Avir at Keller

Inspectors wroteBased on interview and record review the facility failed to ensure, based on the comprehensive assessment of a resident, 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 of 6 residents (Resident #1) reviewed for quality of care. The facility failed to ensure Resident #1's biliary drain (thin plastic tube used to clear blocked bile ducts) was flushed per the physician's order for seven days. This failure could place residents at risk for worsening of condition which could lead to serious harm.

Inspectors wroteBased on interviews and reviews, the facility failed to ensure the assessment accurately reflected the resident's status for 1 of 3 residents (Resident #1) reviewed for accuracy of assessments. The facility staff failed to ensure Resident #1's quarterly MDS dated [DATE] addressed resident Safety and Quality of Performance: Eating; Oral hygiene; C. Toileting hygiene; E. Shower/bathe self; F. Upper body dressing; G. Lower body dressing; H. Putting on/taking off footwear; Personal hygiene. Indicate the type of wheelchair or scooter used. This failure could result in residents missing essential treatments and interventions for care.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the interdisciplinary team determined if it was clinically appropriate to self-administer medications for 1 of 5 residents (Resident #7) reviewed for medication administration. The facility's interdisciplinary team failed to ensure Resident #7 was clinically appropriate to self-administer antihistamine eyedrops that was at the resident's bedside. This failure could place residents at risk of not receiving the therapeutic benefit of medication or an adverse drug reaction.

Inspectors wroteBased on observation, interview, 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 1 of 4 medication carts (Halls 300 nurse medication cart) reviewed for labeling of drugs and biologicals. The facility failed to ensure expired medications was removed from the Hall 300 medication cart. This failure could place residents at risk of not receiving the therapeutic benefit of medication or an adverse drug reaction.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure drugs and biologicals 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 of 2 medication refrigerators reviewed for pharmacy services. The facility failed to ensure insulin vials were dated after they were opened in the medication refrigerator. This failure had the potential to result in decreased therapeutic efficacy which could lead to uncontrolled blood sugars.

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 residents (Resident #1) reviewed for transfers. CNA failed to safely transfer Resident #1 on 11/09/25, when she did not use a gait-belt to assist the resident on or off the toilet. As a result, Resident #1 fell when being transferred from the toilet to the wheelchair, and the resident sustained a 10th rib fracture and a right tibia spiral fracture (break that twists around the right shin bone) as well as a proximal (where the limb begins) and distal (where the limb ends) right fibula (bone on the outside of your lower leg) fracture to Resident #1's right leg. The noncompliance was identified as past noncompliance. The IJ began on 11/09/2025 and ended on 11/14/2025. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure parenteral fluids were administered consistent with professional standards of practice and in accordance with physician orders for one of one (Resident #1) reviewed for intravenous fluids. The facility failed to change Resident #1's PICC (this is a soft, flexible catheter inserted into a central vein used for prolonged antibiotic therapy) line dressing before 02/20/25. This failure could affect residents by placing them at risk for infection and IV complications.

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 disease and infections for 1 of 7 residents (Resident #1) reviewed for infection control. CNA B failed to wear a gown for Enhanced Barrier Precautions while assisting LVN A with wound care for Resident #1. These failures could place residents at risk of infectious disease.

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 residents (Resident #1) reviewed for accidents. CNA A failed to use a gait-belt to transfer Resident #1 from her bed to the shower chair on 09/03/24 causing a 1.0 cm x 1.5 cm skin tear on Resident #1's right arm. This failure could place residents at risk of injury.

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 one of three residents (Resident #1) reviewed. The facility failed to ensure the Wound Care Nurse used proper body mechanics while providing incontinence care to Resident #1 on 07/11/24. This failure could place residents at risk of injury, change in condition, and not receiving proper treatment and care in a timely manner.

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 of three residents (Resident #1) reviewed for infection control. 1. The facility failed to ensure Caregiver A provided incontinence care using the proper technique when she wiped Resident #1's perineal area from back to front on 07/11/24. 2. The facility failed to ensure Caregiver A changed her gloves after she wiped Resident #1's perineal area on 07/11/24. These deficient practices could place residents at-risk for infections.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to ensure a resident who is unable to carry out activities of daily living receives the necessary services to maintain good nutrition, grooming, and personal and oral hygiene for three (Residents #36, #107, and #69) of eight residents reviewed for ADL care. 1. The facility failed to provide two female residents, Residents #36 and #107, with grooming to ensure their facial hair was shaved. 2. The facility failed to provide Resident #69 assistance with timely incontinence care. These failures could place the residents at risk for decreased feelings of self-worth, skin breakdown, and infection.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents who needed respiratory care were provided such care, consistent with professional standards of practice for one (Resident #57) of three residents reviewed for respiratory care. The facility failed to ensure Resident #57's had a physician's order for oxygen treatment. This deficient practice could affect residents who received oxygen therapy from receiving inadequate oxygen support and a decline in health.

Inspectors wroteBased on interview and record review, the facility failed to coordinate assessments with the PASARR program for 1 (Resident #1) of 4 residents reviewed for PASRR coordination. The facility failed to meet deadlines for submitting a NFSS for specialized services and customized manual wheelchair for Resident #1. This failure could place residents at risk of not receiving qualified specialized services.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure an environment that was free of accident hazards and that each resident received adequate supervision to prevent elopement for two (Residents #1 and#2) of four residents reviewed for elopement. 1. The facility failed to ensure Resident #1 was provided with adequate supervision to prevent him from eloping from the facility on 09/25/23. 2. The facility failed to ensure Resident #2 was provided with adequate supervision to prevent him from eloping from the facility on 09/28/23. The non-compliance was identified as past non-compliance. The Immediate Jeopardy (IJ) began 09/25/23 and ended on 09/30/23. The facility corrected the non-compliance before surveyor's entrance. This failure placed residents at risk of harm and/or serious 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 safety in the facility's only kitchen. -The facility failed to ensure food items and clean dishes were kept away from airborne contaminants and an unsanitary environment. -The facility failed to ensure that two ice machines were clean and sanitary. These failures could place all residents, who receive food from the kitchen, at risk for food contamination and food-borne illness.

Inspectors wroteBased on observations, interviews, and record review the facility failed to ensure total privacy for residents in 4 of 28 rooms (Rooms 401 A bed, 401 B bed, 405 A bed, and 405 B bed) reviewed for privacy. The facility failed to provide privacy curtains to ensure residents' privacy in Rooms 401 A bed, 401 B bed, 405 A bed, and 405 B bed. Each of these rooms only had one curtain. This failure could place residents at risk of decreased self-worth by being exposed during resident care.

Inspectors wroteBased on observation, interview, and record review, the facility failed to implement their written policies and procedures for investigating and reporting allegations of abuse, neglect, exploitation or mistreatment, including injuries of unknown source and misappropriation of resident property, for 1 (Resident #35) of 18 residents reviewed for abuse. The facility failed to follow their policy and report to the State Survey Agency when Resident #35 alleged he had been cursed at by CNA C. The failure could place residents at risk of repeated injuries, abuse and/or neglect.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure that all alleged violations involving abuse and neglect, including injuries of unknown source, were reported immediately, but not later than two hours after the allegation was made, if the events that caused the allegation involved abuse or resulted in serious bodily injury, to the State Survey Agency in accordance with State law through established procedures for 1 (Resident #35) of 18 residents reviewed for abuse and neglect. The facility failed to report to the State Agency when Resident #35 made an allegation of verbal abuse against CNA C. This failure could place residents at risk of incidents of abuse, neglect, and exploitation not being reported timely .

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure drugs and biologicals used in the facility were labeled in accordance with professional principles, and included the appropriate accessory and cautionary instructions, and the expiration date when applicable for 1 (500 Hall) of 2 medication rooms (refrigerators) reviewed for medication storage. The facility failed to dispose of two expired vials of the influenza vaccine. This failure could place the residents at risk of not receiving the required therapy or receiving vaccines that were expired.

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 disease and infection for 1 (Resident #12) of 4 residents reviewed for infection control during medication administration. The facility failed to ensure MA D disinfected the blood pressure cuff in between blood pressure checks for Resident #34 and Resident #12. These failures could place residents at-risk of cross contamination which could result in infections or illness.