Health inspection·October 31, 2025

F 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few make herself understood and could usually understand others. Resident #4 was assessed with impaired vision without eyeglasses. Resident #4 was assessed with a BIMS score of 13 out of a possible 15 which indicated she was cognitively intact. A record review of Resident #4's care plan dated 10/28/2025 revealed, I have the potential to be verbally aggressive related to dementia . Anticipate my needs; food, thirst, toileting needs, comfort level, body positioning, pain, . If behavior is a threat to myself or others, immediately call for assistance. observe for and immediately report to the nurse and coordinator any signs or symptoms posing a danger to myself and or others . A record review of the facility's grievance log dated August 2025 revealed the log was blank revealing no grievances were documented for the month. A record review of Resident #3's nursing progress notes revealed LVN A documented a note on 8/14/2025 at 7:57 AM, Note Text: Alerted by staff that Resident [#3] was in dining room yelling, screaming, and shouting at other Resident [#4] this morning. Resident was becoming increasingly aggressive and verbally aggressive towards other Resident[s] and staff. Resident [#3] redirected by this nurse and other staff members. During an interview on 10/28/2025 at 11:00 AM Resident #3 stated on 8/14/2025 prior to the breakfast meal he and peer residents assembled in the dining room to await the breakfast meal the staff were preparing. Resident #3 stated the dietary staff and CNAs served coffee prior to the meal. Resident #3 stated he had purchased and kept his own powdered flavored creamer and had a routine where he would pour some creamer into a cup and take it to the dining room. Once there he would add the creamer to his coffee and would enjoy his flavored coffee. Resident #3 stated during this time Resident #4 had approached him to demand he give her his creamer to which he denied her request. Resident #3 stated he had valid reasons not to share his creamer primarily he was not aware if she could tolerate the creamer, he did not have enough creamer to share, etc Resident #3 stated Resident #4 became irate at Resident #3's denial of the coffee creamer and began to shout obscene insults at Resident #3 to which Resident #3 returned the obscene insults with equal volume. Resident #3 stated they were shouting at each other to the point it greatly disturbed him. Resident #3 stated LVN A intervened and escorted Resident #3 to his room where he continued to complain and explain to LVN A his complaint against Resident #4. Resident #3 stated he believed LVN A was not interested in resolving his complaint against Resident #4 and he resolved to refuse care and medications in protest to his dismissed complaint. During an interview on 10/28/2025 at 4:00 PM LVN A stated she was on duty on 8/14/2025 from 6:00 AM to 6:00 PM. LVN A stated early that morning prior to the breakfast meal being served she was alerted by a CNA to a disturbance in the dining room. LVN A stated she witnessed Resident #3 angrily cursing at Resident #4 and Resident #4 was cursing and shouting at Resident #3. LVN A stated she redirected Resident #3 away from the dining room and another CNA redirected Resident #4. LVN A stated Resident #3 was upset to the point of tears and cried and complained he was upset at Resident #4 who took his coffee creamer. LVN A stated the peace of the dining room was broken to the point other residents were emotionally disturbed. LVN A stated she documented the incident and reported it to the RN supervisor, RN B. LVN A stated she did not generate a grievance report but had reported the incident to her supervisor. During an interview on 10/31/2025 at 11:00 AM the DON stated the staff had received training to include the grievance process to document all grievances made by residents and to report those grievances to leadership. The DON stated she was not aware Resident #3 had made a grievance regarding Resident #4 and the disturbance in the dining room. The DON stated it was the responsibility of RN B and LVN A to have documented a grievance for Residents #3 and #4 and to also have reported the grievances to the grievance coordinator, the Administrator. The DON stated she would reinforce the staff training to include the grievance process. The DON stated the grievance process included the documentation of the resident's (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676301 If continuation sheet Page 2 of 8 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 676301 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Schertz 3301 Fm 3009 Schertz, TX 78154 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 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete complaint, the complaint would be reviewed by the grievance coordinator, the Administrator. The Administrator would assign the complaint to the appropriate department head and then would review the department head's report and resolution of the resident's complaint. The DON stated the potential negative outcome for residents not having their grievances resolved could be unresolved issues. A record review of the facility's Grievances / Complaints, Filing policy dated April 2017, revealed, Policy statement: presidents and their representatives have the right to file grievances, either orally or in writing, to the facility staff or to the agency designated to hear grievances . policy interpretation and implementation: all grievances, complaints or recommendations stemming from resident or family groups concerning issues of resident care in the facility will be considered. Actions on such issues will be responded to in writing, including the rationale for the response. upon receipt of a grievance and were complaint, the grievance officer will review and investigate the allegations and submit a written report of such findings to the administrator within 5 working days of receiving the grievance and or complaint. The resident or person filing the grievance and or complaint on behalf of the Resident, will be informed verbally and in writing of the findings of the investigation and the actions that will be taken to correct any identified problems. a written summary of the investigation will also be provided to the Resident, and a copy will be filed in the business office. Event ID: Facility ID: 676301 If continuation sheet Page 3 of 8 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 676301 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Schertz 3301 Fm 3009 Schertz, TX 78154 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record reviews the facility failed to ensure that all alleged violations involving abuse, neglect, exploitation or mistreatment, including injuries of unknown source and misappropriation of resident property, were reported immediately, but not later than 2 hours after the allegation is made, if the events that cause the allegation involve abuse or result in serious bodily injury, or not later than 24 hours if the events that cause the allegation do not involve abuse and do not result in serious bodily injury, to the administrator of the facility and to other officials (including to the State Survey Agency and adult protective services where state law provides for jurisdiction in long-term care facilities) in accordance with State law through established procedures. In response to allegations of abuse, neglect, exploitation, or mistreatment for 2 of 4 residents (Residents #3 and #4) reviewed for reporting allegations of ANE.On the morning of 8/14/2025 LVN A failed to report an allegation of verbal abuse and exploitation to the Administrator when Resident #4 harassed Resident #3 for his personal property, coffee creamer, and both Residents engaged in a verbal shouting match with an exchange of cursing insults between Resident #3 and Resident #4. This failure could place residents at risk for harm by verbal abuse and exploitation of personal property. The findings included: A record review of Resident #3's admission record dated 10/28/2025 revealed an admission date of 9/1/2024 with diagnoses which included mood disorder and schizoaffective disorder bipolar type (a chronic mental health condition that combines symptoms of both schizophrenia and bipolar disorder. Individuals with this type of schizophrenia experience psychotic symptoms like hallucinations and delusions, along with manic [highs] and depressive [lows] episodes that characterize bipolar disorder.) A record review of Resident #3's quarterly MDS assessment dated [DATE] revealed Resident #3 was a [AGE] year-old male admitted for long term care related to his needs for ADL supports with myasthenia (a chronic autoimmune disorder that causes progressive muscle weakness that worsens with activity and improves with rest) and safety supports with his schizoaffective disorder. Further review revealed Resident #3 was assessed with adequate hearing, adequate speech pattern, could make himself understood, could understand others, and used eyeglasses. Resident #3 was assessed with a BIMS score of 9 out of a possible 15 which indicated moderate cognitive impairment. A record review of Resident #3's care plan dated 10/28/2025 revealed, I have the potential to be verbally aggressive related to ineffective coping skills, poor impulse control . anticipate and remove triggers that cause me to show signs of agitation, anger or aggression. A record review of Resident #4's admission record dated 10/28/2025 revealed an admission date of 8/22/2022 with diagnoses which included dementia (a general term for a loss of mental abilities, like memory and thinking skills, that is severe enough to interfere with daily life), anxiety, major depressive disorder, and impulse disorders (a group of psychiatric conditions characterized by the inability to resist an urge or impulse to perform an act that is harmful to oneself or others). A record review of Resident #4's quarterly MDS assessment dated [DATE] revealed Resident #4 was a [AGE] year-old female admitted for long term care with supports for her needs related to Parkinson's disease (a progressive neurological disorder that affects movement, caused by the death of brain cells that produce dopamine, a chemical messenger) and dementia. Resident #4 was assessed with moderate difficulty hearing, did not use hearing aids, had clear speech, could usually make herself understood and could usually understand others. Resident #4 was assessed with impaired vision without eyeglasses. Resident #4 was assessed with a BIMS score of 13 out of a possible 15 which indicated she was cognitively intact. A record review of Resident #4's care plan dated 10/28/2025 revealed, I have the potential to be verbally aggressive related to dementia . (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676301 If continuation sheet Page 4 of 8 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 676301 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Schertz 3301 Fm 3009 Schertz, TX 78154 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Anticipate my needs; food, thirst, toileting needs, comfort level, body positioning, pain, . If behavior is a threat to myself or others, immediately call for assistance. observe for and immediately report to the nurse and coordinator any signs or symptoms posing a danger to myself and or others . A record review of the Texas Unified Licensure Information Portal websitehttps://txhhs.my.salesforce.com/?ec=302&startURL=%2Fvisualforce%2Fsession%3Furl%3Dhttps%253A%252F%2 10/28/2025, revealed no information / report for the incident between Resident #3 and Resident #4 on 8/14/2025. A record review of Resident #3's nursing progress notes revealed LVN A documented a note on 8/14/2025 at 7:57 AM, Note Text: Alerted by staff that Resident [#3] was in dining room yelling, screaming, and shouting at other Resident [#4] this morning. Resident was becoming increasingly aggressive and verbally aggressive towards other Resident[s] and staff. Resident [#3] redirected by this nurse and other staff members. During an interview on 10/28/2025 at 11:00 AM Resident #3 stated on 8/14/2025 prior to the breakfast meal he and peer residents assembled in the dining room to await the breakfast meal the staff were preparing. Resident #3 stated the dietary staff and CNAs served coffee prior to the meal. Resident #3 stated he had purchased and kept his own powdered flavored creamer and had a routine where he would pour some creamer into a cup and take it to the dining room. Once there he would add the creamer to his coffee and would enjoy his flavored coffee. Resident #3 stated during this time Resident #4 had approached him to demand he give her his creamer to which he denied her request. Resident #3 stated he had valid reasons not to give his creamer away, primarily he was not aware if she could tolerate the creamer, he did not have enough creamer to give away, etc Resident #3 stated Resident #4 became irate at Resident #3's denial of the coffee creamer and began to shout obscene insults at Resident #3 to which Resident #3 returned the obscene insults with equal volume. Resident #3 stated they were shouting at each other to the point it greatly disturbed him. Resident #3 stated LVN A intervened and escorted Resident #3 to his room where he explained to LVN A that Resident #4 attempted to take his coffee creamer. Resident #3 stated he believed LVN A was not interested in resolving his complaint against Resident #4 and he resolved to refuse care and medications in protest to his dismissed complaint. During an interview on 10/28/2025 at 4:00 PM LVN A stated she was on duty on 8/14/2025 from 6:00 AM to 6:00 PM. LVN A stated early that morning prior to the breakfast meal being served she was alerted by a CNA to a disturbance in the dining room. LVN A stated she witnessed Resident #3 angrily cursing at Resident #4 and Resident #4 was cursing and shouting at Resident #3. LVN A stated she redirected Resident #3 away from the dining room and another CNA redirected Resident #4. LVN A stated Resident #3 was upset to the point of tears and cried and complained he was upset at Resident #4 who attempted to take his coffee creamer. LVN A stated the peace of the dining room was broken to the point other residents were emotionally disturbed. LVN A stated she documented the incident and reported it to the RN supervisor, RN B. LVN A stated she did not report the incident to the DON and/or the Administrator and stated, I did document the incident in the residents nursing progress notes. During an interview on 10/31/2025 at 11:00 AM the DON stated the staff had received training to include prevention and reporting allegations of ANE and to document all allegations of ANE and to report those allegations to leadership. The DON stated she had not received a report from RN B nor LVN A concerning the exchange of shouting insults between residents #3 and #4 during the disturbance in the dining room. The DON stated it was the responsibility of RN B and LVN A to have documented and reported to the ANE coordinator, the Administrator, the shouting between Residents #3 and #4. The DON stated she would reinforce the staff training to include the reporting ANE allegations process. The DON stated the reporting ANE allegations process included the documentation of the incident, the Allegations would be reviewed by the ANE (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676301 If continuation sheet Page 5 of 8 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 676301 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Schertz 3301 Fm 3009 Schertz, TX 78154 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete coordinator, the Administrator. The Administrator would report the ANE allegation to the State Agency, assess residents for safety, assign the investigation to the appropriate department head and then would provide the staff with re-enforced training for ANE prevention and reporting protocol. The DON stated the potential negative outcome for residents not having their allegations of ANE reported could be ANE. A record review of the facility's Abuse, Neglect, Exploitation or Misappropriation - Reporting and Investigating dated September 2022, revealed, Policy Statement:All reports of resident abuse (including injuries of unknown origin), neglect, exploitation, or theft/misappropriation of resident property are reported to local, state and federal agencies (as required by current regulations) and thoroughly investigated by facility management. Findings of all investigations are documented and reported.Policy Interpretation and Implementation Reporting Allegations to the Administrator and Authorities:If resident abuse, neglect, exploitation, misappropriation of resident property or injury of unknown source is suspected, the suspicion must be- reported immediately to the administrator and to other officials according to state law and HHSC reporting guidelines.The administrator or the individual making the allegation immediately reports his or her suspicion to the following persons or agencies:The state licensing/certification agency responsible for surveying/licensing the facility.The local/state ombudsman.The resident's representative.Adult protective services (where state law provides jurisdiction in long-term care).Law enforcement officials.The resident's attending physician; andThe facility medical director. Event ID: Facility ID: 676301 If continuation sheet Page 6 of 8 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 676301 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Schertz 3301 Fm 3009 Schertz, TX 78154 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews the facility failed to develop and implement a comprehensive person-centered care plan for each resident, consistent with the resident rights for 1 of 4 residents (Resident #1) reviewed for care plans. On 8/21/2025 Resident #1 returned to the facility after hospitalization for a left arm fracture. Resident #1 was prescribed to wear a stabilization arm sling. The sling was not added to the care plan. This failure could place residents at risk for not having a care plan for care needed. The findings included: A record review of Resident #1's admission record dated 10/28/2025 revealed an admission date of 7/9/2024 with diagnoses which included hemiplegia (a medical condition characterized by paralysis or severe weakness on one side of the body). A record review of Resident #1's quarterly MDS assessment dated [DATE] revealed Resident #1 was a [AGE] year-old male admitted for LTC with supports for ADLs and his needs for care with semi-paralysis. Resident #1 was assessed with a BIMS score of 13 which indicated intact cognition. Resident #1 was assessed with adequate eyesight without glasses, adequate hearing without hearing aids, and had the ability to understand others and could make himself understood. A record review of Resident #1's physicians orders dated 8/22/2025 revealed the physician ordered for Resident #1 to wear an arm sling, Ensure sling to left arm is in place - may remove for showers and skin assessments - non weight bearing to left arm - every shift - related to fracture of upper end of left humerus (the long bone in the upper arm, extending from the shoulder joint to the elbow joint). A record review of Resident #1's care plan dated 10/30/2025 revealed, I had an actual fall 8/21/2025 r/t self-transferring to toilet from W/C without assist, Injury noted, Date Initiated: 04/21/2025, Revision on: 10/29/2025. Further review revealed no focus, goal, nor interventions to support Resident #1 with his need for a stabilizing arm sling for his fractured left arm. During an observation and interview on 10/30/2025 at 4:10 PM revealed Resident #1 self-ambulating in the facility in his wheelchair. Resident #1 presented with a left arm soft cast / brace and a sling. Resident #1 stated he was prescribed the sling to stabilize his broken left arm until the doctor decided how to fix his arm. Resident #1 stated the nurses and CNAs helped him with his sling and were very good to him. During an interview on 10/28/2025 at 4:00 PM LVN A stated she was a nurse who cared for Resident #1. LVN A stated she Resident #1 had a fall where he fractured his left arm and now was prescribed to use a sling and soft cast to his left arm. LVN A stated she reviewed the care plan, and no focus, goals, and interventions were documented for the soft cast brace / sling. LVN A stated although there were no care plan interventions for Resident #1; she ensured Resident #1 wore his sling and delegated to her CNAs to ensure Resident #1 wore his sling. During an interview on 10/30/2025 at 12:00 PM the DON stated Resident #1 had a fall from his toilet, fractured his left arm, was hospitalized , and returned from the hospital with a prescribed sling for his left arm. The DON stated she was responsible for reviewing all post hospitalization admissions. The DON stated Resident #1 had returned from the hospital after being diagnosed with his left arm broken and was prescribed to wear a sling. The DON stated she failed to ensure the care for the sling was care-planned. The DON stated the potential negative outcome for residents not having their orders care-planned could be no support for their needed care. A record review of the facility's Care Plans, Comprehensive Person-Centered policy dated March 2022, revealed, Policy Statement:A comprehensive, person-centered care plan that includes measurable objectives and timetables to meet the resident's physical, psychosocial and functional needs is developed and implemented for each resident.Policy Interpretation and Implementation: .2. The comprehensive, person-centered care plan is developed within seven (7) days of the completion of the required MDS (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676301 If continuation sheet Page 7 of 8 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 676301 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Schertz 3301 Fm 3009 Schertz, TX 78154 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 0656 Level of Harm - Minimal harm or potential for actual harm assessment (Admission, Annual or Significant Change in Status), and no more than 21 days after admission.3. The care plan interventions are derived from a thorough analysis of the information gathered as part of the comprehensive assessment.7. The comprehensive, person-centered care plan:a. includes measurable objectives and time frames;b. describes the services that are to be furnished to attain or maintain the residents' highest practicable physical, mental, and psychosocial well-being, . Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676301 If continuation sheet Page 8 of 8