Avir at Graham

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure each resident received food prepared by methods that conserve nutritive value, flavor, and appearance and was provided food that was palatable, attractive and at a safe and appetizing temperature for meals prepared and served from 1 of 1 kitchen. 1. Mechanically altered chicken and macaroni and cheese were not reheated prior to being placed on the steamtable during observation of the lunch meal preparation on 8/14/2025.2. Cold milk was used while preparing pureed hot food items during the lunch meal preparation on 8/14/2025.3. Hot food item holding temperatures were not maintained at a minimum of 140 degrees Fahrenheit on the steamtable for the lunch meal on 8/14/2025.4. A sample test tray with a regular diet for the lunch meal on 8/14/2025 was determined to be luke warm. [...]

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 in one of one kitchen., in that: The reach-in freezer was not maintained at an interior temperature of zero degrees or below and food stored in the freezer was not frozen solid. The reach-in-freezer temperature was documented on a Refrigerator and Freezer Temperature Log and 10 degrees F was recorded two times daily during May 2024, June 2024, and July 1 - 15, 2025. This failure placed the residents at risk for foodborne illness from being served food that had not been stored at the proper temperature.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the maintenance of mechanical and electrical equipment in safe operating condition in 1 of 1 kitchen, in that: The reach-in freezer was not maintained at an interior temperature of zero degrees or below and food stored in the freezer was not frozen solid. This failure placed the residents at risk for foodborne illness from being served food that had not been stored at the proper temperature.

Inspectors wroteBased on interview and record review the facility failed to ensure assessments accurately reflected the resident's status for 1 of 6 residents (Resident #40) reviewed for accuracy of assessments. 1. The facility failed to ensure Resident# 40's MDS accurately reflected that he was not on an anticoagulant. This failure could place residents at risk for not receiving care and services to meet their physical needs.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure that a resident who needs respiratory care, is provided such care, consistent with professional standards of practice, the comprehensive person-centered care plan, the residents' goals, and preferences for 1 of 1 residents (#41) reviewed for respiratory care. A. The facility failed to ensure oxygen tubing for Residents #41 were changed weekly. These failures could place residents at risk for infections and transmission of communicable diseases.

Inspectors wroteBased on observations, interviews and record reviews, 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 (Resident #9) of 2 residents reviewed for infection control , in that: RN A failed to follow EBP (enhanced barrier precautions) signage instructions for Resident #9 by not donning a gown when caring for and administering medications via his gastrostomy (an opening into the stomach through the abdominal wall to provide medication and nourishment) tube, and while performing care for his Tracheostomy (a surgically created hole with a tube inserted into the windpipe to provide an alternative airway for breathing). This failure could affect residents and place them at risk for cross contamination and infections.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the resident environment remained as free from accident hazards as was possible and each resident received adequate supervision and assistive devices to prevent accidents for 1 of 9 residents (Resident #1) reviewed for accidents and supervision. CNA A failed to ensure Resident #1 was properly transferred by two persons using a Hoyer Lift to prevent accidents. CNA B failed to ensure Resident #1 remained free from accidents while operating the Hoyer Lift. This failure could place the residents at risk of injury.

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 in 1 of 1 kitchen, in that: 1. The manual can opener food contact surface was soiled with a dark-colored substance. 2. The electric mixer stand was soiled with a dried, splattered white colored substance. 3. The wooden shelf units in the kitchen and dry food storage area had gouged and scraped paint surfaces, which were not sealed surfaces. 4. The wooden shelf units in the kitchen were covered with vinyl shelf liner in various patterns, sizes, and layers, which were soiled with grease and dust. 5. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure expired medications, including prescription and over-the-counter medications were removed from use from one of two medication carts ,and one of one medication room. One (1) prescription medication inside the refrigerator located in the medication room was expired and three (3) over-the-counter overstock medications on shelves inside the medication room were expired. There were two (2) over-the-counter medications that were expired in one (1) of two (2) medication carts reviewed. This failure places residents at risk of receiving expired medications which may have reduced efficacy.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure resident's medications were properly stored in locked compartments for one of two medication carts (cart for Hall D). One (1) medication cart (for Hall D) was left unlocked and unattended. The failure could cause harm to residents who may access medications not intended for them, or result in drug diversion (illegal transfer of a legally prescribed medication from a resident to someone else).

Inspectors wroteBased on observation, interview, and record review the facility failed to accurately assess each resident's status for 1 of 4 Residents (Resident #27) reviewed for assessment accuracy in that: Resident #27's Quarterly MDS dated [DATE], did not have Section I (diagnoses) and Section N (medications) coded correctly. This failure could place residents at risk of not receiving the proper care and services due to inaccurate records.

Inspectors wroteBased on observation, interviews, and record review the facility failed to refer to the local authority, 1 of 4 residents whose PASARR evaluations were reviewed (Resident #27) who had newly evident mental disorders in that: The facility failed to refer Resident #27 for PASARR review following new mental illness diagnoses of Major Depressive Disorder. This deficient practice could affect residents who had qualifying diagnoses with a negative PASARR Level 1 evaluation by not receiving the care they are entitled to.

Inspectors wroteBased on interview and record review, the facility failed to develop a comprehensive care plan within 7 days after completion of the comprehensive assessment for 2 of 6 residents (Resident #4 and Resident #11) whose records were reviewed for assessments and care plans. The facility failed to ensure that Resident #4, Resident #11 had a comprehensive care plan developed and updated within 7 days following the completion of the admission comprehensive assessment. This failure could place residents at risk of not have having their care plans completed accurately and timely.

Inspectors wroteBased on interviews the facility failed to designate a registered nurse to serve as the director of nursing on a full-time basis for 1 of 1 facility reviewed for nursing services, in that: The facility had not designated an RN to serve as the DON on a full-time basis since April 14, 2023. This failure could place residents at risk of receiving poor and unsupervised nursing services/care.