Avir At Cowhorn Creek

F 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

care of the resident, she had not asked her to get out of bed. She said she had gotten her up to go shower

on some days. She said the morning of 08/13/25 the resident did not ask to get up and she did not offer to get the resident up. She said she did not offer because the resident usually did not want to get up. During

an interview on 08/13/25 at 2:52 p.m., LVN C said Resident #2 was usually gotten up three days a week.

She said it was the CNAs responsibility to get the residents out of bed. She said Resident #2 did not refuse to get up very often. She said the CNAs were supposed to report to the nurses anytime a resident refused to get up. She said she did not know why CNA G did not offer to get Resident #2 up this morning, 08/13/25.

She said residents need to get up out of the bed and off their bottoms. She said it also helped their spirits to get up.During an interview on 08/13/25 at 3:14 p.m., the DON said Resident #2 was gotten up out of bed every day. She said they got her up out of bed if she wanted to get up. She said Resident #2 did not like to get up. She said Resident #2 should have been gotten up daily if that was her preference. She said she would expect staff to get her up and offer to get her up daily. She said staff should never tell her they do not have time to get her up. She said residents not being gotten up out of bed could hurt their feelings.During

an interview on 08/13/225 at 3:51 p.m., the Administrator said she would have expected for Resident #2 to have been gotten out of bed if she wanted to get out of bed. She said she expected staff to offer every day, and the resident then had the right to refuse. She said she saw Resident #2 up out of bed most days. She said a resident had the right to get up if they requested to get up. Record review of a Resident Rights facility policy last revised in February 2021 indicated, .Federal and state laws guarantee certain basic rights to all residents of this facility. These rights include the resident's right to.self-determination.be supported by the facility in exercising his or her rights .

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

08/15/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Avir at Cowhorn Creek

5524 Cowhorn Creek Texarkana, TX 75503

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 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

April 2017 reflected . Residents and their representatives have the right to file grievances, either orally or in writing, to the facility staff or agency designated to hear grievances . the Administrator and staff will make prompt efforts to resolve grievances to the satisfaction of the resident and/or representative . 1. Any resident . may file a grievance or complaint concerning care, treatment, behavior of other residents, staff members, . care that has not been furnished . 3. All grievances, complaints or recommendations stemming from resident . concerning issues of resident care in the facility would be considered . actions on such issues would be responded to in writing, including a rationale for the response . 8. Upon receipt of a grievance and/or complaint, the grievance officer would review and investigate the allegations and submit a written report of such findings to the Administrator within five working days of receiving the grievance and/or complaint . 10. The grievance officer, Administrator and staff would take immediate action to prevent further potential violations of resident rights while the alleged violation was being investigated . 11. The Administrator would review the findings with grievance officer to determine what corrective actions, if any, need to be taken . 12. The resident, or person filing the grievance and/or complaint on behalf of the resident, would be informed (verbally and in writing) of the findings of the investigation and the actions that would be taken to correct any identified problems . 14. The results of all grievances files, investigated and reported would be maintained on file for a minimum of three years from the issuance of the grievance decision .

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

08/15/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Avir at Cowhorn Creek

5524 Cowhorn Creek Texarkana, TX 75503

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

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

way. CNA J said it would affect Resident #1's quality of life if she was unable to communicate her needs.

CNA J said not being allowed time to communicate needs, providing care without telling the resident what you were going to do, not speaking to the resident during care, would make the resident feel less of a human, and if not able to communicate then you would not get anywhere. CNA J said she had not received any training related to caring for a resident with ALS, just what she had learned working with Resident #1.

CNA J said she had not had any in-services related to caring for Resident #1. CNA J denied ever telling Resident #1 to stop crying that they were not running a daycare center. During an interview on 8/13/25 at 12:52 PM, CNA G said she had worked at the facility for about 2 months on the 6 AM-2 PM shift. CNA G said they had 7-8 residents on the 400 hall that required 2-person assistance. CNA G said she felt she was able to meet the needs of the residents sometimes. CNA G said if she had Resident #1 then it was hard to care for the other residents when Resident #1 took 2-2.5 hours to feed twice on her shift sometimes. CNA G said usually no one provided care to her other residents when she was feeding Resident #1, and then

she had to come out when she was done feeding Resident #1 and work hard to get her other residents' care completed before the end of her shift. CNA G said one of her other residents pushed their call light while she was feeding Resident #1, then someone may go check them, but usually no one checked on her other residents until she was able to go back when she was done. CNA G said she would feel tortured or abused if staff just walked in and started providing care without speaking. CNA G said she would feel exposed if left on a bed pan fully exposed with the window blinds open to the street. CNA G said it would be

a dignity issue. CNA G said if staff did not allow Resident #1 time

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

08/15/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Avir at Cowhorn Creek

5524 Cowhorn Creek Texarkana, TX 75503

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 0675 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some

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

said if staff moved Resident #1's communication device out of her reach and did not give her time to communicate, then how was Resident #1 supposed to let her needs known if unable to communicate needs and it would make her angry. CNA J said she would be mad if her momma was done that way. CNA J said it would affect Resident #1's quality of life if she was unable to communicate her needs. CNA J said not being allowed time to communicate needs, providing care without telling the resident what you were going to do, not speaking to the resident during care, would make the resident feel less of a human, and if not able to communicate then you would not get anywhere. CNA J said she had not received any training related to caring for a resident with ALS, just what she had learned working with Resident #1. CNA J said she had not had any in-services related to caring for Resident #1. CNA J denied ever telling Resident #1 to stop crying that they were not running a daycare center. During an interview on 8/13/25 at 12:52 PM, CNA G said she had worked at the facility for about 2 months on the 6 AM-2 PM shift. CNA G said they had 7-8 residents on

the 400 hall that required 2-person assistance. CNA G said she felt she was able to meet the needs of the residents sometimes. CNA G said if she had Resident #1 then it was hard to care for the other residents when Resident #1 took 2-2.5 hours to feed twice on her shift sometimes. CNA G said usually no one provided care to her other residents when she was feeding Resident #1, and then she had to come out when she was done feeding Resident #1 and work hard to get her other residents' care completed before

the end of her shift. CNA G said one of her other residents pushed their call light while she was feeding Resident #1, then someone may go check them, but usually no one checked on her other residents until

she was able

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

08/15/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Avir at Cowhorn Creek

5524 Cowhorn Creek Texarkana, TX 75503

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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

She said Resident #2 has been being bathed on day shift for a while. She said residents not getting their bath could cause them to not be clean and make them smell. She said it could cause dignity issues.During

an interview on 08/13/25 at 3:51 p.m., the Administrator said nursing staff were responsible for bathing the residents. She said the aides then documented the bath in the ADL charting in the resident's electronic medical record. She said she would have expected for baths to be given to Resident #2 as scheduled and then to have been documented. She said any refusals should also be charted in their medical records. She said residents not receiving a bath could make a resident feel less confident and would depend on how many days that were missed.Record review of an Activities of Daily Living (ADL) facility policy dated 2001 indicated, .Residents will be provided with care, treatment and services as appropriate to maintain or improve their ability to carry out activities of daily living.Resident who are unable to carry out activities of daily living independently will receive the services necessary to maintain good nutrition, grooming and personal and oral hygiene.Unavoidable decline may occur if he or she.refuses care and treatment to restore or maintain functional abilities.the refusal and information are documented in the resident's clinical record .

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

08/15/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Avir at Cowhorn Creek

5524 Cowhorn Creek Texarkana, TX 75503

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 0806 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

08/13/25. She said she had an email saying she was having trouble eating her meats. She said the kitchen would be responsible for cutting up her meats or even the aides. She said if the Dietary Manager told nursing, they should have downgraded her diet to chopped meats or cut it up for her until she was screened. She said cutting up the meat would be a nursing decision.During an interview on 08/13/25 at 10:25 a.m., the Dietary Manager said on 08/04/25 he went in Resident 2's room to talk to her about food preferences. He said the resident told him she was having difficulty chewing her meats. He said she never said she was having difficulty swallowing, only chewing. He said he notified therapy because they would have to do an evaluation. He said he probably should have let the DON know also. He said if the order had been changed, it would have been the dietary staff's responsibility to chop up her meats. He said he was not going to make the changes until he had an order. He said if therapy had deemed it necessary to change

the dietary order to chopped meats, then dietary staff would be chopping her meats. He said if her order was for a regular diet at this time then she was being served a regular diet. He said he was not sure if the aides were assisting the resident with cutting up her meats. During an interview on 08/13/25 at 11:27 a.m., CNA G said she has carried meal trays to Resident #2. She said the resident had never complained to her about having difficulty chewing her meat. She said she had not been cutting up meat for Resident #2. She said the resident ate just fine to her.During an interview on 08/13/25 at 11:36 a.m., LVN C said Resident #2 had never complained to her about having difficulty chewing and had not had any difficulty swallowing. She said today (08/13/25) was the first time she had heard that Resident #2 wanted her meat chopped for her.

She said Resident #2's family had brought her fried chicken and other meats.During an interview on 08/13/25 at 1:06 p.m., a family member said Resident #2 needed chopped meats. They family member said

they could observe on camera that her meats were not being chopped. The family member said Resident #2 was physically unable to chop her own meat because she was paralyzed on the left side. During an

interview on 08/13/25 at 1:16 p.m., Resident #2 said she did not remember talking to the Dietary Manager about chopping her meats. She said she could not cut her own meat because of her left arm. She said she had difficulty chewing meat. She said it would help her if staff would chop her meats. During an interview on 08/12/25 at 11:05 a.m., the DON said this was the first she had heard of Resident #2 requesting for her meats to be chopped for her. She said if nursing had been notified, they would have chopped her meats for her. She said she expected dietary staff or the aides to chop the meats for her. She said Resident #2's meat not being chopped might cause her to not be able to eat it. During an interview on 08/13/25 at 3:51 p.m.,

the Administrator said she felt nursing staff were responsible for cutting up the meat for Resident #2. She said when they set up a tray sometimes, they do cut up the meat. She said staff told her that sometimes Resident #2 preferred for her meat to be left whole. She said she felt dietary staff should chop the meat if there was an order for the meat to be chopped. She said she did not feel like it was fair for her to be cited since Resident #2's preferences change meal by meal.Record review of an Accommodation of Needs facility policy dated March 2021 indicated, .The resident's individual needs and preferences are accommodated to the extent possible, except when the health and safety of the individual or other resident would be endangered .

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

08/15/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Avir at Cowhorn Creek

5524 Cowhorn Creek Texarkana, TX 75503

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 0838 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

Conduct and document a facility-wide assessment to determine what resources are necessary to care for residents competently during both day-to-day operations (including nights and weekends) and emergencies. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record review, the facility failed to ensure the facility assessment was reviewed and updated as necessary, and at least annually, to include the resident population, diseases, conditions, physical and behavioral health needs, cognitive status, acuity of the resident population, and other pertinent information for 1 of 1 facility.The facility failed to include Resident #1's diagnosis of Amyotrophic Lateral Sclerosis (ALS) (a nervous system disease that causes muscle weakness and paralysis (unable to move) and impacts physical function, ability to talk and breathe).These failures could affect residents by not having the necessary resources to ensure appropriate care was provided. Findings included:Record review of the facility assessment dated [DATE REDACTED] did not address Amyotrophic Lateral Sclerosis (ALS).Record review of Resident #1's face sheet dated 8/12/25 indicated she was [AGE] years old and was admitted to the facility

on [DATE REDACTED]. Resident #1 had diagnoses which included ALS, muscle weakness, lack of coordination, anxiety (feeling of worry, dread, and uneasiness), speech disturbances, dyspnea (difficulty breathing), pain and hypertension (high blood pressure).Record review of Resident #1's quarterly MDS assessment dated [DATE REDACTED] indicated Resident #1 was sometimes understood but was able understand others. The MDS indicated Resident #1 did not complete the BIMS because she was rarely/never understood). The MDS indicated Resident #1 had verbal behavioral symptoms directed toward others 1-3 days and rejected care daily. Resident #1 had impairment to upper and lower extremities. Resident #1 was dependent on staff for all ADLs. Resident #1 was occasionally incontinent of urine and frequently incontinent of bowel. The MDS indicated ALS was Resident #1's primary diagnosis. Resident #1 had shortness of breath or trouble breathing when lying flat. Resident #1 had loss of liquids/solids from mouth when eating or drinking and had coughing or choking during meals or when swallowing medications. Record review of Resident #1's Care Plan indicated she had a diagnosis of ALS and used a communication device to communicate her needs and would also make gestures with her head and able to say some words with interventions including: allowing resident time to use the communication device to communicate needs; if unable to understand resident when she was speaking then ask her to use her communication device; make sure communication device was in place before and after care needs; make sure resident was positioned properly in bed, with the use of pillows if needed to ensure that she can eat, use her device, breathe easily, and be comfortable; make sure the dot that helps her operate her communication device was in place; offer emotional support as needed; and staff to speak calm, clearly, and slowly. Requested a policy on Facility Assessment on 8/14/25 at 8:58 AM.On 8/14/25 at 10:00 AM, the ADM said they did not have a policy related to the Facility Assessment.During an interview on 8/15/2024 at 4:09 PM, the ADM stated she was responsible for completing and updating the facility assessment. The ADM said they update their facility assessment at least every year. The ADM said the purpose of the facility assessment was to give a summary of the types of residents they cared for and to stay in compliance. The ADM said they staff based

on caring for all the residents and did not base their staffing on what was in the facility assessment. The ADM said the facility assessment captured most of the disease processes of the population, but all the diagnoses were not captured on the facility assessment, because there would be thousands of diagnoses.

The ADM said the facility assessment being updated did not affect the care of the residents.

Event ID:

Facility ID:

If continuation sheet