Health inspection·November 21, 2024

F 0573 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Let each resident or the resident's legal representative access or purchase copies of all the resident's records. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to ensure the resident has the right to access personal and medical records pertaining to himself and allow the resident to obtain a copy of the records upon request and upon two working days advance notice to the facility for 1 of 2 residents (CR#1) whose records were reviewed in that: - The facility failed to provide CR#1's Responsible party copies of medical records after a request was submitted to the facility on [DATE]. This failure could place residents at risk of violation of their rights by not receiving copies of their medical records. Findings included: Record review of the admission sheet (undated) for CR #1 revealed a [AGE] year-old male admitted to the facility on [DATE] and discharged on 09/29/2023. His diagnoses included type 2 diabetes mellitus (a long-term condition in which the body has trouble controlling blood sugar and using it for energy), hypertension (a condition in which the force of the blood against the artery walls is too high) and bed confinement (unable to get up from bed without assistance, unable to ambulate, and unable to sit in a chair or wheelchair). Family member was listed as Responsible Party. Resident was transferred to the hospital on [DATE]. Record review of CR #1's Quarterly MDS assessment, dated 09/25/2023, revealed the BIMS score 07 out of 15 indicating severely impaired cognition. He required extensive assistance from staff physical assist for personal hygiene, toilet, dressing and bed mobility. Resident was always incontinent of bowel and bladder. Record review of CR #1's care plan initiated 3/17/2023 and revised on 10/06/2023 revealed the following: Focus: The resident has potential fluid deficit r/t feeding tube as a nutritional approach Goal: The resident will be free of symptoms of dehydration and maintain moist mucous membranes, good skin turgor. Interventions: Administer medications as ordered. Monitor/document for side effects and effectiveness. Monitor/document/report PRN any s/sx of dehydration: decreased or no urine output, concentrated urine, strong odor, tenting skin, cracked lips, furrowed tongue, new onset confusion, dizziness on sitting/standing, increased pulse, (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 2 Event ID: 676314 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 676314 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/21/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Orem 3730 W. Orem Drive Houston, TX 77045 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)