Health inspection·November 25, 2025

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few family arrived at the facility and were notified of findings and new orders from NP. DON, ADON notified. Resident Description: Resident states, it just happened, she denies a fall, denies someone or something hitting that area of her chest., AAOx3, able to make needs known. The administrator was notified 10/21/25 at 10:02 AM. Review of Hospital emergency room Notes from dated 10/23/25 for Resident #1 revealed, Service Date/Time: 10/23/25 at 9:14 AM. emergency room Discharge Instructions revealed Diagnosis from Today's Visit: S/P hemodialysis catheter insertion, Superficial bruising of chest wall. During an interview on 10/24/25 at 9:14 AM, with LVN A Charge Nurse assigned to Resident #1 in the 300-Hall, said, I know why you are here. [Resident #1's] [family member] told me she was going to call the state, because the dialysis had requested for the nursing home to send the resident to the emergency room for evaluation of the ecchymosis (bruise) and large blister in the middle of the resident's chest, that was close to the dialysis access site. I asked her why the dialysis center could not send the resident to the hospital if she was still at the dialysis center. He said Resident #1 did not have the ecchymosis or the blister in the middle of the chest on Monday 10/20/25 when she was sent to dialysis during the morning shift. He said, I had already left when the resident returned from dialysis on that day during the evening shift. He said the evening nurse called the Nurse Practitioner on 10/20/25, and an order was given to start the resident on an antibiotic and would come to see the resident on Thursday. He said, I returned to work on Wednesday 10/22/25 when the nurse from the dialysis center called me and said the nephrologist (kidney doctor) had recommended the resident be sent to the ER for evaluation of the ecchymosis to make sure it was nothing serious due to the proximity to the dialysis access site. I asked the dialysis nurse why they had not sent the resident to ER from the dialysis center instead of sending the resident back to the nursing home. In about ten minutes, I got a call from the resident's [family member] on Wednesday at approximately 12 noon, and she was very upset, yelling and she said the nephrologist had requested for the nursing home to send the resident to the ER for evaluation of the ecchymosis and blood blister on the middle of the chest because of the proximity to the dialysis access site as soon as possible. I asked her why the dialysis center could not send her to the ER from the dialysis unit instead of sending the resident back to the nursing home. The [family member] was very upset and said, so you don't want to send her to be checked at the hospital and hang up on me. I reported this to the DON right away. The resident was sent to the emergency room on Wednesday 10/23/25 by ambulance, and they did an x-ray and labs. She returned from the hospital with instructions to leave the affected area on chest to room air.During an observation and interview on 10/24/25 at 9:27 AM, with LVN A Charge Nurse on the 300-Hall revealed, Resident #1 had maroon ecchymosis of irregular configuration and had a blood-filled blister on the middle of the upper chest close to the dialysis access site. The ecchymosis area was approximately 12 cm x 3 cm, and the blood blister was approximately 4 cm x 1 1/2 cm.During a telephone interview with family member on 10/24/25 at 9:43 AM said, LVN A on the morning shift was very rude to me when I called him on Wednesday 10/22/25 at approximately 1:15 PM to follow up on why he did not want to follow the nephrologist's recommendation to send [the resident] to the hospital for evaluation of the bruise and blood blister on the middle of her upper chest as suggested by the nephrologist at the dialysis center. I was very concerned because of the location of the bruise on [Resident #1's] chest. LVN A said, Oh really, if they felt it was an emergency why did they not send her to the emergency room from the dialysis center if she is still there. I hung up on him because he made me very upset because he did not want to follow the nephrologist recommendation to send [the resident] to the emergency room for evaluation. I also followed up with the evening nurse LVN I on that day at approximately 7:00 PM, and she asked me exactly what LVN A had said, she asked why the dialysis (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676468 If continuation sheet Page 2 of 11 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 11/25/2025 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 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few center had not sent [the resident] to the emergency room if she was still at the dialysis center instead of sending her back to the nursing home. I asked the LVN I why they were refusing to send [Resident #1] to the emergency room for evaluation as suggested by the nephrologist. LVN I, asked me why the dialysis had not sent [Resident #1] to the ER for evaluation if the resident was still at the dialysis center. I do not understand why I must fight a battle with the nurses to get them to get the necessary medical care for [Resident #1]. During an interview on 10/24/25 at 3:37 PM with LVN ADON J said, LVN A told me this morning that the resident's [family member] had called on 10/22/25, was very upset and wanted to know why they did not want to send Resident #1 to the emergency room for evaluation as requested by the dialysis nephrologist. LVN A said he had told the family member that if they thought it was an emergency, why would the dialysis not send her to the emergency room instead of waiting for the resident to return to the nursing facility. She said the Nurse Practitioner had given the order to send the resident to the ER for evaluation and the ambulance had come to pick up the resident after midnight on that day. During an interview on 10/24/25 at 4:02 PM with the DON, in the presence of the Administrator revealed, She said, On Wednesday 10/22/25 LVN A reported to me that he had received a telephone call from the resident's [family member] on that day asking to send [the resident] to the emergency room for evaluation of the ecchymosis and blood blister in the middle of the chest at the request of the nephrologist at the dialysis center. She said the resident was sent to the emergency room on [DATE] during the evening shift because the ambulance had picked up the resident after midnight on that day. During a telephone interview on 10/27/25 at 10:37 AM, with the Facility Manager at Dialysis Center revealed, the resident's family member was upset because the nursing home staff kept asking her why the dialysis center had not sent the Resident #1 to the ER for evaluation of the ecchymosis and blood blister in the middle of the chest on 10/22/25 as suggested by the dialysis nephrologist. He said the dialysis center cannot send residents to the ER for non-emergency situations, and that is why they had called the nursing home staff to inform them of the nephrologist request. He said the resident's vital signs were stable on that day and the resident did have a superficial bruise in the middle of the chest. He said he had suggested to the family member to speak to the social worker at the nursing home to see if she could help her to send the resident to the ER for evaluation as suggested by the nephrologist at the dialysis center. During an interview on 10/27/25 at 11:25 AM with FNP revealed, the nurse had reported to her on Monday 10/20/25 that Resident #1 had a superficial hematoma (bruise) and blood blister in the middle of the chest and she gave orders to keep the area clean and to administer Keflex (an antibiotic) as ordered. She said LVN I had not mentioned anything on that day about sending the resident to the ER for evaluation. She said she had received a call from the nursing home on [DATE] regarding a high potassium level of 6.2 and nothing was mentioned about the hematoma in the middle of the chest. She said later that night, she got another call from LVN I, asking to send the resident to the ER per the family member's request. She said the staff knows that if a family member requests to send a resident to the hospital all they must do is to call her and she will give the nurses an order. She said, It is the family's right to make a request to send their loved one to the hospital for evaluation.During a telephone interview on 10/27/25 at 4:35 PM with facility's Medical Director revealed he had examined Resident #1, and his instinct was that the ecchymosis and blood blister are related to an autoimmune disorder called Bullous Pemphigoid (is a rare autoimmune disease where the body's immune system mistakenly attacks the skin, causing large, itchy blisters on the arms, legs, and torso), that some patients with ESRD could develop. He said the resident was not having pain in the affected area on the chest. He said that the nurses at the facility should have attempted to call the resident's attending physician (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676468 If continuation sheet Page 3 of 11 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 11/25/2025 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 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete on Wednesday 10/22/25, when the family member had asked to send the resident to the hospital as requested by the nephrologist at the dialysis center. All the nurses need to do is call and request an order to send the resident to the ER for evaluation per family's request. He said that it was the family's right to request to send the resident promptly to the hospital for evaluation. During a telephone interview with the RN at the Dialysis Center on 10/28/25 at 10:09 AM, revealed she had called the nursing facility to inform LVN A on the day shift on Wednesday 10/22/25 that the nephrologist at the dialysis center had given an order to send Resident #1 to the ER for evaluation of ecchymosis and a blood blister in the middle of the chest due to the close proximity to the dialysis access site. The RN said the nephrologist had determined the ecchymosis and blood blister was not an emergent situation, the resident was stable and did not know what had caused the ecchymosis and blister in the middle of the chest and the nursing home could send the resident to the ER for evaluation upon return to the nursing facility. She said LVN A had not allowed her to finish telling him what the nephrologist's orders were. She said LVN A had said, Send Resident #1 to the ER for what. Resident #1 was already been started on antibiotics and the Nurse Practitioner will be coming to see the resident on Thursday 10/23/25. The RN said she had received a call from the resident's family member on 10/23/25 and she said she wanted her family member to be sent to the ER for evaluation as ordered by the nephrologist. The RN said the dialysis center will only transport patients to the emergency room for life threating situations, altered mental status or unstable vital signs. During a telephone interview on 10/28/25 at 3:51 PM with attending physician for Resident #1 revealed, he did not think the ecchymosis and blood blister in the middle of the chest were not caused by trauma, because the resident did not complain of pain and there were no signs of suspicion of trauma and x-ray done at the ER was negative for trauma. He said it could be an autoimmune skin condition that affects some patients with ESRD. He said he had given orders for a dermatology consultation to determine what type of skin condition the resident had. He said, The nurse at the nursing facility should have called me to get an order to send the resident to the ER for evaluation as requested by the family. Review of facility's Policy and Procedure on Change in a Resident's Condition revised April 2025, provided by DON on 10/27/25 revealed, Policy Statement: Our facility promptly notifies the resident, his or her attending physician, and the resident representative of changes in the resident' medical/mental condition and/or status (e.g., changes in level of care, billing/payments, resident rights, etc.). Policy Interpretation and Implementation: The nurse will notify the resident's physician or physician on call when there has been a (an): accident or incident involving the resident; discovery of injuries of an unknown source; significant change in the resident's physical/emotional/mental condition; need to transfer the resident to a hospital/treatment center; specific instruction to notify the physician of changes in the resident's condition; ultimately is based on the judgement of the clinical staff. Regardless of the resident's current medical or physical condition, a nurse or healthcare provider will inform the resident of any changes in his/her medical care or nursing treatment. The nurse will record in the resident's medical record information relative to changes in the resident's medical/mental condition or status. Event ID: Facility ID: 676468 If continuation sheet Page 4 of 11 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 11/25/2025 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 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews and record review, the facility failed to ensure the resident had the right to prompt efforts by the facility to resolve resident grievances, for one (Resident #2) of three residents reviewed for grievance resolution. The facility failed to ensure prompt efforts to resolve grievances voiced by Resident #2's family who filed a grievance on 08/22/25 and 10/17/25. This failure could place residents at risk of feeling that their voices were not being heard or taken seriously and could cause feelings of worthlessness.Findings included:Review of the admission Record dated 10/27/25 for Resident #2 revealed, original admission date 06/05/25; re-admission [DATE]. Review of Medical Visit dated 10/27/25 for Resident #2 revealed [AGE] year-old female with recurring UTIs (an infection of the urinary tract), now on hospice. History of cystitis (an inflammation of the bladder, the organ that stores urine), chronic UTI (infections of the urinary tract that are either persistent or keep coming back). Resident alert, oriented to person.Review of Quarterly MDS dated [DATE] for Resident #2 revealed, clear speech, makes self-understood; understands others; BIMS Summary Score: 12 (cognitively moderately impaired); Self-Care-substantial/maximal assistance with eating; Dependent with oral hygiene, toileting, shower, dressing, and personal hygiene. Mobility - Dependent with roll left and right, sit to lying, lying to sitting on side of bed, sit to stand, chair/bed transfer, toilet transfer, shower transfer. Incontinent of bowel & bladder. Active Diagnoses: Renal Failure (is when the kidneys stop working properly, are unable to filter waste, remove excessive fluid, and balance chemicals in the blood), Diabetes Mellitus (a chronic condition where the body does not produce enough insulin or cannot use insulin effectively).Review of Care Plan for Resident #2 revealed, Date initiated: 10/16/25 Infection diagnosis of Sepsis (a life-threatening condition that occurs when the body's immune system overacts to an infection). Approaches: Administer medications per order. Monitor/document/report to MD signs and symptoms of delirium, changes in behavior, altered mental status. Date initiated: 10/16/25 The resident has alteration in neurological status r/t encephalopathy (a general dysfunction of the brain). Approaches: Assess for effects of psychotropic meds, dystonia (a movement disorder characterized by involuntary, sustained, or repetitive muscle contractions that cause abnormal postures or twisting movements), akinesia (the inability to initiate or perform voluntary muscle movements, often experienced as being frozen or having difficulty starting to move), rigidity, and tremors. Cueing, reorientation as needed. Date initiated: ADL self-care deficit. Approaches: Bed Mobility requires assistance to maximize independence with turning & repositioning in bed. Requires assistance with personal hygiene, toileting, and transfers.Review of Concern/Grievance Form dated 08/22/25 revealed, Concern From: Was left blank. Resident Name: Resident #2. Name of the person giving the complaint. [family member]. Telephone: Was left blank. Employee filling in this form: Social Worker. Related to: Nursing Care. Description: Resident [family member] c/o of call bell not being placed where resident can see it. Family reports resident has vision problems and needs call light bell attached to center of her chest. Family complains that staff is inconsistent with placement. Persons/Departments contacted on 08/22/25: Social Worker, ADON J, and Administrator. Summary/Findings: Interventions discussed/clinical team. Recommendations/Action Taken: Sign-In Log will be implemented to ensure call bell placement. Resolution of Grievance/Complaint was left blank. Did not document resolution. Identify the methods used to notify the resident and/or resident representative of the resolution: Was left blank. Date of Notification: Was left blank. This form was completed by the Social Worker and Administrator on 08/27/25.Review of Concern/Grievance Form dated 10/17/25 revealed, Communicated by: Family. Name: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676468 If continuation sheet Page 5 of 11 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 11/25/2025 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 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Resident #2's family member. Relationship: family member/POA. Communicated to: DON, and SW. Name/Dept: DON, Social Worker Communicated via: Verbal. Concerned about: None were checked. Describe concern in detail: Family verbalized concerns: Documented in part - Night nurse LVN P lacks empathy. She focused on facility rules instead of patient care. Nurse asked the family to leave the facility at 9:59 PM, after requesting to stay with the resident. Staff did not check on resident throughout the night. Resident unable to operate call bell. Staff members assigned responsibility for the investigation: DON. Assigned by: Was left blank. Date: Was left blank. Due Date: Was left blank. Findings of investigation: Was left blank. Plan to resolve concern/grievance: Documented in part - DON provided personal cell number to be reached for concerns. Education provided to nurse LVN P. Family will be allowed to remain in the facility after visiting hours to accommodate. Touch call light will be provided. Log will be left at bedside to ensure pt. care and room rounding. Signature of Person completing above report: Was left blank. Signature of Administrator: Was left blank.During an observation and interview on 10/27/25 at 2:53 PM, with Resident #2's family member revealed he visited Resident #2 daily and stayed all day until another family member relieved in the afternoons after she got out of work. The resident was lying asleep in bed with Pad Call Light clipped on her gown on top of her chest. The family member said, Yesterday 10/26/25 I took a picture because [Resident #2's] call light was not within reach, it was clipped on the head of the bed on her left side. He said Resident #2 was able to use the call light if it was kept within reach. He said, We had a meeting with the nursing administration about the 10 PM - 6 AM not answering [Resident #2's] call light and was finally answered two hours later. On Sunday 10/26/25 [Resident #2] was not checked all night by the nursing staff. We could see in the camera; the staff entered the room and just peeked through the side of the divider curtain and left the room without checking if she needed to be changed because she was incontinent. [Another family member] is [Resident #2's] POA. We placed a camera in her room to check that they keep her call light within reach, and she is provided with the needed care.During an interview on 10/27/25 at 3:12 PM with the Social Worker revealed, Resident #2's family had voiced concerns about resident's call light not being within reach. She said, There should be a sign-in log posted on the door to the entrance of the room for staff to initial when they check for call light placement. She said, I know that the sign-in logs were posted on the door prior to the most recent hospitalization. To my knowledge, the sign-in log should still be in place. She said she did not know if the staff had been trained on the use of the sign-in log to check for call light placement. She said the family also made a grievance about the lack of empathy when they were asked by the night nurse LVN P to leave, when they had asked if they could stay with Resident #2 after visiting hours. She said they had talked to the staff and the family and were informed that arrangements could be made to accommodate their request to stay after visiting hours and if the resident's roommate agreed to their request. She said the family had placed a camera in the resident's room. She said the resident's family member visited daily during the day and another family member in the evenings. She said, I met with the [family member] today and he did not voice any concerns. She said that she was not aware that the resident's call light was not within reach on Sunday 10/26/25 when the resident's family member came to the facility in the morning. She said the resident should be checked at least every two hours. She said she was responsible for handling Grievances and complaints according to facility policy and procedure. She said they had not been documenting a resolution of Grievances and/or notification on the Grievance Forms according to facility policy and procedures.During an observation and interview on 10/27/25 at 3:44 with Resident #2's family member revealed, the sign-in log to check for call light placement was not posted on the door to the entrance of the room. The resident's family member (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676468 If continuation sheet Page 6 of 11 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 11/25/2025 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 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few was in the room. When the state surveyor asked the family member about the sign-in log to check for call light placement, he said it had not been posted on the door for a while. He said, We were told by the social worker that the facility was going to post a sign-in log for the staff to sign when they entered the room to check that [Resident #2's] call light was always kept within reach so she could call for assistance as needed. The sign-in log has not been posted on the entrance door for a while as we were told was going to be done by the Social Worker. He said he and another family member had to make sure the call light was placed on Resident #2's chest where she could reach it, and that the staff checked Resident #2 every two hours and kept the call light within reach.During an interview on 10/27/25 at 3:47 PM with CNA H assigned to the 300-Hall on the evening shift, revealed Resident #2 used to have a sign-in sheet on the entrance door to initial when they entered the room to check for call light placement and care provided to the resident. He said, I don't remember seeing the sign-in log today on the entrance door to [Resident #2's] room.During an observation and interview on 10/27/25 at 3:52 PM, with LVN ADON J assigned to the 300-Hall revealed, she had just posted the sign-in sheet on the entrance door to Resident #2's room. She said that she did not know why the sign-in Log to check for call light placement was not posted on the door. She said she was responsible for checking that the sign-in log was posted on Resident #2's door. She said they had not provided any training for the nursing staff on the use of the sign-in logs that should be used to sign when they entered the resident's rooms to check for call light placement and care provided.During an interview on 10/27/25 at 3:55 PM, with CNA G assigned to the 300-Hall on the evening shift revealed Resident #2, used to have a sign-in sheet on the entrance door to initial any time they entered the resident's room. She said the sign-in log had not been posted on the door for a while.During a confidential interview on an undisclosed date at an undisclosed time revealed, the staff just posted the sign-in on the entrance door to resident's room. It was not posted today when the state surveyor came to see the resident. The staff has not posted the sign-in sheet for a while. The CNAs are supposed to sign the sign-in log when they entered the Resident #2's room to check for call light placement, but they had not been doing it.During an interview and record review Sign- In Log on 10/27/25 at 4:02 PM with LVN ADON J in the presence of the DON said the CNAs needed to sign the sign-in log every time they entered the resident's room to check for light placement. She said that the last day the nursing staff documented on the Sign-In Log for October 2025 was 10/05/25.During an interview on 10/28/25 at 10:35 AM with LVN ADON O revealed, she said the CNAs made rounds every two hours and checked that the pad call light for Resident #2 was kept within reach. She said there should be a sign-in log posted on the entrance to the resident's room for the staff to sign when they enter the room to check for the call light placement. She said she was not aware of the resident's family voicing any concerns about the night staff not checking the resident all night on 10/26/25. During an observation and interview on 10/28/25 at 11:17 AM revealed, Resident #2 was lying in bed awake, and her family member was at the bedside. The resident was oriented to person, month, year, and recognized her family member. The Resident was able to answer simple questions. It was observed that the pad call light was clipped to her gown. The Resident's family member asked the resident to push the pad call light to demonstrate to the surveyor that she could use the call light. It was observed that the resident was only able to call for help using the pad call light with the family member's guidance.During an interview on 10/28/25 at 4:52 PM with the DON in the presence of the Administrator revealed, they had a family conference with Resident #2's family regarding a concern related to the night staff not checking the resident all night on Sunday 10/26/25. She said the CNAs had been instructed to sign the sign-in log when they entered the room to check on the call light placement as agreed when they had (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676468 If continuation sheet Page 7 of 11 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 11/25/2025 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 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete addressed a previous concern voiced by the resident's family regarding the call light not being within reach. She said a Grievance Form had not been completed to address the family's concern.During an interview and record review of Grievance Forms on 10/28/25 at 4:53 PM with the Administrator revealed, the Grievance forms should be completed according to facility policy. He said they were not allowed to revise any forms without the approval from their corporate office. He said, each Grievance form should be filled out and each grievance form should have documentation of the resolution and notification of resolution. He said the Grievance forms kept in the Grievance Binder for 2025 did not document a resolution method used to notify the resident and/or resident representative of the resolution and date of notification.Review of In-Service Training Report dated 09/19/25 presented by the Social Worker revealed, Subject: Grievance/Complaint Filing. Summary of In-service: New Grievance Form, New Grievance Process, and New Grievance Location.Review of facility's policy and procedure on Grievance/Complaints, Filing revised April 2017 revealed: Policy Statement: Residents 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 (e.g., the State Ombudsman). Policy Interpretation and Implementation: Any resident, family member or appointed resident representative may file a grievance or complaint concerning care, treatment, behavior of other residents, staff members, theft of property, or any other concerns regarding his or her stay at the facility. Grievance also may be voiced or filed regarding care that has not been furnished. All grievance, complaints or recommendations stemming from residents or family groups concerning issues will be responded to in writing, including a rationale for the response. The administrator has delegated the responsibility of grievance and/or complaints to the grievance officer who is (was left blank). Upon receipt of a grievance and/or complaint, the grievance officer will review and investigate the allegations and submit a written report of such findings to the administrator within five (5) working days of receiving the grievance and/or complaint. The grievance officer, administrator and staff will take immediate action to prevent further potential violations of resident rights while the alleged violation is being investigated. The administrator will review the findings with the grievance officer to determine what corrective actions, if any, need to be taken. 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. The administrator, or his or her designee, will make such reports orally within (was left blank) working days of the filing of the grievance or complaint with the facility. A written summary of the investigation will also be provided to the residents, and a copy will be filed in the business office. Event ID: Facility ID: 676468 If continuation sheet Page 8 of 11 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 11/25/2025 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 observation, 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 of 3 residents (Resident #1) reviewed for clinical records. The facility failed to ensure LVN I accurately documented in Resident #1's Event Report on 10/20/25 when the resident returned from the dialysis center with ecchymosis and a blood blister in the middle of the chest.The facility failed to ensure the DON documented skin assessment for Resident #1 according to facility policy on documentation.The facility failed to ensure LVN I wrote a physician's telephone order on 10/22/25 to send Resident #1 to the emergency room for evaluation of ecchymosis and a blood blister in the middle of the chest.This failure could place residents at risk of having incomplete and inaccurate clinical records. Findings included:Review of the admission Record dated 10/24/25 revealed Resident #1 was originally admitted to the nursing facility on 03/31/25 and re-admitted on [DATE]. Review of Hospital History & Physical dated 08/11/25 revealed, Resident #1 had ESRD on Hemodialysis (the final stage of kidney disease, where the kidneys can no longer function and need hemodialysis. Hemodialysis is a treatment that uses a machine to filter and clean the blood like a healthy kidney would), Diabetes Mellitus, type II (a condition where the body either does not produce enough insulin or cannot use the insulin it makes effectively, leading to high blood sugar levels), Anemia (a condition in which the body does not have enough red blood cells or hemoglobin, the protein in red blood cells that carries oxygen), GI Bleed (bleeding that occurs in the digestive tract, from the esophagus to the anus) and Dementia (a general term for a group of brain disorders that cause a gradual decline in cognitive abilities such as memory, thinking, language, problem-solving, judgement , and orientation). Review of Quarterly MDS dated [DATE] for Resident #1 revealed, Clear speech. Sometimes makes Self-Understood; Sometimes understand others. BIMS Summary Score 01 - Severely Cognitively Impaired. Functional Limitation in Range of Motion - impairment on both sides to lower extremity. Mobility dependent chair/bed-to-chair transfer. Incontinent of bowel & bladder. Active Diagnoses: Anemia, ESRD, Diabetes Mellitus, Non-Alzheimer's Dementia, PVD (a condition where blood vessels outside your heart and brain narrowed, blocked, or damaged, preventing enough blood from flowing to your limbs and organs) Special Treatments - Hemodialysis. Review of Care Plan dated initiated: 10/24/25 for Resident #1 revealed, Resident had a fluid blister to mid-chest. Interventions: Administer antibiotic therapy as prescribed. Monitor for signs of progression or desclination (deterioration) blister. Provide wound care per treatment order. Review of Skin assessment dated [DATE] for Resident #1 written by LVN I revealed, Resident noted with blood filled blister to middle of chest area. Review of Event Report dated 10/20/25 at 9:15 PM, written by LVN I for Resident #1 revealed, Incident Date: 10/20/25. Type of Incident: Skin Tear/Discoloration. Location: Resident's Room. Nursing Description: Resident arrived from Dialysis, assessed resident noted blood filled blister to middle of chest next to dialysis port. The Event Report did not document the ecchymosis (bruise) around the blood blister. Resident denies pain to area. Notified NP. New order to clean area with NS and cover with protective dressing, start Cephalexin 250 mg po BID x 10 days prophylactically, and she will be here Thursday to see resident. The family arrived at the facility and were notified of findings and new orders from NP. DON, ADON notified. Resident Description: Resident states, it just happened, she denies a fall, denies someone or something hitting that area of her chest., AAOx3, able to make needs known. The administrator was notified 10/21/25 at 10:02 AM. Review of Hospital emergency room Notes dated 10/23/25 for Resident #1 revealed, Service Date/Time: 10/23/25 at (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676468 If continuation sheet Page 9 of 11 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 11/25/2025 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 9:14 AM. emergency room Discharge Instructions revealed Diagnosis from Today's Visit: S/P hemodialysis catheter insertion, Superficial bruising of chest wall. Review of Physician Order Summary dated 10/27/25 for Resident #1 revealed, the physician order summary did not document an order to send the Resident #1 to the ER for evaluation of the ecchymosis (bruise) and blister in mid chest. During an observation and interview on 10/24/25 at 9:09 AM with Resident #1 revealed, she was lying in bed awake, was oriented to person and place. Resident said, Look at the bruise on my chest, it does not hurt. I do not know how I got the bruise and the bump in the middle of my chest. It developed suddenly, they sent me to the emergency room, and I was told it was nothing serious. It was observed resident had ecchymosis and a blood blister in the middle of the chest. During an interview on 10/24/25 at 2:45 PM, with LVN I revealed she was assigned to Resident #1 on the 2 PM-10 PM shift on Monday 10/20/25. She said the resident was alert, oriented to person, place, and time and was able to answer questions. She said she had assessed Resident #1 on 10/20/25 upon return from the dialysis center and she had noticed the resident had a blood blister in the middle of the chest and bruising around the area surrounding the blister. She said she had immediately reported the bruise and blister on the middle of the resident's chest to the DON, ADON and Nurse Practitioner. She said the Nurse Practitioner had given orders to start the resident on an antibiotic, cover the area with a protective dressing and said she would come and see the resident on Thursday 10/23/25. During an interview on 10/24/25 at 4:02 PM with the DON revealed, ADON O had reported to her on Monday 10/20/25 via text message that Resident #1 had bruising and a blood blister in the middle of the chest. She said, I assessed the resident on Tuesday on 10/21/25 and did not document my assessment in the resident's clinical record. She said they had been trained to document assessments in the resident's electronic clinical record. During second interview on 10/27/25 at 4:13 PM with LVN I revealed, she had completed the Event Report for Resident #1 on Monday 10/20/25 and said she was more focused on the blood blister than the ecchymosis around the blood blister in the middle of the chest. She said, That is why I did not document the ecchymosis on the Event Report. She said she had not written a physician telephone order on 10/22/25 for the order given by the nurse practitioner to send Resident #1 to the ER for evaluation of the ecchymosis and blood blister in the middle of the chest as requested by the resident's family member. She said she had been trained to write telephone orders given by the physicians and/or Nurse Practitioners in the resident's electronic clinical record. During an interview and record review of Event Report on 10/27/25 at 5:18 PM with the DON, revealed LVN I had not documented the ecchymosis in the middle of Resident #2's chest on 10/20/25 when she had completed the Event Report. She said, The nurse only documented the resident had the blood blister in the middle of the chest. During an interview and record review of Nursing Progress Notes on 10/29/25 at 9:19 AM with the DON in the presence of Administrator and LVN ADON O revealed, she had assessed Resident #2 on Tuesday 10/21/25 after the morning meeting and had noted the ecchymosis and blood blister in the middle of the chest. She said she had not documented her assessment in the resident's clinical record. She said the staff had been trained to document all resident assessments in the resident's electronic clinical record. The DON said LVN I had not written a Physician Telephone Order to send the Resident #2 to the ER for evaluation of ecchymosis and blood blister in mid chest on 10/22/25. She said the staff have been trained to write Physician Telephone Orders for all orders given by NP and/or physicians. Review of facility's Policy and Procedure on Charting and Documentation Revised July 2017 revealed, Policy Statement: All services provided to the resident, progress toward the care plan goals, or any changes in the resident's medical, physical, functional or psychosocial condition, shall be documented in the resident's medical record. The medical record should facilitate communication between the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676468 If continuation sheet Page 10 of 11 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 11/25/2025 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 interdisciplinary team regarding the resident's condition and response to care. Policy Interpretation and Implementation: Documentation in the medical record may be electronic, manual or a combination. The following information is to be documented in the resident medical record: Objective observations; Changes in the resident's condition; Events, incidents or accidents involving the resident; Documentation in the medical record will be objective (not opinionated or speculative), complete, and accurate. Entries may only be recorded in the resident's clinical record by licensed personnel (e.g., RN, LVN, physician, therapist, etc.) in accordance with state law and facility policy. Documentation of procedures and treatments will include care-specific details, including: the assessment data and/or any unusual findings obtained during the procedure/treatment; notification of family, physician or other staff, if indicated; the signature and title of the individual documenting. Event ID: Facility ID: 676468 If continuation sheet Page 11 of 11