Avir at Cowhorn Creek: ALS Resident Missing from Plan - TX
Federal inspectors found that Avir at Cowhorn Creek had not updated its required facility assessment to reflect the complex care needs of Resident #1, who has ALS — a progressive nervous system disease that causes muscle weakness and paralysis while affecting the ability to speak and breathe.
The resident, admitted earlier this year, depends entirely on staff for all daily activities. She experiences shortness of breath when lying flat, loses liquids and solids from her mouth while eating, and coughs or chokes during meals and when taking medications.
Communication presents constant challenges. The resident uses a specialized communication device to express her needs and makes gestures with her head. Staff must position a dot that helps her operate the device and ensure it remains in place before and after providing care. When she attempts to speak, she's sometimes understood, but staff are instructed to ask her to use the communication device if her words aren't clear.
The resident rejects care daily and exhibits verbal behavioral symptoms directed at others one to three days per week. She requires careful positioning in bed with pillows to help her eat, use her communication device, breathe more easily, and remain comfortable.
Her care plan specifies that staff must speak calmly, clearly, and slowly while offering emotional support as needed. The resident is occasionally incontinent of urine and frequently incontinent of bowel.
During the August inspection, investigators requested the facility's policy on facility assessments. The administrator said they didn't have such a policy.
The administrator acknowledged responsibility for completing and updating the facility assessment, stating they update it at least annually to provide "a summary of the types of residents they cared for and to stay in compliance."
However, the administrator explained that the facility assessment captured most disease processes but not all diagnoses "because there would be thousands of diagnoses." She insisted that staffing decisions weren't based on what appeared in the facility assessment and that updating the assessment "did not affect the care of the residents."
Federal regulations require nursing homes to conduct and document facility-wide assessments that determine what resources are necessary to care for residents competently during day-to-day operations and emergencies. These assessments must include the resident population's diseases, conditions, physical and behavioral health needs, cognitive status, and acuity levels.
The facility's assessment, dated earlier this year, made no mention of ALS despite housing a resident whose primary diagnosis is this debilitating neurological condition.
ALS progressively destroys nerve cells that control voluntary muscle movement. Patients typically experience increasing difficulty with speaking, swallowing, and breathing as the disease advances. The condition requires specialized care protocols and equipment, including communication devices and positioning techniques to maintain comfort and safety.
The resident's quarterly assessment documented her extensive care needs. She was rated as rarely or never understood when speaking, preventing completion of a standard cognitive assessment. Her impairment affects both upper and lower extremities.
Inspectors determined that excluding the ALS diagnosis from the facility assessment could affect residents by failing to ensure necessary resources for appropriate care were available.
The facility houses residents with various complex medical conditions requiring specialized attention and resources. A comprehensive facility assessment helps administrators determine staffing levels, equipment needs, and training requirements to meet residents' diverse health challenges.
Without acknowledging ALS in its assessment, the facility may not have adequately planned for the specialized equipment, training, or staffing patterns needed to care for residents with progressive neurological conditions that affect communication, mobility, and respiratory function.
The inspection revealed a gap between the facility's regulatory compliance responsibilities and its actual practice of caring for residents with complex, life-limiting diagnoses that require intensive daily support and specialized interventions.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Avir At Cowhorn Creek from 2025-08-15 including all violations, facility responses, and corrective action plans.
Additional Resources
Data source: Official federal inspection data from the Centers for Medicare & Medicaid Services (CMS).
Editorial process: AI-synthesized regulatory data, reviewed for accuracy by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: June 20, 2026 · Our methodology
AVIR AT COWHORN CREEK in TEXARKANA, TX was cited for violations during a health inspection on August 15, 2025.
The resident, admitted earlier this year, depends entirely on staff for all daily activities.
Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. Review the full report below for specific details and facility response.