Avir At Giddings

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

lightheadedness or dizziness, multiple medications, musculoskeletal abnormalities, peripheral neuropathy, gait and balance disorders, cognitive impairment, weakness, environmental hazards, confusion, visual impairment, and illnesses affecting the central nervous system and blood pressure.4. The physician will identify medical conditions affecting fall risk (for example, a recent stroke or medications associated with Increased falling risk) and the risk for significant complications of falls (for example, increased fracture risk

In someone with osteoporosis or Increased risk of bleeding in someone taking an anticoagulant).a. Falls often have medical causes; they are not just a nursing Issue.3. The staff and physician will continue to collect and evaluate information until either the cause of the falling is identified, or it is determined that the cause cannot be found or that finding a cause would not change the outcome or the management of falling and fall risk. Review of facility policy for Falls and Fall Risk, Managing reflected, Policy heading Based on previous evaluations and current data, the staff will identify interventions related to the resident's specific risks and causes to try to prevent the resident from falling and to try to minimize complications from falling.

Policy Interpretation and ImplementationDefinition According to the MDS, a fall is defined as:Unintentionally coming to rest on the ground, floor or other lower level, but not as a result of an overwhelming external force (e.g., a resident pushes another resident). An episode where a resident lost his/her balance and would have fallen, if not for another person or if he or she had not caught him/herself, is considered a fall A fall without injury is still a fall. Unless there is evidence suggesting otherwise, when a resident is found on

the floor, a fall is considered to have occurred. Challenging a resident's balance and training him/her to recover from loss of balance is an intentional therapeutic intervention. The losses of balance that occur

during supervised therapeutic interventions are not considered a fall.Resident-Centered Approaches to Managing Falls and Fall Risk1. The staff, with the input of the attending physician, will implement a resident-centered fall prevention plan to reduce the specific risk factor(s) of falls for each resident at risk or with a history of falls.2. If a systematic evaluation of a resident's fall risk identifies several possible interventions, the staff may choose to prioritize interventions (i.e., to try one or a few at a time, rather than many at once).5. If falling recurs despite initial interventions, staff will implement additional or different interventions, or indicate why the current approach remains relevant.6. If underlying causes cannot be readily identified or corrected, staff will try various interventions, based on assessment of the nature or category of falling, until falling is reduced or stopped, or until the reason for the continuation of the falling is identified as unavoidable.

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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

11/27/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Avir at Giddings

1400 N Main St Giddings, TX 78942

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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few

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

when Resident #1 was interviewed by the administrative staff on the night of 11/25/2025, that he stated he slipped from the wheelchair. She stated that an incident report was created with the investigation findings related to the fall on 11/13/2025. She stated that the MAINT DIR was involved and interviewed that on the morning of 11/26/2025. She stated that she was informed that she and person with her found him on the floor in his room but had not witnessed the fall. She stated that she had no knowledge of a report that nursing did not respond when they were notified of the fall. She stated that it was her expectation that nursing should come and assess the resident as soon as they are notified of a fall. She stated that if it is safe to get the resident up after assessing them, then they should assist the resident up. She stated that an incident report should be completed for the fall and the physician and RP should be notified. She stated that because there was no injury involved in Resident #1's fall on 11/13/2025, the notification to the MD and DON do not need to occur right away, as they would be made aware on the risk management report the following morning. She stated that therapy would also be informed of the fall during that meeting also and

they would know to screen the resident after the fall. She stated that staff should be implementing interventions after falls to address the root cause to prevent future falls. She stated that she had not read

the witness statements at that time. She stated that safe surveys were done with residents that morning with no reports of abuse or neglect. She stated that she questioned Resident #1's ability to be alone outside when she arrived on site. She stated that she was told that staff monitor Resident #1 while he is outside, but she did not know how frequently they were able to monitor him. She stated that because he does not have the code to the door, the staff were aware when he went outside, because he set off the alarm. She stated that she suggested that staff walk with him if he is going outside. She stated that they did new BIMS

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