Health inspection·March 25, 2024

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observations, interviews, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food safety in the facility's only kitchen where all facility food was prepared. The facility failed to ensure that food was labeled, dated, sealed, and not expired in their kitchen. These failures could place residents at risk for food contamination and food-borne illness. Findings included: An observation on 3/25/24 at 7:45 AM revealed in the walk-in refrigerator, a container with strawberry topping dated 3/15/24. An observation on 3/25/24 at 7:46 AM revealed in the walk-in refrigerator, a container with fruit cocktail dated 3/21/24. An observation on 3/25/24 at 7:47 AM revealed in the walk-in refrigerator, a container with puree fruit dated 3/18/24. An observation on 3/25/24 at 7:50 AM revealed in the walk-in freezer, a bag of turkey sausage patties undated, unlabeled, and unsealed on the bottom shelf in the freezer. An observation on 3/25/24 at 7:51 AM revealed in the walk-in freezer, a bag of boneless chicken breast undated, unlabeled, and unsealed on the bottom shelf in the freezer. An interview with the Dietary Manager on 3/25/24 at 7:58 AM revealed, all dietary staff Should check labels and expiration dates every three to five days. The Dietary Manager revealed, leftovers were only allowed to stay in the refrigerator for up to three days. The Dietary Manager revealed food should be labeled with open date and sealed in a Ziploc bag or container. The Dietary Manager revealed, the residents could get sick from eating expired food . An interview with the Dietary Aide A on 3/25/24 at 8:02 AM revealed, all kitchen staff should check for expired food daily, by the end of shift. Dietary Aide A revealed food should be labeled with a sticker with the open date and put in a container. Dietary Aide A revealed, residents can get sick from eating old food. (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 2 Event ID: 676215 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 676215 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Dallas 4200 Live Oak St Dallas, TX 75204 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)