleeding to the brain. He stated that Resident #1 had infections prior to when she was admitted to the facility. He stated he did not know what could have caused her change in condition on 11/27/2025 because it could have happened from the prior brain hemorrhage or the infections that she was already dealing with prior to her admission. He stated that any small stress in the body such as infection could cause confusion and a change in mental status. He stated that the facility failed to follow their notification policy because they should notify a physician immediately. If she had an infection which she did, and they noticed a change and they didn't catch it, it could progress to sepsis but since she was sent out to the hospital on the same day the risk was low. Interview on 12/10/2025 at 10:30 AM with Hospital Wound Care Doctor L revealed Resident #1 was recently admitted to the hospital for a large stroke prior to her being admitted to the nursing home on [DATE]. Resident #1 was currently on isolation at the hospital because of her ongoing C-Diff infection. She stated Resident #1 had a change in her mental status at the hospital prior to her ever being admitted to the facility on [DATE] as a result of her stroke. She stated that there was a period while at the hospital Resident #1 did not speak at all. She stated that Resident #1 started to speak again and was discharged to the nursing facility but that the change in mental status experienced at the facility could be related. She stated that Resident #1 also had a UTI and C-Diff prior to being admitted to the nursing facility on 11/24/2025 and that could also cause a change in mental status. Interview on 12/10/2025 at 4:15 PM with CNA I revealed that she worked with Resident #1 on 11/27/2025 and was at the facility when she was sent to the hospital. She stated that that was the first day that RN H had worked with Resident #1. She stated he likely did not notice her change in condition because it was not obvious and he had no prior experience with Resident #1. She stated that she also did not notice Resident #1 acting any different, but that was only her second time working with her. Resident #1 was only at the facility for 3 days. She stated that around 4 PM, Resident #1's family member came to the facility and then told RN H that she was acting different than the day before. She stated that she observed the family member tell RN H that he wanted her to be sent to the hospital. She stated that Resident #1 was still able to hold a conversation and was talking normally. She stated that the change in mental condition was not obvious to her. She stated that the facility sent Resident #1 to the hospital at the family member's request. She stated that she did not observe RN H perform the notification to the physician of Resident #1's change in condition. She stated RN H would have been the one responsible for making the physician notification. Interview on 12/10/2025 at 4:30 PM with Assistant Director of Nursing E revealed that Resident #1 was on isolation for C-Diff. She had just had a stroke, UTI, and C-Diff while in the hospital prior to her being discharged to the facility 2 days prior to her being sent to the hospital. Resident #1 had a history of UTI. Assistant Director of Nursing E stated that RN H would have been the staff member responsible for notifying the physician on 11/27/2025 of Resident #1's change in condition. She stated that she agreed that it was a failure of the facility failing to follow their notification policy because Resident #1 had a change in mental status and was sent to the hospital. She stated that (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676120 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 676120 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/10/2025 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)

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Resident #1's reason for the change in mental status likely did not have anything to do with the facility staff or care that she was receiving because Resident #1 came to the facility with prior complications and was only in the facility for 72 hours. She stated that the change in mental status was likely a result of Resident #1's recent stroke, urinary tract infection, or C-Diff infection. She stated that any of those diagnosis could impact a resident's cognitive ability and show a change in mental status. She stated that the staff would not have known Resident #1 very well because the staff members would have been working with Resident #1 for the first time. She stated that regardless, there was a change in condition that resulted in Resident #1 being sent to the hospital at family's request. She stated that RN H failed to notify Physician G. Interview on 12/10/2025 at 4:40 PM Administrator A stated that he understood that RN H should have notified Physician G of Resident #1's change in mental status that resulted in a hospital transfer on 11/27/2025. He stated that RN H was no longer an employee at the facility. Interview on 12/10/2025 at 4:45 PM with Physician G revealed that the facility did not notify Physician G of the change in Resident #1's mental status that occurred on 11/27/2025. Physician G stated that the facility was supposed to notify the physician if there was a change in condition. Physician G stated that the facility should have notified him that Resident #1 was sent to the hospital at the family's request. The physician stated that change in mental status was likely a sign of an underlying infection. Resident #1 was admitted to the facility with a UTI and C-Diff. He stated that no matter what they should have informed the physician or nurse practitioner of Resident #1's change and transfer. He stated that the risk of injury was low because Resident #1 was sent to the hospital, but it was necessary to consider so that residents could receive proper care and monitoring earlier to prevent a more serious outcome. Interview on 12/10/2025 at 2:45 PM with RN H was attempted. Voice Messages were left requesting a call back. Interview on 12/10/2025 at 2:50 PM with RN H was attempted. Voice Messages were left requesting a call back. Record review of the facility Change in Condition policy dated 2/2021 reflected Our facility promptly notifies the resident, his or her attending physician, and the resident representative of changes in the resident's medical/mental condition and/or status. 1. The nurse will notify the resident's attending physician or physician on call when there has been a(an):a. Significant change in the resident's physical/emotional/mental condition;g. Need to transfer the resident to a hospital/treatment center Event ID: Facility ID: 676120 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 676120 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/10/2025 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)

F 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to incorporate the recommendations from the Preadmission Screening and Resident Record review (PASRR) Level II determination and the PASRR evaluation report for 1 of 4 residents (Resident #2) reviewed for PASRR assessments. The facility failed to submit the Nursing Facility Specialized Services (NFSS) form request by the specific deadline for Resident #2 for therapy services. This failure could place residents at risk of not receiving or benefiting from specialized therapy and equipment services they may require. Findings included: Record review of Resident #2's care plan dated 9/17/2025 reflected a [AGE] year-old female admitted to the facility on [DATE]. Resident #2 had diagnoses of Cerebral Palsy (neurological disorders that affect movement, posture, and muscle coordination, primarily caused by damage to the developing brain), Speech and Language deficit, Muscle Weakness (Muscle weakness refers to a decrease in the strength of your muscles, making it difficult to perform everyday activities), Lack of Coordination, Chronic Obstructive Pulmonary Disease (a progressive lung condition that makes it difficult to breathe due to airway inflammation and damage), Ischemic Optic Neuropathy (Ischemic optic neuropathy is when you have sudden vision loss or changes because your optic nerves aren't getting enough blood flow), Dystrophies Retinal Pigment Epithelium (group of inherited macular diseases characterized by pigment deposition, leading to potential vision loss), Cataract (clouding of the eye), Schizoaffective Disorder (mental health condition characterized by a combination of symptoms from schizophrenia and mood disorders, affecting how individuals think, feel, and behave.), Bipolar (mental health disorder that causes extreme mood swings), Paraplegia (paralysis of the legs from nerves and spinal cord), Gout (common and complex form of arthritis characterized by sudden, severe attacks of pain, swelling, redness, and tenderness in one or more joints, most often in the big toe), Cerebrovascular Disease (encompasses a range of conditions that affect blood flow to the brain, leading to serious health issues like strokes and aneurysms). Resident #2 was documented on 8/22/2025 as PASRR positive for Developmental Disability. She required specialized services as indicated by the service coordinator. Resident #2's goal was documented as receiving indicated services through the review date. Record review of Resident #2's quarterly Minimum Data Set (MDS) assessment dated [DATE] reflected the resident had a Brief Interview Mental Status (BIMS) score of 14 indicating that she was cognitively intact. Observation of Resident #2 on 12/09/2025 at 2:35 PM revealed that she was well groomed. Resident #2 refused to be interviewed. She stated that she did not want to be interviewed and did not want to talk to the investigator or let the investigator come into her room. Record review of Resident #2's PASRR Comprehensive Service Plan (PCSP) Form dated 8/27/2025 revealed Resident #2 was evaluated for Specialized Occupational Therapy (OT). Resident #2 was documented as receiving new services for Specialized Assessment Occupation Therapy (OT), Specialized Assessment Physical Therapy (PT), and Specialized Assessment Speech Therapy (ST). Resident #2 was documented as receiving ongoing services for Specialized Occupational Therapy (OT)M Specialized Physical Therapy (PT), and Specialized Speech Therapy (ST). Resident #2 was documented as pleased to continue receiving PT/OT/ST through PASRR. Interview on 12/10/2025 at 3:00 PM with MDS Coordinator C revealed Administrator A forwarded the NFSS compliance form notification that he received from PASRR Representative D on 11/7/2025 to her. She stated that the facility switched from a second party provider in August 2025 who was responsible for submitting the PASRR documentation. She stated that the facility had since then began performing the services themselves under new facility ownership. She stated that the therapy department now handled the submissions. She stated Director of Rehabilitation (DOR) B submitted the NFSS forms on 11/26/2025. She (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676120 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 676120 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/10/2025 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)

F 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few stated that the previous second party failed to submit the documentation in time. She stated that the facility was in the process of switching companies when the NFSS should have been submitted. She stated that everything had since then been sorted out. The requirement was that forms must be submitted within a 20-day deadline after the date of the meeting. The meeting was held on 8/27/2025. The risk to the resident if the 20-day deadline was not met was that residents who were receiving certain therapies may lose the state as a payor source and therefore the facility won't be paid for the continuation of Resident #2's therapy services. She stated that missing the deadline could have a resident's continuation of therapies declined. She stated that Resident #2 did not have any of her services declined as a result of the missed deadline. This was more of a clerical error due to the company transition. The resident was already receiving services, and it was set as ongoing even though the facility missed the deadline. She stated that the therapy team evaluated Resident #2 and then treated her continually without interruption. The NFSS was submitted on 11/26/2025 but it should have been submitted within 20 days after 8/27/2025. She stated that she was unaware of the missed deadline until PASRR Representative D contacted Administrator A to inform him that the facility was not in compliance with the timeframe. She stated they resolved the issue from there and made sure the facility submitted the required documents to get back in compliance. Interview on 12/10/2025 at 3:36 PM with DOR B revealed that the NFSS form should have been completed within the 20-day timeframe after the meeting was held on 8/27/2025. She stated that the risk of not completing the form on time would be that Resident #2 could have their services not paid for and subsequently cancelled. However, that was not what occurred. Resident #2 did not have any of her services cancelled during this timeframe and continued receiving services uninterrupted. She stated that she was not the one who handled the submissions at that time. She stated it was a second party provider that was no longer with the company because the company was undergoing a change in ownership. She stated that she was now responsible for submissions going forward. Interview on 12/10/2025 at 4:00 PM with Administrator A revealed the facility used a second party to handle the PASRR submissions in the past. He stated that he was not aware Resident #2 had not had the required forms submitted on time until he received an email on 11/07/2025 from PASRR Representative D. He stated that the email claimed that according to Resident #2's records, an interdisciplinary team meeting was held and entered into the portal. During the interdisciplinary team meeting it was documented that there were services that were agreed upon. For the facility to be in compliance the facility needed to have services initiated 20 days following the date of the meeting. This meeting was held on 8/27/2025. He stated that this occurred during a timeframe when the company was undergoing a change in ownership. He stated that the current staff at the facility were not involved in this situation. He stated that the meeting was held on 8/27/2025 and 9/17/2025 was when the NFSS form should have been completed by. He stated the prior arrangement was with a second party provider that submitted the agreed upon services and that they failed to do so in this incident. He stated that Resident #2 did not receive harm because she never had her services interrupted. He stated the risk was with the facility because they might not be paid by Health and Human Services (HHSC) for the services they provided to Resident #2 during the timeframe she was not covered. He stated that the facility had since then implemented new systems to handle these requirements internally and no longer rely on a second party provider. Interview attempted with PASRR Representative D on 12/09/2025 at 1:12 PM. A voice message requesting a call back was left. Interview attempted with PASRR Representative D on 12/10/2025 at 3:51 PM. A voice message requesting a call back was left. Record Review of the facility PASRR policy dated 7/29/2025 revealed The PASRR program aims to ensure that individuals with mental illness or intellectual disabilities receive appropriate care (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676120 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 676120 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/10/2025 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)

F 0644 Level of Harm - Minimal harm or potential for actual harm and services. It assesses whether the nursing home is the most suitable setting for the individual's needs. 6. Compliance: Nursing homes must comply with all federal and state regulations regarding PASRR. Failure to do so can result in penalties or loss of funding. The facility follows HHS PASRR For Nursing Facility guidelines. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676120 If continuation sheet Page 6 of 6