Health inspection·August 8, 2025

F 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few painful muscle cramping, slow-healing wounds, and an increased risk of stroke or heart attack), homocysteine [NAME] (is an amino acid that plays a crucial role in protein metabolism), Chronic Kidney Disease stage 3, Alzheimer's dementia (is a group of symptoms that affect a person's ability to perform everyday activities due to a decline in cognitive functioning). Record review of Resident #2's Quarterly MDS, dated [DATE], revealed BIMS Score was 3 (severely impaired), Incontinent of bowel & bladder. Active Diagnoses: Renal Insufficiency, Diabetes Mellitus, Non-Alzheimer's Dementia, Depression, Morbid Obesity, Muscle weakness, muscle wasting and atrophy. Resident has one unhealed pressure ulcer. One Unstageable - Deep tissue injury. Pressure reducing device for chair/bed. Review of Care Plan for Resident #2's revealed:- Care Plan dated initiated: 07/24/25. Resident receiving hospice services r/t Terminal disease process. Interventions: Notify hospice nurse and MD for any decline in resident's condition. - Care Plan initiated: 06/19/25. The resident has an unstageable pressure ulcer to the coccyx and potential for pressure ulcer development r/t disease process (Muscle weakness, DMII, muscle wasting/atrophy and morbid obesity), Immobility. Interventions: Administer treatments as ordered and monitor for effectiveness. Treat pain as per orders prior to treatment/turning etc. to ensure the resident's comfort. Weekly treatment documentation to include measurement of each area of skin breakdown's width, length, depth, type of tissue and exudate. Review of Hospice Certification and Plan of Care for Resident #2 revealed, Start of Care Date: 07/23/25. Diagnoses: Senile degeneration of brain, Type 2 Diabetes Mellitus, Chronic Kidney Disease. Orders and Treatment: Facility to provide wound care as ordered. Goals: Skin breakdown and/or wounds will be managed without infection. DME-Low air loss mattress; incontinent care and wound supplies. Activities Permitted: Complete bedrest. Review of Hospice Communication Log for Resident #2 revealed, 07/28/25 Patient's wound to sacrum with purulent drainage. New wound care orders provided. 07/29/25 Started antibiotics and new wound care orders. Review of Hospice Physician's Telephone/Verbal Order dated 7/28/25 at 11:30 AM, revealed Regarding wound to sacrum, cleanse with normal saline, pat dry, apply Silvadene to wound bed, pack with 4 x 4 gauze moistened with normal saline, cover with 4 x 4 gauze, secure with foam dressing. Change daily and PRN when soiled.Review of Hospice Physician Order Summary dated 07/30/25 for Resident #2 revealed. Order Date: 07/28/25 Wound to sacrum, clean with N/S or wound cleanser, pat dry, apply Silvadene to wound bed, cover with 4x4 gauze, secure with foam dressing, change daily and PRN when soiled for Wound protection. Order Date: 07/28/25: Bactrim DS Oral tablet 800-160 mg give one tablet by mouth one time a day for wound infection for 14 days.Interview on 07/28/25 at 12:08 PM with CNA D assigned to Resident #2, said the resident had a pressure ulcer to the sacral area. During an interview on 07/28/25 at 2:46 PM, with LVN WCC, she said Resident #2 had been admitted from the hospital with a stage IV pressure ulcer to the sacrum. Observation and interview on 07/28/25 at 2:48 PM, revealed Resident #2 was lying in bed on her back. LVN WCC A and CNA B turned the resident to her right side and the resident did not have the dressing on the stage IV pressure ulcer on the sacrum. LVN WCC A stated that the CNAs had been trained to immediately report to her or the licensed staff if the dressing was not on the pressure wounds to prevent contamination of the wound with urine and feces. In an interview on 07/28/25 at 3:57 PM, with LVN C, 2-10 nurse assigned to Resident #2, he said the resident was in the Hospice case load and had a stage 4 pressure ulcer to the sacrum. He said that the CNAs had been trained, to immediately report to the charge nurse or the treatment nurse if the wound dressings were loose and/or if they found a resident without the dressing on the wounds, to prevent to prevent urine and feces from getting in the wound and to prevent infection. He said that no one had reported to him at the start of shift, that Resident #2 did not have the dressing on the wound to the sacrum. During an interview on 07/29/25 at 1:38 PM, with LVN A, 6-2 Shift assigned to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676468 If continuation sheet Page 2 of 12 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 676468 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Patriot 11490 Gateway North Blvd. El Paso, TX 79934 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 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Resident #2, revealed the resident was receiving Hospice services, had been refusing to eat for a while and had a stage 4 pressure ulcer on the sacrum. She said that the CNAs had been trained to immediately report to the nurses, if wound dressings are loose or have fallen off, to prevent urine and feces from getting into the wound and to prevent infection. She said, The Hospice CNA and CNA E did not report to me on 7/28/25 after they had finished the bed bath on that day, that the resident did not have a dressing on the stage IV pressure ulcer on the sacrum. She said that she did not know if the WCC had been informed by CNA E that the resident did not have the dressing to the stage IV pressure ulcer on the sacrum on that day. She said it was important to reapply the dressing as soon as possible to prevent urine and feces from getting into the wound, that could cause the wound to become infected. During an interview on 07/30/25 at 10:14 AM, with the DON, revealed that she had placed a telephone call to the Hospice CNA, and she had confirmed Resident #2, did not have a dressing on the wound to the sacrum, when she came on 07/28/25 in the morning shift to give the resident a bed bath and that she had not reported to the nurse that the resident did not have the wound dressing on the stage IV pressure on the sacrum. She said that the Hospice CNAs had been trained to immediately report to the nurse if the resident were found without the wound dressing on the sacrum to prevent urine and feces getting into the wound and prevent the risk for infection.During an interview on 07/30/25 at 11:08 AM, with CNA D on the 6-2 shift, revealed that on Monday 07/28/25, revealed the Hospice CNA had come to give Resident #2 a bed bath and did not mention to her that the resident did not have the wound dressing to the stage VI pressure ulcer on the sacrum when she changed the resident's brief to give the resident a bed bath on that day. CNA D said they had been trained to immediately report to the nurse if they found a resident without the dressing to the pressure wounds to prevent the urine and feces from getting into the wound and cause an infection. During an interview on 07/30/25 at 11:30 AM, with LVN E assigned to Resident #2 on the weekends, revealed resident had a stage IV pressure ulcer on her sacrum, and treatments were done by the weekend treatment nurse. She said the CNAs had been trained to immediately report to the nurses and/or the treatment nurses when the resident did not have a dressing on the pressure ulcer, to prevent the wound becoming contaminated with urine and feces, that could place the resident at risk of infection. Telephone interview with NP on 08/07/25 at 11:24 AM, revealed that Resident #2 was on Hospice Services for a diagnosis of dementia and had developed an unavoidable pressure ulcer to the sacrum. She said that the resident was immobile, had not been eating a substantial amount of food for over 5 weeks, several treatments to the existing wound were unsuccessful and that was why the resident had been referred to Hospice Services. She said the resident has had significant weigh loss due to not eating, so the poor nutritional intake, poor hydration, her diabetes mellitus and chronic kidney failure, and lack of adequate nutrition results in malnutrition so all these factors contributed to the development of the stage VI pressure ulcer. She said that the staff has also reported to her that the resident does not like to be turned & repositioned in bed and that she prefers to stay on her back. She said that the resident had the right to refuse care and that included not wanting to be turned and repositioned in bed. She said that she was also aware that Hospice had discontinued the appetite stimulant and all the vitamins that were ordered to promote wound healing. She said the physician was aware of the resident's status and agree with the Hospice treatment plan. She said that the pressure ulcer must be always covered with the wound dressing to prevent urine and feces from getting into the wound and cause an infection. Telephone interview on 08/07/25 at 12:58 PM, with Hospice Nurse revealed Resident #2 had been admitted to the nursing facility from the hospital with the stage IV pressure ulcer to the sacrum. She said that they were aware that the eating was eating very little and taking small amounts of water. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676468 If continuation sheet Page 3 of 12 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 676468 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Patriot 11490 Gateway North Blvd. El Paso, TX 79934 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 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete She said the physician was also aware that the resident was not eating and did not allow the staff to turn & reposition her to the sides and preferred to stay on her back. She said that she remembered coming to see the resident on 07/28/25, when the Hospice Aide went to the nursing facility to give the resident a bed bath. She said, I saw the resident prior to the Hospice CNA starting the bed bath and noted that the sacral wound just had an abdominal pad hanging from the wound. She said that the Hospice staff had been trained to immediately report to the facility nurses to prevent urine and feces from getting inside the wound and cause an infection. Review of the facility's P&P on Prevention of Pressure Ulcers revised in April 2022, revealedInspect the skin daily when performing or assisting with personal care or ADLs. Use facility-approved protective dressings for at risk individuals. Review of facility on Pressure Ulcers/Skin Breakdown - Clinical Protocol dated 2001 revealed, Treatment/Management The physician/physician extender will authorize pertinent orders related to wound treatments, including wound cleansing and debridement approaches, dressings (occlusive, absorptive, etc.), and application of topical agents if indicated for type of skin alteration. The physician/physician extender will help identify medical interventions related to wound management; for example, treating a soft tissue infection surrounding an ulcer, removing necrotic tissue, addressing comorbid medical conditions, managing pain related to the wound or to wound treatment, etc. Event ID: Facility ID: 676468 If continuation sheet Page 4 of 12 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 676468 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Patriot 11490 Gateway North Blvd. El Paso, TX 79934 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 - Few 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 interview, and record review, the facility failed to maintain clinical records on each resident that were complete and accurately documented in accordance with accepted professional standards and practices for 1 (Resident #1) of 6 residents reviewed for accuracy and completeness.The facility failed to ensure that LVN A completed a weekly skin assessment for Resident #1 on 7/22/25 in accordance with facility policy. This failure placed residents at risk for unmet care needs, as services may be documented as provided when they were not, potentially leading to delays in treatment or unidentified changes in condition. Findings include:Record review of Resident #1's face sheet dated 07/30/25 revealed an [AGE] year-old male who was admitted to the facility on [DATE] and re-admitted on [DATE]. Record review of Resident #1's history and physical dated 6/22/25 revealed diagnoses of malfunction of nephrostomy tube (the tube placed into the kidney to drain urine isn't working properly. It might be clogged, leaking, or not staying in place), bilateral hydronephrosis (both kidneys are swollen because urine can't flow out the way it should. It usually happens when there's a blockage somewhere in the urinary system), left hydroureter (the ureter on the left side (the tube that carries urine from the kidney to the bladder) is swollen, usually because something is blocking the urine from flowing), and displacement of the left percutaneous nephrostomy tube (the tube placed into the left kidney to help drain urine has moved out of place). Record review of Resident #1's quarterly MDS dated [DATE] revealed a BIMS score of 10, which indicated his cognition was moderately impaired. Section H revealed he had indwelling catheter and ostomy. Record review of Resident #1's care plan dated 5/21/25 revealed a focus care area for risk for impaired skin integrity and need for preventative measures with interventions that included skin checks per facility policy. He also had a focus area for has nephrostomy tube to his right side with interventions that included monitor/document for pain/discomfort due to the catheter. Record review of Resident #1's skin assessments for July 2025 revealed no assessment was completed for the week of 07/21-07/25. During an interview on 07/30/25 at 11:31 am, LVN A stated nurses were responsible for completing skin assessments and that they were scheduled per shift daily. LVN A stated Resident #1 assessments were scheduled every Wednesday. LVN A stated she did not complete the assessment on 7/22/25 because one had been completed on 7/19/25. LVN A stated she reviewed the skin assessment and assumed the nurse had completed a full head-to-toe assessment. When asked about weekly assessment expectations, LVN A changed her response and stated she had completed a full head-to-toe assessment on 7/22/25 because it was the resident's shower day, and she had checked the nephrostomy site but failed to document it. LVN A was unable to provide a reason for not documenting the skin assessment and remained silent, stating she should have completed the documentation. LVN A stated the risks of not completing the weekly skin assessment included lack of continuity of care and failure to complete job duties.During an interview on 07/30/25 at 11:41 am, LVN B stated she completed an assessment following an altercation involving the resident, but did not complete the scheduled weekly skin assessment because she believed the incident-related check was sufficient. LVN B stated a posted schedule at the nurse's station assigned weekly skin assessments to nurses per shift. LVN B stated that nurses were still expected to complete their assigned weekly skin assessments even if an assessment was performed during the week for another reason. LVN B stated that failing to complete the scheduled weekly assessment could impact continuity of care. LVN B stated she had received training on skin assessments but could not recall when.During an interview on 07/30/25 at 1:33 pm, DON stated the wound care nurse began conducting weekly audits on weekends to ensure all residents received weekly skin assessments. The DON stated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676468 If continuation sheet Page 5 of 12 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 676468 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Patriot 11490 Gateway North Blvd. El Paso, TX 79934 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 - Few FORM CMS-2567 (02/99) Previous Versions Obsolete that verification of weekly skin assessments was expected to be completed by the ADONs. The DON stated she would begin conducting spot checks moving forward. The DON stated there was no quality assurance process in place for the weekend audits conducted by the wound care nurse.Record review of facility's Charting and Documentation policy dated 2001 read in part The following information is to be documented in the resident medical record: a. Objective observations; b. Medications administered; c. Treatments or services performed; d. Changes in the resident's condition; e. Events, incidents or accidents involving the resident; and f. Progress toward or changes in the care plan goals and objectives. Event ID: Facility ID: 676468 If continuation sheet Page 6 of 12 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 676468 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Patriot 11490 Gateway North Blvd. El Paso, TX 79934 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment, and to help prevent the development and transmission of communicable diseases and infections for two of five residents (Residents #2 and #3) reviewed for Enhanced Barrier Precautions. The facility failed to implement their policy on Enhanced Barrier Precautions for residents with wounds and/or indwelling medical devices. These failures could place residents at risk for healthcare associated cross-contamination and at risk of the transmission of multi-drug-resistant organism (MDROs).The findings included: Resident #2 Review of Resident #2's admission Record, dated 07/30/25, revealed an [AGE] year-old female who was admitted to the facility on [DATE] and re-admitted on [DATE]. Review of Hospital Physician Progress Note dated 07/07/25 for Resident #2 revealed, [AGE] year-old female with a history of dementia (a condition that causes a decline in thinking, memory, and reasoning skills) presented to the emergency room from nursing home for abdominal distention (belly is sticking out more than usual, making it look swollen or bloated). Stage 4 pressure ulcer (is a very deep crater on the skin in the area of the tailbone) present on admission. Review of Nursing Facility History & Physical dated 07/14/25 for Resident #2 revealed, History of Present Illness: This is an [AGE] year-old Hispanic female patient seen today for a Post Hospitalization where she was treated for Possible aspiration pneumonia (An infection in the lungs that occurs when food, liquid, or saliva accidentally enters the lungs instead of the stomach), Baseline dementia (is a condition where an individual's cognitive function does not return to normal even when all other diseases are under control), Metabolic encephalopathy/multifactorial (is a condition where the brain's function is affected due to metabolic disturbances, often caused by underlying health issues. It can cause confusion, memory loss, and altered consciousness), During the visit the patient was awake in bed, responsive and alert. Per nursing the patient continues to eat very poorly. Will refer for a hospice evaluation and admission. Past Medical History Active Medical Problems: Diabetes Mellitus with PVD (means that a person with diabetes has a higher risk of developing a condition called Peripheral Vascular Disease (a condition that affects the blood vessels outside the heart and brain and lead to symptoms like painful muscle cramping, slow-healing wounds, and an increased risk of stroke or heart attack), homocysteine [NAME] (is an amino acid that plays a crucial role in protein metabolism), Chronic Kidney Disease stage 3, Alzheimer's dementia (is a group of symptoms that affect a person's ability to perform everyday activities due to a decline in cognitive functioning). Record review of Resident #2's Quarterly MDS, dated [DATE], revealed BIMS Score was 3 (severely impaired), Incontinent of bowel & bladder. Active Diagnoses: Renal Insufficiency, Diabetes Mellitus, Non-Alzheimer's Dementia, Depression, Morbid Obesity, Muscle weakness, muscle wasting and atrophy. Weight: 193 pounds. Resident has one unhealed pressure ulcer. One Unstageable - Deep tissue injury. Pressure reducing device for chair/bed. Review of Care Plan for Resident #2's dated 06/19/25 revealed, the resident has an unstageable pressure ulcer to the coccyx and potential for pressure ulcer development r/t disease process (Muscle weakness, DMII, muscle wasting/atrophy and morbid obesity), Immobility. Interventions: Enhanced barrier precautions. Review of Hospice Communication Log for Resident #2 revealed, 07/28/25 Patient's wound to sacrum with purulent drainage. New wound care orders provided. 07/29/25 Started antibiotics and new wound care orders. Review of Physician Order Summary dated 07/30/25 for Resident #2, revealed Order Date: 06/26/25 EBP: Staff must use gown and gloves during high contact resident care activities that could possibly to result in transfer of MDROs to hands and clothing of staff. Enhanced Barrier Precautions are recommended for residents known to be Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676468 If continuation sheet Page 7 of 12 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 676468 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Patriot 11490 Gateway North Blvd. El Paso, TX 79934 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some colonized or infected with a MDRO as well as those who are not confirmed to have an MDRO (e.g., residents with indwelling medical devices). Order Date: 07/28/25 Wound to sacrum, clean with N/S or wound cleanser, pat dry, apply Silvadene to wound bed, cover with 4x4 gauze, secure with foam dressing, change daily and PRN when soiled for Wound protection. Observation and interview on 07/28/25 at 12:08 PM revealed there was not a sign posted on the entrance door for Enhanced Barrier Precautions and there was no PPE in Resident #2's room. Hospice CNA was in the room giving the resident a bed bath. She had on an isolation gown and gloves. The resident was lying on her back on an air mattress. CNA D and CNA F entered the room to assist the Hospice CNA to turn and reposition the resident. CNA D put on gloves and did not put on a gown, assisted the Hospice CNA to turn the resident to her left side for the Hospice CNA to continue with the bed bath. Observation on 07/28/25 at 3:16 PM, with LVN ADON G revealed Resident #2 had stage IV pressure ulcer on sacral area and did not have EBP sign posted on the door to the entrance of the room and there was no PPE readily available by the entrance to the room and/or in the resident's room to use when providing direct care to the resident to prevent cross contamination and prevent the spread of infection. During an interview on 07/30/25 at 11:30 AM, with LVN A assigned to Resident #2 on the 6-2 shift, revealed resident had a stage IV pressure ulcer on her sacrum, and was supposed to be on EBP. She said, I do not recall if the EBP sign was posted on the entrance to the room and if PPE was kept by the entrance to the room on 07/28/25. She said that the ADON posted the EBP signs on the entrance door to the resident rooms and PPE was readily available for staff to use in the resident halls. She said, When residents are placed on EBP, the staff must use a gown and gloves when providing direct care to the resident to prevent cross contamination and prevent the spread of infection. Resident #3 Review of Resident #3's admission Record, dated 07/30/25, revealed a [AGE] year-old female who was admitted to the facility on [DATE]. Review of History & Physical dated 06/13/25 for Resident #3 revealed, Past Medical History: Lymphedema, heart failure, type 2 diabetes mellitus, chronic anemia, and chronic lower extremity wounds. Physical Examination: Alert and oriented x3. Right lower extremity below the knee amputation with Wound VAC (is a medical device that helps wound heal faster by using suction to remove fluid and promote new tissue. It's like a gentle vacuum cleaner for wounds, constantly removing excess fluid and debris while encouraging the wound to close) in place draining serial serosanguineous fluid. Dry dressing. Assessment: Sepsis secondary to right foot ulceration. Status post right below knee amputation on wound VAC. Bilateral venous stasis dermatitis, Morbid obesity, Hypertension, Diabetes mellitus type 2, Acute blood loss, Anemia status post BKA. Review of admission MDS dated [DATE] for Resident #3 revealed, indwelling catheter, occasionally incontinent of bowel; Active Diagnoses: Multidrug-Resistant Organism (MDRO) (is a germ that is resistant to many antibiotics), cellulitis (is a common bacterial infection of the deeper layers of the skin), osteomyelitis (is a bone infection), other major orthopedic surgery; surgical wound; surgical wound care. Review Care Plan for Resident #3 revised 06/13/25, revealed Resident had skin impairment to the Rt. BKA r/t surgical wound. Interventions: Interventions documented in part: Enhanced barrier precautions. Review of Physician Order Summary dated 07/30/25 for Resident #3 revealed, Order Date: 07/15/25 EBP: Staff must use gown and gloves during high contact resident care activities that could result in transfer of MDROs to hands and clothing of staff. Enhanced Barrier Precautions are recommended for residents known to be colonized or infected with a MDRO as well as those who are not confirmed to have an MDRO (e.g., residents with indwelling medical devices). Foley Catheter care every shift and prn. Gently cleanse the right BKA surgical wound with normal saline or wound cleanser, pat dry, apply oil emulsion, abdominal pad and wrap with kerlix daily. Observation on 7/28/25 at 12:18 PM, with Resident #3 revealed there was not a sign posted on the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676468 If continuation sheet Page 8 of 12 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 676468 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Patriot 11490 Gateway North Blvd. El Paso, TX 79934 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some entrance door for Enhanced Barrier Precautions. The resident was alert, oriented to person, place, and time. She said that she needed total assistance with personal care. She said she was admitted with the indwelling catheter from the hospital. She said that she used a brief, because she was incontinent of bowel. She said she had her right lower leg amputated below the knee approximately 2 months ago. She said the treatment to her right leg was done daily by the Wound Care Nurse. Observation and interview on 07/28/25 at 2:26 PM, with LVN WCC, revealed Resident #3 was admitted from hospital with status post BKA to the right lower extremity and had an opened surgical wound. She said resident had an opened surgical wound on the right stump that was treated daily. She said the resident had an indwelling catheter and was incontinent of bowel. It was observed that the nurse put on an isolation gown and gloves prior to starting wound treatment. The nurse did not mention that resident was on EBP when she entered the resident's room. Observation and interview on 07/28/25 at 2:40 PM, with LVN ADON G, confirmed that there was no Enhanced Barrier Precaution signed on the entrance door to Resident #3's room while making rounds with the state surveyor. She said that she was responsible for posting The EBP signs on the doors for all residents that met the criteria for EBP, and the licensed staff were responsible for checking that EBP were posted on the entrance door to those residents that needed to be on EBP, to prevent the spread of MDROs and prevent cross contamination of uniforms and hands when direct care was provided. She said that she randomly checked during daily rounds that EBP signs were posted on the doors for those residents that were placed on EBP. She said that she was not aware that Resident #3 did not have an EBP sign posted on the door to the entrance to the room. She said that Resident #3 had a surgical wound due to BKA of the right lower extremity, an indwelling catheter and needed to be on EBP. During an interview on 07/28/25 at 3:04 PM, with LVN ADON G revealed that residents who had pressure ulcers, opened wounds, G-Tubes, or any type of indwelling tubes, history of MDROs were placed on Enhanced Barrier Precautions (EBP) to prevent cross contamination and the spread of infections. She said, I am responsible for posting the EBP signs on the entrance doors to the resident rooms and for making sure that PPE (gowns, gloves, and mask) are readily available for the staff to use when the staff provided direct care to the residents to prevent cross contamination and spread of infections. I know that several of the residents who have pressure ulcers, opened wounds, G-Tubes, or any type of indwelling tubes, history of MDROs, did not have the EBP signs posted on the doors because we ran out of signs and pending delivery. Observation and interview on 07/28/25 at 3:07 PM, with LVN ADON G revealed, Resident #3 had pressure ulcers, an indwelling catheter, and status post amputation of right lower extremity and had an opened surgical wound. She confirmed that there was not an EBP sign posted on the door to the entrance to the resident's room to prevent cross contamination and prevent the spread of infection. During an interview on 07/28/25 at 3:21 PM, with the DON in the presence of the Corporate Consultant said the LVN ADON G and licensed staff were responsible for posting the EBP signs on the door to the entrance to the resident rooms for those residents that meet the criteria listed on the EBP policy and procedure. The DON stated, The ADON just reported to me, that we did not have EBP signs posted on the entrance door to the rooms for Resident #2 and Resident #3 that met the criteria to be on EBP. The licensed staff and nursing administration are responsible for making sure that EBP signs are posted on the doors to prevent the spread of infection and cross contamination. I have not been checking that LVN ADON G and licensed staff are posting the EBP signs on the resident doors as needed. She said that this failure could result in the spread of infections. Interview on 07/29/25 at 1:38 PM, with LVN A on the 6-2 Shift, said that residents who had open wounds, pressure ulcers, indwelling catheters, or any type of tubes in their body were placed on EBP, to prevent contamination when staff provide direct care and prevent the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676468 If continuation sheet Page 9 of 12 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 676468 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Patriot 11490 Gateway North Blvd. El Paso, TX 79934 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some spread of infection. She said the LVN ADON G, and licensed staff posted the EBP sign on the entrance door to the resident rooms and checked that PPE was readily available for the staff to use when they direct care was provided direct care to the residents who were on EBP. She said that she randomly checked during her rounds that the direct care staff put on a gown and glove when providing direct care to the resident who were on EBP. She said Resident #2 had a stage IV Pressure Ulcer of the sacrum and was on EBP. She said the staff had been trained to use a gown and gloves when direct care was provided for those residents that are on Enhanced Barrier Precautions (EBP), to prevent the risk of spread of infections. She said the nurses had been trained to report to the DON and ADONs if the direct care staff are not following the EBP policy and procedure. She said the license staff were responsible for checking that the EBP signs were posted, and the PPE was available for staff to use as needed when providing direct care to the residents. During an interview on 07/29/25 at 2:26 PM, with CNA D said that she forgot to use PPE on 07/28/25, when entered Resident #2's room, to assist the Hospice CNA to turn & reposition the resident so she could wash the resident's chest, arms and legs. She said, I only put on gloves and forgot to put on an isolation gown. She said they had been trained on EBP and use of isolation gowns and gloves to prevent cross-contamination and spread of infection when they had direct contact with those residents that had opened wounds, pressure ulcers, any type of ostomy, catheters, and certain infections. She said that she did not recall if the EBP sign was posted on the door to the entrance to the room on 07/28/25. During an interview on 07/29/25 at 3:30 PM with LVN ADON G revealed, she was assigned as the Infection Control Preventionist at the facility. She said the last time that the facility staff were trained on EBP was on 07/28/25. She said, I completed the in-service training after I made rounds with you on 07/28/25 and found that Resident #2 and Resident #3 did not have the EBP signs posted on the door to the entrance to the room. The EBP signs are posted on the entrance door for those residents that are placed on EBP, to remind the staff to use a gown, gloves, and goggles as needed when providing direct care to prevent cross contamination and spread of infection. She said, I am responsible for posting the EBP signs and for randomly checking that the EBP signs are posted on the doors as needed. During an observation on 07/29/25 at 4:03 PM, with the WCC revealed EBP sign was posted on the entrance door to the resident's room. The WCC entered that room and informed the resident that she was going to do her treatment to the right stump surgical wound. The WCC prepared the wound care supplies prior to entering resident's room. She washed her hands, put on a blue isolation gown and gloves. She placed an absorbent pad under the right stump, removed the Kerlix gauze, abdominal pad, and oil emulsion pads, and placed them in a plastic bag. She changed gloves and used hand sanitizer. She cleaned the wound with Dermal Wound Cleanser, pat dry the wound with gauze 4 x 4. The WCC changed gloves and applied oil emulsion dressing, covered with abdominal pad, and wrap the right stump with Kerlix gauze. She rolled the absorbent pad and placed in plastic bag, sealed the bag, changed her gloves, used hand sanitizer, and placed the plastic bag in the Red Biohazard bag on the side of the medication cart. She used hand sanitizer and wheeled her treatment cart down the hall. During an interview on 08/08/25 at 11:25 AM, with LVN H assigned to the 300 Hall on the 6-2 shift, revealed she checks during her rounds that EBP signs are posted on the entrance doors to resident's rooms and PPE is readily available for those residents with wounds and/or indwelling medical devices. She said that sometimes she finds during rounds that the EBP signs have fallen off the doors and will promptly re-post the signs. She said that EBPs remain in place for the duration of the resident's stay or until resolution of the wound or discontinuation of the indwelling medical device that places them at increased risk. During an interview on 08/08/25 at 11:29 AM, with CNA I assigned to the 200 Hall on the 6-2 shift, revealed that the nurses will (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676468 If continuation sheet Page 10 of 12 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 676468 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Patriot 11490 Gateway North Blvd. El Paso, TX 79934 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some notify them when a resident is placed on EBP. She said that residents that have opened wounds, catheters, and G-Tubes (is a tube inserted through the abdominal wall directly into the stomach. It's used when someone can't eat or drink enough by mouth to get the nutrients they need) are placed on EBP. She said that EBP signs are posted on the door to the entrance of the resident room, to remind them to put on an isolation gown and gloves when providing direct care to the residents to prevent cross contamination of their uniforms and prevent the spread of infection. She said, that sometimes the EBP fall off and are not posted on the doors and she will notify the nurse right away so they can repost the sign as soon as possible. During an observation and interview on 08/08/25 at 11:32 AM, with the DON, revealed the ADON assigned to infection control kept copies of the EBP signs at the nurse's stations for the nurses to post on the resident doors for after hour admissions and/or if EBP signs fell off the doors for those residents that needed to be placed on EBP precautions. She said that the ADON would follow up on the next working day, to check that EBP had been posted according to facility policy. During an observation and interview on 08/08/25 at 11:34 AM, with the Central Supply Clerk J, revealed that the ADON would send her a text message to inform her that they have a new admission that needs to be placed on EBP. She said she was responsible for placing and checking daily that PPE was readily available to the resident units and storage rooms in front of the nurse's station. She said she re-stocked the PPE on Fridays to make sure the staff had sufficient PPE readily available on the nursing units and storage room. She said the ADON posted the EBP signs on the entrance doors for those residents that needed to be placed on EBP precautions. She said that sometimes the EBP signs fall off the door and she will notify the nurse. She said that they had been trained on EBP, and that they needed to use the PPE when providing direct care to those residents with wounds, infections, foley catheters and G-Tube to prevent cross contamination and spread of infections. It was observed that the facility had an ample supply of PPE in the Central Supply room and storage room directly in front of the nurse's station. During an interview on 08/08/25 at 11:41 AM, with LVN H, revealed that the nurses and the ADON assigned to infection control checked during rounds that EBP were posted on the doors for those residents that had wounds or any type of indwelling medical device and to ensure that PPE was readily available on the unit for the direct care staff to use as needed. She said that he checked while he was doing his work in the hallway, that the CNAs were using the PPE when providing direct care to those residents who were on EBP to prevent cross contamination and spread of infections. Record review of facility's document titled In-Service Training completed on 07/08/25 on Enhanced Barrier Precautions presented to Licensed Staff and Certified Nurse Aides. Topic: Enhance Barrier Precaution Policy & Procedure. Record review of facility's document titled In-Service Training completed on 07/28/25 on Enhanced Barrier Precautions presented to Nursing Staff. Topic: Enhance Barrier Precaution Policy & Procedure. Record Review of facility's Policy & Procedure on Enhanced Barrier Precautions revised on February 2025 revealed, Policy Statement: Enhance Barrier Precautions (EBP) refer to an infection control intervention designed to reduce transmission of multidrug-resistant organisms that employs targeted gown and glove use during high contact resident care activities. Policy Interpretation and Implementation: Enhanced barrier precautions are used as an infection prevention and control intervention to reduce the transmission of multidrug resistant organisms to residents. EBPs employ targeted gown and glove use in addition to standard precautions during high contact resident care activities when contact precautions do not otherwise. Gloves and gowns are applied prior to performing the high contact resident care activities (as opposed to before entering the room). Personal protective equipment (PPE) is changed before caring for another resident. Face protection may be used if there is also a risk of splash or spray. Examples of high-risk contact (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676468 If continuation sheet Page 11 of 12 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 676468 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Patriot 11490 Gateway North Blvd. El Paso, TX 79934 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete resident care activities requiring the use of gowning gloves for EBPs Include: dressing, bathing/showering, transferring, providing hygiene, changing linens, changing brief or assisting with toileting, device care or use (central lines, urinary catheters, feeding tubes, tracheostomy/ventilators, etc.); and wound care (any skin opening requiring a dressing). EBPs are indicated (when contact precautions do not otherwise apply) for residents infected or colonized with a CDC targeted or epidemiologically important MDROs. EBP are indicated (when contact precautions do not otherwise apply) for residents with wounds and/or indwelling medical devices regardless of MDRO colonization. Wounds generally include chronic wounds. (ie., pressure ulcers, diabetic foot ulcers, venous stasis ulcers and unhealed surgical wounds), not shorter lasting wounds such as skin breaks or skin tears. Examples of indwelling medical devices include, but are not limited to, central vascular catheters (including hemodialysis catheters, peripherally inserted central catheters (PICCs), indwelling urinary catheters, feeding tubes and tracheostomy tubes. Peripheral Ivy catheters are not considered an indwelling medical device for purposes of EBPs. EBPs Remain in place for the duration of the resident stay or until resolution of the wound or discontinuation of the indwelling medical device that places them at increased risk. Staff are trained prior to caring for residents on EBPs. Signs are posted on the door or wall outside the resident room indicating the type of precaution and PPE required. PPE EBP's is available outside or inside the resident rooms. Residents, families and visitors are notified of the implementation of EBPs, throughout the facility. Event ID: Facility ID: 676468 If continuation sheet Page 12 of 12