Avir at Giddings

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 the resident rights set forth at S483.10(c)(2) and S483.10(c)(3), that included measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that were identified in the comprehensive assessment for 1 of 6 residents (Resident #01) whose comprehensive person-centered care plans were reviewed. The facility failed to ensure that Resident #01 was receiving larger portions at lunch and dinner meals. This deficient practice could affect residents by failing to ensure residents received appropriate care for their health conditions.

Inspectors wroteBased on interviews, and record review the facility failed to develop and implement a comprehensive person-centered care plan for each resident, which included measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs for 3 of 8 residents (Resident #17, Resident #52 and Resident # 58) reviewed for care plans.1. The facility failed to develop and implement Resident # 17 and Resident #52's care plan to reflect Activity Plans and Interventions.2. The facility failed to develop and implement Resident #52's care plan to reflect ADLs and Activity Plans and interventions.3. The facility failed to develop and implement Resident #58 care plan to reflect ADLs. This failure could place residents at risk of not having their needs met to attain their highest practicable well-being.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure a resident who was unable to carry out activities of daily living received the necessary services to maintain good nutrition, grooming, and personal and oral hygiene for three of eight residents (Resident # 17, Resident #52 and Resident #58) reviewed for ADL care.1. The facility failed to ensure Resident #17's facial hair was removed on 04/21/2026.2. The facility failed to ensure Resident #52 and Resident #58's nails were cleaned on 04/21/2026. These failures could place residents at risk for poor hygiene, dignity issues, and decreased quality of life.

Inspectors wroteBased on interview and record review, the facility failed to provide an ongoing activity program to support residents in their choice of activities, both facility sponsored group and individual activities, and independent activities, designed to meet the interests of and support the physical, mental, and psychosocial well-being of each resident, encouraging both independence and interaction in the community for 3 (Resident #17, Resident #52 and Resident #58) of 8 residents reviewed for activities. The facility failed to provide activities for Resident #17, Resident #52 and Resident #58 to meet their psycho-social and mental needs for the entire month of March and April of 2026. This failure could place residents at risks of boredom, depression, behavior, diminished quality of life and decreased cognitive function.

Inspectors wroteBased on observation, interviews and record reviews the facility failed to ensure drugs used in the facility were labeled in accordance with currently accepted professional principles, and include the appropriate accessory and cautionary instructions, and the expiration date when applicable for 1 (Resident #36) out of 8 residents reviewed for medications. The facility failed to update Resident #36's medication label for hydrocodone-acetaminophen 5-325 mg tablet to reflect a change in the frequency of the administration of the medication. This failure could have placed residents at risk for a medication error such as not receiving adequate pain medication as ordered by the physician.

Inspectors wroteBased on observation, interview, and record review, the facility failed to store, prepare, distribute food in accordance with professional standards for food service safety for one of one kitchen reviewed for kitchen sanitation. The facility failed to ensure the Dietary Manager and Dietary Aide G used proper hand hygiene during food preparation. These failures could place residents who ate food from the kitchen at risk for foodborne illness.

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 2 residents (Resident #10, and Resident #24) of 8 residents observed for infection control practices. The facility failed to ensure RN J followed the hand hygiene policy procedures during wound care on 04/22/2026 for Resident #10 and Resident #24. This failure could place residents at risk for healthcare-associated cross-contamination and infections.

Inspectors wroteBased on observations, interviews and record review, the facility failed to ensure each resident was treated with respect, dignity and care for 1 of 4 residents ( Resident #10) observed for resident rights. RN J failed to ensure Resident # 10's privacy curtain was used or the door to his room was closed when RN J was repositioning Resident #10 in bed and did not ensure his buttocks was not exposed. This failure could place residents at risk of feeling embarrassed and diminish the resident's quality of life.

Inspectors wroteBased on observation, interviews, and record reviews the facility failed to ensure the resident environment remained as free of accident hazards as is possible for one of two housekeeping carts (Housekeeping Cart #1) reviewed for hazards. The facility failed to ensure Housekeeping Cart #1, with chemicals inside the compartments, was locked when unsupervised. This failure could place residents at risk for injuries, illness, and hospitalization.

Inspectors wroteBased on observation, interviews, and record review, the facility failed to ensure a resident with dementia received the necessary care and services to support the highest practicable level of physical, mental, and psychosocial well-being for 1 of 3 residents (Resident #2) reviewed for dementia care. The facility did not identify, document, or implement individualized person-centered interventions that were cognitively appropriate for Resident #2. There was no evidence that care planning addressed the resident's specific preferences, abilities, or need for engagement. This failure resulted in lack of dementia-focused care and placed the resident with dementia at risk for increased behavioral symptoms, boredom, and a decreased quality of life. [...]

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to ensure that resident environment remained as free from accident hazards as is possible, by not providing adequate supervision and assistance devices to prevent accidents for 1 of 5 residents (Resident #1) reviewed for falls. The facility failed to provide adequate supervision to Resident #1, who has frequent falls and severe cognitive impairment, and was allowed to wander outside with no supervision near a busy highway with a speed limit of 45 mph and through restricted construction areas with uneven pavement. This failure resulted in an Immediate Jeopardy (IJ) situation on 11/26/2025. While the IJ was removed on 11/27/2025, the facility remained out of compliance at a severity level of no actual harm with the potential for more than minimal harm with an isolated scope and severity. 2. [...]

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to ensure that residents received treatment and care in accordance with professional standards of practice for 1 of 5 residents (Resident #1) reviewed for quality of care. The facility failed to ensure that nursing staff responded to an unwitnessed fall for Resident #1, and when notified by staff member dismissed the fall as a behavior. The fall was not documented by staff, reported to the DON, physician, or resident representative (RP). This failure could place residents at risk for delays in care that could lead to worsening of a serious injury.

Inspectors wroteBased on interviews and record review, the facility failed to provide pharmaceutical services including procedures that assured the accurate acquiring, receiving, dispensing, and administering of all routine and emergency drugs and biologicals for 1 of 4 residents (Resident #1) reviewed for pharmacy services. The facility failed to ensure Resident #1's Tylenol-codeine 3 were acquired and administered according to physician's orders. These failures could place residents at risk for not receiving therapeutic dosages of their medications as ordered by the physician and a potential for decreased health status and decreased quality of life.

Inspectors wroteBased on observations, interviews, and record review the facility failed to ensure the right to reside and receive services in the facility with reasonable accommodation of resident needs and preferences for 3 of 7 (Resident #6, #49, and #203) residents reviewed for accommodations. The facility failed to ensure that Residents #6, #49, and #203 had their call lights within reach while lying in bed. This failure could place residents at risk of injury, for not receiving timely care, and for not receiving nursing interventions.

Inspectors wroteBased on observations, interviews, and record review, 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 2 of 3 shower rooms (shower rooms A and B), 2 of 24 resident rooms (Residents #18 and 35), and in 2 halls and 1 common area (halls 100 and 600 and the rotunda) reviewed for physical environment. 1. The facility failed to ensure shower rooms A and B were clean from 02/24/25 to 02/26/25. 2. The facility failed to ensure the rooms for Residents #18 and 35 were clean from 02/24/25 to 02/26/25. 3. The facility failed to ensure the 100 and 600 halls and the rotunda were free of unpleasant odors from 02/24/25 to 02/26/25. These failures placed residents at risk of discomfort and diminished quality of life.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure pharmaceutical services were provided to meet the needs of each resident: specifically, expired or opened medical supplies were stored in 1 of 2 (100/200-hall Nurses' medication cart) medication carts. The facility failed to ensure expired or open supplies were removed from the 100/200-hall Nurses' medication cart that included one 5 x 9 Xeroform dressing that expired 01/2025, one sterile cotton tipped applicator that expired 08/01/2024, five 4 x 4 drain sponges that expired 12/05/2024, one 2 x 2 hydrogel saturated dressing that expired 11/15/2024, one 1 x 8 Xeroform dressing that expired 03/2024, three 6 x 7 Silicone Composite Dressings that expired 02/22/2025, and one opened package of rolled gauze bandage. [...]

Inspectors wroteBased on observations, interviews, and record review, the facility failed to store, prepare, distribute food in accordance with professional standards for food service safety for one of one kitchen reviewed for kitchen sanitation. 1. The facility failed to ensure fruit cobbler was covered, dated, or labeled after being in the refrigerator. 2. The facility failed to ensure CK K did not store her shoes on the kitchen utility cart in the kitchen. 3. The facility failed to ensure CK J properly used proper hand hygiene during food preparation. This failure could place residents who ate food from the kitchen at risk for foodborne illness.

Inspectors wroteBased on interviews and record review, the facility failed to provide training on abuse, neglect, exploitation, and misappropriation of resident property, procedures for reporting incidents of abuse, neglect, exploitation, or the misappropriation of resident property, and dementia management and resident abuse prevention to their staff for 4 of 8 staff (RN A, CNA N, CNA O, and CNA P) reviewed for staff training requirements. The facility failed to provide RN A, CNA N, CNA O, and CNA P with orientation, as required by their abuse/neglect prevention policy and procedure prior to scheduling them to work with residents. This failure placed residents at risk of abuse and neglect.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to develop and implement a comprehensive person-centered care plan for 2 of 24 residents (Residents #35 and 104) reviewed for care plans. The facility failed to include Resident #35's behaviors of urinating in places other than the toilet in his care plan. The facility failed to include Resident #104's bilateral heel injuries in her care plan. These failures placed residents at risk of not having their care needs met.

Inspectors wroteBased on observations, interviews, 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 2 of 8 residents (Residents #45 and 104) reviewed for quality of care. 1. The facility failed to follow up with treatment of a skin tear from a fall for Resident #45 after readmission from the hospital. 2. The facility failed to ensure Resident #104 had compression hose applied to both legs from 02/24/25 to 02/26/25 as ordered. These failures places residents at risk of not receiving necessary medical care, worsened swelling, infection, and hospitalization.

Inspectors wroteThe facility failed to ensure a functional emergency call light system in the bathroom for 1 of 5 (Resident # 38) residents reviewed for communication systems. The facility failed to ensure the emergency call light in the bathroom was functional for Resident #38. This failure could place the residents at risk of falls causing injury.

Inspectors wroteBased on interview and record review, the facility failed, to provide an ongoing activities program to support residents in their choice of activities, both facility-sponsored group and individual activities and independent activities, designed to meet the interest of and support the physical, mental, and psychosocial well-being of each resident, encouraging both independence and interaction for residents residing on secure unit, 100 hall, 500 hall and 600 hall. 1. The facility failed to provide activities on secure unit for the month of January 2025. 2. The facility failed to provide activities on 100, 500 and 600 halls 25 days out of 31 days for the month of January 2025, and 13 out of 20 days for the month of February 2025. This failure placed residents at risk for boredom, depression, increased behaviors, and diminished quality of life.

Inspectors wroteBased on observations, interview and record review, the facility failed to ensure a resident who was unable to carry out activities of daily living received the necessary services to maintain good nutrition, grooming, and personal and oral hygiene for two of eight residents (Resident # 1, and Resident #2) reviewed ADL care. 1. The facility failed to ensure Resident #1 and Resident #2 nails were cleaned, trimmed, and did not have any rough edges. This failure could place residents at risk for poor hygiene, dignity issues, and decreased quality of life.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure all residents were provided a nourishing, palatable, well-balanced diet that meets daily nutritional and special dietary needs for one (Resident #4) of five residents reviewed for needs and preferences. The facility failed to ensure Resident #4 received a diabetic diet as listed on his meal ticket and ordered by the physician. This failure placed residents at risk for altered nutritional status and decreased quality of life.

Inspectors wroteBased on interview and record review, the facility failed to maintain medical records in accordance with accepted professional standards and practices that are complete and accurate for 1 (Resident #3) of 5 residents reviewed for medical records. The facility failed to ensure nursing staff documented if the medical physician, nurse practitioner or family was contacted after Resident #3 fell on [DATE]. This failure placed residents at risk of not receiving the proper care and having medical records that are not current/accurate

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure each resident received adequate supervision and assistance devices to prevent accidents for one (Resident #1) of four residents reviewed for elopement. The facility failed to ensure Resident #1, who was an elopement risk, was not left outside in the secure unit courtyard by himself on 08/13/24. The noncompliance was identified as PNC IJ. The IJ began on 08/13/24 and ended on 08/18/24. The facility had corrected the noncompliance before the survey began. This failure could place residents at risk of not receiving their medications and meals, going missing, or sustaining injuries, dehydration, or death.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure each resident received adequate supervision and assistance devices to prevent accidents for 1 of 5 resident (Resident #1) reviewed for fall mats. The facility failed to ensure Resident #1 had a fall mat in place beside his bed per his care plan. This failure could place residents at risk of falls, injuries, pain, and hospitalization.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide a safe, clean, comfortable and homelike environment for 7 of 7 residents (Residents #1- #7) and 4 of 6 halls (100, 200 secure unit, 500, and 600 halls) reviewed for physical environment. The facility failed to ensure the rooms for Residents #1- #7 and the 600-hallway area were clean and in good repair on 04/23/2024. This failure placed residents at risk of decreased quality of life.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure residents had the right to be free from abuse and neglect for 1 (Resident #1) of 5 residents reviewed for abuse and neglect in that: CNA A yelled (verbal abuse) at Resident #1, and refused to make up her bed so she could lie down on 04/12/23. The noncompliance was identified as past noncompliance (PNC). The non-compliance began on 4/12/23 and ended on 4/13/23. The facility corrected the noncompliance before the survey began. This failure (of verbal abuse) could place residents at risk of physical or emotional distress, and injury.

Inspectors wroteBased on observation, interview, and record review the facility failed to provide a safe, functional, sanitary, and comfortable environment for residents, staff, and the public for 3 (Resident #78, Resident #54, and Resident #96) of 7 residents reviewed for safe, clean, sanitary, and comfortable environment in that: A. Resident #78's room had a section of the textured ceiling hanging down from water damage, had a window that would not properly seal allowing air in, and had a toilet with streaks and spots of a dried brown substance around the bowl and down the pedestal portion of the toilet. B. Resident #54's room toilet had a brownish yellow stain with debris in it that ran down the toilet from the bowl to the bottom of the pedestal. Resident #54's toilet was not properly secured to the floor, which allowed the base of the bowl to move some from side to side. C. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to residents received food prepared in a form designed to meet individual needs for 2 of 2 (Resident #7 and Resident #56) residents reviewed for therapeutic diets. The facility failed to ensure CK K prepared pureed meat for Resident #7 and Resident #56. The facility failed to ensure the Dietary Manager checked the service line for correct consistencies for Resident #7 and Resident #56. The facility failed to ensure CK J did not serve ground meat in place of pureed meat to Resident #7 and Resident #56. The facility failed to ensure DA L checked diet texture against therapeutic orders for Resident #7 and Resident #56. The facility failed to ensure LVN D thoroughly checked Resident #7 and Resident #56's trays for texture-modified diet. The facility failed to ensure CNA F did not feed the wrong texture to Resident #7. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to store, prepare, and serve food in accordance with professional standards for food service safety for 1 of 1 kitchen reviewed for sanitation. The facility failed to ensure all items were labeled, dated and discarded prior to its use-by date. The facility failed to ensure DA M washed her hands with warm water. The facility failed to ensure CK J manually washed dishes in water that was at least 120°F. The facility failed to ensure bread was not stored directly under an opened ceiling. The facility failed to ensure the food preparation sink in the dining room was clean and free of debris. These failures placed residents at risk of foodborne illness.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure all drugs and biologicals were stored in under proper temperature controls in accordance with state and federal laws for one of one medication room. The facility failed to ensure the medications in the medication room were stored under proper temperature controls. This failure could place residents at increased risk of receiving medications that have been degraded by temperature changes and no longer provide a therapeutic effect resulting in adverse health consequences.

Inspectors wroteBased on interview and record review, the facility failed to ensure the right to receive written notice of a room change before the change was made for 1 of 2 residents (Resident #48) reviewed for resident rights. The facility failed to ensure Resident #48, 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 all residents had the right to a safe, clean, comfortable and homelike environment for 1 of 8 (Resident #46) residents reviewed for homelike environment. The facility failed to ensure Resident #46's used bandage did not remain on his windowsill. This failure placed resident at risk of an unsafe, unclean, and uncomfortable environment.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide, based on a comprehensive assessment and care plan and the preferences of each resident, an ongoing program to support residents in their choice of activities for group and individual activities and independent activities, designed to meet the interests of and support the physical, mental, and psychosocial well-being of each resident, for 2 of 2 residents (Resident #50 and Resident #32), reviewed for activity preferences, in that: 1. The facility failed to provide individualized, person-centered activities to Resident #50. 2. The facility failed to provide individualized, person-centered activities to Resident #32. These failures could affect residents' psychosocial well-being and could lead to a diminished quality of life.

Inspectors wroteBased on observation, interview and record review, the facility failed to follow menus for 2 of 2 (Resident #7 and Resident #56) residents reviewed for menu accuracy. The facility failed to provide Resident #7 and Resident #56 pureed meat. The facility prepared pureed sandwich bread instead of cornbread for Resident #7 and Resident #56. These failures placed residents at risk of not receiving items on the menu and weight loss.

Inspectors wroteBased on observations, interviews, and record review the facility failed to provide a safe, clean, comfortable, and homelike environment including receiving treatment and supports for daily living safely for 7 (Resident #'s 1, 2, 3, 4, 5, 6 ,7) of 9 residents' rooms observed for a safe, clean, comfortable, and homelike environment. The facility failed to ensure the A/C vents of Residents # 1, 2, 3, 4, 5, 6 and 7 were cleaned, maintained and free from dust and a black-like substance. The facility failed to ensure the windowsills of Residents # 3 and 5 were replaced appropriately. The facility failed to ensure that the tile on Resident #1's floor was replaced. The facility failed to ensure that the damaged wall on Resident #7's room was repaired and painted. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to store all drugs and biologicals in locked compartments for one of six residents (Resident #1) reviewed for medication storage. There was a Tylenol 650 mg on the floor under Resident #1's bed. This failure placed residents at risk of accidental ingestion of medication and not receiving therapeutic benefit of medications.