Avir at Childress

Inspectors wroteBased on interview and record review, the facility failed to use the services of a Registered Nurse (RN) for at least eight consecutive hours a day, seven days a week for the month of April 2026 for 2 days reviewed for weekend RN coverage. The facility failed to ensure they had RN coverage of 8 hours a day, 7 days a week for the following days:04/05/2026 and 04/26/2026. This failure could place residents at risk for inconsistency in care and services.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a safe, clean, comfortable, and homelike environment for 1 of 1 facility observed. Hall 2 contained dried splashed residue on the wall located at the entrance with dusty handrails with cobwebs attached. Flies were present throughout the facility and interfered with residents during lunch time. An anonymous resident had a fly become entangled in her recently styled hair. A bathroom on Hall 3 contained residue at the base of the toilet, peeling paint above the sink and areas of exposed patch material that had not been painted. Fluorescent light fixtures located on Halls 3 and 5 and in the dining, area contained accumulations of dead insects with some insects appearing to still be alive. These failures could affect residents by placing them in an uncomfortable and unsanitary environment.

Inspectors wroteBased on observation, interview and record review the facility failed to provide an ongoing program to support residents in their choice of activities designed to meet the interests of and support the physical, mental, and psychosocial well-being for all residents reviewed for activities. A. The activity calendar was not followed. B. There were no daily activities occurring on a regular basis in the facility. C. The activities did not meet the needs of the residents. D. Room visits were not conducted and did not meet the needs of the residents. These failures could potentially place all residents at risk of decreased self-worth, boredom, poor quality of life, depression, behaviors and decreased cognitive function.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure each resident received and the facility provided food that was palatable and attractive for 3 of 3 food forms (Regular, Mechanical and Alternative) for 1 of 1 (Lunch) meal reviewed for palatability. The facility failed to provide food that was palatable for the lunch meal on 07/06/26. This failure could place residents at risk of decreased food intake, hunger, and unwanted weight loss.

Inspectors wroteBased on observation, interview, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with the professional standards for food service safety for 1 of 1 kitchen reviewed for kitchen sanitation. 1. The facility failed to ensure pantry and freezer items were properly stored and closed to air.2. The facility failed to ensure proper hand hygiene and glove use was practiced. These failures could place residents who ate food served by the kitchen at risk of food-borne illness.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure the resident environment remained as free of accident hazards as is possible and each resident received adequate supervision to prevent accidents for 1 of 16 residents (Resident #35) reviewed for accidents and hazards. The facility allowed Resident #35 to possess smokeless tobacco in his room. This failure could affect the residents at the facility by placing them at risk of injury.

Inspectors wroteBased on observation, interview, and record review, 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 2 Residents (Resident #33) reviewed for incontinent care. The facility failed to ensure Resident #33 was wiped using the correct technique during incontinent care performed by CNA B. This failure places the residents at risk of urinary tract infections or skin breakdown.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure all drugs and biologicals were stored in accordance with currently accepted professional principles for 1 of 2 medication carts (Med Cart A) reviewed for medication storage. The facility failed to ensure Med Cart A was locked when unattended. This failure could place residents at risk of medication errors or drug diversion.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to maintain and ensure safe and sanitary storage of residents' food items for 1 of 1 Resident's personal refrigerators reviewed for food safety (Resident #35) in that:The facility did not have a system in place to assist residents in cleaning and maintaining their personal refrigerators to ensure safe food handling and prevent consumption of spoiled and/or expired foods. The personal refrigerator in Resident #35's refrigerator contained unknown substances that were not labeled or dated and left uncovered. There was lunch meat that expired on 06/09/2026. These failures could put residents at risk of foodborne illness from consuming spoiled food.

Inspectors wroteBased on observation, interview, and record review, the facility failed to establish and 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 diseases and infections for 1 of 3 residents (Resident #33) reviewed for infection control. The facility failed to ensure CNA B performed hand hygiene between glove changes during incontinence care for Resident #33. This failure could place residents at risk for cross contamination and infection.

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 kitchen reviewed for food service safety. The facility failed to ensure stored food was properly labeled and dated. The facility failed to ensure dry goods and frozen items were not open to air. The facility failed to ensure lidded tubs and other containers for dry goods were clean and sanitized. These failures could place residents at risk of food borne illness. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure the right to receive written or verbal notice of a room change before the change was made for 1 of 6 residents (Resident #2) reviewed for resident rights. The facility failed to ensure Resident #2's Responsible Party (RP) received verbal or written notice prior to a room change. This failure could place residents at risk for being displaced without notice and/or reason in order to accommodate other individuals.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure an assessment accurately reflected a resident's status for 1 of 6 residents (Resident #1) reviewed for accuracy of MDS assessments. -The facility failed to accurately assess Resident #1 for oral/dental status on his annual MDS assessment. This failure could place residents at risk for inaccurate and incomplete MDS assessment which could result in residents not receiving correct care and services.

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 diseases and infections for 1 (Resident #1) of 5 residents observed for infection control practices. CNA B performed Resident #1's catheter care without placing a gown for EBP. This deficient practice could place residents at risk of cross-contamination and infections.

Inspectors wroteBased on interview and record review the facility failed to use the services of a registered nurse for at least 8 consecutive hours a day, 7 days a week for 1 of 1 facility reviewed for RN coverage. The facility failed to ensure RN coverage for 51 days of the last 6 months. This failure could place residents at risk of harm due to being left without supervisory coverage for coordination of events such as emergency care and disasters. Findings Included: Record review of the facility payroll-based journal for the first quarter of fiscal year 2025 revealed the facility did not have RN coverage on November 16, 17, and 30 and December 1, 14, 15, 28, and 29 of 2024. Record review of facility payroll revealed the facility did not have RN coverage for January 20; February 8, 9, 12, 13, 18, 20, 21, 22, 23, 24, 25, 26 ,27, and 28; March 3, 4, 5, 6, 7, 8, 9, 15, 16, 22, 23, 29, and 30; [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to store, prepare, and serve food under sanitary conditions in 1of 1 kitchen when they failed to: A. Ensure general cleanliness was maintained. B. Ensure kitchen equipment was in good repair. These failures placed residents who ate food served by the kitchen at risk of cross contamination and food-borne illness.

Inspectors wroteBased on observation, interview and record review the facility failed to provide an ongoing program to support residents in their choice of activities designed to meet the interests of and support the physical, mental, and psychosocial well-being for all residents reviewed for activities. A. The activity calendar was not followed. B. There were no daily activities occurring on a regular basis in the facility. C. The activities did not meet the needs of the residents. D. Room visits were not conducted and did not meet the needs of the residents. [...]

Inspectors wroteBased on interview and record review, the facility failed to provide an activities program directed by a qualified professional for 1 of 1 Activity Director reviewed for staff qualifications . The facility Activity Director was not a qualified therapeutic recreation specialist or an activities professional that met state licensing requirements. This failure could place residents at risk for reduced quality of life due to lack of activities that were individualized to match the skills, abilities, and interests/preferences of each resident. Findings Include: During an interview on 5/13/25 at 3:15 pm, the AD stated she had not become a certified AD and had not started the classes to become certified. The AD stated she started the job as the AD on 9/12/24. The AD stated she had never been an AD before and had not had any experience in activities. [...]

Inspectors wroteBased on observations, interview, and record reviews 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 1 (Resident #33) of 12 residents reviewed for pharmacy services and 1 of 1 treatment cart and 1 of 1 medication room. 1. The facility failed to ensure LVN B did not leave medications unattended with Resident #33. 2. The facility failed to ensure the medication room did not contain expired medications and expired IV tubing and the treatment cart did not contain expired medications. These failures could place residents at risk of harm due to not receiving needed medication, receiving expired medication; receiving medication at the wrong time or in the wrong dose; or receiving another resident's medication. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure all drugs and biologicals were stored properly for 2 of 2 carts (medication cart, treatment cart) reviewed for medication storage. The medication cart had undated insulin pen. The treatment cart had undated wound care supplies. These failures could place residents at risk of receiving expired medications.

Inspectors wroteBased on interviews, observations and record review, the facility failed to provide the right to personal privacy which includes accommodations during wound care for 1 of 12 (Resident #7) residents reviewed for Privacy. LVN B failed to close the door or the curtain during wound care for Resident #7. This failure could place the residents at risk of not having their personal privacy maintained during medical treatment.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure each resident the right to a safe, clean, comfortable, and homelike environment including but not limited to receiving treatment and supports for daily living safely for 1 (Resident #33) of 12 residents reviewed for homelike environment. The facility failed to ensure Resident #33's personal refrigerator was free of rotten and expired food and that his personal food was stored properly. This failure could place residents at risk of contracting food borne illness. Findings Included: [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a resident who is incontinent of bladder receives appropriate treatment and services to prevent urinary tract infections and to restore continence to the extent possible for 1 (Resident #44) of 12 residents reviewed for continence. The facility failed to ensure Resident #44's catheter was changed timely. This failure could place residents at risk of harm due to infection. Findings Included: [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide a safe, clean, and comfortable homelike environment for 1 of 2 shower rooms (100 hall) reviewed for homelike environment. A. The facility failed to ensure the shower room on the 100 Hall did not have black grime buildup on the walls and floor of the shower room. B. The facility failed to ensure the shower room on the 100 Hall did not have a foul smell coming from the drain. These failures could place the residents at risk for a decreased quality of life, an uncomfortable, unhomelike environment due to unsanitary conditions.

Inspectors wroteBased on observation, interview and record review, the facility failed to respect the residents' right to confidentiality in his or her personal and medical records for one (Resident #1) of 6 residents reviewed for privacy. Resident #1's medical information was shared with a surgeon via a nurse's personal email account. This failure could affect the residents residing in the facility by placing them at risk of losing their right to privacy and confidentiality.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide treatment and care in accordance with the comprehensive person-centered care plan and in accordance with professional standards of practice for 1 of 6 residents reviewed for quality of care (Resident #1). LVN A did not inform facility Administration of a surgeon's recommendation for Resident #1 in a timely manner. The failure could place residents at risk for a delay of treatment.

Inspectors wroteFACILITY Kitchen Based on observation, interview and record review the facility failed to employ sufficient staff with the appropriate competencies and skill sets to carry out the functions of the food and nutrition service for 1 of 1 kitchen staff (Dietary Manager) reviewed for qualifications. The facility failed to appoint a dietary manager with the appropriate license, certification, or qualifications. This failure could place the residents who consume food prepared from the kitchen at risk of not receiving services to meet their nutritional needs, contributing to food dissatisfaction, and placing residents at risk of food-borne illness.

Inspectors wroteFACILITY Kitchen Based on observation, interview and record review the facility failed to store and distribute food in accordance with professional standards for food service safety for 1 of 1 kitchen reviewed for kitchen sanitation. 1. The facility failed to ensure stored foods were properly labeled and dated. 2. The facility failed to ensure expired foods were discarded. 3. The facility failed to store foods in accordance with professional standards. This failure could place residents at risk of acquiring a food-borne illness and a diminished quality of life.

Inspectors wroteBased on observations, interviews, and record reviews the facility failed to ensure the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely for 6 (Resident #5, Resident #9, Resident #18, Resident #35, Resident #36, and Resident #42) of 13 residents and for 1 (hall 600) of 6 halls reviewed for residents' rights. 1. The facility failed to keep the floor of Resident #5's room clean. 2. The facility failed to keep the floor and walls of Resident #35's room clean. 3. The facility failed to keep the floor of Resident #36's room clean. 4. The facility failed to keep the floor of Resident #42's room clean. 5. The facility failed to keep the bathroom of Resident #9 and Resident #18 clean. 6. The facility failed to keep the floor of hall 600 clean. [...]

Inspectors wroteBased on interview and record review the facility failed to use the services of a registered nurse for at least 8 consecutive hours a day, 7 days a week for 1 of 1 facility reviewed for RN hours. The facility failed to have RN coverage for one day in October 2023, for two days in November 2023, and for four days in December 2023. This failure could negatively affect residents in the facility by leaving residents and staff without supervisory coverage for coordination of events such as emergency care and disasters. Findings Included: Record review of the facility's Payroll Based Journal Staffing Data Report for fiscal year quarter 1 2024 (October 1-December 31) revealed the facility triggered for no RN hours on 10/01/23, 11/18/23, 11/19/23, 12/02/23, 12/03/23, 12/16/23, and 12/17/23. [...]

Inspectors wroteBased on observation, interview and record review the facility failed to ensure residents received, and the facility provided three meals daily, at regular times comparable to normal mealtimes in the community, as well as suitable, nourishing alternative meals and snacks for residents who want to eat at non-traditional times or outside of scheduled meal service times, consistent with the resident's plan of care. The facility failed to ensure all residents in the facility, received food trays at times comparable with normal mealtimes in the community. The facility failed to provide all residents who wanted snacks, at regular intervals between the three daily meals. These failures could place residents at risk of diminished nutritional status, food dissatisfaction and diminished physical well-being.

Inspectors wroteBased on interview and record review the facility failed to develop and implement written policies and procedures that prohibit and prevent abuse, neglect, and exploitation of residents and misappropriation of resident's property for two (Cook C and DA E) of 14 employees reviewed for criminal history background checks prior to or at hire. The facility failed to implement their policy and complete a criminal history background check on [NAME] C and DA E prior to hire. This failure could place residents at risk of abuse, neglect, exploitation, or misappropriation of their property by staff members. Findings Included: Record review of facility policy titled, Abuse, Neglect, and Exploitation and dated 10/2023 revealed the following: . [...]

Inspectors wroteBased on observations, interviews, and record reviews the facility failed to develop and implement a baseline care plan for each resident that includes the instructions needed to provide effective and person-centered care of the resident that meet professional standards of quality care for 1 (Resident #97) of 13 residents reviewed for baseline care plans. The facility failed to address Resident #97's oxygen therapy in her baseline care plan. This failure could place residents at risk of not receiving correct and/or necessary care/treatment.

Inspectors wroteBased on observations, interviews, and record reviews 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, the comprehensive person-centered care plan, and the residents' goals and preferences for 1 (Resident #97) of 13 residents reviewed for respiratory care. The facility failed to ensure Resident #97 had physician's orders for oxygen before administering oxygen. This failure could place residents at risk for receiving oxygen at the wrong rate which could lead to hypercapnia (too much carbon dioxide in the blood), pulmonary oxygen toxicity (damage to the lung lining tissues and air sacs), hypoxemia (low levels of oxygen in the blood, decreasing the oxygen supply to vital organs), and shortness of breath.

Inspectors wroteBased on observation, interview and record review the facility failed to establish and maintain an infection control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 2 of 2 CNAs (CNA B and CNA C) reviewed for infection control. CNA B and CNA C failed to don appropriate PPE when delivering meals to Covid positive residents. This failure could place well residents who took meals in their rooms, at risk of sickness due to the transmission of Covid-19 which could lead to a reduction in resident's quality of life and psychosocial well-being.

Inspectors wroteBased on interview, observation and record review the facility failed to inform the resident's physician and resident's representative when there was an accident or incident which resulted in injury or had the potential for physician intervention for 2 of 6 residents (Resident #1 and Resident #2) reviewed for Change in Status. The facility failed to inform Resident #1 physician after Resident #1 was involved in an altercation. The facility failed to inform Resident #2's physician and responsible party after Resident #2 was involved in an altercation and three additional falls, one of which resulted in injury. This failure could place residents at risk of not receiving essential physician care and resident representatives not being notified of change in status, which could affect the resident's physical and psychosocial well-being.

Inspectors wroteBased on observation, interview and record review the facility failed to, at the time of admission, have physician orders for the resident's immediate care for 1 of 6 (Resident #3) residents reviewed for admission orders. Resident #3's clinical record did not contain physician orders for care of Resident #3's surgical incision. This failure could place residents at risk of not receiving essential care consistent with the resident's physical and psychosocial well-being upon admission to the facility.