Inspection·May 7, 2024

F 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to develop and implement a baseline care plan within 48 hours of admission that included the instructions needed to provide effective and person-centered care of the resident that meets professional standards of quality care for 2 of 6 residents (Resident #1 and Resident #2) reviewed for baseline care plans. The facility failed to ensure Resident #1 and Resident #2 had baseline care plans completed within 48 hours of admission. This failure could place newly admitted residents at risk of receiving inadequate care and services. Findings included: 1. Record review of the face sheet dated 5/7/24 indicated Resident #1 was a [AGE] year-old male admitted to the facility on [DATE] with diagnoses including heart failure, muscle weakness, diabetes, hypertension (elevated blood pressure), and difficult walking. Record review of the MDS dated [DATE] indicated Resident #1 admitted to the facility on [DATE]. The MDS indicated Resident #1 was understood by others and usually understood others. The MDS indicated Resident #1 had a BIMS of 07 and was moderately cognitively impaired. Record review of the baseline care plan dated 2/8/24 indicated sections including activities of daily living, fall/safety/restraints/alarms, nutrition, pain, skin, sensory needs, elimination, infection, anticoagulant therapy, treatment(s)/procedures, and physician orders theses sections were not filled out for Resident #1. The baseline care plan for Resident #1 was not locked or signed. 2. Record review of the face sheet dated 5/7/24 indicated Resident #2 was a [AGE] year-old female admitted to the facility on [DATE] with diagnoses including dementia, weakness, atrial fibrillation (an irregular, often rapid heart rate that commonly causes poor blood flow), chronic obstructive pulmonary disease (a group of lung diseases that block airflow and make it difficult to breathe, and hypertension. Record review of the MDS dated [DATE] indicated Resident #2 admitted to the facility on [DATE]. During an interview on 5/3/24 at 1:37 pm the DON said Resident #2 did not have a baseline or comprehensive care plan. The DON said the facility had an action plan related to baseline care plans. (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: 745021 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 745021 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/07/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Lindale 13905 Fm 2710 Lindale, TX 75771 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)