Avir At Overton

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

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

[Resident #2] being arrested. ([Resident #2] will not be returning.Care Plan reviewed and updated.In-services planned: AN&E, Managing residents with Behaviors, and de-escalation tactics, Supervision.Review of in-service titled Secure Unit Staffing Plan conducted on 7/17/25 was attended by all staff and indicated Both male and female secure unit will be staff with two staff members and the charge nurse/designee will cover staff member on the unit breaks.Review of in-service titled Abuse and Neglect, Res to Res Altercation, De-escalation, COC (Reporting) conducted on 7/17/25 was attended by all staff.Skin assessments were completed on all residents residing on men's secure hall who were unable to be interviewed. Review of monitoring document dated 7/19/25 - 8/12/25 titled 5 staff members to be interviewed over abuse policy and education provided indicated ongoing staff interviews were being conducted weekly. Review of monitoring document dated 7/24/25 - 8/12/25 titled Staffing Reviews indicated ongoing staff reviews were being conducted daily. Review of monitoring document dated 7/18/25 - 8/12/25 titled 5 staff members to be interviewed over abuse policy and education provided indicated ongoing staff interviews were being conducted. Record review of a psychiatric visit summary dated 7/18/25 indicated Resident #1's was evaluated by psychiatric services following the resident-to-resident altercation. Record

review of document Identification of residents with prior incidents. Review with MD and psych provider.

Indicated residents residing on secured men's halls with similar behaviors were reviewed for placement on 7/18/25. Record review of facility staffing assignment sheets revealed two staff members were assigned to both men's and women's secured units. Observations at various times throughout the investigation revealed two staff members were always on both men's and women's secured units. During staff interviews on multiple shifts at various times and of varying disciplines throughout the investigation indicated all Staff interviewed 5 LVNs (LVN B, LVN J, LVN K, LVN L, LVN O), 4 CNAs (CNA C, CNA E, CNA H, CNA M), 1 Sitter (Sitter D), 1 LCSW, 1 ADON, 1 DA, 1 DON. said they received in-service training following Resident #1's resident-to-resident altercation which included resident-to-resident altercations, managing aggressive resident behaviors, and protecting residents from harm. All staff said they were trained in resident-to-resident altercations and dealing with aggressive resident behaviors. All staff said they were trained to separate residents and to use de-escalation techniques including physical and verbal redirection.

All staff verbalized to report any instances of abuse to the facility administrator who is the abuse coordinator. All staff members interviewed said the secure units were to be staffed with two staff members at all times and staff must be relieved before going on break or leaving the unit.

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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

08/13/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Avir at Overton

1110 Hwy 135 S Overton, TX 75684

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

instructed staff to make sure exit doors were closed when exiting the facility and do not block exit doors.Review of document titled Door Alarms Records indicated daily checks were performed on all door locks and alarms from 8/5/25 to 8/9/25.Review of electronic logbook report indicated daily checks were performed on all door locks and alarms on 8/11/25 and 8/12/25.Interviews with staff of various disciplines and shifts were conducted during the investigation and were all able to verbalize signs of exit seeking behavior and appropriate interventions. All staff were able to verbalize appropriate action to take in the event of a missing resident. Staff interviews included 5 LVNs (LVN B, LVN J, LVN K, LVN L, LVN O), 4 CNAs (CNA C, CNA E, CNA H, CNA M), 1 Sitter (Sitter D), 1 LCSW, 1 ADON, 1 DA, 1 DON.

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If continuation sheet