Avir At Magnolia

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few

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

and fighting us when we were trying to change him. We always have two people and both of us have to try to care for him. He is combative everytime we try to change him and we have to hold him down. I feel he gets worse at night but also in the mornings he is very very bad. On this day I think he was worse than most days. When we were trying to hold him he was very strong and kept getting away from us. Wherever we were holding him he was able to get away from us. [CNA A] had her knee on [Resident #2] to hold him down to. We have to get him up and he will not try to get out of bed if he up[sic?]. If he is up he is calm.

Signed by NA C.Review of unsigned, undated, witness statement reflected the following: On September 18, 2025, [CNA A] stated she remembered the day when they had trouble with [Resident #2] and the day was Thursday and [LVN E] was the nurse. In the beginning [NA C] and she were cleaning up [Resident #2]. They had raised the bed to [CNA A]'s hip which was approximately 23 inches above the floor. With the bed raised to hip level it would be 25 inches from the ground. [Resident #2] was being combative, and [CNA A] stated

they texted [NA B] to come and help them. When [NA B] came to the room [CNA A] stated [NA B] was holding [Resident #2]'s hands and [NA C] was trying to keep him from kicking [NA B] and herself. [CNA A] and [NA B] switched positions because [NA B] could not turn his upper body. [NA B] stated she got both hands and held them on his left shoulder with one hand and turned him with the hand[sic?] while [NA B] finished cleaning the BM from his right side which was difficult since they had him turned on this right side facing the wall. [NA C] was holding his leg and [CNA A] stated they struggled to push the sheets under him and then they turned him on his bed. They were able to get his brief on and then they were only able to put

a draw sheet under him. [CNA A] stated they then positioned him in the bed so that he could eat breakfast and then they all walked out. [CNA A] stated she remembered that day clearly because [Resident #2] had never been that combative before or hit her like that before.Per [CNA A] via textReview of in-service dated 09/27/2025, with subject Abuse/Neglect/Abuse Prevention coordinator is [ADM] and her cell is [###-###-####]. If not at the facility notify her on her cell for any allegations of abuse/neglect/exploitation.

When a resident is combative walk away from the resident and go and get your charge nurse. Sometimes a resident will get care from someone else. Also remember the change in personality is the disease process reflected 36 of the 98 staff members attended the in-service. Review of the facility policy titled Identifying Types of Abuse, dated 2001 and revised September 2022, reflected the following: Policy StatementAs part of the abuse prevention strategy, volunteers, employees and contractors

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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

11/05/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Avir at Magnolia

1105 N Magnolia Luling, TX 78648

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 0609 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few

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

cleaning up [Resident #2]. They had raised the bed to [CNA A]'s hip which was approximately 23 inches above the floor. With the bed raised to hip level it would be 25 inches from the ground. [Resident #2] was being combative, and [CNA A] stated they texted [NA B] to come and help them. When [NA B] came to the room [CNA A] stated [NA B] was holding [Resident #2]'s hands and [NA C] was trying to keep him from kicking [NA B] and herself. [CNA A] and [NA B] switched positions because [NA B] could not turn his upper body. [NA B] stated she got both hands and held them on his left shoulder with one hand and turned him with the hand[sic?] while [NA B] finished cleaning the BM from his right side which was difficult since they had him turned on this right side facing the wall. [NA C] was holding his leg and [CNA A] stated they struggled to push the sheets under him and then they turned him on his bed. They were able to get his brief

on and then they were only able to put a draw sheet under him. [CNA A] stated they then positioned him in

the bed so that he could eat breakfast and then they all walked out. [CNA A] stated she remembered that day clearly because [Resident #2] had never been that combative before or hit her like that before.Per [CNA A] via text Review of in-service dated 09/27/2025, with subject Abuse/Neglect/Abuse Prevention coordinator is [ADM] and her cell is [###-###-####]. If not at the facility notify her on her cell for any allegations of abuse/neglect/exploitation. When a resident is combative walk away from the resident and go and get your charge nurse. Sometimes a resident will get care from someone else. Also remember the change in personality is the disease process reflected 36 of the 98 staff members attended the in-service.Review of the facility policy titled Abuse, Neglect, Exploitation or Misappropriation - Reporting and Investigating, dated 2001 and last revised 09/2022, reflected the following: .1. If resident abuse, neglect, exploitation, misappropriation of resident property or injury of unknown source is suspected, the suspicion m

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

11/05/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Avir at Magnolia

1105 N Magnolia Luling, TX 78648

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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

and [CNA A] stated they texted [NA B] to come and help them. When [NA B] came to the room [CNA A] stated [NA B] was holding [Resident #2]'s hands and [NA C] was trying to keep him from kicking [NA B] and herself. [CNA A] and [NA B] switched positions because [NA B] could not turn his upper body. [NA B] stated

she got both hands and held them on his left shoulder with one hand and turned him with the hand[sic?] while [NA B] finished cleaning the BM from his right side which was difficult since they had him turned on

this right side facing the wall. [NA C] was holding his leg and [CNA A] stated they struggled to push the sheets under him and then they turned him on his bed. They were able to get his brief on and then they were only able to put a draw sheet under him. [CNA A] stated they then positioned him in the bed so that he could eat breakfast and then they all walked out. [CNA A] stated she remembered that day clearly because [Resident #2] had never been that combative before or hit her like that before. Per [CNA A] via textDuring phone interview on 10/16/2025 at 01:25 PM, A representative from the local police department stated the police department received a call to service on 10/14/2025 at 01:26 PM from the facility related to a staff member abused a resident but no further information was provided regarding the staff member's name or

the resident's name. She stated the call to service was cancelled on 10/14/2025 at 01:29 PM. She stated that no investigation by the police department was conducted. Review of the facility policy titled Abuse, Neglect, Exploitation or Misappropriation - Reporting and Investigating, dated 2001 and last revised 09/2022, reflected the following: Policy StatementAll reports of resident abuse (including injuries of unknown origin), neglect, exploitation, or theft/misappropriation of resident property are reported to local, state and federal agencies (as required by current regulations) and thoroughly investigated by facility management. Findi

Event ID:

Facility ID:

If continuation sheet