Avir at Killeen

Inspectors wroteBased on observations, interviews, and record review. The facility failed to provide maintenance services necessary to maintain a comfortable interior for 3 of 16 Residents (Resident #6, Resident #21, and Resident #35) who were reviewed for a home-like environment. The facility failed to ensure that the walls of Residents #6, #21, and #35 rooms were free of scuff marks and paint damage. The deficient practice could place residents at risk of a clean and comfortable home-like environment

Inspectors wroteBased on interview and record review, the facility failed to ensure the Pre-admission Screening and Resident Review (PASARR) Level I assessment accurately reflected the resident's status for 2 of 5 residents (Resident #12 and Resident #11) reviewed for PASARR Level I screenings. 1. The facility failed to ensure the accuracy of the PASARR Level 1 screening for Resident #11 and Resident #12. The PASARR Level 1 screening did not indicate a diagnosis of mental illness, although the diagnosis PTSD (post-traumatic stress disorder) with an onset was present upon Resident #12 and Resident #11's admission. 2. The facility did not complete a 1012 form to update Resident #12 and Resident #11's PASARR Level 1 with the new diagnosis. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure the Pre-admission Screening and Resident Review (PASARR) Level I assessment accurately reflected the resident's status for 2 of 5 residents (Resident #81 and Resident #67) reviewed for PASARR Level I screenings. 1. The facility failed to ensure the accuracy of the PASARR Level 1 screening for Resident #81 and Resident #67. The PASARR Level 1 screening indicated a negative level 1 despite the resident had a diagnosis prior to the PASARR being completed. This failure could place residents who had a mental illness at risk of not receiving a needed assessment (PASARR Evaluation), individualized care, or specialized services to meet their needs.

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, for one of one kitchen reviewed for food storage. The facility failed to label and date food correctly. These failures could place residents at risk for foodborne illnesses.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure a resident who was unable to carry out activities of daily living received the necessary services to maintain good grooming and personal hygiene for 3 of 8 residents (Resident #1, Resident #2, and Resident #3) reviewed for ADL care. The facility failed to ensure Resident #1 was provided with ADL care and repositioned timely per Resident #1's care plan The facility failed to ensure Resident #2 was assisted with ADLs timely. The facility failed to ensure that Resident #3 was assisted with incontinent care timely. This failure could place residents at an increased risk of not receiving services or care, diminishing quality of life, and decreased self-esteem.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure residents are given the appropriate treatment and services to maintain or improve his or her ability to carry out the activities of daily living (ADLs) for 2 of 5 residents (Resident #1 and Resident #2) reviewed for hygiene. The facility failed to ensure Residents #1 and Resident #2 were provided with care and services for hygiene. This failure could place residents at risk for poor self-esteem, infections, socialization, ADL decline and diminished quality of life.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure food and drink that is palatable, attractive, safe and appetizing temperature for residents in the 1 kitchen of 1. The facility failed to ensure residents received food that tasted good. The facility failed to ensure residents did not receive cold food. The facility failed to prepare enough food to ensure all residents received the meals offered. These failures could place residents on regular diet and puree diet at risk of receiving inadequate diet that could affect their health and unwanted weight loss.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents received necessary treatment and services, consistent with professional standards of practice to promote wound healing and to prevent new pressure ulcers from developing for 1 of 2 residents (Resident #1) reviewed for pressure injuries. The facility nurse did not provide wound care to Resident #1 on 03/28/2026 as ordered. This failure could place residents at risk of improper wound management, deterioration in existing pressure injuries, infection, and pain.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure all drugs and biologicals were stored properly for 1 of 4 medication carts, and 1of 2 medication rooms reviewed for medication storage. The facility failed to ensure the medication cart located at nursing station 2 did not contain loose pills and a cup with a pill. The facility failed to ensure an expired cartridge of Humalog, best by 12/25/2024, was removed from the med room [ROOM NUMBER] refrigerator. These failures could place residents at risk for not receiving prescribed medications as ordered and adverse effects of medications due to incorrect labeling.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure all drugs and biologicals were stored properly for 1 of 4 medication carts, and 1of 2 medication rooms reviewed for medication storage. The facility failed to ensure the medication cart located at nursing station 2 did not contain a cup with a pill. The facility failed to ensure an expired cartridge of Humalog, best by 12/25/2024, was removed from the med room [ROOM NUMBER] refrigerator. These failures could place residents at risk for not receiving prescribed medications as ordered and adverse effects of medications due to incorrect labeling.

Inspectors wroteBased on observation, interviews, and record review, the facility failed to ensure that all alleged violations involving abuse and neglect are reported immediately, but not later than 24 hours if the events that cause the allegation involve abuse and do not result in serious bodily injury for 1 of 3 residents (Resident #1) reviewed for abuse and neglect. The facility failed to ensure that CNA A reported allegation of abuse immediately, but no later than 24 hours to the ADM when Resident #1 reported that her roommate slapped her on her thigh to CNA A.This failure could result in continued abuse or neglect of residents, injury, and/or psychosocial harm.

Inspectors wroteBased on interviews, observations, 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 includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that meet professional standards of quality care for 1 (Resident #2) of 4 residents reviewed for baseline care plans. The facility failed to update Resident #2 care plan on 12/28/2025 after they received orders from the nurse practitioner in regard to his rash. This failure could place residents at risk of getting insufficient care and having personal needs not met and could result in diminished physical and psychosocial well-being.

Inspectors wroteBased on observations, interview and record review, the facility failed to ensure a resident who was unable to carry out activities of daily living received the necessary services to maintain good nutrition, grooming, and personal and oral hygiene for one of four residents (Resident# 1) reviewed for ADL care. The facility failed to provide Resident #1 showers consistent on her shower days who were physically impaired. This failure could place ADL dependent residents at risk of experiencing embarrassment from odors, infection, and skin breakdown.

Inspectors wroteBased on interview and record review, the facility failed to ensure the right to be free from misappropriation of resident property for Resident #2 reviewed for misappropriation. The facility failed to ensure Resident #2 was protected from the AC accessing her bank account, leading to 4 unauthorized transactions totaling $10,250 from Resident #2's account between 10-18-2025 and 10-29-2025. This failure could place residents at risk of decreased quality of life, property misappropriation, and financial hardship.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to follow their own established smoking policy for 2 (Residents #63 and #65) of 2 residents reviewed for smoking. The facility failed on 9/2/2025 to ensure that Residents #63 and #65 did not smoke without supervision and did not keep their personal cigarettes and lighters in their rooms, as per facility policy. This failure could place residents at risk of an unsafe smoking environment and injury.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to accommodate the needs and preferences for one of seven residents (Residents #1) reviewed for accommodation of needs, in that:The facility failed to ensure that Resident #1 had his call light in reach on 8/8/2025. This deficient practice could place residents at risk of injury, for not receiving timely care and nursing interventions.

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 7 residents (Resident #1) reviewed for Infection control. The facility failed to ensure Resident #1's catheter bag was not laying on the floor on 8/8/2025. This failure could result in the spread of diseases to residents which could result in decreased quality of life, illness, and hospitalization.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure each resident received adequate supervision for 1 of 10 residents (Resident #1) reviewed for accidents and supervision. The facility failed to ensure Resident #1 did not exit the facility without staff's knowledge and ambulate approximately 100 yards down their driveway to a busy street with a speed limit of 65 MPH on 05/25/25. The facility failed to ensure staff were knowledgeable on how to properly secure the doors using the door security box located at 2 of 2 nurses' stations (both the skilled nursing and long-term care sides of the facility). Staff were identified by ADON B pressing the door release button with a key emblem instead of the round door secure button resulting in the doors not being secured. An Immediate Jeopardy (IJ) was identified on 06/25/25. [...]

Inspectors wroteBased on interviews and record reviews, the facility failed to notify the resident and resident's representative(s) of the discharge, reasons for the move, and right to appeal in writing and in a language and manner they understand and send a copy of the notice to a representative of the Office of the State Long-Term Care Ombudsman for 2 (Resident #1 and Resident #2) of 10 residents reviewed for discharge planning. A) 1. The facility failed to notify Resident #1 and Resident #1's RP of Resident #1's discharge, reasons for the move, and right to appeal in writing, in a language and manner they understand, and at least 30 days before Resident #1 was discharged from the facility on 05/25/25 in a facility-initiated discharge to another skilled nursing facility.2. [...]

Inspectors wroteBased on observations, interviews, and record reviews, 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, and the residents' goals and preferences for three (Resident's #13, 14, 17) of five residents reviewed for oxygen use and storage. The facility failed to ensure Resident's #13, 14, 17 nebulizer masks were documented when they were changed. This deficient practice could place residents receiving oxygen therapy at risk for infection.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the right to a dignified existence, self-determination, and communication with and access to persons and services inside and outside the facility for 1 (Resident #63) of 5 residents reviewed for resident rights. The facility failed to offer language assistance services or interventions to communicate with Resident #63 who had limited English proficiency. [...]

Inspectors wroteBased on observation, and interviews, the facility failed to keep residents' information secure. This constitutes a failure to protect residents' personal and medical records and violated HIPAA regulations for 1 of 1 laptop. Because of this the facility was in a deficient practice. facility laptop was left open and unattended on a medication cart in the hallway with residents' personal medical information visible to anyone who passed by on 05/17/2025 while the medication aid was in a resident's room. These failures could place residents at risk of having their private information changed or viewed and not kept secure.

Inspectors wroteBased on observation, interview, and record review, the facility did not provide pharmaceutical services to meet the needs of each resident for one (Resident #63) of four residents reviewed for pharmaceutical services, in that: The facility failed to ensure Resident #63 received his Acidophilus (bacterium found in the mouth) on 04/11/25, 04/12/25, and two times on 04/15/25. This deficient practice could place residents at risk of not receiving the intended therapeutic benefit of the medications and supplements, could result in worsening or exacerbation of medical conditions.

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 (Resident #1) of four residents reviewed for quality of care. The facility failed to assess and put treatment orders in place when Resident #1 developed a rash under her abdominal fold causing her excruciating pain. These failures placed residents at risk of improper wound management, the development of new skin integrity issues, deterioration in existing skin integrity, infection, and pain.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a resident who was unable to carry out activities of daily living received necessary services to maintain good nutrition, grooming, and personal and oral hygiene for three of five residents (Resident #3, Resident #4, and Resident #5) reviewed for ADLs. The facility failed to provide showers to Residents #3, #4, and #5 in compliance with their shower schedules. This deficient practice could place residents at risk of a decline in hygiene, at risk of skin breakdown, level of satisfaction with life, and feelings of self-worth.

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 of 3 residents (Resident #2) reviewed for infection prevention and control. CNA B failed to don PPE while performing incontinent care for Resident #2 who was on enhanced barrier precautions. CNA B and LVN C failed to perform hand hygiene while performing incontinent care and wound care for Resident #2. LVN C failed to have a clean field for supplies while performing wound care for Resident #2. The facility failed to have a liner in the trash can in Resident #2's room. These failures could place residents at risk for infection.

Inspectors wroteBased on interviews, and record review, the facility failed to have sufficient nursing staff with the appropriate competencies and skill sets to provide nursing and related services to assure resident safety and attain or maintain the highest practicable, physical, mental, and psychosocial well-being for 1 of 4 (CNA A) certified nurse assistant reviewed for competent nursing care. The facility failed to ensure CNA A followed the facility policy while providing incontinent care to Resident #1 when she did not perform proper perineal care (the process of washing the genital and anal areas of the body) during a disposable underwear change. The non-compliance was identified as Past Noncompliance. The past noncompliance began on 5/31/2024 and ended on 6/02/2024. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents who were unable to carry out activities of daily living received the necessary services to maintain good nutrition, grooming, and personal and oral hygiene for 1 of 11 residents (Resident #1) reviewed for activities of daily living. The facility failed to ensure Resident #1 received her showers as scheduled, received nail care, and received assistance with oral hygiene. The failure placed residents at risk of embarrassment, injury, skin breakdown, and infection.

Inspectors wroteBased on observations, interviews and record reviews, the facility failed to ensure each resident had the right to be free from abuse for 1 (Resident #1) of 5 residents reviewed for abuse. The facility failed to ensure Resident #1 was safe from sexual abuse. On 02/27/24, Resident #1 alleged she was sexually assaulted, facility staff transferred her to the hospital, and hospital staff took a sexual assault exam. On 04/16/24, the sexual assault exam results showed a presence of semen in Resident #1's brief and on and in her vagina. An IJ was identified on 05/10/24. The IJ template was provided to the facility on [DATE] at 6:24 p.m. While the IJ was removed on 05/13/24, the facility remained out of compliance at a scope of isolated and a severity level of potential for more than minimal harm because of the facility's need to evaluate the effectiveness of the corrective systems. [...]

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure that the residents' environment remained as free of accident hazards as was possible in 6 (room [ROOM NUMBER], 504, 506, 701, 707, and 801) of 38 resident room sinks and 1 (600 Hall Shower) of 2 resident shower rooms reviewed for hot water in the facility's 500 - 800 hallways. The facility failed to maintain resident use hot water at safe and comfortable temperatures (between 100-110). Resident use hot water was not reliably controlled and ranged from between 117.1 F and 145.0 F in reviewed locations. These failures resulted in an Immediate Jeopardy (IJ) situation on 03/12/2024. While the IJ was removed on 03/13/2024 the facility remained out of compliance at a severity level of no actual harm at a scope of pattern due to staff needing more time to monitor the plan of removal for effectiveness. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to store, prepare, distribute, and serve food under sanitary conditions in the facility's only kitchen reviewed for sanitation. The facility failed to discard of food products that were past the use by date in the dry storage area. The facility failed to discard of a food product that was past the use by date in their double door refrigerator. The facility failed to store boxes off the floor in the walk-in-freezer. These failures could place residents at risk of cross contamination and foodborne illness.

Inspectors wroteBased on interview and record review, the facility failed to consider the views of a resident or family group and act promptly upon the grievances and recommendations of such groups concerning issues of resident care and life and failed to demonstrate their response and rationale for such response for one of one resident council meeting. There was no documentation of the facility's effort to resolve grievances collected at Resident Council meetings on 11/07/2023, 12/12/2023, and 01/09/2024. This failure placed residents at risk of indignity and diminished quality of life.

Inspectors wroteBased on observation, interview and record review the facility failed to maintain a clean, sanitary, comfortable, and homelike environment in 1 of 1 resident rooms (Resident #69) and 1 of 2 medication storage rooms (Pod 1 medication storage room) as evidenced by, 1) Resident #69 had feces on his commode, feces-soaked towels on his floor, and brown stains on his bedspread and wheelchair. 2) The Pod 1 medication storage room had loose trash, a box of ostomy bags, and debris and dirt on the floor. The interior of the specimen refrigerator had brown and yellow stains and chunks of brown debris. The freezer section had a large amount of unidentified brown debris. These failures could place all residents in the facility at risk for a diminished quality of life and a diminished clean, homelike environment.

Inspectors wroteBased on interviews and record review the facility failed to ensure residents had the right to be free from abuse and neglect for one resident (Resident #68) out of 18 reviewed for abuse. The facility to failed to ensure a social worker at the facility did not verbally abuse a resident when they yelled at Resident #68 and called him stupid; the incident was witnessed by the ADON, who reported it immediately. The failure could place residents at risk of physical or emotional distress, and injury.

Inspectors wroteBased on observation, interview and record review, the facility the facility failed to provide the necessary services to maintain grooming and personal care for 6 of 10 residents (#4, #69, #81, #74, #12, and # 240) reviewed for ADL care. The facility failed to ensure Residents #4, #69, #81, #74, #12, and # 240 were provided assistance with personal hygiene. These failures could place residents at risk of skin breakdown, infection, and loss of self-esteem.

Inspectors wroteBased on observation, interview and record review the facility failed to provide, based on comprehensive assessment and care plan and the preferences of each resident, an ongoing program to support residents in their choices of activities, both facility-sponsored group and individual activities and independent activities, designed to meet the interest of and support the physical, mental, and psychosocial well-being of each resident, encouraging interaction in the community for 3 of 6 residents (Resident #6, Resident #36 and Resident #37) reviewed for activities. The facility failed to ensure one-on- one activities for Residents #6, Resident #36 and Resident #37 was provided according to the one-one activity schedule. This failure could place residents at risk for a decline in social, mental, psychosocial well-being and a diminished quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that residents who need respiratory care were provided such care, consistent with professional standards of practice for 2 (Resident #18 and #19) of 4 Residents reviewed for respiratory care. The facility failed to ensure that Resident #18's Nebulizer tubing and mouthpiece, which includes the nebulizing chamber (unit into which liquid medicine is converted into aerosol or mist by the pressurized air pumped through the tubing), were dated, bagged, and replaced every seven (7) days. The facility failed to ensure that Resident #19's Nebulizer tubing and mask were bagged and replaced every seven (7) days. The facility failed to ensure that the oxygen tubing for Resident #19 was dated and replaced every seven (7) days. [...]

Inspectors wroteBased on observation, interview and record review the facility failed to ensure residents received services in the facility with reasonable accommodation of each resident's needs for 5 of 15 residents (Residents #54, #24, #52, #81 and #69) reviewed for call lights. Residents #54, #24, #52, #81 and #69 were observed in their rooms with their call lights not in reach. This failure could affect residents who needed assistance with activities of daily living and could result in needs not being met.

Inspectors wroteBased on interview and record review, the facility failed to conduct an accurate comprehensive assessment of each resident's functional capacity for one (Resident #240) of eight residents reviewed for comprehensive assessments. The facility failed to ensure Resident #240's admission assessment was completed by the 14th day of admission. These failures placed residents at risk of not receiving the proper care required to attain or maintain the highest practicable physical, mental, and psychosocial well-being.

Inspectors wroteBased on interviews and record reviews, the facility failed to develop a comprehensive care plan within seven days after the comprehensive assessment was required to be completed for one (Resident # 240) of seven resident reviewed for comprehensive care plans. The facility failed to complete comprehensive person-centered care plan to address Resident #240's needs within seven days after the comprehensive MDS assessments was expected to be completed. This failure could place residents at risk of not having their individual care needs met in a timely manner or diminished quality of life.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure that residents received treatment and care accordance with professional standards of practice for one (Resident #29) of four residents reviewed for quality of care. The facility failed to assess Resident #29 prior to moving resident after a fall from her bed to the floor. This failure placed residents at risk for potential delay in medical intervention, decline in health and a decreased quality of life.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure all drugs and biologicals 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 (Pod 2 medication storage room) of 2 medication storage rooms, 1 (Pod 2 medication cart) of 1 medication carts and 1 (Pod 2 treatment cart) of 1 nurse treatment carts. The facility failed to ensure three medications (total of 5 bottles) were not past their expiration dates in the Pod 2 medication storage room. The facility failed to ensure two medications were not expired in the Medication Aide cart on Pod 2. The facility failed to ensure one bottle of aspirin was not expired in the nurse treatment cart on Pod 2. [...]

Inspectors wroteBased on interview and record review, the facility failed to establish policies, in accordance with applicable Federal, State, and local laws and regulations, regarding smoking, smoking areas, and smoking safety that take into account nonsmoking residents for one of one facility reviewed for smoking. The facility failed to develop a policy to address residents within the facility that were smokers. The facility failed to develop a policy to address smoking materials possessed by residents who are known smokers within the facility. The facility failed to notify residents in writing during admission that it is a no smoking facility and address options for smokers. These failures could place residents at risk for injury, burns, and an unsafe smoking environment. Findings Include: [...]

Inspectors wroteBased on observation, interviews, and record review the facility failed to place most recent survey readily accessible to residents in a place most frequented by residents for 9 of 9 residents reviewed for resident group meeting. The facility failed to have the survey manual readily accessible for the residents to view the surveys. This failure could place residents at risk of not being able to fully exercise their rights to be informed of the facility's survey citation history.

Inspectors wroteBased on interview and record review, the facility did not provide pharmaceutical services to meet the needs of each resident for one (Resident #1) of four residents reviewed for pharmaceutical services, in that: The facility failed to check Resident #1's blood pressure and administer one scheduled blood pressure medication (Hydralazine) as ordered on the morning of 01/17/24. This deficient practice could place residents at risk of not receiving the intended therapeutic benefit of the medications and supplements, worsening or exacerbation of chronic medical conditions, and hospitalization.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to ensure residents had the right to be free from neglect for 1 (Resident #1) of 13 residents reviewed for neglect in that: The facility failed to provide goods and services to Resident #1 that are necessary to ensuring Resident #1's bed wheels were locked on 10/16/23. Resident #1, who the facility knew was legally blind, rolled out of bed and fell on the ground. Resident #1 was transported by emergency medical services to the hospital on [DATE]. Hospital x-rays revealed Resident #1 had a intertrochanteric fracture of right femur. An IJ was identified on 11/10/23. The IJ template was provided to the facility on [DATE] at 7:38 p.m. [...]

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to ensure the resident environment remained free of accidents and hazards and each resident received adequate supervision and assistance devices to prevent accidents for 1 (Resident #1) of 11 residents reviewed for falls in that: 1. The facility failed to ensure Resident #1's bed wheels were locked on 10/16/23. Resident #1, who was legally blind, rolled out of bed and fell on the ground. Resident #1 was transported by emergency medical services to the hospital on [DATE]. Hospital x-rays revealed Resident #1 had a intertrochanteric fracture of right femur. 2. The facility failed to investigate and determine who unlocked Resident #1's bed. 3. The facility failed to train staff on how and when to unlock and lock residents' beds. 4. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the residents were free from abuse for 2 (Residents #1 and #2) of 7 residents reviewed for abuse. The facility failed to ensure Residents #1 and #2 were protected from verbal abuse including verbally aggressive behavior, such as cursing, insulting, and intimidation from Residents #3 and #4. Residents #1 and #2 suffered continual negative psychosocial outcomes including fear, anxiety, feelings of hopelessness, and withdrawal from former social patterns. An IJ was identified on 10/20/23. The IJ template was provided to the facility on [DATE] at 9:57 PM. [...]