Avir At Borger

F 0805 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Appropriate Liquid (Milk or Other Appropriate Liquid) and dated 08/26/25 revealed the following: . Entrees Broth or other appropriate sauce/gravy from menu .Record review of facility recipe for pureed scrambled eggs dated 08/26/25 revealed the following: . Ingredients 1 Tbsp Milk or Appropriate Liquid 1/4 Cup Egg Scrambled . NOTE: Cooking liquid, broth, gravy or other suitable liquid may be substituted for liquid in recipe with pureeing this food for PU4. NOTE: As this food item contains a high percentage of fluid, additional fluid may not be needed. Drain well before pureeing, and once the items in pureed, add additional liquid only if necessary. Thickener may also be needed to achieve the proper consistency for PU4.Record review of facility recipe for pureed oatmeal dated 08/26/25 revealed the following: . Ingredients 1/2 cup Cereal Oatmeal f/Quick Oats 1 Tbsp Milk or Appropriate Liquid . Drain any excess liquid from food.

Place prepared recipe portion into a blender or food processor. Blend until smooth. Additional liquid and/or thickener may be needed to ensure puree is smooth, moist and appropriate for PU4.Record review of facility policy titled Puree Food Preparation and dated 08/01/25 revealed the following: . It is the policy of

this facility to provide puree food that has been prepared in a manner to conserve nutritive value, palatable flavor, and attractive appearance. ‘Puree' means that all food has been ground, pressed and/or strained to a consistency of a soft, smooth, thick paste similar to a thick pudding. 1. The facility should provide each resident food that is prepared by methods that conserve nutritive value, flavor, and appearance. 2. Puree foods should be prepared to prevent lumps or chunks. The goal is a smooth, soft, homogenous consistency similar to soft mashed potatoes. 3. If the food item requires chewing, it should be excluded from the puree diet and prepared in a way that preserved vitamins and a minimum loss of nutrients. 5. Follow the recipe to prepare puree foods. 7. Examples of items to use to puree foods: . Meats: broth or gravy .

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

09/12/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Avir at Borger

1316 S Florida Borger, TX 79007

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many

FORM CMS-2567 (02/99) Previous Versions Obsolete

routinely cleaned and sanitized. All equipment must be thoroughly washed and sanitized between uses .

Food Storage and Sanitation * Foods are stored at least 6 inches off the floor . * Food removed from its original packaging must be labeled with name of food. *Do not use bare hands to touch read to eat food contact surfaces. Document temperature on appropriate temperature log for all refrigerators and freezers daily. * All opened containers or leftover food is to be tightly wrapped or covered in clean containers. It should be labeled, dated with the opened or use by date. * Dented or otherwise damaged cans will not be used. Once identified, dented cans should be stored in a separate area of the storeroom to be returned to vendor or discarded. Cleaning Schedules * Cleaning schedules are posted at the beginning of each day, week or month in the kitchen depending on the type of schedule. * It is the responsibility of the team member to follow the cleaning schedule and to complete as indicated. Sign the cleaning schedule once task is complete.Record review of facility menus for pureed pork breakfast sausage patty, pureed oatmeal, and pureed scrambled eggs dated 08/26/25 revealed the following: . Wash hands before beginning preparation and sanitize surfaces and equipment.Record review of facility policy titled Hand Washing and dated 10/01/18 revealed the following: . The facility recognizes that food-borne illness has the potential to harm elderly and frail residents. All Nutrition and Foodservice employees will practice good hand washing practices in order to minimize the risk of infection and food borne illness. Hands should be washed after the following occurrences: . k. Touching un-sanitized equipment, work surfaces .Record review of facility policy titled General Kitchen Sanitation and dated 10/01/18 revealed the following: . All Nutrition and Foodservice employees will maintain clean, sanitary kitchen facilities in accordance with the state and US Food Codes

in order to minimize the risk of infection and food borne illness. 1. Clean and sanitize all food preparation areas, food contact surfaces . 3. Keep food-contact surfaces of all cooking equipment free of encrusted grease deposits and other accumulated soil. 6. Clean non-food contact surfaces of equipment at intervals as necessary to keep them free of dust, dirt, and food particles . 11. Check restrooms regularly throughout

the shift .Record review of facility policy titled Food Preparation and Handling and dated 6/1/19 revealed the following: . To ensure that all food served by the facility is of good quality and safe for consumption, all food will be prepared and handled according to the state and US Food Codes . General Guidelines a. Use clean, sanitized surfaces, equipment . c. Prepare food with the least manual contact possible. Do not allow bare hands to touch raw food directly.Record review of facility policy titled Food Storage and dated 10/01/19 revealed the following: . To ensure that all food served by the facility is of good quality and safe for consumption, all food will be stored according to the state, federal and US Food Codes . Dry storage rooms d. All containers must be labeled and dated.h. Store all items at least 6 inches above the floor .

Refrigerators . d. Date, label, and tightly seal all refrigerated foods . e. Use all leftovers within 72 hours.

Discard items that are over 72 hours old. h. Temperatures (of refrigerators) should be checked each morning and again on the PM shift. Record the temperatures on a log that is kept near the refrigerator.

Freezers . e. Store frozen foods in moisture-proof wrap or containers that are labeled and dated.Record

review of facility policy titled Handwashing Guidelines for Dietary Employees and dated 07/25/25 revealed

the following: . Handwashing is necessary to prevent the spread of bacteria that may cause foodborne illnesses. Frequency of Handwashing . n. 3. After engaging in any activity that may contaminate the hands.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

09/12/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Avir at Borger

1316 S Florida Borger, TX 79007

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880

Provide and implement an infection prevention and control program.

Level of Harm - Minimal harm or potential for actual harm

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

observation, interview, 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 1 (Resident #5) of 3 residents observed for infection control practices. The DON did not wear a gown when performing wound care for Resident #5. This failure could place residents at risk of cross-contamination and infections.Findings include: Record review of Resident #5's clinical record revealed a [AGE] year-old male resident admitted to

the facility on [DATE REDACTED] with diagnoses to include stage 4 pressure ulcer of the sacral region (a sever, full-thickness skin and tissue injury that extends into the muscle, tendo, and ligament, or bone at the base of the spine, below the lumbar vertebrae and above the coccyx (tailbone) and dysphagia (difficulty or discomfort in swallowing). Record review of Resident #5's clinical record revealed his last MDS was a quarterly completed 7/25/25 listing him with a BIMS of 15 indicating he was cognitively intact, he had a functionality of requiring supervision for most of his activities of daily living, and he had an unhealed stage 4 pressure ulcer. Record review of Resident #5's care plan with admission date of 11/06/24 revealed the following: Problem Start Date: 06/05/2025Category: GeneralI require enhanced barrier precautions due to

the following:I am at increased risk of a MDRO acquisition due to having a wound. Approach Start Date: 06/05/2025PPE will be available (including gowns/gloves/face shield or goggles) will be available right outside my room, in the shower room. Problem Start Date: 06/05/2025Category: GeneralI require enhanced barrier precautions due to the following: pressure ulcer and colostomy. Approach Start Date: 06/05/2025Staff will wear PPE during high-contact activities such as dressing, bathing/showering, transferring, providing hygiene, changing linens, incontinent care, wound care of any type requiring a dressing, device care or use. Problem Start Date: 05/29/2025I have a colostomy R/T chronic wound infection to buttocks. Record Review of Resident #5's Orders printed 8/26/25 revealed the following order: -Enhanced Barrier Precautions - I have a pressure ulcer and colostomy. Start Date: 6/05/25. During an

observation on 08/26/2025 at 09:42 AM the DON performed Resident #5's wound care to his Stage 4 Pressure Ulcer on his coccyx. The DON did not put on a gown at any time during the care. During an

interview on 08/26/2025 at 9:56 AM the DON verified she did not put on a gown during the wound care for Resident #5's pressure ulcer on his coccyx. The DON reported this did violate EBP precautions because he had a wound and he had a colostomy. The DON reported not following EBP would result in violating infection control. During an interview on 08/26/2025 at 1:20 PM RN E reported any resident on EBP was on that process to maintain infection control. Anyone with a catheter, wound, or something similar to that should be on EBP which means they should have a station placed outside their room with gowns, gloves, and googles if needed. RN E reported EBP was done to prevent the spread of infection. During an interview

on 08/27/2025 at 8:52 AM the CN reported EBP should be utilized with any resident that has a catheter, wound, ostomy, PICC line, of something like that. The CN reported she expects staff to wear the appropriate PPE with any of these procedures. The CN reported if staff do not follow EBP then they violate infection control and can spread infections. Record review of the facility provided policy titled, Enhanced Barrier Precautions date implemented 6/25, revealed the following: Policy: It is the policy of this facility to implement enhanced barrier precautions for the prevention of transmission of multidrug-resistant organisms. 3. Implementation of Enhance Barrier Precautions:b. PPE for enhanced barrier precautions is only necessary when performing high-contact care activities.4. High-contact care activities include:h.

Wound care: any skin opening requiring a dressing.

Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet