Avir at Paris

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure the resident resided and received services in the facility with reasonable accommodation of resident needs and preferences for two (Resident #1 and Resident #20) of 14 residents reviewed for call lights. Staff failed to ensure Resident #1 and Resident #20's call bells were within reach. This failure could place residents at risk for decreased self-worth, quality of life, and dignity.

Inspectors wroteBased on interview and record review, the facility failed to ensure each resident received an accurate assessment, which was reflective of the resident's status for one (Residents #27) of four residents reviewed for accuracy of assessments. The facility failed to ensure Resident #27's (a discharged resident) most recent quarterly and discharge assessments accurately reflected his physical behaviors directed at others. This failure could place residents at risk of not receiving care and services to meet their needs, diminished function of health, and regressions in their overall health.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents who had a urinary catheter, received appropriate treatment and services to prevent urinary tract infections to the extent possible for 1 of 4 residents reviewed for catheter care. (Resident #81). The facility failed to provide physician ordered catheter care for Resident #81 by not emptying the Resident #81's foley catheter once a shift while on an antibiotic for 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 interviews and record reviews, the facility failed to ensure a gradual dose reduction was attempted for 1 of 4 residents (Resident #15) reviewed for unnecessary medications/ gradual dose reduction. The facility failed to do a gradual dose reduction or document contraindication for a gradual dose reduction for Resident #15's ordered Risperdal 2mg orally twice daily ordered 08/14/2023 and Risperdal Consta suspension extended release 25mg/ml (2ml) intramuscular every 14 days ordered 02/22/2024. These failures could place residents at risk for possible psychotropic medication side effects, adverse consequences, decreased quality of life and dependence on unnecessary medications.

Inspectors wroteBased on interview and record review the facility failed to ensure residents were free of any significant medication errors for 1 of 16 residents reviewed for medications. (Resident #26) The facility failed to ensure Resident #26 received his full eight-week course of Mavyret (antiviral medication used to treat Hepatitis C, which is a disease of the liver caused by a virus that causes damage to the liver) ordered by the Infectious Disease physician and started on 11/15/23. This failure could cause prolonged illness and increased recovery time for residents.

Inspectors wroteBased on interview and record review, the facility failed to ensure the resident's right to participate in the development and implementation of his or her person-centered plan of care, for 1 of 7 residents (Resident #1, Resident #2, and Resident #3) reviewed for care plans. The facility did not have a quarterly care plan meetings to discuss Resident #1, Resident #2, or Resident #3's care. This failure could cause residents not to be able to participate in the planning of their care, not receiving the care they want or need, and not being informed of all services offered by the facility.

Inspectors wroteBased on interview, and record review, the facility failed to be administered in a manner that enabled it to use its resources effectively and efficiently to maintain the highest practicable well-being of each resident for 44 of 44 residents who resided in the facility. The Administrator failed to follow abuse policies and report incidents of abuse. The Administrator failed to follow abuse policies and protect Resident #39 from further abuse by allowing CNA B to work when she was supposed to be suspended for an allegation of abuse. The Administrator failed to ensure residents were not fearful of retaliation. The Administrator allowed CNA B to work during suspension from an alleged abuse allegation. The Administrator was aware of multiple staff verbally abusing residents and did not place any protective measures in place. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure the right of the residents to be free from abuse for 3 of 12 residents (Resident #'s 29, 39, and 41) reviewed for abuse. The facility failed to keep Residents #41 and Resident # 39 free from abuse and neglect. The facility failed to implement interventions after each incident between Resident #29 and Resident #41 to prevent further incidents of abuse. The facility failed to protect the resident by allowing CNA B to work after an abuse allegation was made by Resident #39. The facility failed to ensure residents were not fearful of retaliation. The facility failed to protect resident from abuse by staff. This failure resulted in an Immediate Jeopardy (IJ) identified on 08/23/23. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to develop and implement written policies and procedures that prohibit mistreatment, neglect, and abuse of residents and establish policies and procedures to report and investigate such allegations, for 2 of 16 residents (Resident's #29 and Resident #41) reviewed for abuse. The facility failed to thoroughly report to the State when the administrator received a report that Resident #29 attempted to stab Resident #41 in the eye with a fork and threw coffee on her. The facility did not implement policy on reporting abuse when Resident #29's family member visited the facility on 08/13/23 and was yelling at resident and threw his personal belongings outside of his room. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure an allegation of suspected abuse was thoroughly investigated for 2 of 12 (Resident #'s 39 and 41) residents reviewed for abuse. The facility failed to thoroughly investigate when the administrator received a report that Resident #29 attempted to stab Resident #41 in the eye with a fork and threw coffee on her. The facility failed to thoroughly investigate when Resident #39 reported an allegation of abuse regarding CNA B. The facility failed to report the Resident #'s 39 and 41's allegations of abuse to HHSC. This failure resulted in an Immediate Jeopardy (IJ) identified on 08/23/23. [...]

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure that residents who are trauma survivors receive culturally competent, trauma-informed care in accordance with professional standards of practice and accounting for residents' experiences and preferences in order to eliminate or mitigate triggers that may cause re-traumatization of the resident for 1 of 2 residents' (Resident #6) reviewed for trauma-informed care. 1. The facility did not ensure Resident #30 had a trauma screening that identified possible triggers when Resident #30 had a history of trauma. 2. The facility did not ensure Resident #30 was protected from triggers of previous emotional trauma. Resident #297 yelled at Resident #30 in the dining room. Resident #297 was aggressive and had the same name as a man from Resident #30's past that triggered her previous emotional trauma. 3. [...]

Inspectors wroteBased on observation, interviews, and record review the facility failed to ensure residents have the right to be informed in advance, by the physician or other practitioner or professional, of the risks and benefits of proposed care, of treatment and treatment alternatives and to choose the option he or she prefers for 3 of 5 residents reviewed for right to be informed. (Resident #12, #13, and #39) 1. The facility failed to ensure Resident #12 had a signed psychotropic consent form for ziprasidone (an antipsychotic medication). 2. The facility failed to ensure Resident #13 had signed a psychotropic consent form for Seroquel 100mg (antipsychotic). 3. The facility failed to obtain Resident #39's written consent prior to administration of an anti-psychotic medication. These failures could place residents at risk for treatment or services provided without informed consent.

Inspectors wroteBased on interview, and record review the facility failed to ensure residents had the right to send and receive mail, and to receive letters, packages and other materials delivered to the facility for the resident through the means other than a postal service for 8 of 9 confidential residents reviewed for weekend mail delivery. The facility failed to ensure residents received their mail on the weekend. This failure could place residents at risk for not receiving mail in a timely manner that could result in a decline in resident's psychosocial well-being and quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide a safe, clean, and comfortable homelike environment for 3 of 16 resident rooms (room [ROOM NUMBER], room [ROOM NUMBER], and room [ROOM NUMBER]A) reviewed for physical environment. The facility did not ensure the bathroom light worked in room [ROOM NUMBER]. The facility did not ensure the bathroom light worked in room [ROOM NUMBER]. The facility failed to ensure scratches on the wall in room [ROOM NUMBER]A were repaired. The facility failed to ensure the light cover in room [ROOM NUMBER]A was not broken. The facility failed to ensure the 4 chairs in the sitting area were in good repair. The facility failed to ensure the florescent dining room lights were free from dead insects. The facility failed to ensure the patio was clean and free from a weather boxed gazebo. [...]

Inspectors wroteBased on interview, and record review the facility failed to ensure assessments accurately reflected the resident status for 3 of 16 residents (Resident #12, Resident #34, and Resident #247) reviewed for MDS assessment accuracy. The facility did not ensure Resident #12's MDS assessment was accurately coded to reflect her level II PASRR status for mental illness. The facility failed to accurately reflect Resident #34's use of oxygen. The facility failed to accurately document Resident #247's tobacco use. This failure 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 develop and implement a comprehensive person-centered care plan that included measurable objectives and timeframes to meet a resident's needs for 3 of 16 residents (Resident #'s 29, 44, and 247) reviewed for care plans. 1. The facility failed to ensure Resident #247 care plan indicated he smoked. 2. The facility failed to refer Resident #247 to the ENT. 3. The facility did not ensure Resident #44's weight bearing status was care planned. 4. The facility did not ensure Resident #44's desired weight loss was care planned. 5. The facility did not implement a comprehensive care plan to address Resident #29's combative and aggressive behavior. These failures could place residents at risk for unmet care needs and decreased quality of care.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a resident who was unable to carryout activities of daily living received services to maintain grooming and personal hygiene for 3 of 5 residents (Resident #'s 9, 23, and 38) reviewed for ADLs. The facility did not ensure Resident #9 and #38 was routinely showered. The facility did not ensure Resident #23 was shaved. The facility did not ensure Resident #38 had routine nail care. These failures could place residents at risk for not receiving services/care and a decreased quality of life.

Inspectors wroteBased on observations, interviews, and record reviews the facility failed to ensure that the resident environment remains as free of accident hazards as is possible and each resident receives adequate supervision and assistance devices to prevent accidents for 4 of 16 (Resident #27, Resident #29, Resident #9 and Resident #38) residents reviewed for monitoring and supervision. The facility failed to properly store wound cleanser leaving it on Resident #'s 9 and 38's bedside tables. The facility failed to properly store wound cleanser leaving it on Resident #'27's bathroom floor. The facility failed to provide supervision and interventions as evidenced by Resident #29's wandering. This failure could place residents at an increased risk for injury and for future resident-resident altercation.

Inspectors wroteBased on interview, observation, 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 4 medication carts (Southeast nurse's cart and [NAME] Hall medication cart) and 1 of 25 residents (Resident #42) reviewed for pharmacy services. 1. The facility did not ensure LVN's M, N and RN G counted controlled drugs every shift change. 2. The facility failed to obtain and administer Resident #42's gentamicin eye drops (antibiotic eye drops) as ordered by the physician. These failures could result in an inaccurate controlled medication count, drug diversion, and decreased therapeutic effects from medications.

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 did not ensure: 1. The deep fryer was clean and had clear grease. 2. The can opener was cleaned. 3. 2 muffin pans were free from encrusted black colored grease buildup coating the entire outside and most of the inside surface. 4. The juice machine spigot was free from a red gooey substance where the juice was dispersed. 5. The microwave was clean and free of food debris. 6. The dish room was free from missing tiles. These failures could place residents at risk for foodborne illness.

Inspectors wroteBased on interview and record review, the facility failed to ensure the facility assessment was reviewed and updated as necessary, and at least annually for 1 of 1 facility. The facility did not update their facility assessment when they admitted Resident #35 and #43 who required hemodialysis (a treatment to filter wastes and water from your blood, as your kidneys did when they were healthy) treatment. The facility did not update their facility assessment when they admitted Resident #39 with a wound vac (a type of therapy to help heal wounds). These deficient practices could affect the resident by not having the necessary resources to ensure appropriate care is provided.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the medical record was complete and accurately documented for 2 of 16 residents (Resident #1 and Resident #34) reviewed for resident records. The facility failed to ensure RN G documented the administration of medications to Resident #1 on 08/04/2023, 08/05/2023, 08/06/2023, and 08/20/2023. The facility failed to ensure RN G documented the administration of medications to Resident #34 on 08/04/2023, 08/06/2023, and 08/20/2023. This failure could place residents at risk of not receiving medications as ordered by the physician and medication errors.

Inspectors wroteBased on interview and record review, the facility failed to maintain a quality assessment and assurance committee consisting at a minimum the required committee members for 5 of 5 meetings (March 2023, April 2023, May 2023, June 2023, and July 2023) reviewed for QAPI. The facility did not ensure the ADON attended QAPI meetings in March 2023, April 2023, and May 2023. The facility did not ensure the DON attended QAPI meeting in June 2023. The facility did not ensure one additional staff member attended QAPI meetings in April 2023, May 2023, June 2023, and July 2023. This failure could place residents at risk for quality deficiencies being unidentified, no appropriate plans of action developed and implemented, and no appropriate guidance developed.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure an infection prevention and control program designed to provide a safe and sanitary environment and to help prevent the development and transmission of communicable diseases and infections for 2 of 2 residents (Resident #19, Resident #247) reviewed for infection control practices related to wounds, 3 of 6 facility staff members (CNA F, LVN H, MA L) reviewed for infection control practices related to incontinent care and medication pass, and 1 of 1 biohazard storage area. The facility further failed to ensure facility personnel handled, stored, processed, and transported linens so as to prevent the spread of infection for 1 of 3 clean linen carts. 1. The facility failed to ensure Resident #19 was on transmission-based precautions following a positive culture for multi-drug resistant organisms. 2. [...]

Inspectors wroteBased on observation, and interview the facility failed to ensure the facility corridors were equipped with firmly secured handrails on each side of the corridor for 2 of 3 corridors reviewed for secured handrails. (South and [NAME] Halls) The facility failed to ensure the [NAME] hall's handrails were affixed to the walls securely. The facility failed to ensure the handrail were properly secured between room [ROOM NUMBER] and #18, room [ROOM NUMBER] and room [ROOM NUMBER], and room [ROOM NUMBER] and #25 on South Hall. This failure could affect residents by placing them at risk for injury, and falls.

Inspectors wroteBased on interviews and record reviews, the facility failed to follow their own established smoking policy for 1 of 12 residents (Resident #13) reviewed for smoking. The facility failed to ensure Resident #13 followed the facility's policy on smoking. The facility failed to follow their safety and supervision policy and allowed cigarette smoking outside of the only smoking area. The facility failed to ensure smoked cigarettes were extinguished in a fire-retardant receptacle. This failure could place residents at risk of an unsafe smoking environment and injury. This deficient practice could place residents at risk for injury and burns due to the presence of discarded and used cigarette butts.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to treat each resident with respect and dignity and provide care in a manner that promotes maintenance or enhancement of his or her quality of life for 1 of 16 residents (Resident #1) and 1 of 1 staff (MA L) reviewed for resident rights. The facility failed to ensure Resident #1 was treated with dignity by sitting him at the front by the nurses' station with dirty, soiled shirts. The facility failed to ensure MA L knocked prior to entering Resident #4's room. These failures could place residents at risk for diminished quality of life, loss of dignity and loss of self-worth.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure each resident had the right to reside and receive services in the facility with reasonable accommodation of resident needs and preferences, except when to do so would endanger the health or safety of the resident or other residents for 1 of 16 residents (Resident #13) reviewed for reasonable accommodations. The facility failed to ensure Resident #13 had a grab bar to assist with transferring to the toilet. This failure could place residents at risk for a delay in assistance and decreased quality of life, self-worth, and dignity.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure that 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, for 1 of 16 residents reviewed for abuse and neglect (Resident #29). The facility did not report abuse when Resident #29's family member visited the facility on 08/13/23 and was yelling at resident and threw his personal belongings outside of his room within the 2-hour time frame. This failure could place the residents at risk for unreported allegations of abuse, neglect, and injuries of unknown origin.

Inspectors wroteBased on interview and record review, the facility failed to complete a comprehensive resident-centered assessment of each resident's cognitive, medical, and functional capacity in a timely manner for 1 of 16 residents (Resident #247) reviewed for accuracy of assessments. The facility failed to complete Resident #247's admission MDS assessment within 14 days of admission. This failure could place residents at risk of not having their needs met.

Inspectors wroteBased on observation, interviews, and record review, the facility failed to meet professional standards of care, for 2 of 7 residents (Resident #4 and Resident #42) reviewed for professional standards with medication administration. The facility did not ensure Resident #4 was given Calcium with Vitamin D3 600mg-12.5 mcg. The facility did not ensure Resident #42 was given Gentamicin into one eye instead of both eyes. These failures could place residents at an increased risk for inaccurate drug administration and not receiving the care and services to meet their individual needs.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure that residents receive treatment and care in accordance with professional standards of practice for 1 of 16 (Resident #35) residents reviewed for quality of care. The facility failed to provide wound care for Resident #35 per the physician's orders. This failure could place residents of risk for not receiving appropriate care and treatment.

Inspectors wroteBased on observations, interviews, and record review the facility failed to ensure respiratory care was provided with professional standards of practice for 2 of 16 residents (Resident #9 and Resident #34) 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 Resident #34. The facility failed to ensure Resident #9's non-invasive ventilator (bi-pap) mask was properly covered. This failure could place residents who receive respiratory care at risk for developing respiratory complications.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure that it was free of medication error rate of 5 percent or greater. The facility had a medication error rate of 6.9 %, based on 2 errors out of 29 opportunities, which involved 2 of 7 residents (Resident #4 and #42) reviewed for medication administration. 1. The facility did not ensure Resident #4 was given calcium with vitamin D3 600mg-12.5 mcg. 2. The facility failed to administer Resident #42's gentamicin eye drops (antibiotic eye drops) as ordered by the physician. These failures could place residents at risk for not receiving the intended therapeutic benefit of their medications or receiving them as prescribed, per physician orders.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure, in accordance with State and Federal laws, all drugs and biologicals were stored in locked compartments under proper temperature controls and permitted only authorized personnel to have access to the keys for 2 of 4 medication carts (medication and nurse carts) reviewed for storage of medications. The facility failed to ensure [NAME] Hall nurse's cart and Southeast medication cart was secured and unable to be accessed by unauthorized personnel. This failure could place residents at risk of medication misuse and diversion.

Inspectors wroteBased on interview and record review, the facility failed to collaborate with hospice representatives and coordinate the hospice care planning process for each resident receiving hospice services, to ensure quality of care for the resident, ensuring communication with the hospice medical director, the resident's attending physician, and others participating in the provision of care for 1 of 2 residents (Resident #7) reviewed for hospice services. The facility did not ensure Resident #7's hospice records were a part of their records in the facility. This deficient practice could place residents who receive hospice services at-risk of receiving inadequate end-of-life care due to a lack of documentation, coordination of care and communication of resident needs.

Inspectors wroteBased on interview and record review, the facility failed to electronically submit to CMS complete and accurate direct care staffing information, including information for agency and contract staff, based on payroll and other verifiable and auditable data in a uniform format according to specifications established by CMS fiscal year 2023 for the second quarter (January 1, 2023, to March 31, 2023) reviewed for administration. The facility failed to submit accurate RN hours for: 1/3 (TU); 1/6 (FR); 1/16 (MO); 1/17 (TU); 1/20 (FR); 1/25 (WE); 1/31 (TU); 2/8 (WE); 2/15 (WE) These failures could place residents at risk for personal needs not being identified and met.