Avir at Emerald Hills

In the surveyor’s words

From the most serious findings on record at Avir at Emerald Hills, in the surveyor’s own words.

• Immediate jeopardy, isolatedF607Jun 26, 2025

  Based on observation, interview, and record review, the facility failed to develop and implement written policies and procedures that prohibited and prevented abuse, neglect, and exploitation of residents and misappropriation of resident property for one of one resident (Resident #1) reviewed for abuse, neglect, and exploitation. The facility failed to implement their policies and procedures to ensure Resident #1 was free from neglect when the facility failed to have effective interventions and services in place to address the resident's care, which resulted in Resident #1 sustaining injuries of ICH (intracerebral hemorrhage (type of stroke bleeding on the brain tissue due to a ruptured blood vessel), and a closed displaced intertrochanteric fracture of left femur with routine healing… […]

• Immediate jeopardy, isolatedF689Jun 26, 2025

  Based on observation, interview, and record review, the facility failed to ensure the residents received adequate supervision and assistive devices to prevent accidents for 1 resident of 8 residents (Resident #1) reviewed for assistive devices and supervision. The facility failed to ensure Resident #1 received adequate supervision and care in accordance with professional standards when the resident was left attended on the toilet resulting in her falling and sustaining fractures to the Femur and left Hip. […]

• Actual harm, isolatedF777Apr 22, 2026

  Based on observation, interview, and record review the facility failed to promptly notify the ordering physician of results that fall outside of clinical reference ranges in accordance with facility policies and procedures for 1 of 3 residents (Resident #1) reviewed diagnostic services. LVN A failed to ensure x-ray results for Resident #1's swollen left wrist was reported to the physician when they were available in the lab portal at 11:00 PM on 04/07/26. The facility did not check the lab portal for Resident #1's x-ray results until the morning of 04/08/26 around 6AM when LVN B arrived to work, and the x-ray report revealed Resident #1 had a fractured left wrist, which had resulted from a fall. […]

• Actual harm, isolatedF684Sep 1, 2022

  Based on observation, interview and record review, the facility failed to provide treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the residents' choices for one (Residents #1) of three residents reviewed for wound care treatment. The facility failed to maintain Resident #1's skin integrity, while removing a bordered dressing, during wound treatment which resulted in the resident sustaining a skin tear that measured 9 cm x 4 cm. This failure could place residents at risk for diminished quality of care and skin injuries. Findings included Review of Resident #1's admission MDS assessment dated [DATE] reflected the resident was a [AGE] year-old female admitted to the facility on [DATE]. […]

• No harm, potential for more than minimal, widespreadF727Jun 18, 2026

  Based on interview and record review, the facility failed to ensure a Registered Nurse was on duty in the facility for a minimum of eight consecutive hours a day, seven days a week, for 1 of 4 quarters, (Quarter 1), reviewed for RN coverage. 1. The facility failed to have 8 consecutive hours of RN coverage for 7 of 31 days in October 2025.2. The facility failed to have 8 consecutive hours of RN coverage for 1 of 30 days in November 2025.This failure could affect the residents by placing them at risk for not having their nursing and medical needs met and receiving improper care.Findings included:Record review of the CMS PBJ Staffing Data Report revealed no RN hours for the following dates: 10/02/25, 10/05/25, 10/18/25, 10/19/25, 10/20/25 and 10/21/25.Record review of an excel file, undated,… […]