Avir At Patriot

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

on Wednesday 10/22/25, when the family member had asked to send the resident to the hospital as requested by the nephrologist at the dialysis center. All the nurses need to do is call and request an order to send the resident to the ER for evaluation per family's request. He said that it was the family's right to request to send the resident promptly to the hospital for evaluation. During a telephone interview with the RN at the Dialysis Center on 10/28/25 at 10:09 AM, revealed she had called the nursing facility to inform LVN A on the day shift on Wednesday 10/22/25 that the nephrologist at the dialysis center had given an order to send Resident #1 to the ER for evaluation of ecchymosis and a blood blister in the middle of the chest due to the close proximity to the dialysis access site. The RN said the nephrologist had determined

the ecchymosis and blood blister was not an emergent situation, the resident was stable and did not know what had caused the ecchymosis and blister in the middle of the chest and the nursing home could send

the resident to the ER for evaluation upon return to the nursing facility. She said LVN A had not allowed her to finish telling him what the nephrologist's orders were. She said LVN A had said, Send Resident #1 to the ER for what. Resident #1 was already been started on antibiotics and the Nurse Practitioner will be coming to see the resident on Thursday 10/23/25. The RN said she had received a call from the resident's family member on 10/23/25 and she said she wanted her family member to be sent to the ER for evaluation as ordered by the nephrologist. The RN said the dialysis center will only transport patients to the emergency room for life threating situations, altered mental status or unstable vital signs. During a telephone interview

on 10/28/25 at 3:51 PM with attending physician for Resident #1 revealed, he did not think the ecchymosis and blood blister in the middle of the chest were not caused by trauma, because the resident did not complain of pain and there were no signs of suspicion of trauma and x-ray done at the ER was negative for trauma. He said it could be an autoimmune skin condition that affects some patients with ESRD. He said he had given orders for a dermatology consultation to determine what type of skin condition the resident had.

He said, The nurse at the nursing facility should have called me to get an order to send the resident to the ER for evaluation as requested by the family. Review of facility's Policy and Procedure on Change in a Resident's Condition revised April 2025, provided by DON on 10/27/25 revealed, Policy Statement: Our facility promptly notifies the resident, his or her attending physician, and the resident representative of changes in the resident' medical/mental condition and/or status (e.g., changes in level of care, billing/payments, resident rights, etc.). Policy Interpretation and Implementation: The nurse will notify the resident's physician or physician on call when there has been a (an): accident or incident involving the resident; discovery of injuries of an unknown source; significant change in the resident's physical/emotional/mental condition; need to transfer the resident to a hospital/treatment center; specific instruction to notify the physician of changes in the resident's condition; ultimately is based on the judgement of the clinical staff. Regardless of the resident's current medical or physical condition, a nurse or healthcare provider will inform the resident of any changes in his/her medical care or nursing treatment. The nurse will record in the resident's medical record information relative to changes in the resident's medical/mental condition or status.

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

11/25/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Avir at Patriot

11490 Gateway North Blvd.

El Paso, TX 79934

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 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

addressed a previous concern voiced by the resident's family regarding the call light not being within reach.

She said a Grievance Form had not been completed to address the family's concern.During an interview and record review of Grievance Forms on 10/28/25 at 4:53 PM with the Administrator revealed, the Grievance forms should be completed according to facility policy. He said they were not allowed to revise any forms without the approval from their corporate office. He said, each Grievance form should be filled out and each grievance form should have documentation of the resolution and notification of resolution. He said the Grievance forms kept in the Grievance Binder for 2025 did not document a resolution method used to notify the resident and/or resident representative of the resolution and date of notification.Review of In-Service Training Report dated 09/19/25 presented by the Social Worker revealed, Subject: Grievance/Complaint Filing. Summary of In-service: New Grievance Form, New Grievance Process, and New Grievance Location.Review of facility's policy and procedure on Grievance/Complaints, Filing revised April 2017 revealed: Policy Statement: Residents and their representatives have the right to file grievances, either orally or in writing, to the facility staff or to the agency designated to hear grievances (e.g., the State Ombudsman). Policy Interpretation and Implementation: Any resident, family member or appointed resident representative may file a grievance or complaint concerning care, treatment, behavior of other residents, staff members, theft of property, or any other concerns regarding his or her stay at the facility. Grievance also may be voiced or filed regarding care that has not been furnished. All grievance, complaints or recommendations stemming from residents or family groups concerning issues will be responded to in writing, including a rationale for the response. The administrator has delegated the responsibility of grievance and/or complaints to the grievance officer who is (was left blank). Upon receipt of a grievance and/or complaint, the grievance officer will review and investigate the allegations and submit a written report of such findings to the administrator within five (5) working days of receiving the grievance and/or complaint. The grievance officer, administrator and staff will take immediate action to prevent further potential violations of resident rights while the alleged violation is being investigated. The administrator will

review the findings with the grievance officer to determine what corrective actions, if any, need to be taken.

The resident, or person filing the grievance and/or complaint on behalf of the resident. Will be informed (verbally and in writing) of the findings of the investigation and the actions that will be taken to correct any identified problems. The administrator, or his or her designee, will make such reports orally within (was left blank) working days of the filing of the grievance or complaint with the facility. A written summary of the investigation will also be provided to the residents, and a copy will be filed in the business office.

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

11/25/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Avir at Patriot

11490 Gateway North Blvd.

El Paso, TX 79934

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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

interdisciplinary team regarding the resident's condition and response to care. Policy Interpretation and Implementation: Documentation in the medical record may be electronic, manual or a combination. The following information is to be documented in the resident medical record: Objective observations; Changes

in the resident's condition; Events, incidents or accidents involving the resident; Documentation in the medical record will be objective (not opinionated or speculative), complete, and accurate. Entries may only be recorded in the resident's clinical record by licensed personnel (e.g., RN, LVN, physician, therapist, etc.)

in accordance with state law and facility policy. Documentation of procedures and treatments will include care-specific details, including: the assessment data and/or any unusual findings obtained during the procedure/treatment; notification of family, physician or other staff, if indicated; the signature and title of the individual documenting.

Event ID:

Facility ID:

If continuation sheet