Inspection·December 11, 2025

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few completed by RN J indicated Resident #4 had a skin tear on her left antecubital (inner part of elbow). During an interview on 12/9/25 at 10:55 a.m., Resident #4 said she could not recall the incident and did not want to speak to surveyor.Review of a written statement regarding incident involving Resident #4 by RN J dated 10/6/25 indicated .Nurse walked over to help the resident and noticed large circle of blood on the resident's shirt on her left forearm. Nurse asked resident what happened and resident stated that girl was being too rough with me, I told her to stop!.Once in room, nurse provided privacy and resident in B bed was crying about her own experience with aide. Resident B told nurse that aide had been too rough with resident in Bed A. Bed B also said that Bed A told the aide that she was bleeding prior to her shirt being put on. Bed B said that she heard her saying stop, you're being too rough, you're hurting me, you cut me. Resident in Bed B said that aide continued to dress the resident and she didn't heard her say anything.During an interview on 12/10/25 at 11:45 a.m., Resident #6, who was Resident #4's roommate, said she could not recall any incident of alleged abuse. Resident #6 said she had not been abused or mistreated in the facility.Review of a skin assessment dated [DATE] at 11:25 a.m. indicated Resident #6 had edema to bilateral lower extremities but no other alterations in skin integrity and no complaints of pain.Review of a phone interview on 10/6/25 at 8:40 a.m. conducted by ADM with CNA F regarding incident with Resident #4 indicated .When asked about the incident she responded that she went in to assist resident with morning ADL care to get her ready for breakfast. During transfer she reported resident was leaning forward, grabbing at her bed and wheelchair. During this process a skin tear to residents left arm happened .Attempted telephone interviews with CNA F on 12/11/25 at 4:15 p.m. and 5:25 p.m. Requested personnel file for CNA F from ADM and was advised by ADM the facility had no file for CNA because she was an agency employee.Review of a facility policy titled Safe Lifting and Movement of Residents indicated .In order to protect the safety and well-being of staff and residents, and to promote quality of care, this facility uses appropriate techniques and devices to lift and move residents.2.Review of an admission Record dated 12/10/25 for Resident #5 indicated she was a [AGE] year-old female readmitted to the facility on [DATE] with diagnoses of Unspecified Dementia (altered cognition), cognitive communication deficit (impaired ability to communicate), difficulty walking, unsteadiness on feet, and muscle wasting and atrophy.Record review of a quarterly MDS dated [DATE] indicated Resident #5 had moderately impaired cognition with a BIMS of 8. She required setup/cleanup assistance with eating; she required supervision with oral hygiene; she required moderate assistance for upper body dressing and personal hygiene; she required maximal assistance for toileting hygiene, shower/bath, lower body dressing, and putting on/taking off footwear.Record review of a comprehensive care plan dated 10/19/25 indicated Resident #5 had limited mobility related to obesity, thrombocytopenia, pain, and generalized weakness requiring a wheelchair for mobility. Appropriate interventions were in place for ADL assistance which included extensive staff assistance with bathing.Record review of a comprehensive care plan dated 10/19/24 indicated Resident #5 insisted on transferring herself to/from bed/chair/toilet, she was reminded by staff frequently to call for assistance. During an interview on 12/10/25 at 12:30 p.m., Resident #5 said a CNA left her in the shower, but she was unable to provide additional details. Resident #5 said she could not recall the incident well.During an interview on 12/10/25 at 1:00 p.m., LVN H said she worked 6:00 a.m. to 6:00 p.m. on 5/14/25 and observed CNA G sitting in the hallway in a chair on her cell phone while Resident #5's call light was active. LVN H said she told CNA G she needed to take care of the residents. LVN H said CNA G told her Resident #5 was being rude and she wasn't going to go back into her room. LVN H said she began answering call lights on the hall. LVN H said she noted CNA G was then sitting at the nurse's station on her cell phone. LVN H said she again told (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745021 If continuation sheet Page 2 of 5 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 12/11/2025 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)

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete CNA G she needed to get off her phone and take care of the residents. LVN H said CNA G told her she would just go home, then. LVN H said CNA G left the facility and the CNAs working the other halls took care of her assigned residents the rest of the night. LVN H said she continued answering call lights and assisted Resident #5 out of the shower and into her chair.During an interview on 12/10/25 at 1:20 p.m., CNA G said she worked 6:00 p.m. to 6:00 a.m. on 5/14/25. CNA G said she was called into Resident #5's room and found her in the shower. CNA G said Resident #5 required assistance from two staff members for showering, but had put herself into the shower. CNA G said she left Resident #5 in the shower to go and get a towel for her to step out onto. CNA G said when she returned Resident #5 refused all care, hit her, and sprayed her with water. CNA G said she notified the charge nurse that Resident #5 refused care. CNA G said she left the facility that night with permission after notifying the scheduler. During an interview on 12/10/25 at 4:37 p.m., CNA H said she was the scheduler on 5/14/25. CNA H said that night CNA G left her shift early without notifying her for relief. CNA H said the other CNAs working had to cover CNA G's assigned hallway after she left early. During an interview on 12/11/25 at 5:10 p.m., the DON said residents who require shower assistance are never to be left alone during a shower. The DON said CNAs were expected to remain with the resident during a shower and utilize the call light to call for assistance if needed. The DON said nursing staff were expected to take care when assisting or transferring residents as many residents have thin skin. The DON said if a resident tells a staff member to stop or that they are hurting them, then they should stop immediately and get additional assistance. During an interview on 12/11/25 at 5:20 p.m., the ADM, who was the abuse coordinator, said CNAs were never to leave a resident alone in the shower if the resident required shower assistance. The ADM said CNAs were expected to utilize the emergency call lights if additional assistance is required. The ADM said CNAs were expected to assist residents with ADLs and/or transfers safely without causing harm to the residents. The ADM said he planned to conduct in-service training to address all concerns he was made aware of. The ADM said he conducted an investigation into the allegation of abuse related to Resident #4. The ADM said he interviewed CNA F and she said Resident #4 was attempting to lean over and grab her wheelchair which caused the skin tear. The ADM said Resident #4 had no history of physical aggression with staff members to his knowledge. The ADM said the facility did not have a file for CNA F because she was agency staff. The ADM said she was suspended immediately pending the investigation and placed on the do not use list going forward. Review of resident safe surveys conducted on 5/14/25 indicated 6 of 6 residents surveyed who were on CNA H's said they felt safe in the facility and were happy with their care.Review of facility policy titled Bath, Shower/Tub dated February 2018 indicated .Stay with resident throughout the bath. Never leave the resident unattended in the tub or shower.Review of a facility policy titled Abuse, Neglect, Exploitation and Misappropriation Prevention Program revised 2021 indicated .Residents have the right to be free from abuse, neglect, misappropriation of property and exploitation. Event ID: Facility ID: 745021 If continuation sheet Page 3 of 5 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 12/11/2025 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)

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. 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 residents who are unable to carry out activities of daily living received the necessary services to maintain good personal hygiene for 3 of 11 residents (Resident #1, #2 and #3) reviewed for ADL care in that: The facility failed to ensure Resident #1 was provided appropriate incontinent care on 12/9/25 at 2:00 p.m. when she was observed wearing two briefs (double briefed) at the same time.The facility failed to ensure Resident #2 and Resident #3 was provided appropriate incontinent care at an unknown date and time when they said they had been double briefed in the facility.This failure could place all residents at risk of loss of dignity, skin breakdown, infection, and hospitalization.Findings included: Resident #2 Review of an admission Record dated 12/9/25 for Resident #2 indicated she was a [AGE] year-old female readmitted to the facility on [DATE] with diagnoses of chronic respiratory failure, chronic heart failure, type 2 diabetes, abnormal gait and mobility, and generalized weakness. Record review of an annual assessment MDS dated [DATE] indicated Resident #2 had moderately impaired cognition with a BIMS of 8. She required setup/cleanup assistance with eating and oral hygiene; she required maximal assist upper body dressing; she required total assist for toileting hygiene, shower/bath, lower body dressing, and putting on/taking off footwear. Record review of a comprehensive care plan dated 5/25/24 indicated Resident #2 had bowel and bladder incontinence related to diagnosis of immobility and obesity. Appropriate interventions was in place including check resident as required for incontinence and change disposable brief as needed. During an interview on 12/9/25 at 10:15 a.m., Resident #2 said staff had double briefed her as often as they can get away with. Resident #2 said she could not recall any specific dates or staff members involved. During an observation on 12/9/25 at 11:00 a.m., Resident #2 was assisted with incontinent care by CNA C. Resident #2 was not double-briefed and no concerns of skin integrity were noted. Review of a skin assessment dated [DATE] indicated Resident #2 had no alterations in skin integrity noted. Resident #3 Review of an admission Record dated 12/9/25 for Resident #3 indicated she was a [AGE] year-old female readmitted to the facility on [DATE] with diagnoses of functional quadriplegia (inability to move), type 2 diabetes, and morbid obesity.Record review of a quarterly MDS dated [DATE] indicated Resident #3 had intact cognition with a BIMS of 15. She required setup/cleanup assistance with eating; she required supervision for oral hygiene; she required moderate assist for personal hygiene; she required maximal assistance for upper body dressing; she was dependent on staff for toileting hygiene, shower/bath, lower body dressing, and putting on/taking off footwear. She was always incontinent of bowel and bladder.Record review of a comprehensive care plan dated 12/3/25 indicated Resident #3 was at risk for UTIs and skin breakdown related to bladder and bowel incontinence. Appropriate interventions was in place including monitor every 2 hours and change brief promptly for incontinent episodes. During an interview on 12/9/25 at 1:10 p.m., Resident #3 said facility staff had put two briefs on her in the past. Resident #3 said she could not recall specific details of when it happened or what staff members were involved. Resident #3 said she was not double briefed right now. Review of a skin assessment dated [DATE] indicated Resident #3 had rash to her groin with no other alterations in skin integrity.Resident #1Review of an admission Record dated 12/9/25 for Resident #1 indicated she was a [AGE] year-old female readmitted to the facility on [DATE] with diagnoses of Unspecified Dementia (altered cognition), cognitive communication deficit (impaired ability to communicate), and age-related physical debility. Record review of an annual assessment MDS dated [DATE] indicated Resident #1 had severely impaired cognition with a BIMS of 5. She required setup/cleanup assistance with eating; she required moderate assistance with oral hygiene, upper Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745021 If continuation sheet Page 4 of 5 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 12/11/2025 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)

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete body dressing, and personal hygiene; she required maximal assistance with toileting hygiene, shower/bath, lower body dressing, and putting on/taking off footwear. She was always incontinent of bowel and bladder.Record review of a comprehensive care plan dated 2/3/25 indicated Resident #1 had bowel and bladder incontinence related to diagnosis of dementia. Appropriate interventions were in place including check resident as required for incontinence and change disposable brief as needed. Record review of a comprehensive care plan dated 7/19/25 indicated Resident #1 had a history of UTIs. Appropriate interventions was in place including check every 2 hours for incontinence, and wash, rinse, and dry soiled areas.During an observation on 12/9/25 at 2:00 p.m., CNA A and CNA B assisted Resident #1 with incontinent care. Resident #1 was observed to be wearing two briefs, both saturated with urine. There was redness noted to her buttocks, barrier cream was applied by CNAs.During an interview on 12/9/25 at 2:15 p.m., CNA A said she had seen other residents wearing two briefs in the past, but not recently. CNA A could not recall resident names who had been seen wearing two incontinent briefs. CNA A said using two briefs (double briefing) on a resident was not acceptable practice because it could cause skin breakdown.During an interview on 12/9/25 at 2:18 p.m., CNA B said she had not seen any other residents in the facility wearing two briefs. CNA B said double briefing was not allowed as it could cause skin breakdown.During an interview on 12/9/25 at 2:30 p.m., CNA C said he was assigned Resident #1's care that day. CNA C said he checked on Resident #1 at approximately 6:00 a.m. and again when he got her up for lunch approximately 11:00 a.m., and Resident #1's brief was dry. CNA C said he did not notice Resident #1 was double briefed. CNA C said double briefing was not permitted in the facility because it could cause skin breakdown.During an interview on 12/9/25 at 2:35 p.m., LVN D said she had not observed any resident in the facility being double briefed. LVN D said it was unacceptable practice to double brief a resident and she would immediately address it with the assigned staff member if she observed a resident double briefed. LVN D said double briefing can cause skin integrity issues and infection.During a telephone interview on 12/9/25 at 3:20 p.m., CNA E said she worked 6:00 p.m. to 6:00 a.m. on 12/8/25 and was assigned to care for Resident #1. CNA E said she double briefed Resident #1 because other staff members told her to. CNA E said she could not recall the staff member who told her to double brief Resident #1. CNA E said she had completed incontinent care training and skills check offs as part of her new hire training which indicated not to double brief residents. During an interview on 12/11/25 at 5:10 p.m., the DON said double briefing was not an accepted practice. The DON said she had already begun disciplinary action with CNA E and CNA D and planned to in-service staff on appropriate incontinent care. The DON said risks of double briefing include skin breakdown and infection.During an interview on 12/11/25 at 5:20 p.m., the ADM said he was responsible for ensuring all staff receive required training from the time they are hired. The ADM said he was unsure if the facility had a specific policy that addressed double briefing, but the practice was not allowed. The ADM said he planned on in-servicing staff regarding appropriate incontinent care.Review of a Competency Assessment Perineal Care dated 12/2/25 indicated CNA E demonstrated competency in all required skills. Review of a facility policy titled Perineal Care dated February 2018 indicated .The purpose of this procedure is to provide cleanliness and comfort to the resident, to prevent infections and skin irritation, and to observe the resident's skin condition. Review of a facility policy titled Activities of Daily Living (ADL), Supporting dated February 2025 indicated .Residents who are unable to carry out activities of daily living will receive the services necessary to maintain good nutrition, grooming and personal and oral hygiene. Event ID: Facility ID: 745021 If continuation sheet Page 5 of 5