Health inspection·January 15, 2026

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete facility, then every quarter and with any change of condition. Nursing staff take responsibility as well for overlooking care plans and were placed into PCC correctly. MDS nurse stated there was no specific order for Resident #1's medical diagnosis for dehydration but there was no risk since there was a care plan order for fluid imbalance which could indicate for either at risk for renal failure or dehydration. The care plan stated a goal for Risk for altered Fluid balance which stated intervention/task evaluate blood pressure and Evaluate resident/Representative on methods to relieve dry mouth while maintaining fluid restriction. MDS nurse stated, those are all interventions on the resident's profile that could be used for dehydration, so it is addressed on there. In an interview on 01/14/2026 at 03:11 pm Administrator stated that the responsibility for care plans would be the MDS nurses and the RNs, they go over them and make sure it is all correct and then they sign off on the care plans as well as the QRM who overlook as well to make sure of its input correctly. Since the resident had a medical diagnosis of dehydration there should have been a care plan due to her history of hospitalization due to dehydration and UTIs. The risk was if one doesn't know what symptoms or interactions to look for would affect the health of the resident. Nurses were trained upon hire and come up with their Relias training (learning management designed for healthcare workers to meet regulatory compliance, reduce risk, and improve employee perfromace) or when in-services were conducted. Nursing staff have had in-services regarding fluid intake in the last month, or month and a half and admin had instructed the managers in the morning meetings to be checking to make sure all pitchers have water and have been offering residents water consistently to prevent any dehydration at the facility. Jelly drops have also been ordered in which were used for Resident #1 as well but unsure if she liked them or not. The facility had been very focused on hydration. Review of facility policy titled Care plans, Comprehensive Person-Centered revision date March 2022, stated A comprehensive, Person-Centered care plan that includes measurable objectives and timetables to meet the resident's physical, psychosocial and functional needs is developed and implemented for each resident. Policy interpretation and implementation:7.) The comprehensive, person-centered care plan:b.) describes the services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being, including:C.) Includes the residents stated goals upon admission and desired outcomes; e.) reflects currently recognized of practice for problem areas and conditions.10.) When possible, interventions address the underlying source (s) of the problem area (s), not just symptoms or triggers.11.) Assessments of residents are ongoing, and care plans are revised as information about the residents and the residents' conditions change.12.) The interdisciplinary team reviews and updates the care plan:c.) when the resident has been re-admitted to the facility from a hospital stay: and Event ID: Facility ID: 745038 If continuation sheet Page 2 of 4 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 745038 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/15/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Tierra Este 14300 Pebble Hills Blvd El Paso, TX 79938 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview and record review the facility failed to maintain food service practices under sanitary conditions by not ensuring dietary staff performed proper hand hygiene during food handling and meal service. The facility failed to ensure dietary staff A performed good hand hygiene within the context of food handling and sanitation.This failure could place residents at risk of cross contamination and the potential transmission of infectious organisms. Findings included: An observation on 01/14/2025 at 12:10 PM during lunch Dietary staff A was seen using her cell phone before the lunch trays were about to be distributed. Dietary Staff A quickly put her phone away in her pocket and walked up to the food line table to begin placing trays onto carts to be distributed to the residents. Dietary Staff A placed 4 trays onto a cart when LVN A asked Dietary staff A to place an object on the door to prevent it from closing. Dietary staff A went and grabbed a food can and placed it at the bottom of the door to prop open the door. She then went back to the table line and started placing food trays onto carts again. Dietary Staff A was not seen performing hand hygiene during these two transactions. In an observation on 01/14/2025 at 12:20 PM Dietary staff A still had not performed hand hygiene and was asked to provide food covers for residents' trays in which she handled with both hands. She was then asked to provide a resident with salsa and ground chicken, in which she handed to LVN A. She then proceeded to continue with food tray line and placed food trays on the food cart.In an observation on 01/14/2025 at 12:22 PM Dietary staff A walked away into the back of the kitchen where she could not be seen. When she returned to the food line she was seen with gloves on. Unaware if Dietary Staff A performed hand hygiene prior to placing gloves on. In an interview on 01/14/2025 at 12:50 pm the Dietary manager stated, Dietary staff aids were supposed to wash their hands prior to handling food trays on the food line and staff were not allowed to touch anything else after that. If they need to touch anything else, then the food tray staff need to go back and wash their hands before returning to the food tray line. What Dietary Staff A did was not okay for her to do. Dietary Manager stated he needed to do an in-service with her. Dietary Manager stated Dietary Staff A was relatively new and was trained on hand hygiene and when to perform hand hygiene when going to grab something else and then returning to the food line. The risk of her not performing hand hygiene during her handling all the objects she did was a risk for infection control. In an interview on 01/14/2026 at 01:20 PM, DON stated Dietary Staff A should have worn gloves or performed hand hygiene. After handling anything other than food and placing it on the floor would require hand hygiene. The risk was cross contamination and infection.In an interview on 01/14/2026 at 03:11 PM, Administrator stated when staff go from one modality or station to the other, they should be washing their hands. If staff handle nonfood items and then return to the food line, they should be washing their hands before getting to the food line. The risk was cross-contamination, or food poisoning.In an interview on 01/15/2026 at 12:39 pm, Main [NAME] stated he had been employed at the facility for approximately 2 years and 7 months and consistently practiced proper hand hygiene. He further stated that the facility provides hand hygiene training at least every six months and instructs staff especially new hires, that if they touch anything outside of the food tray line, they must immediately perform hand hygiene prior to continuing food service. Failure to wash or sanitize hands after touching non-food items or after handling multiple trays posed a risk to infection control and cross-contamination control or cross contamination.Review of facility policy titled Handwashing/Hand Hygiene revision date October 2023, updated 01/2025, stated The facility considers hand hygiene the primary means to prevent the spread of healthcare- associated infections.1.) All personnel are trained and regularly in-serviced on the importance of hand (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745038 If continuation sheet Page 3 of 4 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 745038 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/15/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Tierra Este 14300 Pebble Hills Blvd El Paso, TX 79938 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 0812 Level of Harm - Minimal harm or potential for actual harm hygiene in preventing the transmission of healthcare-associated infections.2.) All personnel are expected to adhere to hand hygiene policies and practices to help prevent the spread of infections to other personnel, residents, and visitors. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745038 If continuation sheet Page 4 of 4