Avir At Lindale

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

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

January 2017 reflected the following: Policy Statement Residents, family, and resident representatives have

the right to voice or file grievances, either orally or in writing, to the facility staff or the agency designed to hear grievances (e.g. the state Ombudsman) You are requested to follow the procedures outlined below when filing grievance or complaint: 1. 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.2. Residents, family and resident representatives have the right to voice or file grievances without discrimination or reprisal in any form and without fear of discrimination or reprisal.3. All grievances, complaints or recommendations stemming from residents or family groups concerning issues of residents' care in a facility will be considered. Actions on such issues will be responded to in writing including a rational for the response.4.

The administrator has delegated the responsibility of grievance and or complaint investigation to the grievance officer5. Within five (5) working days of the date you filed the grievance; you will be notified of the results of the investigation. (Note: Complaints of abuse, harassment, or mistreatment will be immediately investigated, and you may request a report of the findings, recommendations, and/or corrective action taken within five (5) working days of the filing of the report.)6. It is the policy of this facility to assist you in filing a grievance or complaint. Should you feel that our staff has not assisted you in this matter, or you feel that you are being discriminated against for taking such steps, you are encouraged to report such incidents to the Administrator at once.7. The grievance officer, administrator and staff will take immediate action to prevent further potential violations of residents' rights while the alleged violations are being investigated.

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

10/29/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Avir at Lindale

13905 Fm 2710 Lindale, TX 75771

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 - Actual harm Residents Affected - Few

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

return to facility to complete a statement of the incident events. LVN (B) stated Yall have it all backward.

Several attempts were made by Prior ADON to encourage employees to come to the facility to resolve the issue. Employee LVN (B), self-terminated 08/15/2025, due to failure to return to give statement of incident.

Durning a phone interview on 10/29/2025 at 3:30PM the Prior Interim ADM and prior ADON said, they both had reviewed the RP/care giver provided video footage. Both prior staff members indicated that the video revealed Resident #17 was sitting on the side of the bed calling for help, and the call light button was on,

the video clip time stamped approximated 5:17AM or 5:22 AM . They also witness Resident #17 fall on the floor but unable to recall the exact time of fall because the video clip was not time stamped. Both prior Adm., and ADON. said, the provider responded with safe surveys conducted. Scheduled observations of Resident #17 were performed for 72hr. Suspension of staff pending investigation, and termination of one employee. Both stated staff training on abuse and neglect, fall prevention, notifying administration of staffing shortage, and call light response times all were completed. During an interview on 10/29/2025 at 4:30PM

the Current ADM said he was not on staff at the time of the incident, but stated, he had reviewed the incident report and stated he had initiated a plan of care, during morning reports to identify any resident's concerns, increased the staffing levels on the heavy hallways (from 2 CNA to 3 CNA's each shift), and hired

a new staffing coordinator. In serviced staff on Abuse/ Neglect, falls prevention, call lights response time, and staff expectation stating, All staff are responsible for answering call lights, and reporting incidents.

Review of facility policy for Falls prevention, Abuse & Neglect, Call light response time and customer service, revealed all seven (7) elements were addressed: Screening, Training, Prevention, Identification, Investigation, Protection and Reporting. There were no concerns with facility policy. In-services were reviewed and were compliant.

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

10/29/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Avir at Lindale

13905 Fm 2710 Lindale, TX 75771

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 0804

Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.

Level of Harm - Minimal harm or potential for actual harm

Based on observations, and interviews, and record review the facility failed to serve food that was palatable for 1 of 1 meal reviewed for food palatability. (noon meal 10/28/2025). The facility did not provide palatable and appetizing food for the residents for the 10/28/2025 noon meal. Residents #1, 3, 4, 6, 11, 14, 15 and 19 complained of cold food and food that was not flavorful. These failures could place residents who received food from the kitchen at risk for diminished meal satisfaction and potential weight loss due to poor meal intake.Findings included: 1.During interviews during the initial tour on 10/27/2025 the following was noted: *At 9:46 AM Resident #11 said the food was very cold and very salty at times. *At 9:50 AM Resident #3 said the food was bad. *At 10:09 AM Resident #4 said the food was not that good. *At 10:31 AM Resident #6 said the food was not good. *At 10:33 AM Resident #15's family member said the food here was not very good. *At 10:35 AM Resident #19 said the food was not the greatest lately. **At 11:17 AM Resident #14 said the food is just ok. 2. During observations on 10/28/2025 at 12:00 PM the test tray left the kitchen after

the dining room was served, and was hand delivered by the RD. The test tray for the surveyors. On 10/28/2025 at 12:10 PM the test tray arrived in the work room. The plate of food was on a tray and covered with a hard plastic cover. The RD was present with the tasting of the food. The following were found: *Regular tray- spaghetti with thick noodles, tossed green salad, and a garlic bread stick. Spaghetti was cool, seasoned ok. [NAME] tossed salad cool Garlic bread was hard No dessert on trayNo drinks on tray

The second test tray which came after the last hall trays were served on 10/28/2025 at 12:30 pm Spaghetti was cold, seasoned ok. [NAME] tossed salad cool Garlic bread was hard difficult to chew Cup of diced peaches with whip cream on top - coolNo drinks on tray During an interview on 10/28/2025 at 12:30pm The RD agreed with the findings. The spaghetti on the regular tray was not hot, and seasoned ok, the bread stick was hard difficult to bite into, no dessert and no drink. The second test tray's Spaghetti was cold, seasoned ok. [NAME] tossed salad cool. Garlic bread was hard difficult to chew. Cup of diced peaches with whip cream on top - coolNo drinks on tray 4. During interviews on 10/28/2025 the following statements were made regarding the noon meal of spaghetti, salad, bread stick and peaches with whip cream: *At 11:35 AM Resident #11 said it's food, but it's not good. She said, I may eat a little of it. *At 11:36 AM Resident #3 said it may look good, but it never tastes good, she said it is always too spicy. *At 11:49 AM Resident #14 said he was going to eat some of the meat. He said he didn't want the rest of it, and he wished they would improve on the food. *At 1:05 PM Resident #1 said her lunch food was cold and very salty. *At 1:20 PM Resident #19 said it probably would have been good if it were not cold and they don't give me enough. *At 1:25 PM Resident #6 said the food was just ok. She said it was not like home cooked food, she said she always has to wait on her tea, and it is never hot. During an interview with the Administrator on 10/27/2025 at 9:30 AM he said that the dietary manager had called in this morning 10/27/2025 and gave her notice to quit and he currently did not have a dietary manager and his thoughts were that, each resident should be provided with a nourishing, palatable, well-balanced diet that meets his or her daily nutritional and special dietary needs, taking into consideration the preferences of each resident, that food and nutrition services staff will inspect food trays to ensure that the correct meal is provided to each resident, the food appears palatable and attractive, and it is served at a safe and appetizing temperature. The Administrator said this deficiency cold put the resident at risk for weight loss, and multiple dietary issues. Record Review of the facility's policy for Food Preparation and Service dated revised November 2022 documented the following: Food and nutrition services employees prepare, distribute and serve food in a manner that complies with safe food handling practices

Residents Affected - Some

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

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

10/29/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Avir at Lindale

13905 Fm 2710 Lindale, TX 75771

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)

Federal health inspectors cited AVIR AT LINDALE in LINDALE, TX for a deficiency under regulatory tag F-F0812 during a complaint investigation conducted on 2025-10-29.

Category: Nutrition and Dietary Deficiencies

The facility was found deficient in the following area: Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

Scope/Severity Level F: widespread, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 4 deficiencies cited during this inspection of AVIR AT LINDALE.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-10-30.