Avir At New Braunfels

During an observation and attempted interview on 12/29/2025 at 03:46 p.m., Resident #1 was observed in his bed asleep.

Portable oxygen tank was in resident room near sink and had no oxygen tubing attached. No noted signage on or around door to room.

During an interview with RNC on 12/30/2025 at 9:55a.m. when asked about the oxygen policy for the facility, the response was I told them (facility staff) last week that it needs to be posted even if not scheduled. RNC also stated that Oxygen should be posted if in room, regardless of scheduled or PRN.

During an interview on 12/31/2025 at 12:21p.m. LVN floor nurse stated when asked how they let people know that oxygen could be in use in a room that there is supposed to be a sign on the door that says that there is oxygen in the room.

When also asked who is responsible for posting the signage floor LVN stated that everybody is responsible for posting or ensuring it is posted.

During an interview on 12/31/2025 at 04:09 p.m. with the RNC and ADMIN, both stated that when oxygen is in a room there should be a sign posted noting this, even if oxygen is not actively in use.

Record review of facility policy, Oxygen Storage, dated as revised November 2022, reflected ?Policy It is the policy of this center to maintain appropriate and safe storage of oxygen.' Policy also states that ?Storage areas will be clearly identified with a no smoking sign posted on door.'

Record review of facility policy.

Oxygen Administration, dated October 2010, reflected the steps in the procedure of administering oxygen as ?Placing an ?Oxygen in Use' sign on the outside of the room entrance door.

455020 12/31/2025

Avir at New Braunfels 821 US Hwy 81 W New Braunfels, TX 78130

The facility failed to post the required current nurse staffing and census information from 12/17/2025 to 12/29/2025.

This failure could place all residents, their families, and facility visitors at risk of not having access to information regarding staffing data and the facility census.

The findings included: During an observation on 12/29/2025 at 03:52 p.m., a document labeled [facility name] Federal Staffing Posting, dated 12/16/2025, was posted on a wall outside the initial nurses' station passed following entry to the facility.

The document included the following information: census and the number and hours worked of registered nurses, licensed vocational nurses, medication aides, and certified nurse aides for day shift, evening shift, and night shift.

During an interview on 12/29/2025 at 03:55 p.m., ADON B revealed the SC was new to her position and she was unsure if the SC had been taught the process of creating and updating the nurse staffing and census posting. ADON B stated the WC Nurse was working with the SC and initially focused on creating the staff schedule. ADON B stated the prior SC left suddenly the prior week, but the nurse staffing and census posting was usually done every morning and posted.

During an interview on 12/30/2025 at 09:55 a.m., the RNC stated the facility did not have a policy on the daily nurse staffing and census posting.

She stated it was a state regulation, and the facility followed state regulations.

During an interview on 12/31/2025 at 09:20 a.m., the WC Nurse revealed the prior SC resigned two weeks prior and she had been assisting the new SC in creating the schedule for the current month.

The WC Nurse stated she had not been involved in posting the nurse staffing and census posting and was unsure on the procedure for the document.

During an interview on 12/31/2025 at 11:12 a.m., the SC revealed she had recently changed positions and became the SC.

She stated the prior employee who was supposed to orient her in the new position did not stay and she was learning the job responsibilities and procedures day by day, which was resulting in some trial and error.

She stated she had just been notified of the procedure for posting the nurse staffing and daily census but had assumed someone else was covering this task.

She stated she was unsure how not having the daily census and nurse staffing information posted daily would have impacted residents or facility guests because she was unsure if the residents or guests knew to look for the posting.

She stated that when residents or guests asked staff about facility staffing, the staff would be capable of informing the resident or facility guest of the facility's standard staffing expectation for each hall and shift.

She stated the staffing schedule was also readily available for staff or facility guests to review.

During an interview on 12/31/2025 at 04:09 p.m. with the RNC and ADMIN, the RNC stated the SC was responsible for posting the daily nurse staffing and census posting.

She stated she was aware that ADON B had provided the SC some training for her new position but was unsure what the training entailed.

The RNC stated the nurse staffing and census posting might possibly have been overlooked.

She did not believe the lack of posting the daily nurse staffing and census would impact anyone because the facility had a staffing book readily available.

The ADMIN stated he believed there was a breakdown in communication and following the posting procedures after the prior SC left. He stated he had never had a resident or facility guest request to view the posting, only surveyors, and therefore did not feel it impacted anything other than meeting the requirement.

455020 12/31/2025

Avir at New Braunfels 821 US Hwy 81 W New Braunfels, TX 78130

Based on observation, interview and record review, the facility failed to store over the counter

room in secure Co-ed unit.

The facility failed to ensure that the medication storage room held no expired medications per state and federal guidelines.

This failure could cause adverse reactions to residents when ingesting expired medications.

The findings included: Observation of 4 expired supplemental shakes within the medication room, each with an expiration date of 09/10/2025.

Observation of the medication storage room in the secured Co-ed unit on 12/30/2025 at 8:51a.m. revealed 4 expired supplemental shakes on the counter, with expiration dates of 09/10/2025.

Interview with CMA on 12/30/2025 at 8:51 surveyor asked CMA where expired liquids, such as medications and supplements, were stored. CMA responded that they are usually taken out of here and stored somewhere else.

Surveyor then asked CMA What expiration date do you see on this supplement? CMA responded It says it expires September of 2025. I will let my nurse know so she can handle it.

During an interview on 12/31/2025 at 12:10p.m. with RN on unit, surveyor asked RN about supplements in the medication room in the secure Co-ed unit. RN stated that the supplements were there because the resident would sometimes not eat.

The dialysis clinic and the primary physician were trying to determine who would write order for resident supplements, so they had an order but it was not filled yet due to this. RN also stated that the medication aides were supposed to pull expired medications.

During interview on 12/31/2025 at 04:09p.m. with RNC and ADMIN, RNC stated that all expired medications, whether over the counter or supplements, were to be pulled form medication rooms and disposed of properly.

455020 12/31/2025

Avir at New Braunfels 821 US Hwy 81 W New Braunfels, TX 78130

The facility failed to ensure all (Cook D, KS C, KS H, KS I, KS J, KS K, KS L, KS M, KS N, KS O) dietary staff maintained their competencies and skills through regular in-service training.

The facility failed to ensure KS C met the requirements for food handling by obtaining a current and valid Food Handler's Certificate.

These failures could place residents at risk of not having their nutritional needs met and foodborne illnesses.The findings included: 1.

During an interview on 12/30/2025 at 08:35 a.m., when asked about providing kitchen staff trainings on completing food temperature logs, food labeling procedures, and sanitation procedures for taking food temperatures, the DDS stated the staff do not get trainings but get a text reminder.

She stated the staff get sent a group text because they know what is to be done.

The DDS did not state how often or what the content of the group text reminders she had provided to the kitchen staff.

During an interview on 12/31/2025 at 01:59 p.m., the RDN revealed she expected the DDS to provide the food service staff with ongoing staff education.

She stated she had told the DDS about concerns she had identified regarding the food temperatures in November 2025.

The RDN stated she felt the kitchen staff needed training and had been told by the DDS that the DDS was providing training.

During an interview on 12/31/2025 at 04:09 p.m., the RNC revealed she could not believe that there was not any documentation of food service staff trainings within the requested timeframe.

She stated the DDS was not available today, 12/31/2025, but there should have been some food service training provided by the DDS and some training provided by the RDN.

During an interview on 12/31/2025 at 04:09 p.m., the ADMIN revealed he could not locate food service staff in-service training documents dated within the requested 3-month period (09/29/2025- 12/29/2025). He revealed the contracted food service company was changed around 2 months ago and he knew the prior company provided training. 2.

Record review of a Certificate of Training Awarded to [KS C] For successfully completing the Food Handler Essentials Course awarded to KS C, dated as issued 11/30/2023, reflected the certificate was valid for 2 years indicating the certificate expired on 11/30/2025.

During an interview on 12/31/2025 at 04:09 p.m., the ADMIN revealed KS C was out of the country and stated the DDS notified him she was sure KS C had retested for a current Food Handler Certification, but they did not have the documentation.

Record review of facility policy.

Food Preparation and Service, dated revised November 2022, did not reflect mention of food service staff training expectations or qualifications.

Record review of facility policy.

Sanitation, dated revised November 2022, did not reflect mention of food service staff training expectations or qualifications.

Record review of TFER accessed on 01/02/2026 at 04:27 p.m. at https://www.dshs.texas.gov/licensing-foodhandler-training-programs, (Licensing of Food Handler Training Programs | Texas DSHS) indicated: Licensing of Food Handler Training ProgramsTexas requires that many food service employees complete an accredited food handler training course within 30 days of getting a job.

These courses train employees on food safety including good hygiene practices, how to avoid cross contamination, and more.

455020 12/31/2025

Avir at New Braunfels 821 US Hwy 81 W New Braunfels, TX 78130

During an interview on

she was unsure if she had lost weight.

She stated she would eat in the dining room per her

temperatures taken off the hot service line in November with all the temperatures within appropriate range.

She stated she had received complaints from residents regarding the puree diet, especially the taste of the food.

She stated the risk of food under the appropriate temperature range was that there was a risk for serving unsafe or contaminated food.

She stated the facility had not reported any indicators for foodborne illnesses.

During an interview on 12/31/2025 at 04:09 p.m. with the RNC and ADMIN, the RNC stated she had not heard any complaints regarding the food temperature.

The ADMIN revealed he believed there was a grievance regarding food temperature from one person for one or two days.

The ADMIN revealed he believed the resident had said that the food was not warm enough or they wanted their food to be warmer.

Record review of facility policy, Food Preparation and Service, dated as revised November 2022, reflected Policy StatementFood and nutrition services employees prepare, distribute and serve food in a manner that complies with safe food handling practices.Policy Interpretation and Implementation1. ?Danger Zone' means temperatures above 31 degrees Fahrenheit (F) and below 135 degrees F that allow the rapid growth of pathogenic microorganisms that can cause foodborne illness.2. ?Potentially Hazardous Food (PHF)' or ?Time/Temperature Control for Safety (TCS) Food' means food that requires time/temperature control for safety to limit the growth of pathogens (i.e., bacterial or viral organisms capable of causing a disease or toxin formation).

Examples of PHF/TCS foods include ground beef, poultry, chicken, seafood (fish or shellfish), cut melon, unpasteurized eggs, milk, yogurt and cottage cheese.Food Preparation, Cooking and Holding Time/Temperatures1.

The danger zone for food temperatures is above 41 [degrees] F and below 135 [degrees] F.

This temperature range promotes the rapid growth of pathogenic microorganisms that cause foodborne illness.3.

The longer foods remain in the ?danger zone' the greater the risk for growth of harmful pathogens.

Therefore, PHF must be maintained at or below 41 [degrees] F or at or above 135 [degrees] F.Food Distribution and Service1.

Proper hot and cold temperatures are maintained during food distribution and service.

Foods that are held in the temperature ?danger zone' are discarded after 4 hours.2.

The temperatures of foods held in steam tables are monitored throughout the meal service by food and nutrition service staff.3. If time is used in place of temperature as a means of ensuring food safety, the amount of time PHF/TCS foods are held out of temperature control is tracked and foods are discarded accordingly.

455020 12/31/2025

Avir at New Braunfels 821 US Hwy 81 W New Braunfels, TX 78130

During an interview on 12/31/2025 at 01:59 p.m., the RDN revealed she had completed kitchen tours in November and December of 2025 and had noted unlabeled and undated items in the refrigerator both times.

She stated she talked to the food service staff, including the dietary manager, and her back-up following her tours and had sent a report regarding her findings to the DDS and the ADMIN.

She stated the impact of foods having not been labeled or dated could be that there was a risk of food contamination.

She stated she had observed blanks in the food temperature logs during her tours and did believe the temperatures had been missed.

She stated she had spoken to the DDS about the log, and it was mentioned in her report to the DDS and the ADMIN.

She stated the risk of not having food temperatures documented was that the residents were at risk for contamination of their food and having been served unsafe food.

She stated the food service staff should not be using the Sani-Cloths for wiping the temperature probe.

She revealed she had not observed the staff doing that but had told them how important it was to follow food sanitation and safety guidelines.

She stated that there were certain things that they should not deviate from, and Sani-Cloths were not food grade, and therefore could be contaminated, thus contaminating the residents' food.

She stated the Sani-Cloths were not made to be in contact with food.

During an interview on 12/31/2025 at 04:09 p.m. with the RNC and ADMIN, the RNC stated the impact of foods having not been labeled and dated was that the food could be spoiled and could result in foodborne illnesses if consumed.

She stated she was unable to answer how using the Sani-Cloth could impact residents.

The RNC and ADMIN both stated they had not had any notifications of foodborne illnesses and had not received a report from the RDN.

Record review of facility policy, Food Preparation and Service, dated as revised November 2022, reflected Policy StatementFood and nutrition services employees prepare, distribute and serve food in a manner that complies with safe food handling practices.Policy Interpretation and Implementation .General Guidelines .2.

Cross-contamination can occur when harmful substances, i.e. chemical or disease-causing microorganisms are transferred to food by hands (including gloved hands), food contact surfaces, sponges, cloth towels, or utensils that are not adequately cleaned.4.

When verifying food temperatures, staff use a thermometer which is both clean, sanitized, and calibrated to ensure accuracy.Food Distribution and Service .2.

The temperatures of foods held in steam tables are monitored throughout the meal service by food and nutrition service staff.3. If time is used in place of temperature as a means of ensuring food safety, the amount of time PHF/TCS foods are held out of temperature control is tracked and foods are discarded accordingly.

Review of the FDA Food Code 2022 https://www.fda.gov/food/retail-food-protection/fda-food-code accessed 01/02/2026 revealed: 3-602.11 Food Labels. (A) FOOD PACKAGED in a FOOD ESTABLISHMENT, shall be labeled as specified in LAW, including 21 CFR 101 - Food labeling, and 9 CFR 317 Labeling, marking devices, and containers.(B) Label information shall include:(1) The common name of the FOOD, or absent a common name, an adequately descriptive identity statement;(2) If made from two or more ingredients, a list of ingredients and sub-ingredients in descending order of predominance by weight, including a declaration of artificial colors, artificial flavors and chemical preservatives, if contained in the FOOD.(3) An accurate declaration of the net quantity of contents;(4) The name and place of business of the manufacturer, [NAME], or distributor; and(5) The name of the FOOD source for each MAJOR FOOD ALLERGEN contained in the FOOD unless the FOOD source is already part of the common or usual name of the respective ingredient. (6) Except as exempted in the Federal Food, Drug, and Cosmetic Act S 403(q)(3) - (5), nutrition labeling as specified in 21 CFR 101 - Food Labeling and 9 CFR 317 Subpart B Nutrition Labeling.