The Director of Rehabilitation at Avir at New Braunfels had been requesting the signed hospice care plan since at least June 2025, but the delay actually stretched back about a year from January 2025, federal inspectors found during a November complaint investigation.
Without the signed plan, the facility couldn't complete a required assessment that would have allowed them to order a Custom Manual Wheelchair for the resident. The specialized equipment was designed to assist with her positioning needs.
The rehabilitation director told inspectors he had spoken with several hospice staff members for months, including the nurse manager, requesting the signed plan of care "to no avail." He brought up the issue during morning meetings and explained why the facility's application for specialized services had been denied.
He never considered discussing the problem directly with the Administrator, his immediate supervisor, to get help resolving the matter.
The hospice Director of Nursing acknowledged during a November 19 interview that she had not provided a current plan of care for the resident because they had been waiting for the physician's signature. She confirmed the delay had been ongoing since at least June 2025.
But the rehabilitation director revealed the problem had actually persisted for about a year as of January 2025.
The Administrator told inspectors on November 20 that he didn't remember the rehabilitation director bringing up the problem during meetings. He also didn't recall receiving emails from the state assessment representative about the issue.
However, he stated that when he called hospice that day, "they came right over and provided a signed plan of care." Speaking with the rehabilitation director helped him realize the issue had been ongoing for about a year.
"It should not have taken this long to complete the NFSS and it was Resident #1 who ultimately was at a disadvantage because she was not able to utilize the CMWC to assist her with positioning," the Administrator acknowledged.
The rehabilitation director had consulted with a company resource person who recommended that he "keep asking hospice to provide the resident's plan of care." But the simple solution of escalating the problem within his own facility's management structure apparently never occurred to him.
The facility's own policy on specialized assessments, dated July 29, 2025, emphasizes collaboration with healthcare professionals to ensure continuity of care. The policy states that care planning should be "tailored to the individual's needs" based on evaluation findings.
The case illustrates how bureaucratic delays can directly impact resident care. While staff members exchanged requests and explanations for months, the resident remained without equipment specifically designed to help her positioning needs.
The hospice care plan signature that took over a year to obtain was apparently available immediately when the Administrator finally made a direct phone call to hospice providers.
The resident's disadvantage extended beyond just lacking the wheelchair. The specialized assessment process that required the signed hospice plan is designed to determine whether the nursing home is the most suitable setting for individuals with specific care needs and to identify what specialized services they require.
Federal inspectors classified the violation as causing minimal harm or potential for actual harm, affecting few residents. But for the individual resident involved, the year-long delay meant months without positioning assistance that had been deemed medically necessary.
The facility's morning meetings, where the rehabilitation director repeatedly raised the issue, apparently functioned more as information-sharing sessions than problem-solving forums. Despite months of discussion about the missing signature, no one escalated the matter or sought alternative approaches.
The Administrator's immediate success in obtaining the signed care plan when he finally contacted hospice directly raises questions about why this direct approach wasn't attempted earlier in the process.
The resident ultimately received her signed hospice care plan only after federal inspectors arrived to investigate the complaint, more than a year after the process should have been completed.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Avir At New Braunfels from 2025-11-24 including all violations, facility responses, and corrective action plans.