Avir at Cotulla

Inspectors wroteBased on interviews and record reviews, the facility failed to maintain the services of a Registered Nurse (RN) for at least 8 consecutive hours a day, 7 days a week, of the 6-month review period for (25 of 184 days), reviewed for RN coverage. The facility failed to ensure the facility maintained the required RN coverage for 25 days between July 2025 to December 2025. The dates are: 7/3/2025 - 7/7/2025, 8/4/2025 - 8/8/2025, 9/8/2025 - 9/12/2025, 10/9/2025- 10/12/2025, 11/10/2025-11/12/2025 and 12/16/2025 - 12/18/2025This failure could place residents at risk of not having their nursing and medical needs met and receiving improper care.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the resident assessment accurately reflected the resident's status for 3 of 9 residents (Resident #6, Resident #41, and Resident #52) who were reviewed for resident assessments. 1. The facility failed to document Resident #6's lack of use of scheduled pain medication on the quarterly MDS assessment. 2. The facility failed to document Resident #41's diagnosis of anxiety on the quarterly MDS assessment. 3. The facility failed to document Resident #52's use of an antidepressant on the quarterly MDS assessment. These failures could place residents at risk of improper or incorrect care or of not receiving services necessary for their physical, mental, and psychosocial well-being.

Inspectors wroteBased on observation, interview and record review, the facility failed to store, prepare, distribute, and serve food for 1 of 1 kitchen in accordance with professional standards for food service safety. The facility failed to date items after receiving/opening them located in the kitchen pantry. 2. The facility failed to take temperatures for both breakfast and lunch meals on 01/05/2026. This deficient practice could place residents at risk for food borne illness.

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 1 of 2 medication carts (Med Cart 2) reviewed for pharmacy services. The facility failed to ensure the controlled substance reconciliation log was signed for accuracy of medication quantities during hand off of the cart key for Med Cart 2 during lunch. 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 ensure safe and sanitary storage handling, and consumption of residents' food items for 1 (refrigerators in resident room [ROOM NUMBER]-A) of 4 residents' refrigerators reviewed in that: The personal refrigerator in resident's room [ROOM NUMBER]-A contained unlabeled, undated food items. This deficient practice could place residents at risk of foodborne illness due to consuming foods which could be spoiled.

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 of communicable diseases and infections for 1 of 5 residents (Resident #6) reviewed for infection control. The facility failed to ensure LVN B wore a PPE gown while administering medication to Resident #6 via PEG tube (a flexible feeding tube inserted through the abdominal wall into the stomach that allows for the delivery of nutrition, fluids, and medications directly into the stomach). This failure could place residents at risk for cross contamination and infection.

Inspectors wroteBased on observation, interviews, and record reviews, 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 1 residents (Resident #6) reviewed for infection control, in that: While providing incontinent care for Resident #6, CNA A did not change her gloves or wash her hands after touching the bed remote before starting to provide care. CNA B did not change her gloves or wash her hands after touching the privacy curtain before starting to provide care. CNA A changed gloves multiple times and did not sanitize between change of gloves. These deficient practices could place residents at-risk for infection due to improper care practices.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents with limited range of motion received appropriate treatment and services to increase range of motion and/or prevent further decrease in range of motion for one (Resident #46) of 17 residents reviewed for range of motion. The facility failed to have interventions and monitoring in place to address Resident #46's left hand contracture. This failure could place residents with ROM issues at risk for decline in range of motion, decreased mobility, and worsening contractures.

Inspectors wroteBased on interview and record review, the facility failed to transmit encoded, accurate, and complete MDS data to the CMS System for 4 (Resident #3, Resident #35, Resident #45, and Resident #47) of 16 residents reviewed for MDS transmission, in that: 1. The facility failed to correct and resubmit incorrect MDS assessments for Resident #3, Resident #45, and Resident #47. 2. The facility failed to transmit a completed MDS assessment for Resident #35. These deficient practices placed residents at risk of not having assessments completed and submitted in a timely manner as required.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide reasonable accommodation of resident needs for 3 of 23 (Residents #4, #22, #36) residents reviewed for call lights: 1. Resident # 4's call light was connected to the light string hanging behind her bed on the opposite side of the bed she was sitting on and not within reach. 2. Resident #2's call light was attached to the privacy curtain, out of reach. 3. Resident #36's call light was not within reach. This failure could place residents who used call lights for assistance at risk in maintaining and/or achieving independent functioning, dignity, and well-being.

Inspectors wroteBased on observation, interviews, and record review, the facility failed to ensure nursing staff was able to demonstrate competency in skills and techniques for 1 of 2 (RN C) RNs observed during medication pass. The facility failed to prevent RN C from following: 1. Established Infection Control Procedures while passing medications to Resident #5 and Resident #10. 2. HIPAA privacy requirements to lock and close the laptop while passing medications to Resident #7. 3. The procedure to lock the medication cart before walking away during the medication pass. 4. The procedure to prime an Insulin Pen before administering the medication to Resident #7. These deficient practices could affect residents who were receiving medications leaving them at risk for infection, not receiving the proper amount of insulin and exposure of confidential information.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure that it was free of medication error rate of 5 percent or greater. The facility had a medication error rate of 6.67%, based on 2 errors out of 30 opportunities, which involved 2 of 5 residents (Resident #7 and #10) reviewed for medication administration in that: The facility to ensure RN C ensured the Insulin Pen was purged to ensure Resident #7 received her insulin as ordered. The facility failed to prevent RN C from giving Resident #10 the wrong dosage of Lorazepam 0.25mg tablet as ordered. These failures could place residents at risk for not receiving the intended therapeutic benefit of their medications or receiving them as prescribed, per physician orders.

Inspectors wroteBased on observation and interview the facility failed to ensure drugs and biological's used in the facility were labeled in accordance with currently accepted professional principles, and include the appropriate accessory and cautionary instructions for 1 of 5 residents (Resident #10) reviewed during the medication pass in that: The facility failed to prevent Resident #10 from being given 0.5mg of Lorazepam instead of 0.25mg tab. This deficient practice placed residents receiving medications at risk for receiving the wrong dosage as prescribed.

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 2 of 5 residents (Resident #7 and #10) reviewed for infection control practices, in that: The facility failed to prevent RN C from doing the following during medication pass: 1. Setup pills from the blister packs and bottles by using his bare thumb and index finger or palm of his hand to place the medication into the medication cups. 2. Administered by mouth medications for Resident #7 and #10 by placing his bare fingers inside the medication cups These failures could place residents at risk for infection, transmission for communicable diseases and or a decline in health.

Inspectors wroteBased on observation, interview, and record review the facility failed to protect the confidentiality of personal health care information for 1 of 42 [Resident #7) residents reviewed for confidentiality of records during the survey in that: The facility failed to ensure RN C locked and closed the laptop during the medication pass exposing Resident #7's personal information to include some of her medications. This failure could affect residents by placing them at risk for loss of privacy and dignity.

Inspectors wroteBased on observation, interviews 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 2 (Resident #7 and #10) out of 5 residents reviewed for medication administration in that: The facility failed to ensure RN C ensured the Insulin Pen was purged before giving Resident #7 her insulin. The facility failed to prevent RN C from giving Resident #10 Lorazepam 0.5mg tab instead of 0.25mg tab. These deficient practices could affect residents with medications and place residents at risk for not receiving the proper dosage.