Inspection·June 19, 2024

F 0565 Honor the resident's right to organize and participate in resident/family groups in the facility. 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 ensure the views of the residents were considered and acted upon promptly concerning issues of resident care and life in the facility for two (Resident #2 and Resident #3) of three residents reviewed for resident council grievances. Residents Affected - Some The facility failed to ensure the DM attended the RC A meeting after several requests by Resident Council members such as Residents #2 and #3. This deficient practice could place residents at risk of a decreased sense of self-worth, a decline in quality of life, and loss of dignity. Findings included: Review of Resident #2's undated face sheet reflected a [AGE] year-old female who was admitted to the facility on [DATE] with diagnoses including vitamin D deficiency, other specified nutritional deficiencies, and muscle wasting and atrophy. Review of Resident #2's quarterly MDS assessment, dated 04/11/24, reflected a BIMS of 15, indicating she was cognitively intact. Review of Resident #3's undated face sheet reflected a [AGE] year-old male who was admitted to the facility on [DATE] with diagnoses including hypertension (high blood pressure), muscle weakness, and other lack of coordination. Review of Resident #3's quarterly MDS assessment, dated 05/30/24, reflected a BIMS of 15, indicating he was cognitively intact. During an observation and interview on 06/19/24 at 11:32 AM, Residents #2 and #3 were in the activity room and they stated they were frustrated with the food served at the facility. They stated what was even more frustrating was that the RC A had requested on several occasions that the DM attend their meeting so they could be heard, and he had never showed up. Resident #2 stated it hurt their feelings and they (residents) deserved to be heard. Resident #3 stated the DM did not care about their concerns because he got to go home and eat what he wanted. During an interview on 06/19/24 at 10:21 AM, the DM stated he had been invited to a Resident Council meeting a couple of times but he had been too busy to attend. He stated he was not aware if he was expected to go or not when he was invited. (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 4 Event ID: 676486 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 676486 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Johnson City 206 Haley Rd. Johnson City, TX 78636 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)