Avir at Bandera

Inspectors wroteBased on observations, interviews, and record review the facility failed to ensure Comprehensive Care Plans - The facility must develop and implement a comprehensive person-centered care plan for each resident, consistent with the resident rights, that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment. The resident's preference and potential for future discharge. Facilities must document whether the resident's desire to return to the community was assessed and any referrals to local contact agencies and/or other appropriate entities, for this purpose. Discharge plans in the comprehensive care plan, as appropriate, in accordance with the requirements for 3 of 16 (Residents #3, #51, #41) residents reviewed for care plans. 1. [...]

Inspectors wroteBased on observations, interviews, and record reviews the facility failed to ensure Other Environmental Conditions - The facility must ensure that the resident environment is free from accident hazards over which the facility has control and provides supervision and assistive devices to each resident to prevent avoidable accidents. This includes: a safe, functional, sanitary, and comfortable environment for residents, staff, and the public for 2 of 2 (100/200 hall and 300/400 hall) main shower rooms in that and 1 of 1 facility common area for accidents and hazards. The facility failed to ensure the 100/200 and the 300/400 shower rooms did not have several razors and 2 chemical sprays used for cleaning in an unlocked area in the shower rooms. This failure could lead to resident accident or injury. [...]

Inspectors wroteBased on observation, interview and record review the facility failed to ensure each resident received, and the facility provided, food and drink that was palatable, attractive, and at a safe and appetizing temperature for 2 of 6 residents, and 1 of 1 meal reviewed for palatability, attractiveness, and appetizing foods. The facility failed to provide food that was palatable and at an appetizing temperature for residents. This failure could place residents at risk of a decrease in food intake, hunger, and unwanted weight loss.

Inspectors wroteBased on observation, interview and record review, the facility failed to maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable disease and infection for 1 of 16 residents (Residents #76) and 1 CNA (CNA E) reviewed for infection prevention and control. The facility failed to ensure the SLP and MA P donned the appropriate PPE when on 5/20/2026 they entered Resident #76's isolation room. The facility failed to ensure while passing out trays on the facility's 300-hall, CNA B sanitized her hands between delivering residents' lunch meal trays. This failure could place residents at risk of cross-contamination and the spread of infection.

Inspectors wroteBased on observations, interviews the facility failed to ensure Other Environmental Conditions The facility must provide a safe, functional, sanitary, and comfortable environment for residents, staff and the public for 1 of 1(1 salon) in that: 1. The salon had 2 brushes in a drawer and in the cabinet 4-15 rollers in a tray, with some hair on them. This could affect all residents that use the salon and could cause unsanitary germs to residents. 2. The facility failed to ensure the 300/400 hall shower room did not have bedding sheets on the floor to keep the water from going out in the hall while residents were taking a bath.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to ensure residents who were incontinent of bladder received appropriate treatment and services to prevent urinary tract infections and to restore continence to the extent possible, for 1 of 8 residents (Resident #3) reviewed for catheter care. On 5/19/2026 the facility failed to ensure RN G and CNA J educated and redirected Resident #3 when he applied his urinary drainage collection bag above his bladder and secured the urine collection bag to his waist. The failure could place residents at risk for urinary tract infections.

Inspectors wroteBased on observation, interview and record review, the facility failed to store, prepare, distribute and serve food in accordance with professional standards for food service safety for 1 of 1 kitchens reviewed for food safety requirements. The facility failed to store food in accordance with professional standards for food service safety. This failure could place residents who eat meals from the kitchen at risk for the spread food borne illness.

Inspectors wroteBased on observation, interview, and record review, the facility failed to prepare, distribute and serve food in accordance with professional standards for food service safety for 1 of 1 kitchen observed for food safety. The facility failed to ensure staff with facial hair was covered by a hair restraint or worn properly. This failure could place residents at risk of foodborne illness.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure that all alleged violations involving abuse were reported immediately, but not later than 2 hours after the allegation was made, if the events that cause the allegation involved abuse, to the Administrator and to other officials (including to the State Survey Agency and adult protective services where state law provides for jurisdiction in long-term care facilities) in accordance with State law through established procedures for 1 of 4 residents (Resident #1) reviewed for freedom from abuse, neglect, and exploitation. The facility failed to report to HHSC that Resident #1 had made an allegation of sexual misconduct against CNA A.This failure could place residents at risk of abuse, neglect, and exploitation.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that a resident who is incontinent of bladder receives appropriate treatment and services to prevent urinary tract infections to the extent possible for one (Resident #1) of three residents reviewed for indwelling urinary catheters. The facility failed to identify a change in condition or recognize symptoms of a UTI when Resident #1, who required a catheter and had a history of UTIs, began experiencing increased bladder spasms and dysuria (painful urination) from 03/13/25 - 03/21/25. These failures resulted in an identification of an Immediate Jeopardy (IJ) on 04/04/25 at 1:07 PM and an IJ template was given. [...]

Inspectors wroteBased on interview and record review, the facility failed to immediately notify the resident's physician when there was a significant change in the resident's physical status for one (Resident #1) of three residents reviewed for resident rights. The facility failed to ensure Resident #1's NP was notified when she, who required a catheter and had a history of UTIs, began experiencing signs and symptoms such as increased bladder spasms and dysuria (painful urination) from 03/13/25 - 03/21/25. This failure placed residents at risk of medical diagnoses not getting treated and a decreased quality of life.

Inspectors wroteBased on observations, interviews, and record reviews the facility failed to develop and implement a comprehensive person-centered care plan which described the services that were to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being, to include the resident's preference and potential for future discharge; for 2 of 8 residents (Residents #43 and #84) reviewed for care plan development. 1. The facility failed to care plan Resident #43's wishes to discharge from the facility. 2. The facility failed to develop care plan interventions for Resident #84's implanted defibrillator / pacemaker and accompanying cellular monitor. These failures could place residents at risk for psychosocial and physical harm.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to provide, based on the comprehensive assessment and care plan and the preferences of each resident, an ongoing program to support residents in their choice of activities for 3 (Residents #34, #40, and #48) of 8 residents reviewed for activities. 1. The facility failed to provide residents in the memory care unit, including Resident #40, with activities designed to meet their interests and promote physical, mental, and psychosocial well-being. 2. The facility failed to provide in-room activities for Resident #34, Resident #48 reviewed for activity interventions. This failure could place residents at risk for decline in mental acuity and increase in negative behaviors due to a lack of stimulation, boredom, and depression.

Inspectors wroteBased on interview and record review, the facility failed to ensure that residents received treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the residents' choices for 4 (Residents #1, #34, #37, and #79) of 16 residents reviewed for quality of care. 1. The facility failed to take blood pressure on Resident #37 prior to providing a blood pressure medication, amlodipine, as ordered by the resident's physician. 2. Facility failed to monitor for signs and symptoms of heart failure for Residents #1, #34, and #79 while being treated with diuretic medications furosemide (Resident #1) and spironolactone (Resident #34 and #79). This failure could place residents at risk for not receiving appropriate care and treatment and/or a decline in their health.

Inspectors wroteBased on interview and record review, the facility failed to ensure residents who were unable to carry out activities of daily living received the necessary services to maintain good nutrition, grooming, and personal and oral hygiene for 1 of 6 residents (Resident #37) reviewed for personal hygiene. The facility failed to provide Resident #37, 4 of 20 scheduled showers between 02/03/2025 and 03/20/2025. This failure could place residents who require assistance from staff for personal hygiene at risk of not receiving care and services contributing to overall poor hygiene, risk of experiencing a diminished quality of life, and possible skin infections.

Inspectors wroteBased on interviews and record review, the facility failed to maintain clinical records in accordance with accepted professional standards and practices that were complete and accurately documented for 1 of 5 residents (Resident #1) reviewed for accuracy of records, in that: The facility failed to ensure the medication administration record (MAR) for Resident #1 accurately reflected urine sample was not collected on the January 2024 MAR on the 3rd, 4th, and 5th. The facility failed to document or provide a rationale from a medical provider in January of 2024 when the order for collection of a urine sample for a urinalysis for Resident #1 was canceled on January 11th of 2024 by the DON. This failure could put residents at risk of an untreated urinary tract infection due to inaccurate documentation and lead to missed or delayed diagnosis and treatment.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide adequate supervision to prevent accidents for 1 (Resident #1) of 3 residents reviewed for elopement risk. Resident #1 was found lying in the grass beside his wheelchair on the opposite side of a two-lane road after he had eloped from an exit door of the facility, resulting in a laceration to his right eye and facial bruising. The noncompliance was identified as PNC. The IJ began on 06/4/2024 and ended on 06/05/2024. The facility had corrected the noncompliance before the survey began. This failure could place all 3 residents who used a wander guard at risk for serious injuries.

Inspectors wroteBased on interview and record review, the facility failed to ensure residents were seen by a physician at least once every 30 days for the first 90 days after admission for 22 (Residents #53, #901, #88, #7, #50, #27, #39,, #41, #47, #141, #902, #903, #17, #63, #34, #1, #62, #904, #905, #84, #20, and #906,) of 43 residents reviewed for physician services. The facility failed to ensure PCP A made physician visits since he started on or about 10/01/2023. The facility failed to ensure 22 of 43 residents (Residents #53, #901, #88, #7, #50, #27, #39, #41, #47, #141, #902, #903, #17, #63, #34, #1, #62, #904, #905, #84, #20, and #906) were seen by a Physician within 30 days of admission to the facility. [...]

Inspectors wroteBased on interviews and record reviews, the facility failed to maintain medical records on each resident that are accurately documented for 24 (Residents #53, #901, #88, #7, #50, #27, #39,, #41, #47, #141, #902, #903, #17, #63, #34, #1, #62, #904, #905, #84, #20, and #906,) of 24 residents reviewed for accurate medical records in that: The facility failed to ensure PCP A documented physician notes in the EHR since he started on or about 10/01/2023. This deficient practice could place all residents at an increased risk of not having their total program of care and condition reviewed, decisions about the continued appropriateness of the resident's current medical regimen documented, which could result in a decline in health and well-being.

Inspectors wroteBased on record review and interview, the facility failed to ensure residents who were unable to carry out activities of daily living were provided with the necessary services to maintain good personal hygiene for 8 of 8 (Resident #4, #5, #45, #51, #57, #64, #78) in that: 1. The facility failed to prevent Resident #5 from missing 6 of 10 scheduled showers between 1/1/2024 and 1/25/2024. 2. The facility failed to prevent Resident #45 from missing 9 of 11 scheduled showers between 1/1/2024 and 1/25/2024. 3. The facility failed to prevent Resident #51 from missing 10 of 11 scheduled showers between 1/1/2024 and 1/25/2024. 4. The facility failed to prevent Resident #57 from missing 5 of 11 scheduled showers between 1/1/2024 and 1/25/2024. 5. The facility failed to prevent Resident #64 from missing 7 of 11 scheduled showers between 1/1/2024 and 1/25/2024. 6. [...]