Avir at Irving

Inspectors wroteBased on observations, interview, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food safety in the facility's only kitchen.1. The facility failed to ensure the stand-by freezer food items were sealed and labeled. 2. The facility failed to ensure the stand-by refrigerator food items were dated, labeled, and sealed.3. The facility failed to ensure the dry storage food items were sealed.4. The facility failed to ensure that canned good food items were free of dents.5. The facility failed to ensure that serving utensils were used when handling food items.6. The facility failed to ensure staff personal items were not in the food preparation area. These failures could place residents at risk for foodborne illness and foodborne intoxication.

Inspectors wroteBased on interviews 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 in 1 of 1 facility reviewed for water management. The facility failed to implement a water management program including: 1.) An assessment to identify where Legionella and other opportunistic waterborne pathogens could grow and spread; and2.) to implement measures to prevent the growth of opportunistic waterborne pathogens (control measures), and how to monitor them. This failure could place residents at risk of waterborne illness.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure interventions and ongoing monitoring were provided for 1 of 1 resident (Resident #2) reviewed for dialysis services. The facility failed to obtain physician orders for fluid restriction. The facility failed to monitor his fluid intake. This failure could result in fluid overload in the body and residents not being able to maintain the highest practicable level of well-being.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to maintain all mechanical, electrical, and patient care equipment in safe operating condition for (1 (Wheelchair #1) of 5 wheelchairs observed for safe operating condition. The facility failed to maintain a working brake on the left wheel of Resident #1's wheelchair. This failure could place residents using wheelchairs at risk of falls and injuries.

Inspectors wroteBased on observation, interview and record review, the facility failed to provide pharmaceutical services including procedures that assures the accurate dispensing and administering of all drugs and biologicals to meet the needs of each resident for one (Resident #1) of four residents reviewed for medication administration. The facility failed to ensure Resident #1 had received her medications as scheduled and as ordered by her physician. This failure placed residents at risk for decreased quality of life, unrelieved pain and misappropriation or property.

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. The facility failed to ensure food items in dry storage were dated, labeled, and securely stored. The facility failed to ensure frozen and refrigerated food items were dated, labeled, and securely stored. The facility failed to ensure that a metal container of butter was covered to avoid risk of contamination. A pastry brush was left inside the melted butter container. The facility failed to ensure that prepared foods were held correctly and maintained safe temperatures. The facility failed to ensure that prepared foods were free of cross-contamination risk. The facility failed to ensure that dishwashing protocol was followed. [...]

Inspectors wroteBased on interview and record review, the facility failed to use the services of a Registered Nurse for a minimum of eight consecutive hours a day, seven days a week, for 13 of 26 weekend days. The facility failed to have RN coverage on the following dates in 2024: -April 6, 7, 13, 14, 20, and 21. -May 4, 5, 11, 12, 18, 19, and 26. This failure could place residents at risk of not having their nursing and medical needs met, and not receiving proper care.

Inspectors wroteBased on interview, and record review, the facility failed to ensure residents were free from abuse for one of eight residents (Resident #32) reviewed for abuse. The facility failed to ensure Resident #32 was free from physical abuse when the Former Staffing Coordinator grabbed Resident #32's hand hard enough to cause bruising, while attempting to get the resident to allow himself to be taken to the shower. This failure placed residents at risk for abuse.

Inspectors wroteBased on interview and record review the facility failed to implement the facility's own written abuse and neglect prevention policy and procedure for one (Resident #32) of eight residents reviewed for abuse and neglect. The Former Administrator and corporate staff failed to immediately suspend two staff members (the DON and LVN G) pending investigation when an allegation of physical and emotional abuse of Resident #32 was made in a statement by CNA I on 11/04/24 during the investigation of a self-reported allegation by Resident #32 of physical abuse by the Former Staffing Coordinator (who was suspended). The DON and LVN G were also not suspended immediately when corporate staff became aware on 11/17/24 the DON and LVN G staff had not been suspended by the Former Administrator (the day before their re-investigation of the self-report and allegation by CNA I on 11/18/24). [...]

Inspectors wroteBased on observations, interviews, and record review, 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 one of Two residents (Resident#18) reviewed for medication adminstration via gastrostomy tube (G-tube). RN H did not check placement of Resident #18's G-tube prior to medication administration and feeding. This failure could place residents who had gastrostomy tubes at risk for complications, aspiration, and pneumonia.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure, in accordance with State and Federal laws, all drugs and biologicals were stored in locked compartments under proper temperature controls and permit only authorized personnel to have access to the keys for one of four residents (Resident #7) reviewed for storage of medication. The facility failed to ensure Resident #7's blood pressure patch medication Clonidine was secured by CMA F and not let unattended on top of the medication cart. This deficient practice could place residents at risk of accidental ingestion of unprescribed medications and adverse reactions.

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 2 (Resident #18) residents reviewed for enhanced barrier precaution infection control. The facility failed to ensure RN H wore a gown for PPE while providing care to Resident #18 who was on enhanced barrier precaution. This failure could place residents that require assistance with personal care at risk for healthcare associated cross-contamination and infections.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure the resident resided and received services in the facility with reasonable accommodation of resident needs and preferences for 2 (Resident #1, Resident #2) of 10 residents reviewed for call lights. Staff failed to ensure Resident #1 and Resident #2, call buttons were within reach. This failure could place resident at risk for decreased quality of life, self-worth, and dignity.

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 one (Resident #3) of 5 residents observed for infection control. Resident #3's urinal with urine was left on top of Resident #3's bedside tray table which the resident used to eat meals on every day. This failure could place residents at risk of cross-contamination and the spread of infection.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure all drugs and biologicals were stored securely for 1 (Resident #7) of 12 residents and labeled in accordance with currently accepted professional principles for two (front hall medication cart and back hall medication cart) of two medication carts reviewed for labeling and storage. 1. Resident #7's had eye drops stored at the resident's nightstand and not locked in a lock box or secured in the medication cart or medication room. 2. The facility failed to ensure insulin vials were dated after they were opened. The failure could place residents at risk of unauthorized access to medications or receiving medications that were ineffective.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide food prepared by methods, which conserved nutritive value, flavor, and appearance for five of five residents reviewed for food and nutrition services. The Dietary Manager failed to prepare and serve the pureed lunch meal on 10/19/23 in a manner to conserve nutrition, flavor, and palatability. The failure could place residents at risk for a decrease in nutritive status, loss of appetite, decreased intake and unwanted weight loss.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents who need respiratory care were provided such care, consistent with professional standards of practice for 1 (Resident #11) of 5 resident reviewed for respiratory care. The facility failed to follow physician orders for Resident #11 to receive oxygen at a rate of two liters per minute. This failure could place residents who received oxygen therapy at risk of respiratory complications.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the medication error rate was not five percent (5%) or greater for one staff (LVN A) which resulted in a 14.29% medication error rate after 28 opportunities with 4 errors for one of four residents (Resident #22) reviewed for medications. 1. The facility failed to ensure LVN A administered all the crushed medication in the medication cups without leaving residue for Resident #22. 2. LVN A failed to follow the physician orders for flushing Resident #22's gastrostomy tube with 5-10 mL of water between medication when she administered medication. These failures could put residents at risk for not receiving the correct dose of medication and getting intended therapy.