Average — CMS composite of the measures below.
Past the typical resurvey interval — a standard survey could occur at any time
Estimate from public CMS data, current as of July 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Avir At North Richland Hills during CMS and state inspections, most recent first.
A resident with dementia and impaired cognition complained of left wrist pain and swelling after a reported fall, leading an LVN to obtain an x-ray order and document the pending result on the 24-hour report. The x-ray, completed later that day, showed acute distal radial and ulnar fractures with displacement and was available in the lab portal late that night, but the night-shift LVN did not check or pull the results or notify the practitioner, despite facility policy requiring prompt review and communication of diagnostic findings and immediate reporting of critical values. The abnormal results were only discovered by another LVN the following morning when the lab portal was checked, confirming the fracture and revealing a delay in communicating significant diagnostic findings.
A resident with pneumonitis requiring continuous O2 via nasal cannula did not have a clearly documented admission order for oxygen therapy on the TAR, and her oxygen tubing and related equipment were not changed or dated according to facility practice. The resident reported the nasal cannula had not been changed since admission, and observation confirmed undated tubing in use on a portable tank. An LVN acknowledged there was initially no oxygen order on file, that the resident was on continuous O2, and that he had not changed the tubing, despite understanding it should be changed and dated weekly. The ADON and Administrator stated that nurses were expected to check, change, and date oxygen equipment routinely, but the facility’s written policy addressed only oxygen storage and did not cover care, maintenance, labeling, or dating of oxygen tubing.
A medication aide left a cup containing nine prescribed medications and supplements unattended in a resident's room during morning medication administration, without supervising the resident to ensure the medications were taken as ordered. The resident, who had multiple complex medical conditions and had not been assessed for self-administration, was eating breakfast at the time. Facility policy and staff interviews confirmed that medications should not be left unattended in resident rooms.
A nurse failed to administer a scheduled dose of Keppra to a resident with epilepsy and instead gave lactulose, then incorrectly documented the administration. The error was discovered after reviewing the MAR, and interviews confirmed that the nurse did not follow the required medication administration verification process.
A medication aide used a reusable blood pressure cuff on two residents without sanitizing it between uses, contrary to facility policy and standard infection control practices. Multiple staff, including ADONs and the DON, confirmed that equipment should be disinfected between residents to prevent cross-contamination. The residents involved had conditions increasing their susceptibility to infection.
A resident with cognitive impairment and a history of falls was left unsupervised on the toilet by a CNA who was unfamiliar with the resident's needs and unable to communicate effectively. The resident, unable to use the call light and without access to her communication board, fell and sustained serious injuries including a hip fracture and intracerebral hemorrhage. The facility failed to ensure staff followed care plan interventions and did not promptly investigate or report the incident, resulting in a deficiency related to neglect prevention.
A resident with cognitive impairment, a history of falls, and total dependence on staff for ADLs was left unsupervised on the toilet by a CNA who did not speak the resident's primary language. The care plan required supervision and use of a communication board, but the board was missing and staff were not using it. The resident, unable to use the call light, fell and sustained fractures, a brain bleed, and skin tears. Staff interviews revealed confusion about monitoring responsibilities and a lack of familiarity with the resident's needs, contributing to the incident.
Staff did not ensure a safe and clean environment for a resident with multiple health conditions, as evidenced by an improperly positioned mattress, unmade bed, used gloves and cups left in the bathroom, dirty clothing on a shower chair, and uncovered briefs near the shower. Staff interviews confirmed lapses in routine room checks and immediate disposal of soiled items, despite facility policies requiring regular environmental rounds and sanitation.
A resident with cognitive impairment and a history of falls was left unattended in the bathroom by a CNA unfamiliar with her needs, resulting in a fall and serious injuries including a fractured hip and femur. The incident was not reported to the state agency as required, and the facility administrator did not initiate a timely investigation or collect staff statements immediately after the event.
Two residents with severe cognitive impairment had Out-of-Hospital Do Not Resuscitate (OOH-DNR) forms that were missing the required physician's signature and license number, making the documents invalid. Although DNR orders and care plans were in place, the incomplete documentation was not identified by the social worker responsible for monitoring advanced directives. The facility's policy required proper documentation, but the deficiency resulted from a failure to ensure the OOH-DNR forms were fully completed.
Surveyors found that food items in the kitchen's dry storage, refrigerator, and freezer were improperly stored, including unsealed containers, expired items, and dented cans. Staff were unaware of these issues despite regular in-service training and established policies requiring proper labeling, sealing, and separation of dented cans. These deficiencies were not in compliance with professional standards for food service safety.
Two staff members failed to adhere to droplet precautions for COVID-19 positive residents, with one entering a resident's room without an N95 mask or eye protection, and another relying on prescription glasses instead of a face shield. This non-compliance with the facility's infection control policy posed a risk of cross-contamination.
Failure to Promptly Review and Report Abnormal X-Ray Results
Penalty
Summary
The deficiency involves the facility’s failure to promptly review and communicate diagnostic test results to the ordering practitioner in accordance with its own policy. A female resident with non-Alzheimer’s dementia, depression, and severely impaired cognition (BIMS score of 6) was admitted with partial to supervised assistance needs for ADLs but was independent with ambulation. On the date of the incident, the resident complained of left wrist pain, and staff observed swelling and pain on palpation. An LVN documented the complaint, administered Tylenol, and obtained an order for an x-ray after the resident reported she had fallen and gotten herself up from the floor. The x-ray was completed that day, and the 24-hour report documented that the left wrist x-ray was pending. The facility’s policy required licensed nurses to review lab/diagnostic results and notify the physician, and specified that critical values must be communicated to the provider within one hour. The x-ray results, available in the lab portal at 11:06 PM, showed acute-subacute distal radial and ulnar fractures with displacement. However, the night-shift LVN responsible for two halls did not check or pull the x-ray results from the lab portal during the 10:00 PM to 6:00 AM shift and did not notify the practitioner of the abnormal findings. The results were not discovered until the following morning when another LVN arrived, checked the lab portal, and saw the fracture report. Multiple therapy staff who worked with the resident on the day of the incident reported that the resident guarded her left hand, did not want to use it, and had slight swelling, but she did not consistently complain of pain. The ADON confirmed that the x-ray results came in during the night shift but were not pulled until the next morning, and stated that charge nurses were responsible for checking the lab portal each shift and that pending x-rays should have been noted on the 24-hour report. This sequence of events led to a delay in recognizing and communicating the abnormal x-ray findings of a fractured wrist to the ordering practitioner. This failure could affect residents by placing them at risk for untreated illnesses, and delays in necessary care and deterioration in condition.
Failure to Ensure Ordered and Properly Maintained Oxygen Therapy Equipment
Penalty
Summary
The deficiency involves the facility’s failure to provide safe and appropriate respiratory care, including oxygen therapy, in accordance with professional standards, the care plan, and physician orders for a resident requiring such care. The resident, an older female admitted with pneumonitis due to inhalation of food and vomit, required assistance with multiple ADLs and had moderate cognitive impairment but was alert and able to communicate needs. Her baseline care plan and physician orders included evaluation and treatment by RT and an order for oxygen at 2 LPM via nasal cannula every shift for shortness of breath and to maintain oxygen saturation above 90%, as well as weekly changes of oxygen tubing, administration device, humidifier bottle, and concentrator filter checks. However, review of the Treatment Administration Record (TAR) did not initially reflect an admission order for oxygen treatment, and the facility only provided the oxygen order in the TAR prior to survey exit. During observation, the resident was seen in a wheelchair receiving oxygen via nasal cannula from a portable tank, with tubing that was not dated. The resident reported that the nasal cannula had not been changed on either the concentrator or portable tank since admission and that she was receiving oxygen for pneumonia. An LVN who had worked at the facility for two weeks confirmed he had not changed the resident’s oxygen tubing during his shift, noted there was no oxygen order on file when he reviewed the chart, and acknowledged that the resident was on continuous oxygen and that it was the nurse’s responsibility to ensure an order was in place and tubing was changed and dated weekly or as needed. The ADON, also recently employed, stated she was unaware the oxygen equipment was not dated, confirmed that standard practice was to change and date oxygen equipment weekly and each shift to check it, and stated that failing to date and change equipment placed residents at risk for infections. The Administrator stated that the ADON and DON were responsible for monitoring oxygen equipment each shift, that nurses were expected to change and date tubing weekly, and that the facility’s written policy only addressed oxygen storage and did not address care, maintenance, labeling, or dating of oxygen tubing.
Medications Left Unattended in Resident Room During Administration
Penalty
Summary
A medication aide (MA) failed to provide proper supervision during medication administration for a resident with multiple complex medical conditions, including hypertension, diabetes mellitus, and Alzheimer's disease. The resident was cognitively intact, as indicated by a BIMS score of 13, and had not been assessed for self-administration of medications. During morning medication administration, the MA left a cup containing nine prescribed medications and supplements on the resident's bedside table while she was eating breakfast, without supervising her to ensure the medications were taken as ordered. The resident later confirmed that staff typically observed her taking medications, but on this occasion, the MA left the medications in her room because he was busy. The MA admitted to leaving medications in resident rooms when residents refused or were occupied, and acknowledged that he was not supposed to do so. The facility's policy required staff to observe residents taking medications unless a formal assessment for self-administration had been completed and approved by the care planning team and physician. Interviews with multiple facility staff, including assistant directors of nursing and the director of nursing, confirmed that leaving medications unattended in resident rooms was against facility policy and posed risks, such as residents not taking their medications or other residents accessing them. At the time of the incident, no residents had been approved for self-administration of medications, and there was no documentation supporting such an assessment for the resident involved.
Failure to Administer Anti-Epileptic Medication as Prescribed
Penalty
Summary
A deficiency occurred when a nurse failed to administer a prescribed dose of Keppra (levetiracetam), an anti-epileptic medication, to a female resident with a history of cerebral palsy, epilepsy, and severe cognitive impairment. The resident was dependent on all activities of daily living and had a care plan in place requiring seizure medication to be given as ordered. During a medication pass, the nurse administered lactulose instead of Keppra, then incorrectly documented that the Keppra had been given and failed to document the administration of lactulose. The error was discovered after the nurse reviewed the medication administration record (MAR) and realized the mistake. Interviews with the nurse and multiple members of the nursing leadership confirmed that the nurse did not follow the facility's policy requiring verification of the five rights of medication administration. The nurse acknowledged the error, stating she was unsure why it occurred and that she may have been nervous. The facility's policy required checking the medication label three times to ensure correct administration, which was not done in this instance. The incident was identified through observation, record review, and staff interviews.
Failure to Sanitize Reusable Blood Pressure Cuff Between Residents
Penalty
Summary
The facility failed to maintain an effective infection prevention and control program as evidenced by the improper handling of reusable blood pressure cuffs for two residents. Specifically, a medication aide (MA A) was observed using the same reusable blood pressure cuff on two different residents without sanitizing it between uses. MA A admitted during an interview that he was not taught to clean the cuff between residents, though he acknowledged the risk of transferring bacteria. The observations were corroborated by interviews with multiple staff members, including assistant directors of nursing (ADONs), the director of nursing (DON), and the administrator-in-training, all of whom confirmed that blood pressure cuffs should be sanitized between residents to prevent cross-contamination and infection. The residents involved included one with a progressive neurological condition and hereditary motor and sensory neuropathy, who was noted to have increased susceptibility to infection due to nutritional deficiencies and dehydration, and another with non-traumatic brain dysfunction and dementia, requiring assistance with activities of daily living and having impaired cognition. Record reviews and staff interviews confirmed that the facility's policy required reusable equipment to be cleaned and reprocessed before being used on another resident, but this protocol was not followed in these instances.
Failure to Implement Abuse and Neglect Prevention Policies Resulting in Resident Injury
Penalty
Summary
A deficiency occurred when the facility failed to develop and implement written policies and procedures to prohibit and prevent abuse, neglect, and exploitation of residents, as well as misappropriation of resident property. Specifically, the facility did not ensure that a resident with significant cognitive and physical impairments was protected from neglect, resulting in the resident sustaining serious injuries, including an intracerebral hemorrhage and a closed displaced intertrochanteric fracture of the left femur. The resident had a history of repeated falls, was dependent on staff for all activities of daily living (ADLs), and was assessed as a high fall risk. Despite these known risks, the facility did not provide effective interventions or services to address the resident's care needs. On the day of the incident, the resident, who primarily spoke Spanish and had moderate to severe cognitive impairment, was left unsupervised on the toilet by a CNA who was not familiar with the resident's clinical needs and could not communicate effectively due to the language barrier. The CNA left the resident alone after the resident gestured for privacy, and did not ensure that another staff member was monitoring the resident. The resident subsequently fell in the bathroom, resulting in significant injuries. Interviews revealed that the resident was unable to use the call light due to her cognitive status, and the communication board intended to assist with her needs was not present in her room at the time of the incident. Further review showed that the facility's administrative staff did not promptly investigate or self-report the incident as required. Staff interviews indicated a lack of awareness of the resident's fall risk and care plan interventions, and there was confusion among staff regarding who was responsible for monitoring the resident. The care plan for the resident included the use of a communication board and supervision during toileting, but these interventions were not consistently implemented. The failure to follow established protocols and ensure appropriate supervision directly contributed to the resident's injuries.
Resident Left Unattended on Toilet Resulting in Serious Fall and Injuries
Penalty
Summary
A deficiency occurred when a resident with a history of repeated falls, cognitive impairment, and significant physical limitations was left unattended on the toilet by staff, resulting in a fall that caused serious injuries, including fractures to the femur and left hip, intracerebral hemorrhage, and skin tears. The resident was dependent on staff for all activities of daily living (ADLs), had a BIMS score indicating moderate to severe cognitive impairment, and was frequently incontinent, requiring substantial to maximal assistance. The care plan specifically indicated that the resident should not be left unattended in the bathroom and required the use of a communication board due to language and cognitive barriers. However, the communication board was not present in the room at the time of the incident, and staff were not observed using it to communicate with the resident. On the day of the incident, a CNA who did not speak the resident's primary language assisted her to the toilet and left her alone after the resident gestured for privacy. The CNA did not ensure that another staff member was actively monitoring the resident, despite being aware of her fall risk and cognitive limitations. The resident was left unsupervised for several minutes, during which time she fell and sustained significant injuries. Interviews with staff revealed confusion and lack of clarity regarding who was responsible for monitoring the resident, and the CNA involved was not familiar with the resident's care needs or fall risk status. Additionally, the resident was unable to use the call light due to her cognitive impairment, a fact confirmed by both the resident and her family members. The facility failed to ensure that the resident received adequate supervision and assistive devices as required by her care plan and professional standards. The lack of effective communication tools, failure to follow the care plan, and inadequate staff communication and training directly contributed to the resident being left unattended and subsequently falling. The incident was not promptly investigated or self-reported to the appropriate authorities, and there was inconsistency in staff accounts of the event, further highlighting the breakdown in supervision and care.
Failure to Maintain Safe and Sanitary Resident Environment
Penalty
Summary
Facility staff failed to maintain a safe, clean, comfortable, and homelike environment for a resident with multiple medical conditions, including congestive heart failure, dementia, and a history of falls. Observations revealed that the resident's mattress was not properly positioned on the bed frame, leaving a portion of the metal frame exposed. Additionally, the bed was unmade, and pillows lacked pillowcases. A plastic cup was found under the bed, and the resident's bathroom contained several used disposable gloves in the sink, a plastic cup, and coffee mugs placed on the toilet. Dirty clothing was left on a shower chair, and briefs were found near the shower, some of which were not covered. Interviews with staff confirmed that the resident was capable of some self-care but often left soiled briefs and gloves in the bathroom. Staff acknowledged their responsibility to check rooms for environmental issues and to dispose of used items immediately to maintain sanitation. However, they were unable to account for the presence of dirty clothing and coffee cups in the bathroom. The staff also noted that the mattress may have been moved by the resident, resulting in the exposed bed frame, and that coffee cups should have been returned to the kitchen after use. Facility policy required regular environmental rounds and immediate disposal of soiled items to prevent contamination. Despite these policies, the observed conditions in the resident's room and bathroom did not meet the standards for cleanliness and safety. The resident, when interviewed, expressed satisfaction with her living conditions and denied noticing any unsanitary items, but further observation revealed improperly stored food items in her room. The facility's failure to adhere to its own policies and maintain a sanitary environment was documented through direct observation and staff interviews.
Failure to Timely Report Suspected Neglect After Resident Fall Resulting in Serious Injury
Penalty
Summary
The facility failed to ensure that all alleged violations involving abuse, neglect, exploitation, or mistreatment, including injuries of unknown source, were reported immediately to the state agency as required. Specifically, a resident with a history of repeated falls, cognitive impairment, and significant physical limitations was left unattended in the bathroom by a CNA who was unfamiliar with the resident's care needs and could not communicate effectively due to a language barrier. The resident, who was dependent on staff for all activities of daily living and identified as a fall risk, fell while left alone and sustained a fractured femur and hip. The incident occurred when the CNA, after assisting the resident to the toilet, left the resident alone at her request for privacy and notified another CNA to check on her. However, the second CNA did not receive this instruction, and the resident was left unsupervised for several minutes. The resident attempted to transfer herself and fell, resulting in serious injuries. The care plan for the resident specifically indicated that she should not be left unattended in the bathroom due to her fall risk and cognitive deficits. Additionally, the resident had a communication board care planned to assist with her language and cognitive barriers, but it was not present in her room at the time of the incident. Despite the severity of the injuries and the circumstances indicating neglect, the facility administrator did not report the incident to the state agency as required by regulation. The administrator also did not initiate a timely investigation or collect staff statements immediately following the event. Interviews with staff revealed inconsistencies in the account of the incident, and the administrator ultimately determined internally that the event did not meet the criteria for state reporting, despite regulatory requirements to report such incidents involving serious injury and potential neglect.
Incomplete OOH-DNR Documentation for Two Residents
Penalty
Summary
The facility failed to ensure that two residents' Out-of-Hospital Do Not Resuscitate (OOH-DNR) documents were properly completed, specifically lacking the required physician's signature and license number. Both residents had severe cognitive impairment, as indicated by a BIMS score of 03, and had diagnoses including Alzheimer's disease, non-Alzheimer's dementia, hypertension, and depression. Their care plans and physician orders reflected a DNR status, and the care plans included approaches to honor the DNR wishes and consult with responsible parties. Upon review, it was found that the OOH-DNR forms for both residents were signed by the residents or their medical power of attorney but were missing the physician's statement, signature, date, and license number, rendering the documents invalid. The forms were present in both the residents' electronic medical records and in a binder maintained by the social worker, but neither contained the necessary physician information. The social worker stated that while she assisted with the initiation of these documents and performed audits to ensure forms were on file, she did not always verify the completeness of documents that were initiated prior to her tenure or by outside agencies such as hospice. Interviews with the DON and Administrator confirmed that the social worker was responsible for monitoring advanced directives and that the incomplete OOH-DNR forms had not been previously identified. The facility's policy required residents to be informed of the opportunity to file advance directives upon admission and at least annually, with social services responsible for maintaining current and complete records. However, the lack of physician signatures on the OOH-DNR forms for these two residents constituted a failure to ensure that residents' end-of-life wishes were properly documented and could be honored.
Improper Food Storage and Handling Practices Identified in Kitchen
Penalty
Summary
Surveyors observed that the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety. During an inspection of the kitchen's dry storage, refrigerator, and freezer areas, multiple food items were found to be improperly stored. Specifically, several containers and packages of cereal, oats, pasta, fish fry, rice, tortillas, marshmallows, grape jelly, and hamburger patties were unsealed and exposed to air. Additionally, some items lacked expiration dates, and expired food items were present in storage areas. Four dented cans containing various foods were also found stored alongside undamaged canned goods. Interviews with the Dietary Manager and a Dietary Aide revealed that both were unaware of the presence of expired, unsealed, and dented food items in the kitchen. Both staff members acknowledged that all kitchen staff were responsible for ensuring food items were properly sealed, labeled, and checked for expiration dates. The Dietary Manager stated that dented cans should be separated from other canned foods and placed in a designated area, and that all food items should be stored according to the facility's policy, which includes labeling, dating, sealing, and using the FIFO (First In, First Out) method. The Dietary Aide confirmed similar expectations and procedures based on regular in-service training. A review of the facility's food storage policy and relevant FDA codes confirmed that all food should be stored in tightly covered, labeled, and dated containers, with expired items discarded and dented cans separated. The observed deficiencies in food storage practices, including the presence of unsealed, expired, and dented food items, were not in compliance with these standards and procedures. No specific residents or patient medical histories were mentioned in relation to the deficiency.
Inadequate Adherence to Droplet Precautions for COVID-19 Positive Residents
Penalty
Summary
The facility failed to maintain an effective infection prevention and control program, as evidenced by the actions of two staff members who did not adhere to droplet precautions for residents diagnosed with COVID-19. Resident #1, a female with a BIMS score indicating no cognitive impairment, was under droplet precautions due to a positive COVID-19 test. Despite clear signage and available personal protective equipment (PPE) outside her room, PTA B entered without donning an N95 mask or eye protection, only wearing a surgical mask, gown, and gloves. This was observed during a therapy session, and PTA B admitted to being aware of the resident's COVID-19 status but misunderstood the PPE requirements. Similarly, Resident #2, a male with severe cognitive impairment and a positive COVID-19 test, was also under droplet precautions. CNA C entered his room wearing an N95 mask, gown, and gloves but failed to wear appropriate eye protection, relying instead on her prescription glasses. This was contrary to the facility's policy and the infection preventionist's (IP) instructions, which required a face shield or goggles in addition to the N95 mask. CNA C's actions were based on incorrect information allegedly provided by the IP, who denied giving such instructions. The facility's policy, aligned with CDC guidelines, mandated the use of N95 masks, gowns, gloves, and eye protection for staff entering rooms of COVID-positive residents. The IP confirmed that all necessary PPE was available and that staff had been adequately trained. However, the failure of PTA B and CNA C to comply with these precautions posed a risk of cross-contamination and infection spread within the facility.
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Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
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Nursing homes near North Richland Hills
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Glenview Wellness & Rehabilitation | 1.7 mi | ★★★★★ | 18 | 0 |
| Green Valley Healthcare And Rehabilitation Center | 2.1 mi | ★★★★★ | 4 | 1 |
| North Pointe Nursing And Rehabilitation | 2.3 mi | ★★★★★ | 1 | 1 |
| Oakmont Guest Care Center | 2.4 mi | ★★★★★ | 2 | 1 |
| Avir At Richland Hills | 2.8 mi | ★★★★★ | 6 | 0 |
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