Health 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. Page 1 of 4 676486 676486 06/19/2024 Avir at Johnson City 206 Haley Rd. Johnson City, TX 78636

F 0565 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During an interview on 06/19/24 at 12:37 PM, the AD stated the residents that attend Resident Council meetings have requested the DM to attend on many occasions. She stated the DM will not come to the meetings and always said he was too busy. She stated that made the residents feel terrible as they wanted answers and just wanted to be heard. During an interview on 06/19/24 at 2:28 PM, the ADM stated it was her expectation if a staff member was invited to a Resident Council meeting that they attend. She stated it was important for the staff members to hear the residents' concerns and address them. She stated the residents had a right to be heard. She stated not attending when invited could cause the residents to feel like they were not important. Review of RC A minutes, dated 02/27/24, reflected the following: Dietary: . [DM] has not attended [RC A] in several months . Residents feel he does not listen to their requests. Review of the facility's Grievances/Complaints Policy, revised April 2017, reflected the following: . 3. All grievances, complaints or recommendations stemming from resident or family groups concerning issues of resident care in the facility will be considered . Review of the facility's Resident Rights Policy, revised February 2021, reflected the following: Employees shall treat all residents with kindness, respect, and dignity. 676486 Page 2 of 4 676486 06/19/2024 Avir at Johnson City 206 Haley Rd. Johnson City, TX 78636

F 0800 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide each resident with a nourishing, palatable, well-balanced diet that meets his or her daily nutritional and special dietary needs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide each resident with a nourishing, palatable, well-balanced diet that met his or her daily nutritional and special dietary needs, taking into consideration the preferences of each resident for three (Resident #1, Resident #2, and Resident #3) of five residents reviewed for food preferences. The facility failed provide fresh fruit for Residents #1, #2, and #3. This deficient practice could put residents at risk of weight loss, an increase of feelings of self-worth, and a decreased quality of life. Findings included: Review of Resident #1's undated face sheet reflected a [AGE] year-old female who was admitted to the facility on [DATE] with diagnoses including vitamin B deficiency, constipation, depression, anxiety disorder, and muscle wasting and atrophy (wasting away). Review of Resident #1's quarterly MDS assessment, dated 05/22/24, reflected a BIMS of 15, indicating she was cognitively intact. During an interview on 06/19/24 at 9:52 AM, Resident #1 stated they (residents) received fresh fruit occasionally, usually just a banana. She stated she did not like the canned fruit and would love to have fresh fruit more often. 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 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, primarily that they never received fresh fruit. They both stated they went to Resident Council meetings regularly and had been requesting fresh fruit for several months. Resident #2 stated they did not like the canned fruit and it made them feel mad and aggravated. Resident #3 stated, If you wanted fresh fruit, you would go and get it. Well, we cannot go and get it, so why is it so hard to get fresh fruit? During an observation and interview on 06/19/24 at 10:21 AM revealed the kitchen's dry storage 676486 Page 3 of 4 676486 06/19/2024 Avir at Johnson City 206 Haley Rd. Johnson City, TX 78636

F 0800 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some included canned fruit. There was no fresh fruit in any of the refrigerators. The DM was asked if the kitchen provided the residents with fresh fruit, and he pointed to a bunch of brown bananas on a shelf. He stated they provided bananas and other fruit sometimes but they did not currently have anything other than bananas because their food delivery was on Friday's. During an interview on 06/19/24 at 12:37 PM, the AD stated the residents (including residents that attended Resident Council) had been requesting fresh fruit for at least four months . She stated the DM was well aware and kept saying he would order it. She stated she had started buying fresh fruit herself such as melon and pears because the residents desired it so much. During an interview on 06/19/24 at 2:28 PM, the DON stated she believed the DM did order fresh fruit but it came from a different city and was not always real fresh. She stated she knew the AD had been purchasing fresh fruit for the residents. She stated it was important for the residents to be served food they were requesting. She stated they did not have a policy related to food preferences. Review of a food invoice for a food delivery, dated 06/06/24, reflected no fresh fruit had been purchased. Ten cans of apple sauce had been purchased. Review of Resident Council Minutes, dated 04/30/24, reflected the following: Dietary - alternatives - need variety. Review of Resident Council Minutes, dated 05/30/24, reflected the following: Dietary - tired of cheesecake pudding, apple sauce, and canned fruit. 676486 Page 4 of 4