Avir at Seguin

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide a safe, functional, sanitary, and comfortable environment for residents, staff, and the public for 1 of 1 communal area (secure unit), reviewed for safe environment. Common area in the secure unit had two hanging overhead light covers. This failure could place residents at risk of experiencing a diminished quality of life, accidents and hazards.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to ensure that a resident who needs respiratory care is provided with such care, consistent with professional standards of practice, for one (1) of two (2) residents (Resident #1) reviewed for respiratory care. The facility failed to properly secure Resident #1's oxygen tubing off the floor. This failure could place residents at risk for cross-contamination and respiratory infection.

Inspectors wroteBased on observation, interviews, and record reviews, the facility failed to maintain medical records on each resident that were complete and accurately documented for one (1) of five (5) residents (Resident #2) reviewed for accurate medical records. The facility failed to ensure Resident #2's diagnosis list was complete. This failure could place residents at risk of not receiving the care and services needed due to inaccurate or incomplete clinical records.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents were provided with a sanitary and comfortable environment for one (1) of five (5) residents (Resident #3) reviewed for physical environment. The facility failed to ensure Resident #3's room's HVAC vent was free from grey particle buildup and staining. This failure could place residents at risk for decreased quality of life.

Inspectors wroteBased on observation, interview and record review, the facility failed to develop and implement a comprehensive person-centered care plan for each resident, that include measurable objectives and time frames to meet residents' medical, nursing, and mental and psychosocial needs for 1of 7 residents (Residents #1) reviewed for care plans. The facility failed to ensure Resident #1 had a care plan in his electronic medical record. This failure could place residents at risk of not having their needs met and not receiving appropriate care.

Inspectors wroteBased on interview and record review, the facility failed to develop and implement a comprehensive person-centered care plan for each resident, consistent with the resident rights, that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment for 3 of 4 residents (Residents #2, #3, and #4) reviewed for care plans: The facility failed to ensure Resident #2, Resident #3 and Resident #4's comprehensive care plans were developed and implemented to include care areas identified in the admission MDS assessments. This deficient practice could cause confusion for staff members responsible for providing direct care to the residents and place residents at risk of receiving improper care and services.

Inspectors wroteBased on interviews and record reviews, the facility failed to protect right of residents to be free from physical abuse for 1 of 4 (Resident #1) reviewed for abuse. Resident #1 was hit on the head by NA B.The noncompliance was identified as a PNC. The facility corrected the noncompliance on 8/6/2025 before the surveyor's entry to the facility. This failure could place residents at risk for abuse with injury, intimidation and a decreased quality of life.

Inspectors wroteBased on observation, interview, and record review the facility failed to provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of each resident for 1 of 4 residents (Resident #53) reviewed for pharmacy services. Resident #53's ordered daily Lyrica (pain medication) was not available for the resident from admission on [DATE] to 7/28/25. The resident missed 7 doses. This failure could result in increased pain, and a decreased quality of life.

Inspectors wroteBased on observation, interviews, and record review, the facility failed to ensure the residents had the right to formulate an advanced directive and determine the choice to receive or not receive CPR (cardiopulmonary resuscitation) for 1 (Resident #28) of 8 residents reviewed for accuracy and completeness of clinical records. 1. The facility failed to ensure Resident #28's OOH DNR was legible and able to use in emergency situations. This failure could affect any residents who have medical records and could result in misinformation about professional care provided.

Inspectors wroteBased on observation, interview and record review, the facility failed to develop and implement a comprehensive person-centered care plan for each resident, consistent with the resident rights, that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment for 2 of 8 residents (Resident #5 and Resident #28) reviewed for care plans: 1. The facility failed to ensure Resident #5's comprehensive care plan was completed in a timely manner and included his PICC line (is a long, thin tube that's inserted through a vein in your arm and passed through to the larger veins near your heart). 2. The facility failed to ensure Resident #28's comprehensive care plan was completed in a timely manner and included his code status. [...]

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 1 of 1 kitchen, in that: The cooler had a package of sliced lunch meat with a lot of juice in the package that was sliced opened and not closed. The freezer had a bag of frozen sugar cookie dough that was left open. These failures could place residents that received meals and or snacks from the kitchen at risk for food borne illness.

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 1 resident (Resident #28) reviewed for hospice services, in that: The facility failed to ensure Resident #28's hospice documents including: The most recent hospice plan of care specific to each patient, hospice election form, physician certification and recertification of the terminal illness specific to each patient, names and contact information for hospice personnel involved in hospice care of each patient, and instructions on how to access the hospice's 24-hour on-call system. [...]

Inspectors wroteBased on observation and interview, the facility failed to post the nurse staffing data on a daily basis at the beginning of each shift for 1 of 4 days [PH1] reviewed for nursing services. The daily staff posting was not posted on 7/28/25. This failure could result in residents and visitors not knowing how many staff were providing services to the residents.

Inspectors wroteBased on observations, interviews, 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 residents who eat in their rooms in one (Hall 500) of six halls observed for in-room dining services. While passing lunch trays in hallway 500, CNA-A did not sanitize or clean her hands in between residents. This failure could place residents at risk for infection.

Inspectors wroteBased on observation, interview, and record review, the facility failed to promote and facilitate resident self-determination through support of resident choice to including but not limited to the residents choice to activities, schedules (including sleeping and waking times), healthcare and providers of healthcare services consistent with his or her interest, assessments, and plan of care and other applicable provisions of this part for 1 (Resident #1) of 4 residents reviewed for resident rights. The facility failed to honor Resident #1's request to be assisted out of bed at least once a day. This failure could place residents at risk for depression, diminished quality of life and isolation.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure that a resident receives care, consistent with professional standards of practice, to prevent pressure ulcers based on the comprehensive assessment for 1 of 4 Residents (Resident #1) whose records were reviewed for pressure ulcer care. The facility failed to obtain a physician order for treatment and wound care for Resident #1's right heel resulting in the wound declining from a blister to a stage 4 pressure injury that was later found to have maggots. An IJ was identified on 7/5/2024. The IJ template was provided to the facility on 7/5/2024 at 8:26 pm. While the IJ was removed on 7/6/2024 the facility remained out of compliance at a scope of pattern and severity level of no actual harm because of the facility's need to evaluate the effectiveness of their plan of removal.

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain an effective pest control program to keep the facility free from pests for 1 of 4 residents (Resident #1) reviewed for pest control, in that: The facility failed to ensure an effective pest control program was in place to keep flies out of resident rooms resulting in an infestation of maggots in Resident #1's right heel wound. The noncompliance was identified as PNC. The IJ began on 06/16/2024 and ended on 06/18/2024. The facility had corrected the noncompliance before the investigation began. The failure could place residents with wounds at risk for infection or infestations from pests.

Inspectors wroteBased on observations, interviews, and record reviews the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for 1 of 1 kitchen observed for food service. 1. The facility failed to ensure all open items in the freezers were labeled and dated. a. 4 bags of open frozen foods not labeled with contents or date opened/used by 2. The facility failed to ensure all foods in the refrigerator were labeled and dated. a. Two trays of portioned foods covered and not labeled in the reach in refrigerator (1 of 2) 3. The facility failed to ensure all equipment was clean and sanitary. a. Spilled and partially dried liquid in the bottom of the reach in refrigerator (1 of 2) b. The table-mounted can opener had sticky black and brown grime on the blade and along the base of the equipment. [...]

Inspectors wroteBased on observation, interview and record review revealed residents has a right to a clean and comfortable and homelike environment, including but not limited to receiving support for daily living including clean bed for 1 of 8 Residents (Resident #56) for 3 of 4 survey days (6/2/24 to 6/5/24) whose environment was observed for clean linens. Nursing staff failed to ensure they changed Resident #56's bed sheets for 3 of 4 survey days (6/2/24 to 6/5/24. Resident #56's bed sheets were stained with brown spots and had residue all over them. This deficient practice could affect any resident and contribute to feelings of low self-esteem.

Inspectors wroteBase d on observation, interview and record review the facility failed to provide Preadmission Screening for individuals with a mental disorder for 1 of 1 Resident (Resident #61) whose records were reviewed for PASRR services. The facility failed to recognize on the Level 1 PASRR screening that Resident #61 had a mental illness diagnosis of Bi-polar Disorder which would qualify her for a PASRR evaluation. This deficient practice could affect residents with a mental illness and could result in Resident's not receiving mental health services as needed.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that residents who needed respiratory care were provided such care, consistent with professional standards of practice, for 3 residents (Resident #4, Resident #43 and Resident #52) reviewed for oxygen therapy in that: 1. Residents #4 and #52's, nebulizer tubing was on the bedside table unbagged and undated. 2. Resident #43's filter on the oxygen concentrator had lint build up on it. These failures could place residents who received oxygen therapy at risk for an increase in respiratory complications and or infections.

Inspectors wroteBased on interview and record review, the facility failed to have sufficient nursing staff to provide nursing and related services to assure resident safety and attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, for one of four quarters for 2024 (Quarter 3) reviewed for sufficient nursing staff. According to the PBJ report for Quarter 3 2024 (March 1 through May 31), the facility did not have sufficient staff on weekends. This failure could place residents at risk of diminished quality of life and quality of care.

Inspectors wroteBased on interview, observation, 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 residents who eat in their rooms in halls 100 and 200. While passing lunch trays in hallways 100 and 200 staff did not sanitize or clean hands in between residents. This failure could place residents at risk for infection.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure residents received services in the facility with reasonable accommodation of resident needs for 1 of 8 Residents (Resident #16) who were observed for call light placement. Nursing staff failed to ensure Resident #16's call light was within reach for use if she needed to ask for assistance. This deficient practice could affect any resident who used a call light and could contribute to resident's needs not being met.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure the resident had the right to and the facility must promote and facilitate resident self-determination through support of resident choice, including but not limited to choose health care and providers of health care services consistent with his or her interests, assessments, and plan of care for 1 of 8 Residents (Resident #61) whose records were reviewed for health care services. Resident #61 expressed her desire to find a psychiatrist within the community. The SS worker told Resident #61 she could select a psychiatrist of her choice but because the facility provided in house psychiatry services, she would have to secure her own transportation. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents had the right to personal privacy and confidentiality of his or her personal and medical records for one of five residents (Resident # 15) reviewed for privacy. The facility failed to ensure CMA E locked the computer, which exposed Resident #15's morning medication list after she walked away and left the computer unattended. This failure could place residents at risk of having medical information exposed to others and cause residents to feel uncomfortable and disrespected.

Inspectors wroteBased on observation, interview and record review the facility failed to develop and implement a comprehensive person-centered care plan for each resident, consistent with the resident rights that included measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that were identified in the comprehensive assessment for 1 of 3 (Resident #71) residents reviewed for comprehensive assessments. The facility failed to ensure that Resident #71's care plan documented interventions for the diagnosis of General anxiety disorder. This failure could place residents at risk of not receiving proper care and services related to the disease process.

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 personal hygiene for 1 of 8 Residents (Resident #56) whose records were reviewed for ADL care. Nursing staff failed to ensure Resident #56 received a shower on 6/3/24 and on 6/5/24. This deficient practice could affect any resident and contribute to feelings of low self-esteem.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure each resident received adequate supervision and assistive devices to prevent accidents for 1 of 8 Residents (Resident #12) reviewed for falls. Nursing staff failed to provide adequate supervision for Resident #12 which resulted in her experiencing a fall on 6/3/24. On 6/5/24 nursing staff failed to ensure the fall mats were next to her bed to cushion her fall in an effort to prevent injuries related to having a history of frequent falls. These deficient practices could affect residents at risk for falls and could result in avoidable falls and injuries.

Inspectors wroteBased on interview and record review the facility failed to ensure the attending physician documented in the resident's medical record that the identified irregularity made by the pharmacist had been reviewed and what, if any, action had been taken to address it. If there was to be no change in the medication, the attending physician should document his or her rationale in the resident's medical record for 1 of 3 Residents (Resident #25) whose records were reviewed for unnecessary medications. The DON and ADON failed to identify the pharmacist addressed identified medication irregularities to the wrong physician when completing the pharmacy review for Resident #25. This resulted in a delay in the physician's response to the medication irregularity including Zyrtec (used for allergies) and Hydrocodone (used for pain). [...]

Inspectors wroteBased on observations, interviews, and record review, the facility failed to store all drugs and biologicals in locked compartments under proper temperature controls and permit only authorized personnel to have access to the keys for one medication cart out of two carts reviewed for medication storage , in that : 1. LVN B left the medication cart unsecured on 100 Hallway while administering medications. These deficient practices could place residents at risk for misappropriation, misuse or tampering of medications.

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain and ensure safe and sanitary storage of residents' food items for 2 (refrigerators in resident room [ROOM NUMBER] and room [ROOM NUMBER]) of 5 residents' refrigerators reviewed in that: The personal refrigerators in two residents' rooms contained food items that were unlabeled and undated. This deficient practice could place residents at risk of foodborne illness due to consuming foods which are spoiled.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide a safe, functional, sanitary, and comfortable environment for residents for two (Hall 400 and 500) of six halls and one resident shower rooms on Hall 400 observed for environment. The facility failed to ensure resident rooms on Halls 400 and 500 and the resident shower room on Hall 400 were clean, safe, and in good repair. This failure could place residents at risk for diminished quality of life due to the lack of a well-kept environment.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure professional staff were licensed, certified, or registered in accordance with applicable State laws for 1 of 3 staff (Staff A) reviewed for staff qualifications. The facility failed to ensure Staff A completed the appropriate educational requirements of a bachelor's degree in social work and was appropriately licensed to practice social work in the State of Texas. This failure could place residents at risk of not receiving care and services from staff who were properly trained and supervised.

Inspectors wroteBased on interview and record review, the facility failed to ensure a registered nurse was present in the facility for at least eight consecutive hours per day and seven days per week, and designate a registered nurse to serve as the director of nursing, for 1 of 1 facility reviewed for registered nursing coverage and presence of a director of nursing, in that: A registered nurse was not present in the facility for at least eight consecutive hours per day and seven days per week, and the facility did not have a director of nursing in its employ for approximately five months prior to the survey period. This failure could affect all residents receiving care from facility staff who did not have the advanced training of a registered nurse.

Inspectors wroteBased on interview and record review, the facility failed to provide effective Communications Mandatory Training for 16 of 16 employees (Laundry M, CNA N, CNA O, Transporter P, MA B, CNA Q, Dietary R, DM, AD, LVN S, LVN, A, MDS, RN T, LVN C, LVN F, and SS) reviewed for training, in that: The facility failed to ensure Laundry M, CNA N, CNA O, Transporter P, MA B, CNA Q, Dietary R, DM, AD, LVN S, LVN, A, MDS, RN T, LVN C, LVN F, and SS completed effective communication training. These failures could place residents at risk of miscommunication and social isolation due to lack of staff training.

Inspectors wroteBased on interviews and record reviews, the facility failed to ensure Quality Assurance and Performance Improvement (QAPI) training that outlines and informs staff of the elements and goals of the facility's QAPI program for 16 of 16 employees (Laundry M, CNA N, CNA O, Transporter P, MA B, CNA Q, Dietary R, DM, AD, LVN S, LVN, A, MDS, RN T, LVN C, LVN F, and SS) reviewed for training, in that: The facility failed to ensure Laundry M, CNA N, CNA O, Transporter P, MA B, CNA Q, Dietary R, DM, AD, LVN S, LVN, A, MDS, RN T, LVN C, LVN F, and SS completed QAPI training within the last year. These failures could affect residents and place them at risk of poor care or victimization due to lack of staff training.

Inspectors wroteBased on interview and record review, the facility failed to purchase a surety bond to assure the security of all personal funds of residents deposited with the facility for 1 of 1 resident trust account reviewed, in that: The amount on deposit in the resident trust fund was less than the amount of the surety bond. This failure could affect all residents with funds on deposit in the resident trust fund and cause a lack of security of resident personal funds.

Inspectors wroteBased on interview and record review, the facility failed to ensure residents' right to formulate an advance directive for 5 of 39 residents (Resident #4, Resident #20, Resident #66, Resident #28 and Resident #33) reviewed for advanced directives, in that: 1. Resident #4's OOH-DNR was executed by two physicians and the resident had family members. 2. Resident #20's OOH-DNR was not witnessed and had no accompanying physician order. 3. Resident #66's OOH-DNR was not signed twice by her qualified relative. 4. The facility failed to ensure Resident #28's and Resident #33's OOH-DNR's were signed at the bottom, by either the nearest living relative or the resident. These failures could place residents at-risk for residents' rights not being honored and having CPS performed against the residents' will.

Inspectors wroteBased on interview and record review, the facility failed to implement their written policies and procedures that prohibited and prevented abuse, neglect, and exploitation of residents for 5 of 21 staff (MA I, [NAME] J, Hskg K, AD and MDS Coordinator ) reviewed for abuse and neglect, in that: 1. The facility failed to follow their abuse policy when a criminal background check and the EMR was not completed in a timely manner prior to their hired dates for MA I, [NAME] J, and Hskg K. 2. The facility failed to follow their abuse policy when the AD's and the MDS's annual EMR was not completed within the past year. These failures could place residents at risk for abuse and neglect.

Inspectors wroteBased on observations, interviews, and record reviews the facility failed to ensure a medication error rate below 5% for 5 of 10 Residents (Residents #25, #48, #19, #50, and #35) reviewed for medication administration errors, in that: The Facility staff administered 45 medications of which 25 were administered to Residents #25, #48, #19, and #50, outside of acceptable parameters for safe medication administration; and one medication at the wrong dosage for Resident #35, which resulted in a 57% medication error rate. This failure could place residents at risk for not receiving the intended therapeutic effects of their medications and possible adverse reactions.

Inspectors wroteBased on interview and record review, the facility failed to maintain clinical records in accordance with accepted professional standards and practices that were accurately documented for 1 of 39 Residents (Resident #174) reviewed for medical records, in that: The facility failed to ensure Resident #174's Schizoaffective disorder, bipolar type diagnoses was listed throughout the residents EHR. This failure could place residents at risk for improper care due to inaccurate records.

Inspectors wroteBased on record review and interview the facility failed to ensure the Arbitration Agreement contained all the required elements for all current residents. The facility failed to ensure the arbitration agreement contained the required element: The right to rescind within 30 calendar days of signing. This failure could place the residents and their representatives at risk of being uninformed about their rights regarding binding arbitration and less able to defend their rights related to disputes, controversy or claims arising out of or related to the services provided by the nursing facility.

Inspectors wroteBased on interview and record review, the facility failed to provide medically related social services to attain or maintain the highest practicable physical, mental and psychosocial well-being of each resident, for 5 (Resident #4, Resident #20, Resident #66, Resident #28 and Resident #33) of 39 residents reviewed, in that: The Advanced Directives of five residents were incorrectly executed and were therefore invalid. The Social Services Director was unaware of the Advanced Directive errors, the Social Services Director was unaware that her department was responsible to ensure the accuracy of Advanced Directives, the Social Services Director was unaware of how to correctly execute an OOH-DNR, and the Social Services Director was not a licensed Social Worker. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide a safe, functional, sanitary, and comfortable environment for residents, staff and the public, for 1 (room [ROOM NUMBER]) of 67 resident restrooms reviewed, 1 (400/500 hall) of 2 resident shower rooms reviewed, and 1 (500 hall) of 2 public restrooms reviewed, in that: 1. The sink in resident room [ROOM NUMBER] was loosely affixed to the wall. 2. The resident shower room serving 400 and 500 halls had a foul odor and had soiled briefs in two trashcans. 3. The public restroom located on 500 hall had clothing and trash in the floor and there was brown liquid in the commode. 4. Resident #68 was not provided a safe, functional, sanitary, or comfortable environment due to non-functional window blinds. 5. [...]

Inspectors wroteBased on interview and record review, the facility failed to provide the required education on the rights of the resident and the responsibilities of a facility to properly care for its resident for 3 of 16 employees (the DM, the AD, RN T) reviewed for training, in that: The facility failed to ensure the DM, the AD, and RN T completed resident rights training within the previous year. These failures could affect residents and place them at risk of being uninformed due to lack of staff training.

Inspectors wroteBased on interview and record review, the facility failed to provide the required compliance and ethics training for 5 of 16 employees (CNA O, DM, AD, MDS, and RN T) reviewed for training, in that: The facility failed to ensure CNA O, DM, AD, MDS, and RN T completed compliance and ethics within the previous year. These failures could affect residents and place them at risk of poor care or victimization due to lack of staff training.

Inspectors wroteBased on interview and record review, the facility failed to provide mandatory effective behavioral health training for 8 of 16 employees (CNA O, DM, AD, MDS, RN T, LVN C, LVN F, and SS) reviewed for training, in that: The facility failed to ensure CNA O, the DM, the AD, the MDS, RN T, LVN C, LVN F, and the SS completed behavioral health training within the previous year. These failures could place residents at risk of not attaining or maintaining their highest practicable physical, mental, and psychosocial well-being due to lack of staff training.

Inspectors wroteBased on interview, and record review the facility failed to facilitate the inclusion of the resident or resident representative in the care planning process for 3 (Resident #68, #4, and #10) of 8 residents care plans reviewed, in that: The facility failed to include Resident's #68, #4, and #10 or resident representative in their Care Conference meeting. This failure could affect residents and place them at-risk by contributing to inadequate care.

Inspectors wroteBased on interviews and record reviews, the facility failed to ensure the comprehensive care plan was reviewed and revised by the interdisciplinary team after there was an update for 1 of 39 residents (Resident #16) whose care plan was reviewed, in that: The facility failed to ensure Resident #16's care plan reflected full code instead of DNR. This failure could place residents at risk of receiving the incorrect care and cause health complications with subsequent illness.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure that residents were free of any significant medication errors for 1 (Resident #35) of 10 residents reviewed for safe administration of medications, in that: Resident #35 was administered 3, 300 mg capsules of Gabapentin when 1, 300 mg capsule of Gabapentin was ordered. This failure could place residents at risk of not receiving the intended therapeutic benefit of drugs and biologics, worsening or exacerbation of chronic medical conditions such as physiological and/or psychological addiction.