Avir at Snyder

Inspectors wroteBased on interviews, observation, and record review, the facility failed to ensure each resident was treated with respect, dignity, and care for each resident in a manner and in an environment that promotes the maintenance or enhancement of their quality of life, recognizing each resident's individuality. The facility failed to protect and promote the rights of the residents for 1 of 5 residents (Resident # 1) in that: CNA B failed to treat Resident #1 with respect and dignity when she told Resident #1 to ask her nicely instead of demanding something and that it would get her a lot further if she would say please on 6/19/26. This failure placed residents at risk for diminished quality of life and loss of dignity and self-worth.

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 4 of 6 resident bathrooms (Rooms 10 , 22, 24, and 45) and 2 of 6 resident bedrooms in that: The bed/wall protector board (bumper board) in Resident room [ROOM NUMBER] was loose and not fastened to the wall. The shelf in the bathroom of Resident room [ROOM NUMBER] was not secured on the left side of the shelf, causing it to lean into the adjacent wall. The toilet tank lid in the bathroom in Resident room [ROOM NUMBER] did not fit the toilet tank, which left an open space on both ends and exposed the water in the tank. Baseboard strips in Resident room [ROOM NUMBER] were not secured. Baseboard strips in the bathroom of Resident room [ROOM NUMBER] were not secured. [...]

Inspectors wroteBased on interviews and record review, the facility failed to use the services of a Registered Nurse (RN) for at least eight consecutive hours a day, seven days a week for 7 (1/5, 1/6, 1/16, 1/19, 1/23, 1/24, and 1/25/2026) of 30 days reviewed for RN coverage. The facility failed to maintain RN coverage of eight hours a day for 1/5, 1/6, 1/16, 1/19, 1/23, 1/24, and 1/25/2026. This failure could place residents at risk of not having their nursing and medical needs met and receiving improper care.

Inspectors wroteBased on interviews and record reviews, the facility failed to treat each resident with respect, dignity, and care for each resident in a manner and in an environment that promotes the maintenance or enhancement of their quality of life, recognizing each resident's individuality. The facility failed to protect and promote the rights of 10 of 14 residents in that: The facility failed to ensure staff were not on their personal cell phones while providing care, which included peri-care to residents. This could place residents at risk for diminished quality of life and loss of dignity and self-worth.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide information to residents and their representatives on their rights related to filing grievances or concerns for 10 of 14 confidential residents. The facility failed to ensure 10 of 14 confidential residents were provided, through postings in prominent locations, the Grievance Procedure, were provided information who the facility grievance official was, their contact information, how to file an anonymous grievance, and their right to obtain a written decision related to their grievance. This failure could place the residents at risk of unresolved grievances and decreased quality of life. [...]

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 1 of 1 kitchen reviewed for dietary services, in that: The facility failed on 01/28/26 to seal food stored in the dry storage and date food stored in the refrigerator. This failure could place residents at risk for food contamination and foodborne illness.

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 residents (Resident #15, Resident #19 and Resident #42) reviewed for infection control. CNA E did not change gloves between groin area and buttocks area when providing incontinence care to Resident #42. CNA F did not perform hand hygiene between all glove changes when providing incontinent care to Resident #15. CNA G did not perform hand hygiene or gloves changes when providing incontinent care to Resident #19. These failures could place residents at risk for cross contamination and infection.

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure each resident received adequate supervision to prevent accidents for 2 (Resident #3 and Resident #35) of 14 residents reviewed for accidents and supervision. The facility failed to consistently supervise Residents #3 and #35 while smoking and failed to ensure the need for safety restrictions due to the absence of smoking assessments. These failures had the potential to result in resident harm, including burns or other smoking-related injuries.:A record review of Resident #3's face sheet dated 1/30/26 revealed that Resident #3 was a [AGE] year-old male admitted to the facility on [DATE] with diagnoses that include dementia (decline in memory, thinking, and behavior), need for assistance with personal care, muscle wasting (reduction in muscle strength), and difficulty with walking. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to provide food that was palatable for 2 of 2 meals reviewed for palatability. The facility failed to provide food that was palatable for 1 of 3 food forms served (puree) at 2 of 2 meals observed (01/28/26 dinner and 01/29/26 lunch). This failure could place residents at risk of decreased food intake, hunger, and unwanted weight loss.

Inspectors wroteBased on observation, interview and record review, the facility failed to provide food and drink that was palatable, attractive and at a safe and appetizing temperature for one of one kitchen. A. Resident #7, #18, #53, #159 voiced concerned of cold food, flavor and/or texture. B. Six of the 12 foods sampled on the meal tray were cold. C. Two of the 12 foods sampled on the meal were salty. D. One of the 12 foods sampled on the meal tray was tough. These failures could affect the forms of food provided in the facility (regular, mechanical chopped and pureed) and could result in a decline in residents' consumption of food and residents to have unwanted weight loss.

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 in one of one kitchen reviewed for dietary services. 1) The facility failed to ensure foods were covered, labelled & dated. 2) The facility failed to protect foods from potential contamination. 3) The facility failed to ensure foods were stored under sanitary conditions. These failures could place residents at risk for food-borne diseases.

Inspectors wroteBased on interviews and record review, the facility failed to ensure PRN orders for psychotropic drugs were limited to 14 days unless the attending physician or prescribing practitioner believed that it was appropriate for the PRN order to be extended beyond 14 days and documented their rationale in the resident's medical record and indicated the duration for the PRN order, for 1 of 17 residents (Resident #19). Resident #19 continued to have a PRN order for Clonazepam 0.5mg after 14 days without an evaluation by the physician for continued treatment. This failure could result in residents receiving psychotropic and antipsychotic medications when contraindicated and could also result in residents experiencing adverse drug reactions, decreased quality of life and dependence on unnecessary psychotropic medications.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure that its medication error rate was less than 5 percent. The facility had a medication error rate of 7.14% based on 2 out of 28 opportunities, which involved 2 of 5 Residents (Residents #4 and #36) reviewed for medication administration, in that: 1. LVN A failed to verify the dosage and amount on Resident #4's Seroquel medication order prior to administering the medication, resulting in Resident #4 being underdosed. 2. LVN B was unable to give Resident #36 the ordered medication for Multi Vitamin with iron, due to not having the correct multi vitamin available, resulting in a missed dose. These failures could place residents at risk of incomplete therapeutic outcomes, increased negative side effects, and decline in health.

Inspectors wroteBased on observations, interviews, and record review the facility failed to label drugs and biologicals used in the facility in accordance with currently accepted professional principles and ensure all drugs and biologicals are stored in locked compartments and permit only authorized personnel to have access to the keys, for 1 of 2 medication carts (Med Cart B) reviewed for medication storage. 1. The facility failed to ensure that all medications stored in Med Cart B were stored in their original container/packaging. 2. LVN B failed to lock Med Cart B before stepping away from the cart. These failures could result in medication administration error or misappropriation of drugs. Findings Included: During an observation of Med Cart B on 10/14/2024 at 12:00 pm, one round white pill was found in the second drawer and one round white pill was found in the third drawer. [...]

Inspectors wroteBased on interview and record review the facility failed to ensure the resident had the right to be free from abuse, neglect, misappropriation of property, and exploitation, which includes but is not limited to freedom from corporal punishment, involuntary seclusion and any physical or chemical restraint not required to treat the resident's medical symptoms for 1 of 5 residents (Resident #1) reviewed for misappropriation of property and exploitation. The facility failed to prevent misappropriation of Resident #1's finances when the facility kept Resident #1's wallet with cash in a locked box in a staff member's office with only staff having access to the wallet and it was discovered $1370.00 was missing. This failure could place residents at increased risk for misappropriation of their property including loss of money.

Inspectors wroteBased on interview and record review the facility failed to ensure the resident had the right to be free from abuse, neglect, misappropriation of property, and exploitation, which includes but is not limited to freedom from corporal punishment, involuntary seclusion and any physical or chemical restraint not required to treat the resident's medical symptoms for 1 of 5 residents (Resident #1) reviewed for misappropriation of property and exploitation. The facility failed to prevent misappropriation of Resident #1's finances when the facility HR Coordinator used Resident #1's debit card for personal gain totaling approximately $2631.22 and failed to provide any receipts to Resident #1 for purchases intended for him. This failure could place residents at increased risk for misappropriation of their property including loss of their

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that the resident environment remained free of accident hazards for 1 of 11 residents (Resident #1) reviewed for accident hazards and supervision. CNA A failed to provide adequate supervision for Resident #1 in the shower resulting in Resident #1 falling and fracturing her hip and ankle. Resident #1 had to be hospitalized and required surgical intervention. On 11/03/23 at 7:15 PM, an Immediate Jeopardy (IJ) was identified. While the IJ was removed on 11/04/23 at 12:04 PM, the facility remained out of compliance at a severity level of actual harm and a scope of pattern due to the facility continuing to monitor the implementation and effectiveness of their Plan of Removal. This failure could place residents at risk of harm and/or injury and contribute to avoidable accidents. Findings Included: [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure training and competency skills demonstrations for contracted certified nurse aides who provided activities of daily living services to residents for five of five contracted certified nurse aides (CNA G, CNA H, CNA K, CNA T, and CNA U) competency skills. 1. The facility failed to ensure contacted agency staff CNA G, CNA H, CNA K, CNA T, and CNA U received proper training. 2. CNA K failed to properly assist Resident 1 in the shower resulting in a fall where Resident 1 fractured her hip and required hip surgery. On 11/03/23 at 7:15 PM, an Immediate Jeopardy (IJ) was identified. [...]

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 1 of 1 kitchen reviewed for dietary services, in that: 1)The facility failed to ensure foods were processed under sanitary conditions during puree preparation, 2) The facility failed to ensure Dietary staff dated and labeled foods as required, 3) The facility failed to ensure Dietary staff maintained quaternary sanitizer levels within acceptable ranges in wiping cloth solutions. [...]

Inspectors wroteBased on observation, interview and record, review the facility, failed to ensure sure each resident had a right to a safe, clean, comfortable, and homelike environment in the facility and failed to provide housekeeping and maintenance services necessary to maintain a sanitary, orderly, and comfortable interior in 4 of 4 common baths (Halls 1, 2, 3 and 4), reviewed for environment, The facility failed to ensure resident use common areas were clean, safe and did not need repair. These failures could place residents at risk for living in an unsafe, unclean, uncomfortable, and unhomelike environment which could cause a decline in resident psychosocial well-being.

Inspectors wroteBased on interviews and record review, the facility failed to ensure all Pre-admission Screening and Resident Review (PASRR) Level I residents with mental illness were provided with a PASRR Evaluation assessment for 3 of 24 residents (Residents #9, #19, and #32) reviewed for PASRR screening, in that: Residents #9 and #32 did not have an accurate PASRR Level 1 assessments when they had a diagnosis of mental illness. Resident #19 had an accurate, positive PASRR Level 1 screening; however, no subsequent PASRR Level 2 Evaluation. These failures could place residents with an inaccurate PASRR Level 1 Evaluation and no PASRR Level 2 Evaluation at risk for not receiving care and services to meet their needs.

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 2 of 4 resident halls (Halls 3 and 4) observed for bathroom sink water temperature in that: 4 resident rooms (Rooms 30, 31, 33 and 40) temperatures were not held between the state regulated water temperature of 100-110 Fahrenheit (F) degrees. This failure could place residents at risk for diminished quality of life, injury and burns.

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 permit only authorized personnel to have access to the keys, for 1 of 2 medication carts (Med cart B) and 1 of 1 treatment cart, in that: The facility failed to ensure that medication and treatment carts were secured when unattended. These failures could result in the theft or misuse of medications.

Inspectors wroteBased on observation, interview and record review, the facility failed to dispose of garbage and refuse properly in 5 of 5 dumpsters (#1, #2, #3, #4 and #5), in that: The facility failed to maintain the dumpster/refuse disposal container in a manner that effectively prevented the harborage and attraction of pest. These failures could result in providing harborage and breeding areas for insects, rodents and other pests which could infest the facility.

Inspectors wroteThe facility failed to establish and maintain an effective Infection Control Program designed to provide a safe, sanitary, and comfortable environment and help prevent the development and transmission of disease and infection for all residents in that: -PPE doffing boxes were in the hallway outside the Covid positive rooms. -The Housekeeping Supervisor was observed going in a Covid positive room wearing an N95 mask with no gown, gloves, or face shield on. No handwashing observed before entering Covid positive room or after exiting the Covid positive room. -The facility went from 6 Covid positive residents on 08/28/23 to 33 Covid positive residents on 09/05/23. These failures could place all residents at risk for contracting the COVID 19 virus.