Avir at Longview

Inspectors wroteBased on interview and record review the facility failed to ensure that residents received treatment and care in accordance with professional standards of practice for 1 of 6 (Resident #73) residents reviewed for quality of care. The facility failed to ensure Resident #73's skin was maintained during a respite care stay from 07/03/26 until 07/06/26. This failure could place residents at an increased risk for a decreased quality of care, neglect, and avoidable wound treatment.

Inspectors wroteBased on interviews and record reviews, the facility did not ensure a resident with pressure ulcers received necessary treatment and services, consistent with professional standards of practice, to promote healing for 1 of 3 residents reviewed for pressure injuries (Resident #1). The facility did not ensure Resident #1 received his ordered wound care on the following dates and shifts; 4/24/26 on the pm shift; 5/1/26 on the pm shift; 5/2/26 on the am shift; and 5/3/26 on the pm shift after returning from the hospital for surgical debridement of his Stage IV pressure injury to the right hip. This failure could place Resident's with pressure injuries at risk for infection and wound deterioration.

Inspectors wroteBased on interviews, record reviews, and observations, the facility did not administer parenteral fluids consistent with professional standards of practice and in accordance with physician orders, the comprehensive person-centered care plan, and the resident's goals and preferences for 1 of 2 residents reviewed for parenteral fluids (Resident #1). The facility failed to ensure Resident #1's PICC (peripherally inserted central catheter, is a long, thin, flexible tube inserted through a vein in the upper arm and guided into a large vein near the heart or just inside the heart) line dressing was changed at least every seven days. This failure could place residents receiving fluids or medications through a PICC line at risk of systemic infection.

Inspectors wroteBased on interview and record review, the facility failed to ensure each resident had the right to be free from misappropriation of property, and exploitation for 4 of 4 residents (Resident #1, Resident #2, Resident #3, Resident #4) reviewed for misappropriation of property. 1. The facility failed to prevent the misappropriation of Resident #1's Hydrocodone (Norco). 2. The facility failed to prevent the misappropriation of Resident #2's Acetaminophen-Codeine 300-30 mg two tablets every six hours for pain. 3. The facility failed to prevent the misappropriation of Resident #3's Hydrocodone 10-325 mg (Quantity 20 tablets) delivered on [DATE]. 4. The facility failed to prevent the misappropriation of Resident #4's Pregabalin 200 mg (Quantity 50 tablets) delivered on [DATE]. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the resident's right to be treated with respect and dignity for 1 of 4 residents reviewed for resident rights. (Resident #4)The facility failed to ensure Resident #4 was treated with dignity and respect when LPN M used explicit language while exiting room. This failure could place residents at risk for feeling disrespected, a decreased sense of self-worth, and depression.

Inspectors wroteBased on interview and record review the facility failed to provide pharmaceutical services, including procedures that assured the accurate acquiring, receiving, dispensing and administering of all drugs and biologicals, to meet the needs of each resident for1 of 5 residents (Resident #1) reviewed for pharmacy services. The facility failed to ensure Resident #1's Hydrocodone-Acetaminophen Oral Tablet 5-325 Milligram (is medication used to control or relieve pain) was available for administration on 01/19/26. This failure could place residents at risk for pain.

Inspectors wroteBased on observations, interviews and record review the facility failed to provide a safe, clean, comfortable and homelike environment for 3 of 7 (Residents 1, 5 and 7) residents observed for clean and homelike rooms. The facility failed to ensure that the resident rooms and facility hallways did not smell of fecal matter and urine on 11/25/25 and 11/26/25. This failure placed residents at risk of uncomfortable environment and a decreased quality of life. Findings Include: Observation of entry hallway on 11/25/25 at 11:15 a.m., revealed strong smell of urine and fecal matter in hallway to the right of the entrance. Observation of Resident #1's room on 11/25/25 at 12:35 p.m., the room had an odor of fecal matter. [...]

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 grooming and personal hygiene were provided for 4 of 7 (Residents #1, 3, 5 and 7) residents reviewed for ADLs. The facility failed to ensure Residents #1, 3, 5, and 7 received showers, brief checks and changes as needed in October and November 2025. These failures could place residents at risk of not receiving services/care and decreased quality of life. Findings Include: [...]

Inspectors wroteBased on interview, and record review, the facility failed to ensure the medical record was complete and accurately documented for 1 of 7 residents (Resident #1) reviewed for resident records. The facility failed to ensure the Business Office Manager completed Resident #1's Medicare UB form accurately. This failure could place the resident at risk for not receiving appropriate care due to incomplete/inaccurate information being documented.

Inspectors wroteBased on record review and interview, the facility failed to develop and implement a comprehensive person-centered care plan for each resident that included measurable objectives and timetables to meet residents highest practicable physical, mental, and psychosocial needs for 1 of 5 residents reviewed for care plans, (Resident #1). Resident #1 did not have a fall mat in place when he was found on the floor on 6/30/25. His care plan dated 5/9/25 indicated he was to have a fall mat. This failure could place residents at risk of not receiving the care required to meet their physical, mental, and psychosocial needs for each to attain or maintain their highest practicable physical, mental, and psychosocial outcome.

Inspectors wroteBased on observation and record reviews, and interviews, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety in the facility's only kitchen reviewed for food safety requirements. 1. The facility failed to ensure the handwashing sink had been cleaned. 2. The facility failed to ensure the floor of the kitchen had been cleaned. These failures could place residents at risk of foodborne illness and food contamination.

Inspectors wroteBased on interview and record review, the facility failed to ensure assessments accurately reflected the resident status for 2 of 18 residents (Residents #30 and #65) reviewed for MDS assessment accuracy. 1. Resident #30's significant change MDS dated [DATE], identified the resident was receiving an anticoagulant. However, Resident #30 was not receiving an anticoagulant. 2. Resident #65's admission MDS, dated [DATE], identified the resident was receiving an anticoagulant. However, Resident #65 was not receiving an anticoagulant. These failures could place residents at risk of not receiving adequate care and services to meet their needs.

Inspectors wroteBased on observation, interview, and record review, the facility failed to develop and implement a comprehensive person-centered care plan to meet each resident's medical, nursing, mental and psychosocial needs for 2 of 19 residents reviewed for care plans. (Resident #34 and Resident #55) 1. The facility failed to resolve and update a care plan for Resident #34's removed PICC line (a long, thin, flexible tube inserted into a vein in the arm and threaded up to a large vein above the heart for easy access for administering intravenous medications, fluids, and nutrition) and incision care to right femur on 5/5/2025. 2. The facility failed to update a care plan for Resident #55's dietary orders from pureed to mechanical soft on 1/3/2025. These failures could place residents at risk of not having individual needs met and cause residents not to receive needed services.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure each resident's environment remained free of accident hazards for 1 of 22 residents (Resident #33) reviewed for accident hazards. The facility failed to keep prohibited items, hydrogen peroxide topical solution, out of Resident #33's room. This failure could place residents at risk for injury, harm, and impairment or death.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure that residents who need respiratory care are provided with such care, consistent with professional standards of practices for 1 of 22 residents (Resident #4) reviewed for respiratory care. 1. The facility failed to change the oxygen tubing for Resident #4. 2. The facility failed to ensure that Resident #4's oxygen concentrator reservoir was filled with water. These failures could place residents who receive respiratory care at risk of developing respiratory complications and a decreased quality of care.

Inspectors wroteBased on interview, and record review the facility failed to ensure residents had the right to a safe, clean, comfortable, and homelike environment, including but not limited to receiving treatment and supports for daily living safely for 1 of 8 (Resident #8) residents reviewed for environment. 1. The facility failed to ensure Resident #8's bathroom floor and toilet was free of brown substances from 2/28/2025-3/18/2025. 2. The facility failed to ensure soiled briefs were removed from Resident #8's trash can on 2/28/2025. 3. The facility failed to ensure the bathroom floor was free from debris of toilet paper scattered on the floor from 2/28/2025-3/18/2025. These failures could place residents at risk of an unsafe or uncomfortable environment and a decrease in quality of life and self-worth.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure that residents who need respiratory care are provided with such care, consistent with professional standards of practices for 1 of 10 residents (Resident #1) reviewed for respiratory care . The facility failed to ensure that Resident #1 had a supply of oxygen in her portable oxygen tank. These failures could place residents who receive respiratory care at risk of developing respiratory complications and a decreased quality of care.

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 2 of 5 residents (Resident #2 and Resident #3) reviewed for infection control practices. 1. The facility failed to ensure the ADON applied enhanced barrier precautions when she assisted the nurse with positioning and holding Resident #2 during wound care treatment on 2/20/2025 at 1:24 PM. 2. The facility failed to ensure CNA B applied enhanced barrier precautions when she assisted the nurse with positioning and holding Resident #3 during wound care treatment on 2/26/2025 at 11:55 AM. 3. [...]

Inspectors wroteBased on interview and record review the facility failed to provide pharmaceutical services, including the accurate acquiring, administering and receipt of all drugs and biologicals, to meet the needs of 1 of 4 residents reviewed for pharmacy services. (Resident #1) The facility failed to ensure Resident #1 was administered her diltiazem (medication used to treat high blood pressure) and lisinopril (medication used to treat high blood pressure) 7 days in the month of March 2024. This failure could place residents who receive medications at risk of not receiving the intended therapeutic benefit of the medications. Findings Include: 1. [...]

Inspectors wroteBased on observation, interview and record review the facility failed to ensure residents environment remained as free of accident hazards as possible and each resident received adequate supervision and assistance devices to prevent accidents for 4 of 8 residents (Resident #38, Resident #17, Resident #110, and Resident #35) reviewed for accidents and supervision. 1. The facility failed to put interventions in place to keep Resident #38 from all harmful items. *On 02/18/24, LVN E documented Resident #38 was on the floor, face down with the call light cord wrapped around her neck x4. No harmful items were removed after the incident, from Resident #38's room to ensure her safety. *On 03/09/24, CNA S reported Resident #38 was stabbing herself in the abdomen with scissors. CNA S removed the scissors from Resident #38 put no other actions were initiated until later. [...]

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure each resident received necessary behavioral health care services to maintain the highest practicable mental and psychosocial wellbeing for 1 of 3 residents (Resident #38) reviewed for behavioral services. The facility did not ensure Resident #38 was seen after a counseling evaluation and treatment order was placed on 02/15/24 and a psych evaluation referral was signed by Resident #38 on 03/04/24. The facility failed to comprehensively address Resident #38's behaviors and mental distress. The facility failed to update Resident #38's care plan to reflect her increased anxiety medication needs and behaviors. An IJ was identified on 03/28/2024 at 3:45 p.m. [...]

Inspectors wroteBased on observation, interview and record review the facility failed to ensure the resident had the right to be informed of, and participate in, his or her treatment including the right to be fully informed in a language that he or she could understand of his or her total health status, including but not limited to, his or her medical condition for 1 of 12 resident (Resident #17) reviewed for resident rights. The facility failed to ensure Resident #17 was provided care and services in her primary language, which was Spanish. This failure could place residents at risk for not being informed of health status.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure the right to be free from abuse was provided for 1 of 12 residents reviewed for abuse. (Resident #19) 3/23/24 Facility failed to prevent LVN BB from verbally abusing Resident #19. LVN BB told Resident #19 that no one liked her causing the resident emotional and mental anguish. This failure could place residents at risk of a diminished quality of life and psychosocial harm. Finding Include: Record review of Resident #19's face sheet indicated she was an [AGE] year-old female initially admitted to the facility on [DATE], with diagnoses that included: Vascular Dementia (brain damage caused by multiple strokes), Senile degeneration of brain (a decrease in cognitive abilities or mental decline) and Depression (a common mental disorder). [...]

Inspectors wroteBased on observation, interview and record review the facility failed to provide, based on the comprehensive assessment of a resident and consistent with the resident's needs and choices, the necessary care and services to ensure that a resident's abilities in activities of daily living do not diminish unless circumstances of the individual's clinical condition demonstrate that such diminution was unavoidable for 1 of 12 resident (Resident # 17) reviewed for activities of daily living. The facility failed to ensure Resident #17 was provided care and services in her primary language, which was Spanish. This failure could place residents at risk for a decline and diminished quality of life.

Inspectors wroteBased on interview, and record review, the facility failed to use the services of a registered nurse for at least 8 consecutive hours a day, 7 days a week for 1 of 1 facility reviewed for RN coverage. The facility failed to provide RN coverage for 8 consecutive hours daily on 10/07/2023, 10/08/2023, 10/21/2023, and 10/22/2023. The deficient practice had the potential to affect residents in the facility by leaving staff without supervisory coverage for RN specific nursing activities and for coordination of events such as emergency care and disasters.

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 the facility's only kitchen reviewed for food safety requirements and kitchen sanitation. 1. The facility failed to ensure food was properly sealed and not exposed to air in the storeroom and refrigerator. 2. The facility failed to ensure food and drink items were labeled and dated in the refrigerator, freezer, and drink dispenser. 3. The facility failed to ensure raw chicken was thawing in the appropriate sink under constant flow of cool, running water. 4. The facility failed to ensure items were not stored on the floor in the storeroom and back area near refrigerators. 5. The facility failed to ensure the kitchen did not have a splattered brown substance on the walls near industrial mixer. 6. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure, based on the comprehensive assessment of a resident, residents who had not used psychotropic drugs were not given these drugs unless the medication was necessary to treat a specific condition as diagnosed and documented in the clinical record and residents who use psychotropic drugs received gradual dose reductions, and behavioral interventions, unless clinically contraindicated, in and effort to discontinue these drugs for 3 of 17 residents, (Residents #56, #28, and #50) reviewed for unnecessary medications. 1. The facility failed to ensure Resident #50 received a gradual dose reduction for her Ziprasidone (antipsychotic). 2. The facility failed to ensure Resident #28 received a gradual dose reduction for his Risperdal (antipsychotic). 3. [...]

Inspectors wroteBased on interview and record review, the facility failed to develop and implement written policies and procedures that prohibit mistreatment, neglect, and abuse of residents, and misappropriation of resident property and establish policies and procedures to report and investigate such allegations, for 2 of 17 residents (Resident #38, Resident #50), reviewed for abuse/neglect. The facility failed to ensure the ADM/Abuse Preventionist, followed the facility's policy to report an allegation of neglect for Resident #50 within 2 hours when she was found on the floor on 2/28/24 resulting in an elbow and pelvic fracture. The allegation of neglect was not reported to HHSC until 3/25/24. The facility failed to ensure the ADM/Abuse Preventionist, followed the facility's policy to report an allegation of abuse on 03/09/24, toward Resident #38 by CNA S within 2 hours of the allegations. [...]

Inspectors wroteBased on observation, interviews and record reviews the facility failed to ensure all alleged violations involving abuse, neglect, exploitation or mistreatment, including injuries of unknown source and misappropriation of resident property, are reported immediately, but not later than 2 hours after the allegation is made, if the events that cause the allegation involve abuse or result in serious bodily injury, or not later than 24 hours if the events that cause the allegation do not involve abuse and do not result in serious bodily injury, to the administrator of the facility and to other officials, including to the State Survey Agency for 2 of 17 residents (Resident #50 and Resident #38) reviewed for allegations of abuse, neglect, exploitation, and mistreatment. [...]

Inspectors wroteBased on interviews and record review the facility failed to ensure assessments accurately reflected the resident's status for 1 of 17 residents (Resident #56) reviewed for MDS assessment accuracy. The facility failed to code Resident #56's diagnosis of Schizophrenia on her MDS. These failures could place residents at risk for not receiving care and services to meet their needs.

Inspectors wroteBased on interview and record review, the facility failed to ensure residents receive treatment and care in accordance with professional standards of practice and the comprehensive person-centered care plan for 1 of 17 (Resident #52) residents reviewed for quality of care. The facility failed to ensure Resident #52 received daily wound care per her care plan. A complaint was filed by a local hospital that Resident #52 arrived in the ER on [DATE] with dressings dated 02/29/24. This failure could place residents of risk for not receiving appropriate care and treatment, a decreased quality of life, and pressure ulcers.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents who had urinary incontinence, received appropriate treatment and services to prevent urinary tract infections to the extent possible for 1 of 8 residents reviewed for urinary incontinence. (Resident #22) 1. The facility failed to provide routine incontinent care for Resident #22, resulting in a urinary tract infection. This failure could place residents at risk for urinary tract infections, pain, confusion, and sepsis (infections that spread to the blood).

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 2 of 13 residents (Residents #46 and Resident #23) reviewed for pharmacy services. The facility failed to ensure medications were administered timely for Resident #46 and Resident #23. This failure could place residents at risk for inaccurate drug administration and overdosing of medications.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure that the medication error rate was not 5 percent or greater. The facility had a medication error rate of 6.06%, based on 2 errors out of 33 opportunities, which involved 2 of 7 residents (Residents #2 and #53) reviewed for medication errors . 1. The facility failed to ensure MA Z administered Resident #2's Artificial saliva (mimics natural saliva and helps provide relief for dry mouth) and failed to ensure the medication was in the facility and available for the resident. 2. The facility failed to ensure LVN P did not crush Guaifenesin 600mg tab (help clear mucus or phlegm from the chest when you have congestion from cold or flu) for Resident #53. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to follow their established smoking policy regarding smoking safety for 1 of 1 resident reviewed for safe smoking. (Resident #56) The facility failed to implement Resident #56's care plan intervention to keep her electronic vape secured at the nurse's station per the facilities policy. The facility failed to implement Resident #56's care plan intervention to be supervised while smoking. The facility failed to implement Resident #56's care plan intervention to charge her electronic device with a designated staff member in non-resident areas for safety during charging per the facility's policy. These failures could place residents at risk for not receiving necessary care and services or having important care needs identified.

Inspectors wroteBased on observations, interviews, and record reviews, 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 wellbeing of each resident, as determined by resident assessments and individual plans of care and considering the number, acuity and diagnoses of the facility's resident population in accordance with the facility assessment for one of one facility reviewed for sufficient staff. The facility failed to have sufficient staff available to provide resident care on 2/12/2024. [...]

Inspectors wroteBased on observation, interview and record review the facility failed to ensure residents were free from abuse, neglect, misappropriation of resident property, and exploitation for 3 of 7 residents (Resident #2, Resident #5, and Resident #6) reviewed for abuse and neglect. The facility neglected to oversee the implementation of resident care policies and staff responsibilities. Resident #6 was transferred using a bearhug method by a sitter on 12/2/23 and an RN heard a pop during the transfer. Resident #6 had a left hip fracture. Sitters were providing care to residents that had not been trained, facility staff were aware the sitters were providing care and allowed the practice to continue. The facility failed to have a policy and procedure in place for private sitters outlining the care they could provide. [...]

Inspectors wroteBased on observation, interview and record review the facility failed to ensure residents environment remained as free of accident hazards as possible and each resident received adequate supervision and assistance devices to prevent accidents for 3 of 7 residents ( Resident #2, Resident #5 and Resident #6) and 5 of 7 sitters (Sitters BB, CC, EE, DD and ZZ ) reviewed for accidents and supervision. 1. The facility failed to ensure Resident #6 was appropriately transferred. The resident was transferred using a bearhug method by Sitter ZZ on 12/2/23 and an RN heard a pop during the transfer. Resident #6 had a left hip fracture. 2. The facility failed to have a policy and procedure in place for private sitters outlining the care they could provide. 3. The facility failed to ensure sitters were aware of what their duties were and did not perform care to residents to prevent harm. 4. [...]

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 3 of 7 residents (Resident#1, # 3 and #4) reviewed for ADL care. 1. The facility failed to ensure Residents #1, #3 and #4 were checked prior to breakfast to determine if they needed care. 2. The facility failed to ensure residents were provided care for at least 3 hours and resident briefs were saturated with urine. These deficient practices could place residents at risk of being uncomfortable and could cause skin breakdown.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure a resident who was incontinent of bladder received appropriate treatment and services to prevent urinary tract infections for 2 of 5 residents (Resident #1, and Resident #3) reviewed for appropriate treatment and services to prevent urinary tract infections. The facility failed to ensure Resident #1's catheter bag was placed below the level of the bladder and remained free of dependent loops (a configuration of catheter tubing where the drainage tubing dips below the entry point into the catheter bag). The facility failed to ensure Resident #3's catheter tubing remained free of dependent loops. These failures could place residents at risk for urinary tract infections.

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 1 of 2 residents (Residents #2) reviewed for infection control practices. CNA B did not dispose of the dirty brief, remove her dirty gloves, perform hand hygiene (wash her hands or use hand sanitizer) and place clean gloves on before she placed a clean brief on Resident #2 and pulled up her pants. These failures could place residents at risk for cross contamination and infections.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide the necessary behavioral health care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being 1 of 1 residents (Resident #170) reviewed for behavioral health. 1. The facility failed to assess, provide safety intervention and immediate psychological services, per their policy, for Resident #170 who made a verbalization of suicidal ideation to the facilities on 02/09/23. 2. The facility failed to in-service staff on behavioral healthcare and services as a part of the person-centered environment. 3. The facility failed to train on and implement suicidal precautions per policy, (for example: assigned a one-to-one staff member who will remain within 6 feet of resident and maintain visual contact and document the observation every 15 minutes) for Resident #170. 4. [...]

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 nutrition, grooming, and personal and oral hygiene were provided for 2 of 3 residents (Residents #44 and #48) reviewed for ADLs care. 1. The facility failed to ensure Resident #48 was routinely showered/bathed . 2. The facility failed to ensure Resident #48's fingernails were free from a brown materialsubstance. 3. The facility failed to ensure Resident #44 was showered on 02/06/2023, 02/07/2023, 02/08/2023, 02/09/2023, 02/10/2023 and 02/13/2023. These failures could place residents at risk of not receiving care/services, decreased quality life impacting their loss of dignity.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure a resident who needed respiratory care was provided such care, consistent with professional standards of practice, the comprehensive person-centered care plan, the residents' goals and preferences for 5 of 7 residents (Resident #118, #19, #119, #6, #26) reviewed for respiratory care and services. The facility failed to administer oxygen at 2 liters per minute via nasal cannula as prescribed by the physician for Residents #118, #19, #119, #6, and #26. This failure could place residents at risk for developing respiratory complications.

Inspectors wroteBased on interview and record review, the facility failed to use the services of a registered nurse for at least 8 consecutive hours a day, 7 days a week for 62 days reviewed for RN coverage. The facility failed to provide RN coverage for 8 consecutive hours daily on 12/04/2022, 12/31/2022, 01/14/2023, 01/15/2023, 01/28/2023 and 01/29/2023. The deficient practice had the potential to place residents at risk by leaving staff without supervisory coverage for RN specific nursing activities and for coordination of events such as an emergency care and disasters.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure drugs and biologicals used in the facility were labeled in accordance with currently accepted professional principles, included the appropriate accessory and cautionary instructions, and the expiration date when applicable for 3 of the 3 medication carts reviewed for medications storage (rooms 101-112 medication cart, rooms 417-428 medication cart, and rooms 114-121 medication cart). 1. The facility failed to remove expired over the counter medications from rooms 101-112 medication cart. 2. The facility failed to remove expired over the counter medications from rooms 417-428 medication cart. 3. The facility failed to remove expired over the counter medications from rooms 114-121 medication cart. [...]

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure in accordance with state and federal laws, all drugs and biologicals were stored in locked compartments for 1 of 22 residents (Resident #118) reviewed for storage of medication. The facility failed to securely store Resident #118's [NAME] 2 Cyclo 2 Diclo 5 Lido 5 (Pain relief) cream and Afrin nose spray. These failures could place residents at risk for adverse reactions to medications or overdose.

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 3 of 3 reviewed (Resident #'s 14, 35, and 268) for wound care infection control practices. 1. LVN Q failed to change gloves and sanitize hands after cleaning wound and touching the clean dressing during wound care for Resident #14 and Resident #268. 2. CNA S failed to wash her hands or use hand sanitizer before and after providing care to Resident #35. 3. CNA S failed to remove the soiled gloves prior to touching the clean brief, bed linen, Resident #35's gown, and the sit to stand machine. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents had the right to a dignified existence, self-determination, and communication with access to persons and services inside and outside the facility for 2 of 2 residents (Resident #44 and Resident #170) reviewed for resident rights. The facility failed to ensure Resident #44's and Resident #170's catheter bags had privacy covers. This deficient practice could place residents at risk of loss of dignity.

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 1 of 3 residents (Resident #66) reviewed for Medicare/Medicaid coverage. The facility failed to ensure Resident #66 was given a Skilled Nursing Facility Advance Beneficiary Notice (SNFABN) when discharged from skilled services at the facility prior to covered days being exhausted. This failure could place residents at risk for not being aware of changes to provided services.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure, at the time each resident was admitted , there were physician orders for the resident's immediate care for 1 of 12 residents (Resident #268) reviewed for admission physician orders. The facility failed to ensure Resident #268 had a physician order for dressing change to his left lower leg/foot, PICC line care, and IV antibiotics, Cefazolin 2GM IV every 8 hours. This failure could place residents at risk for not receiving appropriate care, treatment services, and at risk for infection.

Inspectors wroteBased on observation, interview and record review the facility failed to develop and implement a baseline care plan for each resident that included the instructions needed to provide effective and person-centered care of the resident that met professional standards of quality care for 2 of 2 residents (Residents #119 and #268) reviewed for baseline care plans. 1. The facility failed to address Resident #268's PICC line, IV antibiotics and Wound care on his baseline care plan. 2. The facility failed to ensure Resident #119 had a baseline care plan for respiratory care. These deficient practices could place residents at risk of missed care.

Inspectors wroteBased on observation, interview and record review, the facility failed to review and revise the person-centered care plan to reflect the current condition for 1 (Resident #170) of 6 resident reviewed for care plan revisions. The facility failed to update Resident 170's care plan to reflect interventions of suicidal ideations on mood state. This deficient practice could place residents at risk of not receiving appropriate interventions to meet their current needs.

Inspectors wroteBased on interview and record review, the facility failed to ensure the drug regimen was free from unnecessary drugs for 1 of 22 residents reviewed for medications. (Resident #4) The facility did not provide Resident #4 a drug regime free from unnecessary medication. The residents did not have a diagnosis or adequate indication for Seroquel (An antipsychotic medication used to treat certain mental/mood disorders such as schizophrenia, and bipolar disorder). This failure could place residents who received antipsychotic medications at risk of receiving unnecessary medication.

Inspectors wroteBased on interview and record review the facility failed to maintain medical records on each resident that were complete and accurately documented, in accordance with accepted professional standards and practices, for 1 (Resident #170) of 1 resident whose records were reviewed for accuracy and completeness. The facility failed to have the Nurses document every 4 hours the assessment of the resident in the medical records per policy for Resident #170. This deficient practice could place residents at risk of having incomplete or inaccurate records and inadequate care.

Inspectors wroteBased on observation, interview, and record review, the facility failed to post the nurse staffing data daily at the beginning of each shift for the 4 of the 4 days reviewed for staffing. The facility failed to post the total number of hours worked for licensed nurses, and certified nurse aides or the daily census for February 12,2023, February 13,2023, February 14,2023, and February 15,2023. This failure could place residents at risk of being unaware of the facility's daily staffing requirements.