Avir At Overton

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

During an observation and interview on 10/20/25 at 10:50 a.m., Resident #1 was observed in the dining room, sitting at a table with other residents. There were no visible marks, bruises, or skin tears. Resident #1 appeared to show no signs of fear while interacting with other residents. Resident #1 said he could not remember the altercation with Resident #2. Resident #1 said he felt safe in the facility, and he had no pain.

During an interview on 10/20/25 at 11:00 a.m., the Hospitality Aide said Resident #2 had exhibited verbal behaviors which included yelling and cursing at other residents. She said she had not seen Resident #2 exhibit any physical behaviors. She said she had received training on resident-to-resident altercations and would separate the residents to ensure safety and then report the incident to the ADM. During an interview

on 10/20/25 at 12:15 p.m., RN A said CNA B reported that Resident #2 had stomped or kicked Resident #1's foot. RN A said she conducted a head-to-toe assessment of Resident #1 and noted a light bruise on

the side of his right foot. RN A said Resident #1 denied pain and showed no signs of behavioral changes post-incident. RN A said staff are expected to intervene in resident-to-resident altercations, separate residents, and notify the ADM of the incident. During an interview on 10/22/25 at 12:55 p.m., the DON said Resident #2 was having difficulty adjusting to the facility and he was receiving psychiatric services, and his medications had recently been adjusted to address the behaviors. The DON said all staff received training

on abuse and neglect and resident-to-resident altercations. The DON said additional abuse and neglect in-service training for all staff was being conducted that began on 10/20/25. During an interview on 10/22/25 at 1:10 p.m., the ADM said Resident #2 was placed on 1-to-1 observation after the incident. The ADM said Resident #2 was receiving psychiatric services and was seen by a provider on 10/20/25 who determined he was safely placed on the secure men's unit and discontinued 1-to-1 observation. The ADM said they were seeking a referral to a behavioral health facility for Resident #2 and would re-evaluate his placement on the secured unit pending provider recommendations. The ADM said all staff would be receiving additional training in abuse and neglect including resident-to-resident altercations. A facility policy titled Abuse, Neglect, and Exploitation last revised 10/2023 indicated .The facility will develop and implement written policies and procedures that.Prohibit and prevent abuse, neglect, and exploitation of residents.

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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

11/24/2025

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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

During an interview on 10/20/25 at 11:00 a.m., the Hospitality Aide said Resident #2 had exhibited verbal behaviors which included yelling and cursing at other residents. She said she had not seen Resident #2 exhibit any physical behaviors. She said she had received training on abuse and would report any witnessed or suspected abuse to the nurse and the ADM immediately. During an interview on 10/20/25 at 12:15 p.m., RN A said CNA B reported that Resident #2 had stomped or kicked Resident #1's foot. RN A said she conducted a head-to-toe assessment of Resident #1 and noted a light bruise on the side of his right foot. RN A said she notified Resident #1's provider and family members but did not notify the ADM of

the incident. RN A said she had not received training on abuse when she was hired and did not know she was supposed to notify the ADM. During an interview on 10/22/25 at 12:55 p.m., the DON said Resident #2 was having difficulty adjusting to the facility and he was receiving psychiatric services, and his medications had recently been adjusted to address the behaviors. The DON said no staff reported any other instances of suspected abuse to her concerning Resident #2. The DON said all staff received training on abuse and neglect and reporting immediately any alleged or suspected abuse. The DON said additional abuse and neglect in-service training for all staff was being conducted that began on 10/20/25. During an interview on 10/22/25 at 1:10 p.m., the ADM said she was first notified on 10/20/25 at 9:00 a.m. that Resident #2 stomped on Resident #1's foot on 10/19/25 in the evening at an unknown time. The ADM said she reported

the incident to the state upon learning of the incident. The ADM said she had not been notified of any other incidents involving Resident #2. The ADM said Resident #2 was receiving psychiatric services and had been seen by a provider on 10/20/25 who determined he was safely placed on the secure men's unit. The ADM said they were seeking a referral to a behavioral health facility for Resident #2 and would re-evaluate his placement on the secured unit pending provider recommendations. The ADM said all staff would be receiving additional training in abuse and neglect and reporting requirements. Review of a training record dated 9/29/25 indicated RN A received all required training including abuse and neglect training. Review of Abuse, Neglect, and Exploitation Statement dated 10/9/25 indicated .Residents of the facility shall not be subject to abuse. RN A signed the form on 10/9/25. Review of staff personnel files (Medication Aide, ADON, LVN, RN A)_revealed required abuse training had been completed by 4 of 4 staff members reviewed. A facility policy titled Abuse, Neglect, Exploitation or Misappropriation - Reporting and Investigating last revised September 2022 indicated .If Resident abuse, neglect, misappropriation of resident property or injury of unknown source is suspected, the suspicion must be reported immediately to the administrator and to other officials according to state law and HHSC reporting guidelines.

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