Avir At Schertz

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

with the ADON, when asked what is the resident privacy policy and how is it implemented, the ADON stated the right to their privacy, curtains for care, knock on the door and close their door.During an interview

on 09/17/2025 at 12:10 p.m., with the DON, when asked what is the resident privacy policy and how is it implemented, the DON stated the right to privacy, so staff knock on their (residents) door, pull the curtain if

they are going to work with them, make sure their rights aren't violated.During an interview on 09/17/2025 at 12:35 p.m., with the ADM, when asked what is the resident privacy policy and how is it implemented, the ADMIN stated all resident personal info is kept private, residents are covered, curtains were closed, knock

on the door and announce themselves Record review of the facility's policy titled Residents Rights, revealed

the following:1.Federal and state laws guarantee certain basic rights to all residents of this facility. These rights include the residents right to: a. a dignified existence b. be treated with respect, kindness, and dignity; . t. privacy and confidentiality.

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

09/17/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Avir at Schertz

3301 Fm 3009 Schertz, TX 78154

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 0695

Provide safe and appropriate respiratory care for a resident when needed.

Level of Harm - Minimal harm or potential for actual harm

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

observation, interview and record review the facility failed to ensure that a resident who needs respiratory care, was provided such care, consistent with professional standards of practice, the comprehensive person-centered care plan, the residents' goals and preferences, for one of one resident (Resident #6), in

the facility reviewed for respiratory care, in that: The facility failed to ensure Resident #6's oxygen tubing was connected to the oxygen machine (on and running). This failure placed residents at risks of decreased oxygen levels, respiratory distress, falls, a decrease in the ability to perform daily tasks, and hospitalization.The findings included: Record review of Resident #6's admission Record dated 09/15/2025 reflected a [AGE] year-old male originally admitted to the facility on [DATE REDACTED] with a current admission date of 04/21/2025. Record review of Resident #6's admission Record dated 09/15/5025 under the Diagnosis Information section revealed an admission diagnosis of chronic obstructive pulmonary disease (a group of lung diseases that cause ongoing damage to the airways and air sacs in the lungs, making it difficult to breathe), and other diagnoses including coronary artery disease. Record review of Resident #6's MDS dated [DATE REDACTED] reflected a BIMS score of 12 out of 15, which suggested a moderate cognitive impairment (some difficulty making decisions about care and things that affected daily life). Further review reflected Resident #6 required oxygen therapy while in the facility and had chronic obstructive pulmonary disease.

Record review of Resident #6's Comprehensive Care Plan provided on 09/15/2025 revealed no documented focus area for chronic obstructive pulmonary disease. Further review reflected a focus area for

the following: The resident has coronary artery disease (CAD), initiated on 09/11/2025, with interventions including OXYGEN SETTINGS: O2 via (nasal prongs) @ 2-4L (every shift). During an observation in Resident #6's room on 09/10/2025 at 4:00 p.m., revealed Resident #6 wore an oxygen nasal cannula (2-pronged device to deliver oxygen directly into the nose) in his nose. The connection point (opposite from nasal prongs) of the oxygen cannula tubing was not connected to the oxygen machine/humidifier. The oxygen machine was on, running, and set to deliver two liters per minute of oxygen through tubing. During

an interview on 09/10/2025 at 4:02 p.m. Resident #6 stated he wore oxygen with the nasal cannula all the time because if he did not, he could get short of breath. When asked if his oxygen was on and running, Resident #6 stated yes, the oxygen was running through the tubing/prongs in his nose, but he did not feel short of breath at that time. During an interview on 09/10/2025 at 4:10 p.m., with RN A, Resident #6's charge nurse at that time, when asked what she saw when she looked at Resident #6's portable O2 tank's tubing, RN A stated that the resident's O2 tubing was in his nose but not connected to the oxygen machine.

When asked the risks of a resident not being properly connected to an oxygen machine were RN A said, . could cause shortness of breath . woozy, dizzy. doesn't get enough air to the brain, he can get weird. When asked who was responsible for making sure oxygen tubing was set-up properly and the tubing was connected to the machine, RN A stated, the charge nurse on duty. Requested the facility's/a facility respiratory care policy from the Administrator on 09/10/2025 at 4:12 p.m., the policy was not provided

before the survey exit on 09/17/2025.

Residents Affected - Few

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

09/17/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Avir at Schertz

3301 Fm 3009 Schertz, TX 78154

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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

and behind the oxygen tank. The tubing/ nasal cannula was not in a bag or other covering and was open to air.

During an interview on 09/10/2025 at 4:02 p.m. Resident #6 stated he wore oxygen with the nasal cannula all the time because if he did not, he could get short of breath. When asked if his oxygen on and running, Resident #6 believed the oxygen tubing was connected to the machine. He stated he used the portable oxygen daily when he left his room.

During an interview with RN A on 09/10/2025 at 4:10 p.m., when asked what she saw when she looked at Resident #6's portable O2 tank's tubing, RN A stated the O2 tank had tubing that was on the floor, and the tubing should have been in a bag for infection control reasons. RN A stated the O2 tubing Resident #6 had

in his nose was not connected to the oxygen machine and was on the floor. When asked why the portable O2 tank tubing should have been in a bag, RN A stated to prevent bacteria from getting into line.

During an observation and interview on 09/10/2025 at 4:10 p.m., RN A took and replaced Resident #6's oxygen machine and portable oxygen tank tubing. When asked why, RN A said, “Because they were contaminated and, on the floor, and anything that touched the floor needs to be replaced.”.

During an interview on 09/17/2025 at 12:10 p.m. with the DON, when asked how oxygen tubing should be stored, the DON stated “Special bags for it, with a string hang over the concentrator [oxygen machine] above the floor, on the bed. Always in a bag when not in use.” When asked, what were the concerns with oxygen tubing being on the floor or other soiled surfaces, the DON stated, “Throw it away and replace, concern would be that it be on the floor again, solution so it doesn't go to the floor again.”.

Record review of the facility's policy titled “Standard Precautions,” revised in September 2022

the following: “5. Resident-Care Equipment a. Resident-care equipment soiled with blood, body fluids, secretions, and excretions are handled in a manner that prevents skin and mucous membrane exposure. contamination of clothing, and transfer of microorganisms to other residents and environments. b. Reusable equipment is not used for the care of more than one resident until it has been appropriately cleaned and reprocessed. c. Single use items are properly discarded.”. 2 & 3. (Residents #3 and #8)

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

Event ID:

Facility ID:

If continuation sheet