Health inspection·August 1, 2025

F 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Record review of Resident #1's Brief Interview Mental Status (BIMS) reflected Resident #1 had a BIMS of 13 which indicated that Resident #1's cognitive function was intact. Record Review of Resident #1's Physician Orders dated, 7/16/2025, revealed Resident #1 had an active order for continuous oxygen at 6LPM via nasal mask to keep O2 sats >90% Humidified. Record review of Resident #1's discharge planning documentation revealed that Resident #1 was issued a Notice of Medicare Non-Coverage (A NOMNC is a Centers for Medicare and Medicaid Services approved form that a provider must deliver to a patient covered under a Medicare Advantage plan who is receiving covered skilled services, such as Home Health Agency, Skilled Nursing Facility, and Comprehensive Outpatient Rehabilitation Facility services, when services are terminating in certain situations.). Resident #1 signed the agreement on 7/16/2025. The facility had not signed the agreement as of 8/01/2025. Resident #1 was to be discharged to home (Family Member D's Home) but Resident #1 wanted to transport himself from the facility to the dialysis center first and arranged his own transportation. Resident #1 had home health agency scheduled, a ramp for the stairs of the house scheduled. Resident #1's home had water, power, and no food securities. Resident #1 prefers paratransit services to commute and is eligible to discharge with paratransit services. Resident #1 owns his own oxygen with concentrator and receives 8-9 oxygen tanks per week. Resident #1 owns his own wheelchair and a 2 wheeled walker. A new 2 wheeled walker, bedside commode, and nebulizer was placed. Record Review of Facility Progress Note dated, 7/18/2025 at 1:51 PM, revealed Facility Social Worker A documented that she requested dialysis information in order for Resident #1 to secure his dialysis community chair. He was scheduled to discharge on [DATE]. Record Review of Facility Progress Note dated, 7/18/2025 at 1:52 PM, revealed Facility Social Worker A documented that Resident #1 was scheduled to discharge on [DATE]. She documented that Resident #1 will be picked up by Family Member D at 1:00 PM. She documented that she sent a new admission referral through Resident #1's previous dialysis clinic. She stated that Resident #1 was discharging with home health scheduled. She stated that Resident #1 had an appointment scheduled with nurse practitioner. Record Review of Facility Progress Note dated, 7/18/2025 at 1:52 PM, revealed Facility Social Worker A documented that Resident #1 was scheduled to discharge on [DATE]. She documented that Resident #1 will be picked up by Family Member D at 1:00 PM. She documented that she sent a new admission referral through Resident #1's previous dialysis clinic. She documented that order was placed for a rollator and bedside commode. She stated that Resident #1 was discharging with home health scheduled. She stated that Resident #1 had an appointment scheduled with nurse practitioner. Record Review of Facility Progress Note dated, 7/18/2025 at 1:52 PM, revealed Facility Social Worker A documented that Resident #1 was scheduled to discharge on [DATE]. She documented that Resident #1 will be picked up by Family Member D at 1:00 PM. She documented that she sent a new admission referral through Resident #1's previous dialysis clinic. She documented that order was placed for a rollator and bedside commode. She stated that Resident #1 was discharging with home health scheduled. She stated that Resident #1 had an appointment scheduled with nurse practitioner. Record Review of Facility Progress Note dated, 7/18/2025 at 1:52 PM, revealed Facility Social Worker A documented that Resident #1 was scheduled to discharge on [DATE]. She documented that Resident #1 will be picked up by Family Member D at 11:00 AM. She documented that Resident #1 will receive dialysis services on Tuesdays, Thursdays, and Saturdays with a chair time of 12 PM, arrival time for 11 AM. She documented that order was placed for a rollator and bedside commode. She stated that Resident #1 was discharging with home health scheduled. She stated that Resident #1 had an appointment scheduled with nurse practitioner. Record Review of the email correspondence between the facility and dialysis clinic revealed that on 7/23/2025 at 12:01 PM dialysis center sent an email to Facility Social Worker A and stated that the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676215 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 676215 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2025 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)

F 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few physician stated the dialysis clinic was still waiting on the facility to send Resident #1's flow sheets. Record Review of the email correspondence between the facility and dialysis clinic revealed that on 7/23/2025 at 12:14 PM Facility Social Worker A sent an email to the dialysis center and stated that she had already sent Resident #1's flow sheets to the dialysis center. She stated that she had already spoken with the clinic and that the clinic had confirmed receipt of the flow sheets. She stated that she was informed that Resident #1's history and physical was still needed. She stated that she re-faxed the forms again and they confirmed receipt. She stated that they were waiting on the physician to accept Resident #1 and that a response was expected to be provided on that same day 7/23/2025. No response was provided to the facility via email. Record Review of Dialysis Center Progress Note dated, 7/28/2025, revealed Dialysis Social Worker G contacted Facility Social Worker A and informed her that Resident #1 would no longer be able to receive services at the dialysis clinic. The progress note stated, Notified clinic cannot accept patient due to his oxygen requirements. Placed call to SW (Facility Social Worker A). SW (Facility Social Worker A) stated that she was told otherwise last week. This was not provided to the facility by dialysis center. Record Review of Facility Progress Note dated, 7/29/2025 at 12:40 PM, revealed Resident #1 discharged from the facility to home by RN X. Resident #1 stated that he wanted to go to the dialysis clinic from the facility before going home. Resident #1 scheduled his own paratransit company to take him to the dialysis clinic. Resident was discharged with a full tank of oxygen at 6LPM, no distress, alert x4, able to verbalize needs. Resident #1 stated that he would be coming back to the facility later that evening to pick up the remainder of his items because he can not take the items with him on the paratransit. Interview on 8/1/2025 at 10:15 AM with Executive Director F, revealed that she informed her staff not to discharge Resident #1 until everything was appropriately scheduled. She stated that Social Worker A handled the discharge process for Resident #1 and knew not to schedule his discharge unless everything was safely arranged. She stated that RN X performed the discharged as it was scheduled. She stated that the NOMNC had already activated, and the facility was already beyond its allowed limit. She stated that since Resident #1 was already discharged at the time that the facility became aware of the issue then they could not accept him back at the facility without Resident #1 going through the authorization process again. She stated that the facility first became aware of the issue once Resident #1 arrived at the dialysis clinic. There was no action taken by the facility to assist Resident #1 once Resident #1 was outside of the facility. When asked if she was aware of the phone conversation between Facility Social Worker A and Dialysis Social Worker E, she stated that she was not aware that they had called and informed the facility that Resident #1 was unable to receive their services because the medical director of the dialysis clinic denied him. She stated that if it happened the way that the dialysis center claimed then that would be unacceptable and not the proper steps for the facility to initiate a discharge process. Interview on 8/1/2025 at 10:45 AM with Facility Social Worker A revealed, Resident #1 was scheduled to be discharged to home (Family Member D's Home) on 7/29/2025. She stated that she was the one who assisted Resident #1 with discharge planning and arranging his medical needs. She stated Family Member D was aware of Resident #1's discharged because this was a planned discharge. He was to leave from the facility and go to the dialysis center and then go home. Resident #1 wanted to schedule his own transportation services to the dialysis clinic. She stated that when he arrived at the dialysis center he was declined because they had oxygen concerns and could not accept him. She stated that the dialysis clinic did not communicate that to her. She stated that all of his documentation had already been submitted via email and responded to via phone. She stated that the dialysis center approved Resident #1 via telephone call between her and Dialysis Social (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676215 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 676215 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2025 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)

F 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Worker E. She stated that there was a lot of back and forth because the dialysis physicians were having to review Resident #1's orders. She stated that everything was arranged for Resident #1 to have a safe discharged . When asked who was responsible for verifying a safe discharge she did not respond. Family Member D arrived at the facility on 7/29/2025 while Resident #1 was in the hospital. She stated that Family Member D was informed that the facility did what they could do, and she stated that she told him I did my role. She stated it was the dialysis clinic who made the mistake. She stated that they cannot tell her that they have a chair available for him and then later say after he had already been discharged that they cannot accept him. She stated that there were no documented evidence confirming dialysis had a chair available for Resident #1. Interview on 8/1/2025 at 11:00 AM with Family Member D via phone, revealed Resident #1 left from the facility to go to dialysis on 7/29/2025. When Resident #1 arrived at dialysis the staff were not prepared for him to be there. The dialysis clinic stated that Resident #1 was not registered as a client of theirs at that time. Family Member D stated that Resident #1 should have been scheduled if the facility had done their part. He stated that he was informed by the dialysis clinic that Resident #1 would not be able to receive treatment at the dialysis clinic because they could not accommodate him. The paramedics were called to transfer Resident #1 from the dialysis clinic to the hospital so that he could receive treatment. Resident #1 did not suffer from any injuries. Interview on 8/1/2025 at 11:30 AM with Dialysis Social Worker G, revealed that on Monday (7/28/2025), she spoke with Facility Social Worker A. She stated this was the day before the discharge occurred. She stated that she told Facility Social Worker A that the dialysis clinics medical director denied Resident #1 over not being able to meet Resident #1's oxygen needs. The conversation was done verbally, there were no other method of communication for the denial. The weeks leading up to the event did have a lot of back-and-forth email exchanges where the facility was being told to provide more documentation. The email chain does not state Resident #1 was ever approved for dialysis services. She stated that she documented the phone notification to Facility Social Worker A and that it was time stamped. She stated that Facility Social Worker A responded by saying something like Well, I heard otherwise. She stated that Facility Social Worker A immediately hung up the phone. Dialysis Social Worker G admitted that she was the one that had previously told Facility Social Worker A that the dialysis clinic should be able to accommodate Resident #1 the previous week but after further review the medical director determined that the dialysis clinic could not meet his needs. She stated that is why the dialysis clinic called to inform the facility on Monday 7/28/2025. She stated that she could tell that the Facility Social Worker A was upset about being told that they could not accommodate Resident #1 after already being told that they could. She stated the facility never called back, they just discharged and sent Resident #1 to the dialysis clinic the next day anyway on 7/29/2025. She stated that Resident #1 did not have any injuries and that he waited for EMS (Emergency Medical Services) to arrive to take him to the hospital so that he could receive dialysis services. She stated it takes 3 days on average for a resident to be accepted to the dialysis clinic. The doctor will review the records and make decisions about what more is required or if the residents was a candidate. If a resident is accepted to the clinic an official letter of acceptance is sent to the facility to inform them in writing of the acceptance. This letter was not sent to the facility because the resident was not accepted. Interview on 8/1/2025 at 12:00 PM with Dialysis Administrator E, revealed Resident #1 was a previous patient of the dialysis clinic in the past but had not been a patient for a while. Dialysis Administrator E stated that Facility Social Worker A was initially informed a week prior to Resident #1 being discharged that the dialysis services were scheduled. However, the physician reviewed Resident #1's medical files on 7/25/2025 and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676215 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 676215 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2025 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)

F 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few denied Resident #1 because the dialysis clinic could not meet Resident #1's oxygen needs. The following business day, 7/28/2025, the dialysis clinic Social Worker G called the facility Social Worker A and informed her that Resident #1 would no longer be able to receive dialysis services at the clinic because the clinic cannot meet Resident #1's needs. Once informed, facility Social Worker A was quoted as saying Well, that's not what I was told last week. Facility Social Worker A then hung up the phone on dialysis Social Worker G. The following day, 7/29/2025, Resident #1 arrived at the dialysis clinic although the facility had been informed the day prior that Resident #1 would not be able to receive their services. The reason for the denial was because the doctor had previously told the facility they would be able to accept them but once it was reviewed by the medical director that changed. Resident #1 requires 6 to 8 liters of oxygen continuously. The dialysis clinic stated that they could not handle that because their oxygen concentrators only allow 5 liters. The dialysis clinic does not think Resident #1 should have been discharged to receive dialysis services from them when the facility was informed that they could not meet his needs prior to his discharge being completed. Interview on 8/1/2025 at 1:00 PM with Facility Social Worker A revealed, the facility was never informed of Resident #1 being denied by the dialysis clinic. She stated that she was initially informed by the dialysis clinic the week before the discharge that Resident #1 was approved for dialysis services. She stated that nobody called to tell her otherwise. She then stated they called after Resident #1 had already been discharged so it was out of the facilities control at that point because the facility could not take back a resident that had already been discharged . When asked why would the dialysis center state that they informed Facility Social Worker A of Resident #1's denial she stated that it was not true. When asked why the dialysis clinic would state that Facility Social Worker A hung up on the phone when informed of Resident #1's denial she stated that she did not know. Interview on 8/19/2025 at 10:30 AM with Physician Q revealed, Resident #1 was offered dialysis services the day before discharge and on the day of discharge before he left the facility. Resident #1 refused dialysis services because he wanted to go to the dialysis clinic instead of receiving dialysis in the facility. The risk of him having complications within the next 24-48 hours at time of discharge was low. It was not a life-threatening moment for him to have it done on the day of discharge but he should have had it within the next 24 to 48 hours. If he didn't then he could retain too much fluid and have difficulty breathing which would have required a visit to the hospital. This situation was at a limited risk of causing him harm. The dialysis center had 2 weeks' notice that Resident #1 would be coming back to them. Resident #1 was very educated about his illness and could manage his care to a great extent. Resident #1 should have had dialysis appointments scheduled, certainly. There should have been better communication between the facility and the dialysis center about his oxygen needs. This would have caused the facility staff to try to address it as soon as possible. The arrangements are normally 12-24 hours for supplies if a resident requires more assistance to receive care and that should have been able to be accommodated. He should have been able to receive services. If not on the day of discharge, the following day he could have easily received dialysis. That would place him at a low risk. She stated that she saw Resident #1 at the nursing facility. She stated Resident #1 was not affected mentally or physical by this visit. That he appeared to be happy with the level of care he was receiving at the facility. The referral to have him re-admitted after his hospital visit was made and accepted by the insurance company. Interview on 8/19/2025 at 11:00 AM with Medical Director R revealed, Resident #1 was offered dialysis services the day before discharge and on the day of discharge, but he refused. She stated that Resident #1 needs an average of 6-8 liters of oxygen and that it was not normal for the dialysis clinic to accept a resident with those needs. She (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676215 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 676215 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2025 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)

F 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete stated that the clinic was not equipped to meet the needs of the resident at that time. She stated that the resident was in a facility that already could provide him dialysis and that he was offered multiple times and has a history of refusal. She stated that the dialysis clinic was equipped to care for Resident #1 if he was to decide to come back to the dialysis clinic in the future because they have purchased supplies to meet his oxygen needs. She stated that Resident #1 was back at the facility because he was accepted after his hospital visit. She stated that Resident #1 was denied because they only had the supplies to care for someone who received up to 5ml of oxygen. She stated Resident #1 was a very difficult patient to work with and that he refused dialysis treatments even when he knew the risks. She stated that he was a previous patient of theirs in the past. She stated that if he received dialysis on the day of discharge then there is no risk. She stated that he had 24-48 hours to receive services before there was a risk of harm. She stated that he advocated for himself and has the cognition to do so. She stated that the dialysis clinic would have issued an acceptance letter if Resident #1 was accepted to the facility. There was never an acceptance letter sent to the facility for Resident #1. Interview on 8/20/2025 at 10:44 AM with Resident #1 revealed, Resident #1 was back at the nursing facility. He stated that he is fine, and he has no issues with the care that he receives at the facility. He stated he is happy with the staff but that he was not happy with how the discharge process was handled. He stated that he did in fact receive dialysis at the facility the day before he was discharge. He stated that he did not refuse dialysis on the day of discharge prior to discharge. He stated that he thought he was going to receive dialysis services at the dialysis clinic after he was discharged but they denied him, so he had to go to the hospital to receive his dialysis services. He stated now that he is back at the facility everything is okay. Interview on 8/20/2025 at 12:11 PM with Dialysis Technician S revealed, Resident #1 did receive dialysis on 7/28/2025 the day prior to his discharge. She stated that Resident #1 did have a history of refusing to receive dialysis services. She stated that on the day of discharge 7/29/2025, Resident #1 refused to receive dialysis services at the facility because he wanted to wait until he arrived at the clinic. She stated that Resident #1 was aware and that if he did not want to receive dialysis then she could not make him receive dialysis. She stated she was responsible for notifying the physicians that the resident refused dialysis. She stated that Resident #1 preferred to discharge to his outpatient clinic. Record Review of the Transfer and Discharges section of the Resident Rights Policy, dated 11/2021, states that residents have the right to:Not be discharged from the facility, except in accordance with nursing facility regulations. Record Review of the Transfer and Discharges Policy, dated 12/2017, states that discharged residents will have documentation related to discharge or transfer in clinical software. Event ID: Facility ID: 676215 If continuation sheet Page 6 of 6