Avir at Granbury

Inspectors wroteBased on record review and interview, the facility failed to ensure the use of the services of a registered nurse for at least 8 consecutive hours a day, seven days a week for 5 (1/03/2026, 1/24/2026, 1/25/2026, 1/31/2026, and 3/13/2026) of 92 days reviewed for RN coverage. The facility failed to provide evidence that a Registered Nurse (RN) worked 8 consecutive hours a day, seven days a week on 1/03/2026, 1/24/2026, 1/25/2026, 1/31/2026, and 3/13/2026. This failure could place residents at risk of not having decisions made by a RN to manage residents' healthcare needs and in managing and monitoring the direct care staff.

Inspectors wroteBased on interview and record review, the facility failed to consider the views of the resident or family group and act promptly upon the grievances and recommendations of such groups concerning issues of resident care and life in the facility or to demonstrate their response and rationale for such response for 10 of 10 confidential resident council members reviewed for resident/group response. The facility failed to provide a grievance log for the January2026, Febuary 2026, March 2026, April 2026, May 2026, and June 2026 indicating a verbal or written response to the Resident Council addressing the grievances reported from their meetings. This failure could place residents at risk of unresolved grievances, a decreased sense of self-worth, and a decline in quality of life.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to properly store, prepare, distribute, and serve food in accordance with professional standards for food service safety for 1 of 1 kitchen reviewed. The facility failed to ensure foods were sealed and/or labeled properly in refrigerators, freezers and dry storage. The facility failed to ensure all food was not past expiration date. The facility failed to ensure that staff performed hand hygiene while preparing food. The facility failed to maintain proper food safety and sanitation by allowing a hot pad to fall into the tortilla soup during food preparation. The facility failed to maintain proper food safety and sanitation practices by handling ready-to-eat foods with gloves that were not changed after previous tasks. [...]

Inspectors wroteBased on interview and record review the facility failed to maintain a quality assessment and assurance committee consisting at a minimum of the required committee members of 10 of 11 meetings reviewed for QAPI. The facility failed to ensure the MD, or a representative attended the QAPI meetings in September 2025, October 2025, November 2025, December 2025, January 2026, February 2026, March 2026, April 2026, May 2026, and June 2026. This failure could place residents at risk for quality deficiencies being unidentified, no appropriate plans of action developed and implemented and no appropriate guidance developed.

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 of 5 (CNA B & CNA C) staff and 1 of 3 (Resident #58) reviewed for infection control procedures. The facility failed to ensure CNA B and CNA C followed EBP, provided incontinent care and foley catheter care (a flexible tube inserted into the bladder for urination) appropriately, and performed hand hygiene appropriately while providing incontinent care and foley catheter care for Resident #58 on 07/14/2026. These failures could place residents at risk for the transmission of communicable diseases.

Inspectors wroteBased on observation, interviews and reviews, the facility failed to ensure that the MDS assessment accurately reflected the resident's status for 1 of 12 (Resident #39) residents reviewed for accuracy of assessments. The facility failed to accurately code the presence of a condom (external) urinary catheter for Resident #39 on 2 consecutive quarterly assessments on 04/27/2026 and 05/04/2026. This deficient practice could place residents at risk for inadequate care and services to meet their needs based on inaccurate MDS assessments.

Inspectors wroteBased on interviews and record review, the facility failed to refer residents with newly evident or possible serious mental illness or a related condition for PASRR evaluation for 1 of 18 resident (Resident #9) reviewed for PASRR. The facility failed to follow up with the LA for PASRR level II determination when Resident #9's PASRR level I screening reflected she was positive for mental illness This failure placed residents at risk of not receiving or benefiting from specialized therapy and equipment services they may require.

Inspectors wroteBased on observation, interview and record review, the facility failed to develop and implement a comprehensive, person-centered care plan for each resident that included measurable objectives and time frames to meet, attain, and/or maintain the resident's highest practicable physical, mental, and psychosocial well-being for 1 of 6 residents (Resident #55) reviewed for care plans . The facility failed to ensure Resident #55 had a care plan in place to address his smoking status. This failure could affect residents by placing them at risk of not receiving individualized care and services to meet their needs.

Inspectors wroteBased on observation, and interview, and record review, the facility failed to store drugs and biologicals in locked compartments during medication storage inspection for 1 (West Hall Medication Cart) of 3 medication carts reviewed for storage. The facility failed to ensure the [NAME] Hall Medication Cart was locked and secured while unattended. This failure could place residents at risk of drug diversion.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the menu was followed for 3 (Resident #5, Resident #25, and Resident #48) of 18 residents reviewed for food and nutrition services. The facility failed to ensure Resident #5, Resident #25, and Resident #48 received items listed on the lunch menu on 7/14/2026. This failure could place residents at risk of poor intake, chemical imbalance, and/or weight loss.

Inspectors wroteBased on interview and record review, the facility's QAPI committee failed to implement an appropriate action plan to address identified quality deficiencies for 1 of 1 facility. The QAPI committee failed to implement the corrective actions outlined on the Plan of Correction, dated 12/12/2025, for deficient practice F727. This failure could place residents at risk for substandard quality of care due to the failure of the facility to take action on an identified problem affecting resident safety, respiratory treatment, and employee training.

Inspectors wroteBased on interview and record reviews, the facility failed to develop and implement a comprehensive person-centered care plan for each resident, consistent with the resident rights 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 and describes the services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being for 6 of 6 (Resident #1, Resident #2, Resident #3, Resident #4, Resident #5, and Resident #6) residents reviewed for comprehensive person-centered care plans. [...]

Inspectors wroteBased on observation, interviews and record reviews, the facility failed to ensure Preadmission Screening for individuals with a mental disorder and individuals with intellectual disability was performed prior to admission for 1 of 4 (Resident #3) reviewed for PASRR, in that: The facility admitted Resident #3, whose admission was a Pre-admission category and who had a suspicion of mental illness, prior to receiving the required PASRR II evaluation assessment and PASRR determination. This failure could affect all new residents admitted into the facility as a Preadmission with a mental condition at risk for inappropriate admissions and the inability to be evaluated and receive services in the most integrated setting appropriate to their needs.

Inspectors wroteBased on interview and record review the facility failed to ensure the use of the services of a registered nurse for at least 8 consecutive hours a day, seven days a week for 1 of 1((11/01/2025,11/02/2025,11/08/2025,11/29/2025, and 11/30/2025) month reviewed for RN coverage. The facility failed to provide evidence that a Registered Nurse (RN) worked 8 consecutive hours a day, seven days a week for 5 of 30 days (11/01/2025,11/02/2025,11/08/2025,11/29/2025, and 11/30/2025). This failure could place residents at risk of not having decisions made, that would have required an RN to make in the management of the residents' healthcare needs and in managing and monitoring the direct care staff.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the comprehensive assessment accurately reflected the resident's status for 4 (Resident #32, Resident #25, Resident #21, and Resident #39) of 18 Residents reviewed for accuracy of assessments. The facility failed to ensure MDS dated [DATE] reflected the use of oxygen for Resident #32. The facility failed to ensure MDS dated [DATE] reflected hospice services for Resident #25. The facility failed to ensure MDS dated [DATE] reflected hospice services for Resident #21. The facility failed to ensure MDS dated [DATE], reflected the use of anti-anxiety medications for Resident #39. This failure could residents at risk of inaccurate assessments and not receiving appropriate care according to their status.

Inspectors wroteBased on observation, interview, and record review, the facility failed to store all drugs and biologicals in locked compartments and to permit only authorized personnel to have access to 2 (West Hall medication cart and East Hall medication cart) of 4 medication carts reviewed for pharmacy services. The facility failed to ensure the [NAME] Hall and East Hall medication carts, with prescription medications and biologicals, were secured while unattended. This failure could place residents at risk of harm or decline in health due to lack of potency of supplies, medications/biologicals or misappropriation of medications, or drug diversions.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to properly store, prepare, distribute, and serve food in accordance with professional standards for food service safety for 1 of 1 kitchen reviewed. 1. The facility failed to ensure that spoiled food items were disposed of properly. 2. The facility failed to ensure foods were labeled properly. 3. The facility failed to ensure that food items were disposed of properly. 4. The facility failed to ensure cans that were dented were removed from food storage. 5. The facility failed to ensure staff wore beard and hair coverings, that secured all hair. These failures could place residents that eat out of the kitchen at risk for food borne illnesses.

Inspectors wroteBased on interview and record review, the facility failed to collaborate with hospice representatives and coordinate the hospice care planning process for each resident receiving hospice services, to ensure quality of care for the resident, ensuring communication with the hospice medical director, the resident's attending physician and others participating in the provision of care for 3 (Resident #8, Resident #25, and Resident #40) of 18 residents reviewed for hospice services. 1. The facility failed to maintain required hospice forms and documentation, that included certificate of terminal illness to ensure that the needs of the resident were addressed and met 24 hours per day to ensure Resident #8, Resident #25, and Resident #40 received adequate end-of-life care. 2. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure that the residents were free from chemical restraints not required to treat the residents' medical symptoms for 2 (Resident #8 and Resident #39) of 18 residents reviewed for unnecessary medications. 1. The facility failed to ensure Resident #8's PRN Lorazepam (medicine used to treat the symptoms of anxiety) was discontinued after 14 days or document a rationale for the continued provision of the medication. 2. The facility failed to ensure Resident #39's PRN Hydroxyzine (medicine used to treat the symptoms of anxiety) was discontinued after 14 days or document a rationale for the continued provision of the medication. This failure could place residents at risk for adverse reactions and negative side effects from the administration of medication and dependence on unnecessary medications.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to ensure residents were provided respiratory care received care consistent with professional standards of practice for 1 of 18 residents (Resident #32) and 1 of 1 oxygen storage room reviewed for oxygen administration. 1. The facility failed to post No Smoking sign in resident doorway for Resident #32 on 06/02/2025 & 06/03/2025 who used oxygen. 2. The facility failed to post No Smoking sign on doorway for room that oxygen was stored on 06/02/2025. These failures could place residents at risk of people not being notified of no smoking in oxygen storage or oxygen in use and prohibit smoking in any room, ward, or compartment where oxygen was in use or stored.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that each resident received food that is palatable, attractive, and at a safe and appetizing temperature for 1 (Resident #5) of 110 residents tested for nutritive value, flavor, and appearance: The facility failed to provide palatable food served that was palatable and attractive to Residents #5, during lunch on 06/02/2025. Resident #5 received gravy on his hamburger patty. This failure could affect the residents who ate food from the facility kitchen by placing them at risk of poor food intake and/or dissatisfaction of the meals served.

Inspectors wroteBased upon observation and interview, the facility failed to ensure staffing information was posted in a prominent place readily accessible to residents and visitors for 1 (06/02/2025) of 3 days reviewed for nursing services and postings. The facility failed to post in a prominent place the current number of licensed and unlicensed nursing staff on 06/02/2025. This failure could place residents, their families, and visitors at risk of not having access to information regarding staffing and facility census.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that each resident received food that is palatable, attractive, and at a safe and appetizing temperature for 1 of 1 lunch meals tested for nutritive value, flavor, and appearance: The facility failed to provide palatable food served at an appetizing temperature to residents, during lunch on 05/21/2025. This failure could affect the residents who ate food from the facility kitchen by placing them at risk of poor food intake and/or dissatisfaction of the meals served.

Inspectors wroteBased on observation, interviews, and record reviews the facility failed to ensure residents were free from neglect for 1 of 3 residents (Resident #1) reviewed for abuse. When Resident #1 obtained a skin tear on 05/17/24 that reopened on 05/25/24, the facility failed to obtain treatment orders and provide wound care treatment. After the wound reopened on 5/25/24, the facility did not provide wound care until 5/30/34 when a family member changed the dressing. On 06/01/24 maggots were found in the wound and dressing. The facility did not obtain treatment orders until 06/02/24. An IJ was identified on 06/07/2024. The IJ template was provided to the facility on [DATE] at 5:13 p.m. [...]

Inspectors wroteBased on observation, interviews, and record reviews, 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 1 (Resident #1) of 3 residents reviewed for quality of care. When Resident #1 obtained a skin tear on 05/17/24 that reopened on 05/25/24, the facility failed to obtain treatment orders and provide wound care treatment. After the wound reopened on 5/25/24, the facility did not provide wound care until 5/30/24 when a family member changed the dressing. On 06/01/24 maggots were found in the wound and dressing. The facility did not obtain treatment orders until 06/02/24. An IJ was identified on 06/07/2024. The IJ template was provided to the facility on [DATE] at 5:13 p.m. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain medical records, in accordance with accepted professional standards and practices, that were complete and accurately documented for 1 (Resident #1) of 5 residents reviewed for accuracy of medical records. The facility failed to accurately document Resident #1's had a bandaged area on his right elbow when he returned for the emergency room on [DATE] and accurately document an incident when Resident #1 had an open wound that was discovered infested with maggots. This failure could result in residents' records not accurately documenting interventions, monitoring, and inaccurate information provided to nursing staff and could lead to risk for errors in care and treatment.

Inspectors wroteBased on interviews and record reviews, the facility failed to develop and implement a comprehensive person-centered care plan with measurable objectives based on assessed needs with the ability to be evaluated or quantified to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being for 2 (Resident #3, and Resident #10) of 18 residents reviewed for comprehensive person-centered care plans. The facility failed to develop care plan that included Resident #3's current code status. The facility failed to develop care plan that included Resident #10's conditions of probation. The facility failed to develop a care plan that included measurable approach/frequency for Resident #10's wounds on both lower legs. [...]

Inspectors wroteBased on record review and interviews, the facility failed to ensure the use of the services of a registered nurse for at least 8 consecutive hours a day, seven days a week for 8(10/07/2023, 10/08/2023, 10/21/2023, 10/22/2023, 10/28/2023, 10/29/2023, 11/04/2023 and 11/05/2023) of 90 days reviewed for RN coverage. The facility failed to provide evidence that a Registered Nurse (RN) worked 8 consecutive hours a day, seven days a week on 10/07/2023, 10/08/2023, 10/21/2023, 10/22/2023, 10/28/2023, 10/29/2023, 11/04/2023 and 11/05/2023. This failure placed the residents at risk for not having decisions made that would have required an RN to make in the management of the residents' healthcare needs and in managing and monitoring of the direct care staff.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure the menu was followed for 3 of 4 (Residents #12, #36, #37) residents who received a pureed meal reviewed during one lunch meal observed. The facility failed to ensure residents receiving a pureed texture diet were provided the food according to the menu, including a roll. This failure could place residents that eat food from the kitchen at risk of poor intake, chemical imbalance and/or weight loss.

Inspectors wroteBased on observations, interviews, and record reviews the facility failed to properly store, prepare, distribute, and serve food in accordance with professional standards for food service safety for 1 of 1 kitchen reviewed for kitchen sanitation. The facility failed to ensure foods were sealed and/or labeled properly in dry food storage and refrigerator. The facility failed to ensure that food items were discarded when it reached expiration date. The facility failed to ensure that meat was thawed properly. The facility failed to ensure food temperatures were taken properly. These failures could place residents that eat out of the kitchen at risk for food borne illnesses.

Inspectors wroteBased on observation, interview and record review, the facility failed to accommodate residents needs and preferences and accommodation of needs, for 2 (Resident #13, Resident #14) of 19 residents reviewed for dignity. The facility failed to ensure Resident #13 and Resident #14 call lights were within reach. This failure could place residents at risk of a diminished quality of life and lead to a loss of self-esteem and isolation.

Inspectors wroteBased on interviews and record review, the facility failed to ensure resident right to formulate an advance directive for 2 of 5 residents (Resident #42 and #48) reviewed for advance directives. The facility failed to ensure that Resident #42 and #48's advanced directive consent, Out of Hospital Do Not Resuscitate (OOH-DNR) order, was signed by two witnesses. The facility failed to ensure that Resident #42 and #48's physician orders contained the most current code status. This failure could place residents at risk of receiving treatments that go against their personal preferences and does not allow them to make an informed decision about their care.

Inspectors wroteBased on interview and record review, the facility failed to ensure residents had a discharge summary that included a recapitulation of the resident's stay, medication reconciliation, and a discharge plan of care for 1 of 3 resident (Resident #50) reviewed for discharge summaries. The facility failed to complete a discharge summary with necessary medical information that the facility must furnish prior to discharge for Resident #50. The facility failed to complete a post-discharge plan of care with the participation of the Interdisciplinary team, the resident and with the resident's consent, and the resident's representative. This failure could place residents discharged from the facility at risk for incorrect, incomplete, or misleading information regarding discharge.

Inspectors wroteBased on observation and record review, the facility failed to have certified resident rooms equipped for adequate nursing care, comfort, and privacy for 14 (#45W, #45D, #46W, #46D, #47W, #47D, #48W, #48D 49W, #49D, #52W, #52D, #53W, #53D) of 104 certified beds. 1. The facility failed to ensure rooms #45 and #46 were certified for two Title 18 resident beds each and were not resident ready and could not easily be transitioned into resident ready rooms. The rooms were being used for activities, the shared wall between the two rooms had been knocked out to make one large room. 2. The facility failed to ensure rooms #47, #48 and #49 were certified for two Title 18 resident beds each and were not resident ready and could not easily be transitioned into resident ready rooms. [...]

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure drugs and biologicals used in the facility were stored and labeled in accordance with currently accepted professional principles, and included the appropriate accessory and cautionary instructions, and the expiration date when applicable for 1 (South Hall) of 4 medication carts reviewed for medication labeling and storage. The facility failed to ensure that all medications stored in South Hall medication cart were stored in their original container/packaging. The facility failed to ensure that all medications stored in South Hall medication cart were properly labeled. The facility failed to ensure that controlled medication in South Hall medication cart were stored under a double locking system. [...]

Inspectors wroteBased on observations, interviews and record reviews, the facility failed to provide food that accommodates resident's preferences for one (Resident #1) of four residents reviewed for food preferences. The facility failed to ensure Resident #1 did not receive her dislike food (peas) during the lunch meal on 11/22/2023 and failed to label her meal tickets with her likes and dislikes. This failure could affect all residents with food preferences and could result in a decrease in resident choices and weight loss from diminished interest in meals.