Avir at Boerne

Inspectors wroteBased on observation and interview, the facility failed to provide a safe, clean, comfortable, and homelike environment with maintenance services necessary to maintain a sanitary, orderly, and comfortable interior for 1 of 4 units (Unit B), reviewed for physical environment. The facility failed to ensure the door jamb, strike plate, and latch hole of the women's secure unit B shower room was not covered with black duct tape which prevented the door from latching and locking and the push buttons 5, 6, 7, and 9 on the electronic door lock were not missing. The facility failed to ensure the shower floor drain had a drain cover over it. This failure could place residents at risk of being exposed to others while being provided with care and showers, an unsanitary environment, accidents, and could result in embarrassment and being uncomfortable.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure all drugs and biologicals used in the facility were stored and labeled in accordance with currently accepted professional principles for 4 of 6 carts (the C/D hall treatment cart, the A/B hall treatment cart, the B hall medication cart, and the C hall medication cart) reviewed for medication storage and labeling. The facility failed to ensure all insulins located inside the C/D hall treatment cart and the A/B hall treatment cart were properly labeled with opened dates. The facility failed to ensure all medications located inside the B hall medication cart and the C hall medication cart were stored in labeled containers. These failures could place residents at risk of receiving inadequate treatments or ingesting medications for which they were not prescribed.

Inspectors wroteBased on observation, interview, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for 1 of 1 kitchen reviewed for food service safety. 1. A bag of waffles was undated in the refrigerator. 2. A container of orange juice was undated in the refrigerator. 3. A bag of pita bread was in an unsealed plastic bag in the refrigerator. 4. Three boxes of gluten free items were opened and undated in the refrigerator. 5. Two bags of cereal and four prepared bowls of cereals were undated in the pantry. 6. A package of quick oats was in an unsealed and undated bag in the pantry. 7. A package of gravy mix was in an undated bag in the pantry. 8. Scoops were left in the bulk sugar and bulk rice bins in the pantry. 9. A package of corn starch was in an undated bag on the counter. 10. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain an effective pest control program so that the facility is free of pests for 1 of 8 resident rooms (Resident #43) reviewed for physical environment. The facility failed to ensure there were no roaches in Resident #43's room and other areas of the facility. This failure could place residents at risk of unsanitary conditions, feelings of fear, irritation, embarrassment, depression, and an overall decline in quality of life.

Inspectors wroteBased on observation, interview and record review, the facility failed to treat each resident with respect and dignity and care for each resident in a manner and in an environment that promotes maintenance or enhancement of his or her quality of life, recognizing each resident's individuality and to protect and promote the rights of the resident for 1 of 8 residents (Resident #59) reviewed for resident rights. The facility staff failed to ensure Resident #59's lunch meal tray was not placed in front of her, uncovered when they were not ready to assist her with eating and after having access to her meal tray that it was not pushed away from her and out of her reach while her tablemate continued eating her lunch. This failure could place residents at risk of feelings of embarrassment, humiliation, depression, and an overall decline in quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the environment was free from accidents and hazards for 3 of 17 residents (R# 23, # 38 and # 12) in the Men's Secure Unit, in that: Resident # 23 had 3 unsecured bottles (shampoo/conditioner, moisturizer, and hand cream) in his room. Resident # 38 had an unsecured disposable razor and an unsecured electric shaving razor in his bathroom. Resident # 12 was wandering in and out of rooms. This failure could result in residents in the Men's secure unit experiencing accidents, injuries and/or a diminished quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure drug records were in order and that an account of all controlled drugs was maintained and periodically reconciled for 2 of 6 carts (D hall medication cart and C hall medication cart) reviewed for pharmacy services. The facility failed to ensure the controlled substance reconciliation logs were signed for accuracy of medication quantities during shift change. This failure could place residents at risk of not receiving their prescribed medications, experiencing untreated pain and anxiety, and a decreased quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to dispose of garbage and refuse properly for 1 of 1 trash disposal areas that was reviewed for disposal of garbage. The doors on the left and right sides of the dumpster were open, and trash was on the ground outside of the dumpster. These failures could place residents at risk for exposure to germs and diseases carried by vermin and rodents.

Inspectors wroteBased on interviews and record reviews the facility failed to ensure a comprehensive care plan was developed within 7 days after completion of the comprehensive assessment and reviewed and revised by the interdisciplinary team after each assessment, including both the comprehensive and quarterly review assessments for 4 of 9 (#20, #28, #33, #35) residents reviewed for IDT meetings/ care plans in that: 1. The facility failed to review and revise Resident #28's care plan after the MDS assessment on 2/17/25. 2. The facility failed to review and revise Resident #35's care plan after the MDS assessment on 2/25/25 3. The facility failed to review and revise Resident #33's care plan after each assessment in 2023. 4. The facility failed to review and revise Resident #20 care plan after the MDS assessment on 3/3/24, 6/1/24, 9/1/24, 10/9/24 and 1/9/25. [...]

Inspectors wroteBased on observations, interviews 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 kitchen in that: 1. Food containers in the storage room, rice container lid was open and had a smaller container. The flour container lid was not tightly closed. The flour container was on a shelf, underneath the shelf of the flour container was on had a rat trap box. 2. DM Q was not wearing a hairnet while in the kitchen. 3. Dietary aide L was not wearing gloves while placing chicken patties in the deep fryer oil. These failures could place residents at risk for food borne illness.

Inspectors wroteBased on observations and interviews the facility failed to maintain all mechanical, electrical, and patient care equipment in safe operating condition, for 1 of 1 facility's reviewed for maintenance and operation of essential equipment. 1. Laundry facility essential equipment was not operational. a. 2 of the 3 commercial clothing dryers were not operational. b. 1 of the 2 commercial clothing washers was not operational. c. 1 of the 1 Heating, ventilation, and air-conditioning (HVAC) system for the laundry facility was not operational. 2. The stove and deep fryer were not restrained. Deep fryer back right-side leg was propped up by wood. These failures could place residents at risk for neglect and not having their needs met.

Inspectors wroteBased on observations and interviews, the facility failed to provide a safe, functioning, and comfortable environment for residents, staff and public for A wind and B wing in that: 1. The window blinds in three windows in the A Wing common room were broken. 2. The B wing shower tile on ground had mold and the shower curtain had mold spots. This failure could affect residents by placing them at risk for diminished quality of life due to the lack of a well-kept environment.

Inspectors wroteBased on interviews and record reviews the facility failed to ensure allegations neglect were reported immediately, but not later than 24 hours if the events that caused the allegation do not involve abuse and did not result in serious bodily injury, to the administrator of the facility and to other officials (including to the State Survey Agency where state law provides for jurisdiction in long-term care facilities) in accordance with State law through established procedures, for 1 of 1 facility's reviewed for reporting allegations of abuse, neglect, exploitation. On 1/21/2025 the facility's exhaust fan, located in the women's memory care unit's pantry closet, began to produce large amounts of smoke, which caused staff to engage the fire alarm system, alerted the fire department, and staff used a fire extinguisher to extinguish the smoke from the exhaust fan. [...]

Inspectors wroteBased on interviews and record reviews the facility failed to report the results of all investigations in response to allegations of abuse, neglect, exploitation (ANE), or mistreatment to the State Survey Agency, within 5 working days of the incident, for 1 of 1 facility's reviewed for investigating an alleged fire. On 1/21/2025 the facility investigated an alleged fire in the facility without a report to the state agency, when an exhaust fan in the women's Memory Care unit (MCU) produced a large amount of smoke, causing the fire alarm to activate and the local fire department response. This failure could place residents at risk for ANE.

Inspectors wroteBased on observation, record review and interview, the facility failed to ensure that residents received treatment and care in accordance with professional standards of practice for 1 of 8 residents (Resident 35) reviewed for nursing services. The facility failed to follow physicians' orders to monitor for edema (swelling caused by fluid building up in body tissue) for Resident #5 as ordered on 4/30/24. This failure could place residents at risk for not receiving appropriate care and treatment and/or a decline in their health.

Inspectors wroteBased on observations, interviews, and record review the facility failed to provide food that was palatable, and at a safe and appetizing temprature for 1 of 1 test tray. 1. Test tray was not hot and lukewarm. 2. No food temperatures were logged for lunch. These failures could affect all residents who ate their meals prepared by the facility kitchen by placing them at risk of weight loss, altered nutritional status, and diminished quality of life.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure storage of foods brought to residents by family and other visitors to ensure safe and sanitary storage, handling, and consumption 1 of 1 (#35) residents' personal refrigerator in that: Resident #35's personal refrigerator had 3-4 Styrofoam empty cups with mold in them. This failure could affect residents by placing them at risk for food borne illness.

Inspectors wroteBased on observations, interviews, and record reviews the facility failed to ensure the establishment and maintenance of 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 diseases and infections to include standard and transmission-based precautions to be followed to prevent spread of infections, for 2 of 8 residents (Residents #16 and #162) reviewed for Enhanced Barrier Precautions (EBP). 1. On 3/6/2025 CNA I provided catheter care to Resident #16 while not donning Personal Protection Equipment (PPE). 2. On 3/5/2025 CNA J provided incontinent care for Resident #162 while not donning PPE. These failures could place residents at risk for cross contamination and spread of communicable diseases.

Inspectors wroteBased on observations, interviews and record review the facility failed to ensure the Dispose of garbage and refuse properly for 1 of 1 facility in that: The dumpster door on the left side was open. This deficient practice could place residents at risk for exposure to germs and diseases carried by vermin and rodents.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of each resident for 3 of 7 residents (Resident #4, #42, and #38) and 1 of 1 medication room reviewed for pharmacy services. 1. Resident #4 received milk of magnesia for gastro-esophageal reflux disease (stomach contents leak back into the esophagus) on 10/17/2024 at 8:14 a.m., but the resident's physician order said Geri-Lanta (alum-mag hydroxide-simeth) for gastro-esophageal reflux disease. 2. There was Resident #42's insulin flex pen (Aspart) for diabetes with open dated 09/17/2024 found inside the A and B hall nursing cart on 10/16/2024. It should have been discarded 28 days (10/15/2024) after opening. 3. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for 1 of 1 kitchen observed for food service. There was an expired and open container of salsa in srored in the dry storage pantry. This failure could place residents at risk of food borne illnesses.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the resident's right to a safe, clean, comfortable, and homelike environment for 1 of 4 halls (A hall) reviewed, in that: Facility observation of A Hall (male secured wing) on 10/15/24 at 9:30 AM revealed a strong/high urine odor on hallway. These failures could diminish the quality of life due to exposure to an environment that is unpleasant and unsanitary and cause infection.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents received services in the facility with reasonable accommodation of resident needs for 1 of 16 residents (Resident #51) who were observed for call light placement. The facility failed to ensure the call light was within reach for Resident #51 on 10/15/2024 and 10/16/2024. This failure could affect any resident and keep them from calling for help as needed.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to ensure residents received adequate supervision and safe environment to prevent accidents for 1 of 12 residents (Residents #39) reviewed for environment. There was one used disposable razor found on the sink faucet of Resident # 39's bathroom. This deficient practice cause infection or other physical injuries to residents and even staff.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to ensure a resident who is incontinent of bladder receives appropriate treatment and services to prevent urinary tract infections for 1 residents (Residents #23) of 16 residents reviewed for incontinent care, in that: When CNA-B and CNA-F was providing incontinent care to Resident 23 on 10/17/2024, CNA-F cleaned the resident's genital area with multiple pass of a wipe. These failures could place residents who require incontinent care at risk for cross contamination and infections.

Inspectors wroteBased on observation, interviews, and record review, the facility failed to ensure that a resident who needs respiratory care, including tracheostomy care and tracheal suctioning, is provided such care, consistent with professional standards of practice for 1 of 3 (Resident #7) reviewed for respiratory care. Resident #7's oxygen tubing and nasal cannular connected to the oxygen concentrator was not covered in a plastic bag on 10/15/2024 when it was not used. This failure could affect residents administered oxygen and could lead to infections if the tubing and humidifier bottle are not cleaned/ or replaced as ordered by the physician.

Inspectors wroteBased on observation, interview and record review revealed the facility failed to ensure the resident environment remained as free of accident hazards as is possible for 1 of 12 Residents (Resident #1) whose records were reviewed for smoking. 1. The facility staff failed to ensure Residents did not have access to smoking paraphernalia. Resident #1 obtained a lighter, set a piece of paper on fire in his room while his oxygen concentrator was on. An Immediate Jeopardy (IJ) was identified on 08/17/2024. The IJ template was provided to the facility on [DATE] at 04:59 P.M While the IJ was removed on 08/19/2024, the facility remained out of compliance at a scope of Isolated and a severity level of no actual harm with the potential for more than minimal harm because all staff had not been trained on smoking policies. 2. [...]

Inspectors wroteBased on interviews, observation, and record reviews, the facility failed to protect residents' rights to be free from verbal abuse, physical abuse, and involuntary seclusion for 7 (Resident #1, 2, 3, 4, 5, 6, and 7) of 12 residents reviewed for abuse and neglect, in that: 1. Residents #2, 5, and 6 were pinched, pulled, and told bad words by CNA A on 01/11/24. 2. CNA A was arguing with Resident #4 in a disrespectful manner on 01/11/24. 3. CNA A was physically aggressive with Resident #7 on 01/11/24 4. Residents #1 and #3 revealed CNA A verbally abused them, undated. The noncompliance was identified as past noncompliance IJ (Immediate Jeopardy). The noncompliance began on 01/11/24 and ended on 01/12/24. The facility had corrected the noncompliance before the investigation began. [...]

Inspectors wroteBased on interviews and record reviews the facility failed to ensure all alleged violations involving abuse, neglect, exploitation or mistreatment, including injuries of unknown source and misappropriation of resident property, are reported immediately, but not later than 2 hours after the allegation is made, if the events that cause the allegation involve abuse or result in serious bodily injury, or not later than 24 hours if the events that cause the allegation do not involve abuse and do not result in serious bodily injury, to the administrator of the facility and to other officials, including to the State Survey Agency for 2 of 10 residents (Resident #1 and #3) reviewed for allegations of abuse, neglect, exploitation, and mistreatment, in that: [...]

Inspectors wroteBased on interview, and record review, the facility failed to consult with the physician when the resident experienced a change in condition for 1 of 1 resident (Resident #1) reviewed for a change of condition, in that:. The facility failed to notify the physician when Resident #1 had bleeding to the bridge of the nose on 12/17/23 at 2:00 AM. LVN A was aware that Resident #1 had a fall with injury on 12/12/23 and neuro checks were done for 72 hours. The facility staff did not document an assessment, vital signs and communications with the physician for a period of 22 hours when the resident had a change of condition. Resident #1 was taken to the ER on [DATE] at 12:46 AM and diagnosed with a subdural hematoma, nasal fracture, and rib fractures. An Immediate Jeopardy was identified on 01/12/24 at 12:05 PM. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure that, based on the comprehensive assessment of a resident, the resident received treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the resident's choices for 1 of 1 resident (Resident #1) reviewed for nursing services, in that: Facility staff failed to respond appropriately when Resident #1 had a bleeding to the bridge of the nose on 12/17/23 at 2:00 AM. The facility staff did not document an assessment, vital signs, and communications with the physician for a period of 22 hours when the resident had a change of condition. Resident #1 was taken to the ER on [DATE] at 12:46 AM and diagnosed with a subdural hematoma. An Immediate Jeopardy was identified on 01/12/24 at 12:05 PM. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to protect a resident's right to be free from abuse, neglect, misappropriation of resident property, and exploitation for 1 of 4 residents (Resident #1) reviewed for abuse, in that: The facility failed in that they used physical and chemical restraints on Resident #1 when he began exibiting aggressive and exit seeking behaviors. Resident #1's behaviors included; hitting, scratching, pulling, pushing, kicking and grabbing clothes. These failures resulted in an IJ on 8/31/23 at 6:01 p.m. While the IJ was removed on 9/1/23 at 8:19 p.m., the facility remained out of compliance at a level of no actual harm with the potential for more than minimal harm that is not immediate jeopardy with a scope of pattern. [...]

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure residents were free from physical or chemical restraints imposed for purposes of discipline or convenience, and not required to treat the resident's medical symptoms for 1 of 4 residents (Resident #1) reviewed for freedom from physical and chemical restraints, in that: The facility failed to ensure Resident #1 was free from any physical or chemical restraints when exhibiting aggressive behaviors These failures resulted in an IJ on 8/31/23 at 6:01 p.m. While the IJ was removed on 9/1/23 at 8:19 p.m., the facility remained out of compliance at noactual harm with a potential for more than minimal harm that is not immediate jeopardy with a scope of pattern due to the facility's need to evaluate the effectiveness of their plan of removal. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure the Resident(s) environment remained as free of accident hazards as possible and each resident received supervision and assistance devices to prevent accidents for 1 of 4 residents (Resident #1) reviewed for elopements in that: The facility failed to provide adequate safety interventions to prevent Resident #1 from elopement. Resident #1 had elopement events recorded on 5/18/23, 5/27/23, 8/22/23, 8/25/23. On 8/26/23, Resident #1 was found in the middle of the street a half mile down the road from the secure unit. These failures resulted in an IJ on 8/26/23 at 6:00 p.m. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide the necessary behavioral health care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being for 1 of 4 residents, (Resident #1) reviewed for behavioral health services in that: The facility failed to ensure Resident #1 was provided appropriate or timely behavioral health services after showing increased signs of aggression. This failure resulted in an IJ on 8/31/23 at 6:01 p.m. While the IJ was removed on 9/1/23 at 8:19 p.m., the facility remained out of compliance at a level of no actual harm with a potential for more than minimal harm that is not immediate jeopardy with a scope of pattern due to the facility's need to evaluate the effectiveness of their plan of removal. [...]

Inspectors wroteBased on interview and record review, the facility failed to employ or contract a qualified social worker for a facility of 120 beds or less for 1 of 1 facility in that: The facility failed to ensure an employed or contracted social worker visited the facility as needed. This failure could place all residents at risk for not receiving necessary social services.

Inspectors wroteBased on interview and record review, the facility failed to develop and implement written policies and procedures that prohibit and prevent abuse, neglect, exploitation or mistreatment of residents and establish policies and procedures to investigate such allegations for 1 of 4 residents (Resident #5) reviewed for abuse and neglect in that: The facility failed to report an altercation and failed to have evidence a thorough investigation was conducted following a resident-to-resident altercation between Resident #1 and Resident #5. This failure could place residents at risk for continued abuse and neglect due to inappropriate interventions after an incomplete investigation was conducted.

Inspectors wroteBased on interview and record review, the facility failed to develop and implement a comprehensive person-centered care plan for each resident, consistent with resident rights, that included measurable objectives and time frames to meet a resident's mental, nursing, and psychosocial needs that were identified in the comprehensive assessment, for 1 of 4 Residents (Resident #1) reviewed for care plans, in that: The facility failed to fully develop a comprehensive person-centered care plan that was specific for Resident #1 to address the resident's aggression and elopements. This failure could place residents at risk for not getting their medical, physical, and psychosocial needs met and not being provided with the necessary care or services and having personalized plans developed to address their specific needs.