Health inspection·November 21, 2025

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Resident #1 pushed his call light, when staff responded he requested repositioning, three therapy staff and 1 CNA responded to reposition the resident. During an interview on 10/01/2025 at 4:00 p.m., LVN A stated Resident #1 utilized his call light a lot and required staff assistance and attention frequently. LVN A stated Resident #1 was on Ozempic (Semaglutide) and they were trying to get him to lose weight so he would be healthier and could participate in his own care and in therapy. LVN A stated the resident could have snacks in addition to his prescribed diet. He stated staff should monitor his food intake and record it in the medical record. LVN A stated he did not have anything to do with the care plans and was not certain what should be contained in them. He stated he wasn't sure who was responsible for the care plans. During an interview on 10/01/2025 at 5:05 p.m., the MDS Coordinator stated Resident #1 was totally dependent on staff for his care and needed help with moving, sitting, etc[TF5] . She stated Resident #1's care plan did not specify what his bed mobility or other ADL requirements were, or the number of staff needed to provide his care. She stated a place holder was added to the care plan, but the care itself was not specified. The MDS Coordinator stated Resident #1's care plan also included spaces for cardiac diet with no interventions because that part of the care plan was not finished. She stated the part that indicated intake more than body requirements was created but an evaluation of the resident's weight and goals were not specified. The MDS Coordinator stated she was the only full-time MDS Coordinator at the facility. She stated care plans were primarily her responsibility. She stated they used to have weekly care plan meetings on Thursdays, and they had not occurred in one month. She stated she was new to the role of MDS Coordinator and needed more assistance. She stated complete care plans were important so the facility could meet the resident's level of care and because it was used as a reference for how nurses cared for the resident[TF6] . During an interview on 10/01/2025 at 5:32 p.m., the ADON stated the care plans were completed by the RN's and the MDS Coordinator. She stated the DON reviewed and signed them. She stated she could make suggestions for the care plans but did not edit them because she was an LVN. During an interview on 10/01/2025 at 6:00 p.m., the DON stated the facility ran into a glitch with care plans. She stated when a LVN completed an assessment it opened up a baseline care plan in the medical record. She stated she had to go into the record, delete them and reopen a care plan. She stated the computer software company was working on a solution. The DON stated the MDS Coordinator was responsible for ensuring the comprehensive care plans were complete, but again because of the glitch they were not triggering, and it was a known problem. The DON stated an accurate care plan was important, so they knew how to care for the resident. Record review of the facility's policy titled Comprehensive Person-Centered Care Plans, dated March 2022, revealed: 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. 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, c. includes the resident's stated goals upon admission and desired outcomes d. builds on the resident's strengths and e. reflects currently recognized standards of practice for problem areas and conditions. Event ID: Facility ID: 745050 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 745050 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Kerrville 1555 Bandera Hwy Kerrville, TX 78028 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 0680 Ensure the activities program is directed by a qualified professional. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review the facility failed to ensure the activities program was directed by a qualified professional who was a qualified therapeutic recreation specialist or an activities professional who was licensed or registered by the State to for 72 of 72 residents reviewed for qualifications of activity professionals.The facility failed to have a qualified Activities Professional to direct their activities program.This deficient practice could place residents at risk of not receiving approaches that were individualized to match the skills, abilities, and interests/preferences of each resident for activities.The findings include: During an interview on 10/01/2025 at 3:40 p.m., the HR [TF1] Director stated the personnel file for the Activity Director did not have any proof of education. He stated it was his understanding, the Activity Director had a year to complete training. The HR Director stated the Administrator had intentions on enrolling the Activity Director in training but as of this interview she had not yet been enrolled. During an interview on 10/01/2025 at 4:46 p.m., the Activity Director stated she was the facility Activity Coordinator. She stated she had been in the position for the past 4-5 weeks. She stated she did not have any training right now and was not currently enrolled in any training for Activity Director. She stated she was not an OT[TF2] or OTA[TF3] , and she did not have any prior experience. She stated she was doing a little trial run to see if she was interested in the position. She stated she wanted to make sure she could take the job seriously and do the position justice and do it right. The Activity Director stated she loved the job. She stated she communicated to the Administrator within the first week that she wanted to do it full time. During an interview on 10/02/2025 at 1:03 p.m., the Administrator stated the Activity Director was hired as an assistant because she worked at as CNA. The Administrator stated the facility was working on getting her certified and she was going to be enrolled in one of the training courses for Activity Director. He stated she was not currently registered for the training. The Administrator stated he did not have anyone else who met the Activity Director requirements. He stated it was important to have an Activity Director on staff who met requirements to assist with cognition, so residents' had the opportunity to express themselves and so they could flourish in their home[TF4] [TF5] . Record review of the facility's, unsigned and undated, job description for the Activity Coordinator, revealed: Qualifications: previous office experience preferred, previous nursing home experience preferred, previous supervisory experience preferred. Record review of the facility's policy titled Activity Program, dated June 2018, revealed: The Activity programs are designed to meet the interests of and support the physical, mental and psychosocial well-being of each resident. The policy did not address the Activity Director. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745050 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 745050 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Kerrville 1555 Bandera Hwy Kerrville, TX 78028 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to ensure medical records were maintained in accordance with accepted professional standards and practices for each resident, that were complete and accurately documented for 1 of 6 residents (Residents #2[TF1] ) reviewed for accuracy of medical records. The facility failed to ensure Resident #2's progress notes were documented accurately and according to professional standards of practice when RN B documented under LVN A's profile. This deficient practice could place residents at risk for errors in care and treatment and inaccuracies in documentation. The findings include: Record review of Resident #2's face sheet dated 9/30/2025 revealed an [AGE] year-old female admitted on [DATE] with diagnoses which included: retention of urine, type 2 diabetes mellitus and hypertension. [TF1] Record review of Resident #2's EMR revealed a progress note, dated 9/24/2025 at 18:10 (6:10 p.m.), of an assessment note, with RN B's typed name at the end of the note. The progress note, had a date and time stamp and electronic signature belonging to LVN A. During an interview on 10/01/2025 at 2:31 p.m., RN B stated she was a new RN, and this was her first job as a nurse. She stated she worked at the facility for two days on 9/24/2025-9/25/2025 before quitting. She stated on 9/24/2025 she was assigned LVN A to shadow and to learn the computer system. She stated she did not have her own log in to PCC. RN B stated she did not have her own assignment of patients to care for as she was supposed to be learning. RN B stated on 9/24/2025 she documented an assessment of Resident #1 using LVN A profile. She stated LVN A allowed her to use his profile to look around in the system to see how it worked. RN A stated LVN A was aware she was documenting under his profile. She stated he told her he would have to review and approve the note, but he was not with her when she entered it in the computer. RN B stated she had not been instructed to document in the EMR by any staff member. During an interview on 10/01/2025 at 4:00 p.m., LVN A stated he was training RN B on the system (PCC) on 9/24/2025. He stated she did not have any log in information, so he was training her how to use the system on his profile. LVN A stated RN B completed an assessment on Resident #2. LVN A stated RN B was doing stuff he didn't know she was doing. LVN A stated he did not know RN B had put the progress note in. He stated later that evening he saw it. He stated he did not realize she was actually writing a note in the medical record. LVN A stated RN B did not have his password. He stated he logged into PCC for her. He stated he thought she was just looking. LVN A stated after he saw the note he told the DON. He said the DON stated they were going to look over her notes. During an interview on 10/01/2025 at 5:32 p.m., the ADON stated she worked with RN B on day 1 (9/24/2025). She stated RN B would not stay with her trainer (LVN A) and was trying to do her own thing without direction of management. The ADON stated RN B had to be redirected multiple times. She stated RN B was making phone calls and charting things she was not authorized to chart. The ADON stated RN B was a new nurse and was very eager, but she was not fully trained. The ADON stated the next day, RN B called and said she would not be returning to the facility. The ADON stated she was not aware RN B had documented under LVN A's profile. She stated RN B should not have done that. The ADON stated the EMR was a permanent record of the resident. She stated another staff could not document under someone else's electronic signature because it had the appearance of something LVN A did. She stated if there was an error in documentation it would fall on LVN A[TF2] . During an interview on 10/01/2025 at 6:00 p.m., the DON stated RN B was a new nurse with no experience. She stated she was only at the facility for 12 hours and that was enough for her. She stated after the 12 hours she called and said she was not cut out for nursing and never came back. The DON stated when she found out RN B had documented under LVN A's credentials, she told RN B (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745050 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 745050 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avir at Kerrville 1555 Bandera Hwy Kerrville, TX 78028 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete no that was not okay. She stated she told RN B it was never okay to document under someone else. The DON stated it was falsifying documentation and could get someone in trouble. The DON stated LVN A was not graining [TF3] RN B on any nursing skills. He was training her on the computer. She stated she told HR she did not want RN B back in the building after this occurred. Record review of the facility's policy titled Charting and Documentation, dated July 2017, revealed: 3. Documentation in the medical record will be objective (not opinionated or speculative), complete, and accurate. 4. Entries may only be recorded in the resident's clinical record by licensed personnel (e.g. RN, LPN/LVN, physicians, therapists, etc.) in accordance with state law and facility policy. Event ID: Facility ID: 745050 If continuation sheet Page 5 of 5