Avir at Johnson City

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that nurse aides were able to demonstrate competency in skills and techniques necessary to care for residents' needs as identified through resident assessments and described in the plan of care for one of two nurse aides (CNA A) reviewed for personnel requirements. CNA A was observed sitting down on her phone during her shift as a caregiver on 7/28/2026. This failure placed residents at risk of decreased monitoring and supervision.

Inspectors wroteBased on the interview and record review, the facility failed to properly complete a performance review of every nurse aide at least once every 12 months, for 2 of 4 (CNA A and CNA C) reviewed for nursing services. The facility failed to provide a completed competency checklist for the mechanical lifting device (assists staff with transferring a resident from the bed to a wheelchair and back to the bed) for CNA A and CNA C.This deficient practice resulted in an injury to the Resident #27 and could place other residents at risk of falls and injury.

Inspectors wroteBased on observations, interviews, and record reviews the facility failed to ensure the residents' environment remained free from accidents and hazards as was possible and that each resident received adequate supervision and assistance devices to prevent accidents, for 4 of 11 residents (Resident #20, Resident #27, Resident #28 and Resident #34,) reviewed for quality of life. The facility failed to ensure Resident #27's mechanical lift sling was securely attached to the sling bar. The facility failed to ensure that the call light was within reach for Resident #34 and Resident #20. The facility failed to serve Resident #28 a mechanically altered diet on 6/1/2026. [...]

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety in the 1 of 1 kitchen reviewed for food and nutrition services. The facility failed to consistently monitor and discard expired food The facility failed to maintain a sanitary kitchen by keeping the ice scoop in the ice machine. The facility did not label and date food items in the kitchen. The facility failed to keep employee's food items away from residents' food items. These failures can place residents at risk for foodborne illness.

Inspectors wroteBased on the interview and record review, the facility failed to treat Resident #27 with dignity and respect in a manner and environment that promoted the maintenance or enhancement of his or her quality of life for 1 of 11 (Resident #27) residents reviewed for resident rights. The facility failed to ensure Resident #27's private area was covered while staff transferred the resident via a mechanical lift (assists staff with transferring a resident from the bed to a wheelchair and from the wheelchair back to the bed) from the bed to a chair. This deficient practice could place residents at risk for unnecessary exposure, embarrassment, and diminished quality of life.

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, 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 #14) reviewed for care plans.1. The facility failed to develop a comprehensive care plan to reflect Resident #14's diagnoses.2. The facility failed to develop a comprehensive care plan to reflect Resident #14's preferences. These failures could place residents at risk of not receiving appropriate interventions to meet their psychosocial and medical needs. [...]

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure the safe storage of medications and medical supplies within the medication cart for 1 of 2 medication carts (medication cart on 100 hall) reviewed for pharmacy services. The facility failed to prevent the storage of expired medication and supplies in the medication cart on 100 hall. This deficient practice could place residents at risk of the medications and supplies not being as effective and dealing with the symptoms that the meds were supposed to treat.

Inspectors wroteBased on interview and record review, the facility failed to ensure the residents' right to formulate an advance directive for 1 of 6 residents (Resident #1) reviewed for advanced directives, in that:The facility failed to ensure Resident #1's OOH-DNR was valid with a physician signature which resulted in Resident #1 receiving life saving measures including CPR when Resident #1 was found unresponsive. This failure places residents at risk of having their end-of-life wishes dishonored, and of having CPR performed against their wishes.

Inspectors wroteBased on observation, interview 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 1 (Resident #1) of 4 residents reviewed for quality of care. The facility failed to ensure Resident #1 had orders in place to treat his heel abrasion from 11/14/2025 through 12/03/2025. The facility failed to ensure Resident #1 had a weekly skin assessment completed on 11/22/2025 and 11/29/2025. These failures could place residents at risk for unassessed changes in conditions and to not receive adequate care

Inspectors wroteBased on interview and record review, the facility failed to provide pharmaceutical services including procedures that assure the accurate acquiring, receiving, dispensing and administering of all routine and emergency drugs and biologicals for 3 of 4 (Resident #1, Resident #2, and Resident #3) reviewed for pharmacy services. The facility failed to ensure that all of Resident #1's, Resident #2's, and Resident #3's medications were administered on time as indicated by physician's orders on 11/27/2026. These failures could place residents at risk of exacerbation and/or deterioration of their health conditions, and delayed relief or treatment of symptoms which could result in decreased quality of life, discomfort or hospitalization.

Inspectors wroteBased on interview and record review, the facility failed to use the services of a registered nurse of at least 8 consecutive hours a day, 7 days a week for 2 of 14 days reviewed (11/27/2025 and 11/28/2025) reviewed for RN coverage. The facility failed to ensure they had an RN charge nurse on duty on 11/27/2025 and 11/28/2025. This failure could place residents at risk of missed nursing assessments, interventions, care and treatment.

Inspectors wroteBased on observations, interviews, and record review the facility failed to store, prepare, and distribute food in accordance with professional standards for food service safety in 1 of 1 kitchen and 1 of 1 nourishment room reviewed for kitchen and food sanitation. 1. The facility failed to ensure food in the refrigerator was properly sealed from air-borne contamination. 2. The facility failed to ensure food in the dry storage area was properly sealed from air-borne contamination. 3. The facility failed to maintain a sanitary open front refrigerator/freezer in the nourishment room. 4. The facility failed to label, date, and discard expired food items in the side-by-side refrigerator in the kitchen. 5. The facility failed to label, date, and discard expired food items in the nourishment room refrigerator and freezer. [...]

Inspectors wroteBased on observations, interviews, and record review the facility failed to ensure residents received services in the facility with reasonable accommodations of resident's needs and preferences except when to do so would endanger the health and safety of the resident or other residents for 2 of 7 residents (Resident #18 and #22) reviewed for resident rights. The facility failed to ensure Resident's #18's and Resident #22's call light was within reach on 03/31/25. This failure could place residents at risk of needs not being met.

Inspectors wroteBased on interviews and record review, the facility failed to ensure individuals with mental health disorders were provided an accurate Preadmission Screening and Resident Review (PASRR) Level 1 Screening for 1 of 2 residents (Resident #14) reviewed for PASRR. The facility failed to ensure Resident #14 had an accurate PASRR Level 1 Screening indicating a diagnosis of mental illness on 03/03/2025. This failure could place residents at risk of not receiving needed individualized care, and specialized services to meet their needs.

Inspectors wroteBased on observations, 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 2 of 7 residents (Resident's #30 and #14) reviewed for care plans. The facility failed to include the resident was a smoker and the resident had a diagnosis of acute gastritis with bleeding in Resident #30's comprehensive care plan. The facility failed to ensure Resident #14's care plan was updated to reflect their current ADL functional status. This failure could place residents at risk for not receiving necessary care and services or having important care needs identified and met.

Inspectors wroteBased on interview, and record review, the facility failed to ensure the resident environment remained as free of accident hazards as was possible and each resident received adequate supervision and assistance devices to prevent accidents for one (Resident #1) of three residents reviewed for accidents and hazards. NA A failed to have another staff assist while providing care for Resident #1 in the bed on 12/29/2024. Resident #1 rolled out of the bed, fell to the floor face down, was transferred to the ER and was diagnosed with laceration on left forehead, a subdural hematoma (collection of blood outside the brain that can be life threatening), a subarachnoid hemorrhage(bleeding in the space below the arachnoid layer of the brain) and possible C6/T1 fractures (C6 is the 6th cervical vertebrae that is in your neck, supports the head, protect the spinal cord and allow head motion; [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure that pain management was provided to residents who required such services, consistent with professional standards of practice, the comprehensive person-centered care plan, and the residents' goals and preferences for one (Resident #1) of four residents reviewed for pain. The facility failed to provide effective pain management or investigate the reason for the increased pain for Resident #1 when he complained of pain to his lower abdomen/groin area from 09/01/24 - 09/03/24. He was sent to the ER on [DATE] and diagnosed with a UTI, sepsis, and a blood clot in his bladder. This failure resulted in an identification of an Immediate Jeopardy (IJ) on 10/29/24 at 3:56 PM and an IJ template was given. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the resident environment remained as free of accident hazards as was possible and each resident received adequate supervision and assistance devices to prevent accidents for one (Resident #2) of three residents reviewed for accidents and hazards. The facility failed to have consistent documentation for Resident #2's transfer status and failed to ensure she was properly transferred on 10/27/24. Her left leg foot caught on the wheelchair while being transferred by one person assistance to her bed which resulted in multiple fractures to her tibia and fibula (spiral fractures). This failure resulted in an identification of an Immediate Jeopardy (IJ) on 10/29/24 at 3:56 PM and an IJ template was given. [...]

Inspectors wroteBased on interviews and record review, it was determined that the facility failed to ensure residents have the right to receive visitors of his or her choosing at the time of his or her choosing for 2 of 4 Residents (Resident #1 and Resident #2) reviewed for resident rights. The facility did not allow Resident #1 and Resident #2 to visit with a family member of a former resident. This failure placed residents at risk of isolation, decreased emotional wellbeing, and diminished quality of life.

Inspectors wroteBased on interviews and record reviews, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety for 1 of 1 kitchen. The facility failed to ensure [NAME] A checked and logged food temperatures before serving breakfast on 07/29/24. This failure could place residents who received meals and/or snacks from the kitchen at risk for foodborne illness.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the views of the residents were considered and acted upon promptly concerning issues of resident care and life in the facility for two (Resident #2 and Resident #3) of three residents reviewed for resident council grievances. The facility failed to ensure the DM attended the RC A meeting after several requests by Resident Council members such as Residents #2 and #3. This deficient practice could place residents at risk of a decreased sense of self-worth, a decline in quality of life, and loss of dignity.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide each resident with a nourishing, palatable, well-balanced diet that met his or her daily nutritional and special dietary needs, taking into consideration the preferences of each resident for three (Resident #1, Resident #2, and Resident #3) of five residents reviewed for food preferences. The facility failed provide fresh fruit for Residents #1, #2, and #3. This deficient practice could put residents at risk of weight loss, an increase of feelings of self-worth, and a decreased 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 for food and nutrition services. The facility failed to ensure foods were labeled properly in refrigerators. The facility failed to ensure that food items were disposed of properly. The facility failed to ensure staff used proper hand hygiene. These failures could place residents that eat out of the kitchen at risk for food borne illnesses.

Inspectors wroteBased on interviews and record reviews, the facility failed to make sure that the comprehensive care plan is prepared by a team that included the attending physician, a nurse, and a nurse aide with responsibility for the resident for 4 of 13 residents (Residents #1, #9, #25, and #30) reviewed for care plans. The facility failed to ensure that care plan meetings were completed quarterly and within 7 days after completion of the comprehensive assessment. This failure could place the residents at risk for not receiving the care and services to meet their needs.

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 one of one facility reviewed for nursing services. The facility failed to provide evidence that a Registered Nurse (RN) worked 8 consecutive hours a day, seven days a week for 7 of 90 days (07/19/2023, 07/25/2023, 07/26/2023, 08/02/2023, 08/04/2023, 08/23/2023 and 09/27/2023) reviewed. This failure placed the residents at risk for altered physical, mental, and psychological well-being due to decisions 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 observations, interviews, and record reviews, the facility failed to store all drugs and biologicals in locked compartments for 1 of 1 treatment carts reviewed for label and storage of drugs and biologicals. The facility failed to ensure the treatment cart (#1 of 1) was locked when unattended by LVN-A. This failure could place residents at risk of having access to unauthorized medications, wound care and medical supplies leading to possible harm or drug diversions.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the menu was followed for 4 of 4 (Resident #1, Resident #6, Resident #7 and Resident #25) residents who received a pureed meal reviewed during the lunch meals served reviewed for food and nutrition services. 1. The facility failed to ensure residents, receiving a puree texture diet, were provided the food according to the menu, including an herb roll and banana cake on 02/14/2024 at 11:50 AM. 2. The facility failed to ensure the recipes for pureed meals were followed for rice and charro beans on 02/13/2024 at 11:00 AM, and frosted banana cake on 02/14/2024 at 11:50 AM. This failure could place residents that eat out of the kitchen at risk of poor intake, chemical imbalance, and/or weight loss.

Inspectors wroteBased on interview and record review, the facility failed to ensure each resident was informed before, or at the time of admission, and periodically during the residents stay, of services available in the facility and of changes for those services, which included changes for services not covered under Medicare/Medicaid or by the facility's per diem rate for 2 of 3 residents (Resident #20 and Resident #33) reviewed for resident rights. [...]

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 safety in the facility's only kitchen reviewed for dietary services. 1. The facility failed to ensure expired food items were discarded appropriately. 2. The facility failed to ensure the food service staff wore hair restraint while on duty in the kitchen. These failures could place residents at risk for food contamination and food-borne illness.