Health inspection·January 27, 2024

F 0677 The findings were: Level of Harm - Minimal harm or potential for actual harm Record review of Resident #5's face sheet, dated 1/26/2024, reflected a [AGE] year-old resident initially admitted on [DATE] with diagnosis including acute pancreatitis without necrosis or infection, unspecified (a condition where the pancreas becomes inflamed over a short period of time), dysphagia (difficulty or discomfort in swallowing), and fibromyalgia (a chronic disorder characterized by widespread pain). Residents Affected - Some Record review of Resident #5's MDS, dated [DATE] reflected the resident was noted as Dependent under Section GG, in the evaluation of resident's ability to shower or bathe themselves. Record review of Resident #5's Care Plan, dated 12/28/2023, reflected interventions stating the resident required assistance of staff while bathing/showering. Record review of the facility shower schedule, dated 1/26/2024, revealed that Resident #5 was scheduled to shower every week on Tuesday, Thursday, and Saturday during the 2:00 PM to 10:00 PM shift. Record review of Resident #5's Shower Documentation Report, dated 1/26/2024, reflected Resident #5 received 4 of 10 scheduled showers between 1/1/2024 and 1/25/2024. Resident #5's Shower Documentation Report reflected Yes for resident bathing on dates 1/4/2024, 1/9/2024, 1/16/2024, and 1/23/2024. There is no documentation to indicate that the resident was showered or bathed on the scheduled shower dates: 1/2/2024, 1/6/2024, 1/11/2024, 1/13/2024, 1/18/2024, and 1/20/2024. This is 19 of 25 days in January 2024 without a shower. Record review of Resident #45's face sheet, dated 1/26/2024, reflected an [AGE] year-old resident initially admitted on [DATE] with diagnosis including dementia (A group of thinking and social symptoms that interferes with daily functioning), and Chronic Systolic (Congestive) Heart Failure (occurs when your left ventricle can't pump blood efficiently). Record review of Resident #45's MDS, dated [DATE], reflected the resident was noted as requiring Substantial/maximal assistance under Section GG in the evaluation of the resident's ability to shower or bathe themselves. Record review of the facility shower schedule, dated 1/26/2024, revealed that Resident #45 was scheduled to shower every week on Monday, Wednesday, and Friday during the 2:00 PM to 10:00 PM shift. Record review of Resident #45's Shower Documentation Report, dated 1/26/2024, reflected Resident #45 received 2 of 11 scheduled showers between 1/1/2024 and 1/25/2024. Resident #45's Shower Documentation Report reflected Yes for resident bathing on scheduled shower dates 1/5/2024 and 1/12/2024. There was no documentation to indicate that the resident was showered or bathed on the scheduled shower dates: 1/1/2024, 1/3/2024, 1/8/2024, 1/10/2024, 1/15/2024, 1/17/2024, 1/19/2024, 1/22/2024, and 1/24/2024. Record review of Resident #51's face sheet, dated 1/26/2024, reflected a [AGE] year-old resident initially admitted on [DATE] with diagnosis including non-Hodgkin lymphoma (cancer that starts in the lymphatic system), and type 2 diabetes (a condition that affects the body's ability to process blood sugar). Record review of Resident #51's MDS, dated [DATE], reflected the resident was noted as requiring (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676233 If continuation sheet Page 2 of 15 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 676233 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Bandera 222 Fm 1077 Bandera, TX 78003 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 0677 Level of Harm - Minimal harm or potential for actual harm Setup or clean-up assistance under Section GG in the evaluation of the resident's ability to shower or bathe themselves. Record review of Resident #51's care plan, dated 12/28/2023, reflected interventions that the resident preferred to be showered 2-3 times weekly and required supervision assistance with showering. Residents Affected - Some Record review of the facility shower schedule, dated 1/26/2024, revealed that Resident #51 was scheduled to shower every week on Monday, Wednesday, and Friday during the 6:00 AM to 2:00 PM shift. Record review of Resident #51's Shower Documentation Report, dated 1/26/2024, reflected resident #51 received 2 of 12 scheduled showers between 1/1/2024 and 1/26/2024. Resident #51's Shower Documentation Report reflected Yes for resident bathing on scheduled shower dates 1/10/2024 and 1/26/2024. There is no documentation to indicate that the resident was showered or bathed on the scheduled shower dates: 1/1/2024, 1/3/2024, 1/5/2024, 1/8/2024, 1/12/2024, 1/15/2024, 1/17/2024, 1/19/2024, 1/22/2024, and indication the resident refused a shower on 1/24/2024. Record review of Resident #57's face sheet, dated 1/26/2024, reflected a [AGE] year-old resident initially admitted on [DATE] with diagnosis including chronic obstructive pulmonary disease (group of lung diseases that block airflow and make it difficult to breathe), and dementia (group of thinking and social symptoms that interferes with daily functioning). Record review of Resident #57's MDS, dated [DATE], reflected the resident was noted as requiring Setup or clean-up assistance under Section GG in the evaluation of the resident's ability to shower or bathe themselves. Record review of the facility shower schedule, dated 1/26/2024, reflected that Resident #57 was scheduled to shower every week on Monday, Wednesday, and Friday during the 2:00 PM to 10:00 PM shift. Record review of Resident #57's Shower Documentation Report, dated 1/26/2024, reflected resident #57 received 6 of 11 scheduled showers between 1/1/2024 and 1/26/2024. Resident #57's Shower Documentation Report reflected Yes for resident bathing on scheduled shower dates 1/1/2024, 1/8/2024, 1/15/2024, 1/17/2024, 1/19/2024, and 1/24/2024. There was no documentation to indicate that the resident was showered or bathed on the scheduled shower dates: 1/3/2024, 1/5/2024, 1/10/2024, 1/12/2024, 1/22/2024. Record review of Resident #64's face sheet, dated 1/26/2024, reflected a [AGE] year-old resident with diagnosis including severe protein-calorie malnutrition and hypoxemia (an abnormally low concentration of oxygen in the blood). Record review of Resident #64's MDS, dated [DATE], reflected the resident was noted as requiring Supervision or touching assistance under Section GG in the evaluation of the resident's ability to shower or bathe themselves. Record review of Resident #64's care plan, dated 1/2/2024, reflected interventions that the resident had a self-care deficit and preferred to be showered 2-3 times weekly. Record review of the facility shower schedule, dated 1/26/2024, reflected that Resident #64 was scheduled to shower every week on Tuesday, Thursday, and Saturday during the 6:00 AM to 2:00 PM shift. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676233 If continuation sheet Page 3 of 15 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 676233 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Bandera 222 Fm 1077 Bandera, TX 78003 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Record review of Resident #64's Shower Documentation Report, dated 1/26/2024, reflected resident #64 received 4 of 11 scheduled showers between 1/1/2024 and 1/26/2024. Resident #64's Shower Documentation Report reflected Yes for resident bathing on scheduled shower dates 1/4/2024, 1/11/2024, 1/13/2024, and 1/23/2024. There was no documentation to indicate that the resident was showered or bathed on the scheduled shower dates: 1/2/2024, 1/6/2024, 1/9/2024, 1/16/2024, 1/18/2024, 1/20/2024, and indication that the resident refused a shower on 1/25/2024. Record review of Resident #78's face sheet, dated 1/26/2024, reflected a [AGE] year-old resident with diagnosis including type 2 diabetes (a condition that affects the body's ability to process blood sugar). Record review of Resident #78's MDS, dated [DATE], reflected the resident was noted as requiring Substantial/maximal assistance under Section GG in the evaluation of the resident's ability to shower or bathe themselves. Record review of Resident #78's care plan, dated 1/5/2024, reflected the resident required staff assistance while showering and preferred to be showered 2-3 times weekly. Record review of the facility shower schedule, dated 1/26/2024, reflected that Resident #78 was scheduled to shower every week on Tuesday, Thursday, and Saturday during the 2:00 PM to 10:00 PM shift. Record review of Resident #78's Shower Documentation Report, dated 1/26/2024, reflected resident #78 received 1 of 11 scheduled showers between 1/1/2024 and 1/26/2024. Resident #78's Shower Documentation Report reflected Yes for resident bathing on scheduled shower dates 1/9/2024. There was no documentation to indicate that the resident was showered or bathed on the scheduled shower dates: 1/2/2024, 1/4/2024, 1/6/2024, 1/11/2024, 1/13/2024, 1/16/2024, 1/18/2024, 1/20/2024, 1/23/2024, and 1/25/2024. On 1/24/2024 at 2:45 PM, during confidential interviews, 3 of 4 residents interviewed stated they are not showered on their scheduled days and if a shower was requested on a Sunday, they are told that showers are not performed on Sundays. Interview on 1/26/2024 at 11:45 AM, the Administrator stated that they are confident residents are showered but were not aware why it was not documented. Interview on 1/26/2024 at 12:15 PM, the DON stated that she was confident that residents are showered, but that CNA's do not have time to document residents' showers at times. In an interview on 1/26/2024 at 12:40 PM, CNA C stated that she was frequently tasked with providing showers to residents. CNA C stated she provided the showers to residents on their schedule day when she was working. CNA C stated she does not always have time to document that she provided a shower to a resident. CNA C stated she did not know if she had missed providing a shower to a resident. In an interview on 1/26/2024 at 12:44 PM, the DON stated that there was some risk that documentation was not done, but she was confident the care was being provided. The DON stated the nurse managers should be spot checking showers are given and documented. The DON stated nurse managers include the ADONs and her as the DON. The DON stated she does not think anyone has been checking for bathing documentation. The DON stated that the nurse managers can tell by looking at the residents, that they (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676233 If continuation sheet Page 4 of 15 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 676233 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Bandera 222 Fm 1077 Bandera, TX 78003 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 0677 are being bathed as needed. Level of Harm - Minimal harm or potential for actual harm Record review of Facility Policy titled Activities of Daily Living, dated February 2017, reflected each resident's ability to perform activities of daily living will not diminish unless the individuals clinical condition demonstrates that diminution was unavoidable, including personal hygiene. Residents Affected - Some Record review of Facility Policy titled Routine Resident Care, revised January 2023, reflected, showers, tub baths and/or shampoos should be scheduled at least twice weekly and more often as needed or per residents' preference. Shower schedules should be geared to resident preference and scheduled as such. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676233 If continuation sheet Page 5 of 15 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 676233 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Bandera 222 Fm 1077 Bandera, TX 78003 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 0712 Ensure that the resident and his/her doctor meet face-to-face at all required visits. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure residents were seen by a physician at least once every 30 days for the first 90 days after admission for 22 (Residents #53, #901, #88, #7, #50, #27, #39,, #41, #47, #141, #902, #903, #17, #63, #34, #1, #62, #904, #905, #84, #20, and #906,) of 43 residents reviewed for physician services. Residents Affected - Many The facility failed to ensure PCP A made physician visits since he started on or about 10/01/2023. The facility failed to ensure 22 of 43 residents (Residents #53, #901, #88, #7, #50, #27, #39, #41, #47, #141, #902, #903, #17, #63, #34, #1, #62, #904, #905, #84, #20, and #906) were seen by a Physician within 30 days of admission to the facility. This failure could place residents at an increased risk of not receiving appropriate, adequate medical care in a timely manner resulting in a decline in health status or diminished quality of life. The findings included: Record review of the EHR revealed a lack of physician documentation for newly admitted residents, after 10/1/2023, wherein PCP A documented a review of the resident's total program of care, including the resident's current condition, progress and problems in maintaining or improving their physical, mental and psychosocial well-being and decisions about the continued appropriateness of the resident's current regimen. There were no physician progress notes written, signed and dated by PCP A for newly admitted residents after 10/1/2023. Record review of Admission/Discharge Report dated 1/27/2024, indicated there were 43 residents admitted [DATE] to 1/23/2024. Of those 43 residents, there was no documentation of required physician visits available in the EHR for 22 residents. Record review of admission record revealed Resident #53 was a resident admitted on [DATE] with dementia [general term for the impaired ability to remember, think, or make decisions that interferes with doing everyday activities] as a diagnosis. Record review of admission record revealed Resident #901 was a resident admitted on [DATE] with osteomyelitis [infection of the bone] as a diagnosis. Record review of admission record revealed Resident #88 was a resident admitted on [DATE] with Parkinson's disease [progressive disorder that affects the nervous system and the parts of the body controlled by the nerves] as a diagnosis. Record review of admission record revealed Resident #7 was a resident admitted on [DATE] with chronic obstructive pulmonary disease [chronic inflammatory lung disease that causes obstructed airflow from the lungs] as a diagnosis. Record review of admission record revealed Resident #50 was a resident admitted on [DATE] with severe chronic kidney disease, stage IV [severe loss of kidney function for 3 months or more] as a diagnosis. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676233 If continuation sheet Page 6 of 15 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 676233 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Bandera 222 Fm 1077 Bandera, TX 78003 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 0712 Level of Harm - Minimal harm or potential for actual harm Record review of admission record revealed Resident #27 was a resident admitted on [DATE] with acute respiratory failure as a diagnosis. Record review of admission record revealed Resident #39 was a resident admitted on [DATE] with weakness as a diagnosis. Residents Affected - Many Record review of admission record revealed Resident #41 was a resident admitted on [DATE] with hypertensive heart and chronic kidney disease state V [also known as end-stage kidney disease] as a diagnosis. Record review of admission record revealed Resident #47 was a resident admitted on [DATE] with respiratory syncytial virus [common respiratory virus that usually causes mile, cold-like symptoms, but can be severe symptoms in older adults and infants] as a diagnosis. Record review of admission record revealed Resident #141 was a resident admitted on [DATE] with repeated falls as a diagnosis. Record review of admission record revealed Resident #902 was a resident admitted on [DATE] with acute respiratory failure as a diagnosis. Record review of admission record revealed Resident #903 was a resident admitted on [DATE] with orthopedic surgery aftercare as a diagnosis. Record review of admission record revealed Resident #17 was a resident admitted on [DATE] with ataxic cerebral palsy [developmental disorder that affects motor function such as balance and coordination] as a diagnosis. Record review of admission record revealed Resident #63 was a resident admitted on [DATE] with disorientation as a diagnosis. Record review of admission record revealed Resident #34 was a resident admitted on [DATE] with urinary tract infection as a diagnosis. Record review of admission record revealed Resident #1 was a resident admitted on [DATE] with chronic obstructive pulmonary disease as a diagnosis. Record review of admission record revealed Resident #62 was a resident admitted on [DATE] with syncope [fainting] and collapse as a diagnosis. Record review of admission record revealed Resident #904 was a resident admitted on [DATE] with systemic inflammatory response syndrome [exaggerated defense response from the body to a harmful stressor] as a diagnosis. Record review of admission record revealed Resident #905 was a resident admitted on 12/202023 with dehydration [occurs as a result of abnormal water loss from the body, or not taking in enough fluids] as a diagnosis. Record review of admission record revealed Resident #84 was a resident admitted on [DATE] with encephalopathy [any diffuse disease of the brain that alters brain function or structures, results in (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676233 If continuation sheet Page 7 of 15 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 676233 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Bandera 222 Fm 1077 Bandera, TX 78003 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 0712 altered mental state] as a diagnosis. Level of Harm - Minimal harm or potential for actual harm Record review of admission record revealed Resident #20 was a resident admitted on [DATE] with falls as a diagnosis. Residents Affected - Many Record review of admission record revealed Resident #906 was a resident admitted on [DATE] with alcohol dependence as a diagnosis. Record review of the EHR, between 1/24/2024 and 1/25/2024, produced no electronic documentation of physician visits for Residents #53, #901, #88, #7, #50, #27, #39,, #41, #47, #141, #902, #903, #17, #63, #34, #1, #62, #904, #905, #84, #20, or #906. In a confidential interview on 1/24/2024 at 2:45 PM, 2 of 5 residents stated they had not seen their doctor in a while and wanted to see him/her more often. These residents could not recall the name of their new doctor or the last time they saw him. In an interview on 1/25/2024 at 4:13 PM, the ADM stated the MD stepped down as providing PCP services, and PCP A took over the PCP role about 10/01/2023. The ADM stated PCP A was at the facility multiple times per week and saw many residents each time he was in the building. The ADM stated most of his communication with PCP A was via messages or over the telephone. The ADM stated PCP A usually conducted his visits to the facility outside of normal business hours of Monday to Friday 8:00 AM to 5:00 PM, so it was not often that the ADM saw PCP A. The ADM stated he did not have a list of residents the PCP A or NP B had seen as a required physician visit once every 30 days during the first 90 days, and every 60 days thereafter. The ADM stated the facility did not keep track of which residents were seen and when. In a joint interview on 1/25/2024 at 5:00 PM, the DON and the ADM stated the MD would be adding a quality assurance check for the monitoring of physician visits for PCP A and NP B. The ADM stated when PCP A started, he knew there was a learning curve for using the facility's EHR. The ADM stated he had only just learned today [1/25/2024] that PCP A had not entered any physician notes. The ADM stated, it was his understanding that PCP A would be working on immediately transcribing and uploading his notes into the EHR system. The ADM stated it was his sincere belief that all residents' medical concerns had been attended to promptly. The DON stated she did not believe any resident health care concerns had been missed, and all necessary treatments had received valid orders in a timely manner and that facility staff had executed those orders appropriately. The ADM stated he would run an audit report [Admission/Discharge Report] and indicate which residents were missing documentation of required physician visits. In an interview on 1/26/2024 at 12:44 PM, the DON stated that there was some risk that documentation was not done, but she was confident the care was being provided. The DON stated she felt the level of communication between the facility, NP B and PCP A was intact and therefore adequate for provision of care to the residents. The DON stated she felt that all the residents' medical needs were being attended to and appropriate care was provided. In an interview on 1/26/2024 at 3:30 PM, the MD stated he had been medical director at this facility since it opened, approximately 15 or 20 years now. The MD stated it had never come up on a facility meeting agenda for the medical director to track timely physician visits. The MD stated that he was the medical director for over 50 nursing facilities in the area. The MD stated he assumed each nursing home was tracking when each resident needed to be seen for a physician visit versus a medically (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676233 If continuation sheet Page 8 of 15 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 676233 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Bandera 222 Fm 1077 Bandera, TX 78003 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 0712 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many necessary visit. The MD stated he did not know if residents were seen by a physician every 60 days or if newly admitted residents were seen by a physician once every 30 days for their first 90 days after admission. The MD stated, the residents at the facility could elect to see him in his clinic, but he would not be considered the primary care physician because he did not see patients at the nursing home. In an interview on 1/26/2024 at 4:10 PM, NP B stated he had covered this facility since October 2023. NP B stated he visited the facility 2 or 3 times per week depending on acuity. NP B stated at each facility visit he saw between 10 and 15 residents. NP B stated that he believed the rules for nurse practitioner visits were that new residents needed to be seen within the first 7 to 10 days after arrival at the facility, and every 60 days thereafter for long term residents as a follow up, and of course PRN for medically necessary occurrences, along with annual visits. NP B stated he prioritized which residents would be seen based on the after hours on-call notifications, a review of new laboratory and imaging results, consults with on-site nursing staff regarding any issues for residents. NP B stated there was a communication binder in which the on-site nurses would document any concerns they wanted him to address via orders. NP B stated these were typically non-acute or routine issues that needed orders to be filled. NP B stated he did not feel that any medical or nursing concern had been missed. NP B stated there is a lot of communication occurring between facility staff and the medical team to address any issues. NP B stated he did not have a list of which residents were seen on particular dates he visited the facility. NP B stated he did not have a list of which residents were seen for a medically necessary visit versus a required physician visit delegated to the NP role. In an interview on 1/27/2024 at 10:45 AM, the ADM stated, the MD saw all the residents on or about 9/25/2023, when the MD was stepping down from dual role of PCP and MD and would be assuming the role of MD only. The ADM stated that the residents would have next had a required visit on or about 11/25/2023 that could be an alternate visit conducted by NP B. The ADM stated that with the 10-day slippage, or grace period, there was still enough time for the required physician visits scheduled for 1/25/2024 to occur. The ADM stated that prior to that 10-day slippage, or grace period being up, all residents would be seen by either PCP A or the MD for the required physician visit every 30 days in the first 90 days and every 60 days thereafter visit. The ADM stated this would include a review of each resident's total program of care, current condition, progress or problems with health and well being maintenance. The ADM stated going forward, it would be a specific visit to meet the regulatory requirements. A telephone interviews with PCP A were attempt and unsuccessful on the following days: *1/25/2024 at 3:30 PM, * 1/26/2024 at 3:15 PM, and *1/27/2024 at 11:15 AM. Record review of Physician Services and Medical Director policy, implemented 2/2017, revealed, under the subheading Physician responsibilities, .physician is responsible for reviewing and approving the resident's total program of care. Under the subheading of Frequency of physician visits, residents are seen at least once every 30 days for the first 90 days after admission and at least once every 60 days thereafter. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676233 If continuation sheet Page 9 of 15 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 676233 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Bandera 222 Fm 1077 Bandera, TX 78003 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 0712 Record review of Medical Records policy, revised 1/2023, did not address accuracy or timely updates to the medical records. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676233 If continuation sheet Page 10 of 15 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 676233 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Bandera 222 Fm 1077 Bandera, TX 78003 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record reviews, the facility failed to maintain medical records on each resident that are accurately documented for 24 (Residents #53, #901, #88, #7, #50, #27, #39,, #41, #47, #141, #902, #903, #17, #63, #34, #1, #62, #904, #905, #84, #20, and #906,) of 24 residents reviewed for accurate medical records in that: The facility failed to ensure PCP A documented physician notes in the EHR since he started on or about 10/01/2023. This deficient practice could place all residents at an increased risk of not having their total program of care and condition reviewed, decisions about the continued appropriateness of the resident's current medical regimen documented, which could result in a decline in health and well-being. The findings included: Record review of the EHR revealed a lack of physician documentation for newly admitted residents, after 10/1/2023, wherein PCP A documented a review of the resident's total program of care, including the resident's current condition, progress and problems in maintaining or improving their physical, mental and psychosocial well-being and decisions about the continued appropriateness of the resident's current regimen. There were no physician progress notes written, signed and dated by PCP A for newly admitted residents after 10/1/2023. Record review of Admission/Discharge Report dated 1/27/2024, indicated there were 43 residents admitted [DATE] to 1/23/2024. Of those 43 residents, there was no documentation of required physician visits available in the EHR for 22 residents. Record review of admission record revealed Resident #53 was a resident admitted on [DATE] with dementia [general term for the impaired ability to remember, think, or make decisions that interferes with doing everyday activities] as a diagnosis. Record review of admission record revealed Resident #901 was a resident admitted on [DATE] with osteomyelitis [infection of the bone] as a diagnosis. Record review of admission record revealed Resident #88 was a resident admitted on [DATE] with Parkinson's disease [progressive disorder that affects the nervous system and the parts of the body controlled by the nerves] as a diagnosis. Record review of admission record revealed Resident #7 was a resident admitted on [DATE] with chronic obstructive pulmonary disease [chronic inflammatory lung disease that causes obstructed airflow from the lungs] as a diagnosis. Record review of admission record revealed Resident #50 was a resident admitted on [DATE] with severe chronic kidney disease, stage IV [severe loss of kidney function for 3 months or more] as a diagnosis. Record review of admission record revealed Resident #27 was a resident admitted on [DATE] with (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676233 If continuation sheet Page 11 of 15 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 676233 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Bandera 222 Fm 1077 Bandera, TX 78003 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 0842 acute respiratory failure as a diagnosis. Level of Harm - Minimal harm or potential for actual harm Record review of admission record revealed Resident #39 was a resident admitted on [DATE] with weakness as a diagnosis. Residents Affected - Many Record review of admission record revealed Resident #41 was a resident admitted on [DATE] with hypertensive heart and chronic kidney disease state V [also known as end-stage kidney disease] as a diagnosis. Record review of admission record revealed Resident #47 was a resident admitted on [DATE] with respiratory syncytial virus [common respiratory virus that usually causes mile, cold-like symptoms, but can be severe symptoms in older adults and infants] as a diagnosis. Record review of admission record revealed Resident #141 was a resident admitted on [DATE] with repeated falls as a diagnosis. Record review of admission record revealed Resident #902 was a resident admitted on [DATE] with acute respiratory failure as a diagnosis. Record review of admission record revealed Resident #903 was a resident admitted on [DATE] with orthopedic surgery aftercare as a diagnosis. Record review of admission record revealed Resident #17 was a resident admitted on [DATE] with ataxic cerebral palsy [developmental disorder that affects motor function such as balance and coordination] as a diagnosis. Record review of admission record revealed Resident #63 was a resident admitted on [DATE] with disorientation as a diagnosis. Record review of admission record revealed Resident #34 was a resident admitted on [DATE] with urinary tract infection as a diagnosis. Record review of admission record revealed Resident #1 was a resident admitted on [DATE] with chronic obstructive pulmonary disease as a diagnosis. Record review of admission record revealed Resident #62 was a resident admitted on [DATE] with syncope [fainting] and collapse as a diagnosis. Record review of admission record revealed Resident #904 was a resident admitted on [DATE] with systemic inflammatory response syndrome [exaggerated defense response from the body to a harmful stressor] as a diagnosis. Record review of admission record revealed Resident #905 was a resident admitted on 12/202023 with dehydration [occurs as a result of abnormal water loss from the body, or not taking in enough fluids] as a diagnosis. Record review of admission record revealed Resident #84 was a resident admitted on [DATE] with encephalopathy [any diffuse disease of the brain that alters brain function or structures, results in altered mental state] as a diagnosis. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676233 If continuation sheet Page 12 of 15 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 676233 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Bandera 222 Fm 1077 Bandera, TX 78003 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 0842 Level of Harm - Minimal harm or potential for actual harm Record review of admission record revealed Resident #20 was a resident admitted on [DATE] with falls as a diagnosis. Record review of admission record revealed Resident #906 was a resident admitted on [DATE] with alcohol dependence as a diagnosis. Residents Affected - Many Record review of the EHR, between 1/24/2024 and 1/25/2024, produced no electronic documentation of physician visits for Residents #53, #901, #88, #7, #50, #27, #39,, #41, #47, #141, #902, #903, #17, #63, #34, #1, #62, #904, #905, #84, #20, or #906. In a confidential interview on 1/24/2024 at 2:45 PM, 4 of 5 residents stated they had not seen their doctor in a while and wanted to see him/her more often. These residents stated that they could not recall the name of their new doctor or the last time they saw him. In an interview on 1/25/2024 at 4:13 PM, the ADM stated the MD stepped down as providing PCP services, and PCP A took over the PCP role about 10/01/2023. The ADM stated PCP A was at the facility multiple times per week and saw many residents each time he was in the building. The ADM stated most of his communication with PCP A was via messages or over the telephone. The ADM stated PCP A usually conducted his visits to the facility outside of normal business hours of Monday to Friday 8:00 AM to 5:00 PM, so it was not often that the ADM saw PCP A. The ADM stated he did not have a list of residents the PCP A or NP B had seen as a required physician visit once every 30 days during the first 90 days, and every 60 days thereafter. The ADM stated the facility did not keep track of which residents were seen and when. In a joint interview on 1/25/2024 at 5:00 PM, the DON and the ADM stated the MD would be adding a quality assurance check for the monitoring of physician visits for PCP A and NP B. The ADM stated when PCP A started, he knew there was a learning curve for using the facility's EHR. The ADM stated he had only just learned today [1/25/2024] that PCP A had not entered any physician notes. The ADM stated, it was his understanding that PCP A would be working on immediately transcribing and uploading his notes into the EHR system. The ADM stated it was his sincere belief that all residents' medical concerns had been attended to promptly. The DON stated she did not believe any resident health care concerns had been missed, and all necessary treatments had received valid orders in a timely manner and that facility staff had executed those orders appropriately. The ADM stated he would run an audit report [Admission/Discharge Report] and indicate which residents were missing documentation of required physician visits. In an interview on 1/26/2024 at 12:44 PM, the DON stated that there was some risk that documentation was not done, but she was confident the care was being provided. The DON stated she felt the level of communication between the facility, NP B and PCP A was intact and therefore adequate for provision of care to the residents. The DON stated she felt that all the residents' medical needs were being attended to and appropriate care was provided. In an interview on 1/26/2024 at 3:30 PM, the MD stated he had been medical director at this facility since it opened, approximately 15 or 20 years now. The MD stated it had never come up on a facility meeting agenda for the medical director to track timely physician visits. The MD stated that he was the medical director for over 50 nursing facilities in the area. The MD stated he assumed each nursing home was tracking when each resident needed to be seen for a physician visit versus a medically necessary visit. The MD stated he did not know if residents were seen by a physician every 60 days or if newly admitted residents were seen by a physician once every 30 days for their first 90 days (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676233 If continuation sheet Page 13 of 15 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 676233 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Bandera 222 Fm 1077 Bandera, TX 78003 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many after admission. The MD stated, the residents at the facility could elect to see him in his clinic, but he would not be considered the primary care physician because he did not see patients at the nursing home. In an interview on 1/26/2024 at 4:10 PM, NP B stated he had covered this facility since October 2023. NP B stated he visited the facility 2 or 3 times per week depending on acuity. NP B stated at each facility visit he saw between 10 and 15 residents. NP B stated that he believed the rules for nurse practitioner visits were that new residents needed to be seen within the first 7 to 10 days after arrival at the facility, and every 60 days thereafter for long term residents as a follow up, and of course PRN for medically necessary occurrences, along with annual visits. NP B stated he prioritized which residents would be seen based on the after hours on-call notifications, a review of new laboratory and imaging results, consults with on-site nursing staff regarding any issues for residents. NP B stated there was a communication binder in which the on-site nurses would document any concerns they wanted him to address via orders. NP B stated these were typically non-acute or routine issues that needed orders to be filled. NP B stated he did not feel that any medical or nursing concern had been missed. NP B stated there is a lot of communication occurring between facility staff and the medical team to address any issues. NP B stated he did not have a list of which residents were seen on particular dates he visited the facility. NP B stated he did not have a list of which residents were seen for a medically necessary visit versus a required physician visit delegated to the NP role. In an interview on 1/27/2024 at 10:45 AM, the ADM stated, the MD saw all the residents on or about 9/25/2023, when the MD was stepping down from dual role of PCP and MD and would be assuming the role of MD only. The ADM stated that the residents would have next had a required visit on or about 11/25/2023 that could be an alternate visit conducted by NP B. The ADM stated that with the 10-day slippage, or grace period, there was still enough time for the required physician visits scheduled for 1/25/2024 to occur. The ADM stated that prior to that 10-day slippage, or grace period being up, all residents would be seen by either PCP A or the MD for the required physician visit every 30 days in the first 90 days and every 60 days thereafter visit. The ADM stated this would include a review of each resident's total program of care, current condition, progress or problems with health and well being maintenance. The ADM stated going forward, it would be a specific visit to meet the regulatory requirements. A telephone interviews with PCP A were attempt and unsuccessful on the following days: *1/25/2024 at 3:30 PM, * 1/26/2024 at 3:15 PM, and *1/27/2024 at 11:15 AM. Record review of Physician Services and Medical Director policy, implemented 2/2017, revealed, under the subheading Physician responsibilities, .physician is responsible for reviewing and approving the resident's total program of care. Under the subheading of Frequency of physician visits, residents are seen at least once every 30 days for the first 90 days after admission and at least once every 60 days thereafter. Record review of Medical Records policy, revised 1/2023, did not address accuracy or timely updates (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676233 If continuation sheet Page 14 of 15 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 676233 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Bandera 222 Fm 1077 Bandera, TX 78003 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 0842 to the medical records. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676233 If continuation sheet Page 15 of 15