Above average — CMS composite of the measures below.
The next survey window likely opens around April 2027
Estimate from public CMS data, current as of October 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Avir At Sealy during CMS and state inspections, most recent first.
Failure to provide grooming and personal hygiene for residents needing ADL assistance. Two residents with impaired cognition were observed with facial hair on the chin despite care plans requiring bathing and grooming assistance, and one resident with intact cognition but dependent ADL status was observed with dry, flaky, ashy skin over the back and lower extremities. Staff stated the residents should have been shaved or lotioned during shower care and as needed, but these services were not provided as observed.
A resident with an indwelling catheter and recurrent UTIs had a catheter bag observed more than half full and not emptied as needed, while another resident’s foley bag was placed on the bed during care, the tubing was not held during cleansing, and the stabilization device did not secure the tubing. Staff and the DON acknowledged the bag should have remained below the bladder, the tubing should have been supported, and the bag should have been emptied before it became overly full.
A resident with dementia and major depressive disorder missed ordered Risperidone doses because an LVN documented the medication as not in the facility and on reorder even though it was available on the cart. MAR review showed missed night-shift doses and multiple refusals, while the DON and pharmacist confirmed the medication supply discrepancy and that the drug had been present in the facility.
Overcooked squash was placed on the steam table hours before lunch, and it was served mushy and unattractive at mealtime. Two residents said the squash was overcooked, most residents did not eat it, and the Dietary Manager agreed it did not look good. A kitchen staff member stated squash was usually overcooked, and the facility policy required nourishing, well-balanced meals that consider resident preferences.
Kitchen sanitation and food handling were deficient. A dietary staff member handled clean dishes without hand hygiene after working with soiled dishes, and multiple items in the dish room and kitchen were dirty, including plates, cups, pots, pans, shelves, ovens, the microwave, the ice machine, and the deep fat fryer. Food storage was also poor, with several refrigerated items undated or past the expected use period, open foods left unlabeled, and freezer items not sealed. Hot foods on the steam table were below the required holding temp and were reheated after surveyor intervention.
A resident with a care plan for a 2-person mechanical lift transfer was moved by a hospice aide using a one-person transfer, causing the wheelchair to tip backward and the resident to fall and hit her head, requiring hospital evaluation. In a separate event, a resident with severe cognitive impairment and wandering behavior entered an unlocked staff restroom that lacked a call light, showing the area was not secured as intended.
Failure to Hold BP Medication Within Ordered Parameters: A resident with HTN, dementia, and other chronic conditions had a physician order for Metoprolol 50 mg BID with hold parameters for low BP or HR. Review of the MAR showed the medication was not documented as held on multiple occasions when SBP was below the ordered threshold, and there was no documentation that the MD was notified. The DON, Administrator, and Wound Care Nurse stated meds should be given as ordered and BP should be checked before administration.
A resident with an indwelling foley catheter, parkinsonism, bladder dysfunction, and a hx of CVA had her foley bag and privacy cover observed touching the floor while in bed. During foley and incontinent care, a CNA placed the bag on the bed after floor contact and left it there for about 10 minutes, and she changed gloves multiple times without sanitizing or washing her hands after glove removal. The DON and WCN stated the bag should have remained below the bladder and off the floor, and facility policy required hand hygiene immediately after glove removal.
Surveyors found that multiple residents with dysphagia, cognitive impairment, and nutritional risk were not receiving physician-ordered fortified and mechanically altered diets. Despite documented orders and tray tickets specifying fortified puddings, super puddings, fortified meal plans, and mighty shakes, residents were observed at meals receiving standard items such as potatoes, fish, hush puppies, and sandwiches without the prescribed fortified components. Meals for these residents appeared identical to regular meals, and staff interviews confirmed that fortified preparations were not consistently provided as ordered.
Surveyors found that the kitchen failed to maintain proper food storage, equipment sanitation, and staff hygiene. Spills and residues were left uncleaned, storage bins were inadequate, and kitchen equipment was not cleaned after use. Staff did not use appropriate hair or beard restraints, had long fingernails, and handled food and surfaces improperly while wearing gloves, all contrary to facility policy and professional standards.
The facility did not ensure RN coverage for at least 8 consecutive hours daily, as required, with staffing records showing no RN hours on multiple weekends and one weekday. The DON, who is salaried and does not use a time clock, stated she covered shifts as needed, but the PBJ report did not reflect RN hours for 12 days. The Administrator confirmed the absence of a weekend RN prior to a recent hire and noted there was no formal policy for RN coverage.
The facility did not consistently post up-to-date nurse staffing information at the main entrance, as required. Observations showed that the staffing postings were outdated on multiple occasions, and interviews with the DON, Administrator, and AD revealed uncertainty about who was responsible for ensuring the information was posted each day. The AD eventually updated the posting after realizing it had been overlooked due to other duties.
Failure to Provide Grooming and Skin Care for Residents Needing ADL Assistance
Penalty
Summary
The facility failed to provide necessary grooming and personal hygiene for residents who were unable to complete ADLs independently. Resident #45, a female with Alzheimer’s disease, hypertension, diabetes mellitus, and moderately impaired cognition, was assessed as needing extensive assistance and dependence on staff for ADL care. Although her care plan called for bathing assistance and the April 2026 documentation showed no missed showers or bed baths, an observation on 05/03/26 found white and black facial hair on her chin. She stated she wanted the facial hair shaved and said she received showers every other day, but the aide did not shave her every other day and she could not remember when she was last shaved. Resident #6, a female with dementia, hypertension, and multiple sclerosis, had severely impaired cognition and needed moderate to extensive staff assistance with showers and personal hygiene. Her care plan required one staff member for all ADL care, and the April 2026 documentation also showed no missed showers or bed baths. During an observation on 05/03/26, she was noted to have facial hair on her chin, and she said she wanted it plucked. She said she received showers but did not know how often or when she was last shaved, and she thought she may have told the aide to shave her but was not sure. Resident #5, a female with parkinsonism, neuromuscular dysfunction of the bladder, and cerebral infarction, was dependent on staff for ADL care and required assistance with bathing and grooming. During care on 05/04/26, she was observed to have ashy, dry, flaky skin from the middle back to the lower back and from both outer thighs to the ankles. Staff interviews stated she needed lotion on shower days and as needed, and the WCN and CNA said the dry skin could lead to skin breakdown or scratching. The DON stated the aides were supposed to apply lotion on shower days and as needed, and that the resident had not been reported as refusing bathing or lotion application.
Catheter Care and UTI Prevention Deficiencies
Penalty
Summary
The facility failed to ensure appropriate care for residents with indwelling urinary catheters and failed to provide care to prevent urinary tract infections for two residents reviewed for incontinent care. One resident had a history of urinary tract infections, a neurogenic bladder, and an indwelling catheter, and was dependent on staff for toileting and other ADLs. Her care plan directed staff to provide incontinent care at least every two hours and as needed and to monitor for signs and symptoms of UTI. During observation, her catheter bag was found more than half full, with urine reaching the 1800 mL line on a 2000 mL bag, and it had not been emptied as needed. The same resident had prior lab results showing E. coli and cloudy urine, and her record showed multiple antibiotic treatments for UTI and an active order for methenamine hippurate for prophylactic treatment related to flaccid neuropathic bladder. The resident’s representative stated the catheter bag was occasionally full and that staff were called to empty it. A CNA stated the bag should have been emptied before it reached 1800 mL because urine could travel back up the tube and cause infection, and that a full bag could also cause pulling on the tube due to gravity. The DON stated the bag should have been emptied when urine reached 200 mL to avoid backflow, and that staff should have been checking the bag every two hours and as needed and before shift change. For another resident with parkinsonism, neuromuscular dysfunction of the bladder, intact cognition, and dependence on staff for ADL care, the facility failed to provide catheter care in accordance with the resident’s needs and the facility policy. During observed foley and incontinent care, a CNA placed the catheter bag on the bed for about ten minutes, did not hold the catheter tubing while cleaning the peri area, and the stabilization device was attached but the tubing was not secured in the loop. The CNA stated the bag should not have been placed on the bed because urine could flow back into the bladder and cause infection, and that the tubing should have been held to prevent pulling and pain. The WCN and DON both stated the bag should have remained below the bladder, the tubing should have been held during care, and the stabilization device was not functioning properly because it did not keep the tubing secured.
Failure to Administer Ordered Risperidone
Penalty
Summary
The facility failed to provide pharmaceutical services to meet the needs of a resident with dementia, major depressive disorder, hypertension, and hyperlipidemia by not ensuring Risperidone was administered as ordered. Record review showed the resident had severe cognitive impairment with a BIMS score of 00 and required assistance with several activities of daily living. His care plan included interventions for elopement risk, ADL deficits, psychotropic medication use, and depression, with orders to administer medications as prescribed and monitor for adverse reactions and behavior changes. Medication administration records showed that the resident did not receive Risperidone on two night shifts in March 2026 and on eight night shifts in April 2026 after the dose was changed to 1.5 tablets twice daily. The MAR also showed multiple refusals during morning administration times in March. The medication was available in the facility, but LVN Z documented it as not in the facility and marked it as on reorder. The DON stated Risperidone was on the medication cart and that LVN Z did not look for it, instead documenting it was unavailable when it was present. The pharmacist reported no record that the facility pulled Risperidone from the e-kit for April or May 2026. During interview, the DON and Administrator acknowledged the medication discrepancy and stated the resident appeared to be at baseline and had not exhibited behaviors. Observation of the medication supply showed multiple blister packs of Risperidone, including whole and half tablets, and an in-use pack with remaining tablets. The facility policy stated medications are to be administered in a safe and timely manner and in accordance with prescriber orders.
Overcooked squash served from steam table
Penalty
Summary
Food was not prepared in a way that conserved nutritive value, flavor, and attractive appearance in one kitchen. On 5/3/2026 at 9:00am, observation of the steam table showed cooked squash and mashed potatoes already placed there for lunch, resulting in the squash being overcooked, mushy, and unattractive in appearance. During lunch at 12:05pm, the squash served was observed to be mushy and unattractive in appearance, and by 12:45pm more than half of the residents had not eaten the squash. During interviews at 12:45pm, two unidentified residents stated the squash was overcooked, and most residents interviewed did not express preferences because they simply did not eat it. [NAME] B stated that whenever he prepared squash it was usually overcooked and asked for suggestions on how to cook it without overcooking. The Dietary Manager stated at 12:50pm that the squash was overcooked and did not look good, and she observed that most residents did not eat it. Record review of the facility policy titled Food and Nutrition Services stated that each resident is to be provided a nourishing, well-balanced diet that meets daily nutritional and special dietary needs while taking into consideration resident preferences.
Kitchen sanitation, food storage, and hot holding deficiencies
Penalty
Summary
Food service sanitation was deficient in the kitchen because multiple food contact surfaces, equipment, storage areas, and utensils were observed dirty or not maintained in sanitary condition. During observation, Dietary Staff A was prewashing soiled dishes and removed clean dishes from the dish machine without washing hands or removing soiled gloves, and no hand washing was observed in the kitchen. The crate used to hold soiled dishes had an accumulation of brown material, shelves below multiple metal tables had grease, dust, brown stains, and food particles, and the nonfunctioning plate warmer had grease and dust on it. The steamer wells had calcium deposits and grease, the microwave had dried food particles and grease, the ice machine had food particles and grease, and clean cups and divided plates were observed with food particles and calcium buildup inside. Additional observations showed the floor between the ice machine and stove had cracked tiles with a black substance in the cracks, tiles under the coffee machine had brown stains, and the deep fat fryer had dust and grease inside and outside with black oil. The grill, stove top, oven interiors, oven racks, and oven doors had grease, burnt food particles, and food stains. The ice machine had a black substance on the metal compartment and brown stains on the outside, the two refrigerators had grease, food particles, and food stains inside, and the shelf above the stove had dust and grease. Muffin pans, cake pans, and pots had dry food particles in them. Food storage and temperature control were also deficient. In the refrigerator, chilled pasta salad, chicken salad, and breakfast sausage were dated outside the expected use period, and open ham, leftover salad, and slaw had no dates. A box of lettuce in the dry storage room refrigerator was brown and was discarded by the Dietary Manager during the observation. In the freezer, rolls and beef patties were in a carton box that was not sealed. On steam table observation, cooked carrots and another menu item were below the required hot holding temperature and were removed and reheated after the surveyor intervened. The facility policy stated that foodservice areas should be clean and sanitary, equipment and utensils should be clean and sanitized, foods in refrigerators and freezers should be covered, labeled, and dated, and hot foods should be maintained above 135 degrees.
Accident Hazards and Supervision Failures
Penalty
Summary
The facility failed to keep the resident environment free of accident hazards and to provide adequate supervision and assistance devices to prevent accidents. One event involved a resident with multiple diagnoses including CHF, anxiety, DM2, HTN, polyneuropathy, and a history of UTIs, who had a BIMS score of 13 and was totally dependent on staff for chair/bed-to-chair transfers and several ADLs. Her care plan required a total assist of 2 with a mechanical lift, but a hospice aide attempted to transfer her from her wheelchair to bed using the lift alone. During the transfer, the wheelchair tipped backward, the resident fell, and she struck her head with bleeding noted at the back of her head. She was sent to the hospital for evaluation after the fall. Interviews and record review showed the hospice aide knew the resident should have had two people assisting with mechanical lift transfers, and the facility policy stated at least two nursing assistants were needed to safely move a resident with a mechanical lift. The aide reported she did not lock one wheelchair wheel and did not realize the sling was not completely under the resident until after the fall. The hospice nurse, hospice administrator, CNA, and other staff all described that the resident was transferred with only one person assisting and that the resident hit her head during the incident. The facility’s incident report initially did not list the resident, and an updated report later identified the event as a witnessed fall. A second event involved a resident with dementia, major depressive disorder, HTN, and hyperlipidemia who had severe cognitive impairment with a BIMS score of 00 and was care-planned as an elopement risk/wanderer. During observation, he entered the staff/visitor restroom at the nurse’s station by opening an unlocked door. The restroom did not have a call light. Staff redirected him back to his room and stated the restroom should have been locked. The DON stated the public restrooms were supposed to be locked and checked periodically, but the door was found unlocked when the resident accessed it.
Failure to Hold BP Medication Within Ordered Parameters
Penalty
Summary
Resident #12 was admitted and readmitted to the facility with diagnoses including hypertension, hyperlipidemia, dementia, depression, GERD, hypokalemia, pulmonary embolism, protein calorie malnutrition, and acute embolism and thrombosis. Her quarterly MDS showed a BIMS score of 09, indicating moderate cognitive impairment, and she was coded as always incontinent of bladder and bowel. A physician order dated 12/31/2025 directed Metoprolol Tartrate 50 mg by mouth twice daily for hypertension, with instructions to hold the medication for SBP less than 110, DBP less than 60, or HR less than 60. Review of the April 2026 MAR showed Metoprolol was not documented as held on multiple occasions when the resident’s SBP was below the ordered parameter, including readings of 103/74, 104/67, 106/66, 107/64, and 108/68. The record also showed no documentation that the physician was notified of the blood pressure readings or why the medication was not held. During interviews, the DON stated the medication should have been held as ordered and that there was no code indicating it was held, and the Administrator and Wound Care Nurse stated medications were expected to be given as ordered and vital signs checked before blood pressure medications were administered.
Infection Control Lapses During Foley Care
Penalty
Summary
The facility failed to maintain an infection control program for a resident with an indwelling foley catheter. The resident was a female with diagnoses including parkinsonism, neuromuscular dysfunction of the bladder, and cerebral infarction. Her quarterly MDS showed a BIMS score of 15, indicating intact cognition, and she was dependent on staff for ADL care. Her care plan included an indwelling foley catheter related to neuromuscular dysfunction of the bladder and skin breakdown, with instructions to keep the catheter and tubing below the level of the bladder and away from the entrance room door. During observation, the resident’s foley bag and privacy covering were seen touching the floor while she was lying in bed. During foley and incontinent care, CNA J placed the foley bag on the bed after it had touched the floor and left it there for about ten minutes while care was provided. CNA J changed her gloves multiple times during the care but did not wash or sanitize her hands after removing dirty gloves and before putting on clean gloves. The WCN and DON both stated that the bag should not have touched the floor and should have remained below the bladder, and that the CNA should have sanitized her hands between glove changes. Record review showed the resident had received antibiotics for UTIs earlier in the year, including cefdinir and amoxicillin-pot clavulanate. The facility’s hand hygiene policy stated hand hygiene is the primary means to prevent the spread of healthcare-associated infection and is indicated immediately after glove removal. The urinary catheter care policy stated the drainage bag must be kept lower than the bladder at all times and kept off the floor. The facility’s perineal care policy stated the procedure is intended to provide cleanliness and comfort and prevent infection and skin irritation.
Failure to Provide Physician-Ordered Fortified and Therapeutic Diets
Penalty
Summary
Surveyors identified a deficiency in the facility’s failure to provide therapeutic and fortified diets as ordered by physicians for four residents with dysphagia, cognitive impairment, and nutritional risk. Physician orders and meal tickets documented requirements for mechanically altered diets and fortified items such as fortified puddings, super puddings, fortified meal plans, and mighty shakes. However, during meal observations, these ordered fortified components were not provided, and the meals served appeared the same as regular meals without the prescribed enhancements. For one male resident with depression, dysphagia, GERD, hyperlipidemia, hypertension, and dysphagia following cerebral infarction, the MDS showed severe cognitive impairment and pain with swallowing, and he was coded as being on a mechanically altered diet. Physician orders included a regular mechanical soft diet with ground texture and fortified pudding twice daily for malnutrition. His meal ticket reflected a regular diet, mechanical soft diet, and fortified pudding cream. During a lunch observation, he was seen self-feeding potatoes, fish, and hush puppies, with no fortified pudding present, and his meal looked identical to those of residents receiving regular meals. A female resident with Alzheimer’s disease, depression, dysphagia, GERD, hyperlipidemia, and abnormal weight loss had an MDS indicating severe cognitive impairment, pain with swallowing, and a mechanically altered diet. Her physician orders included mighty shake 4 oz twice daily at lunch and dinner and fortified pudding 4 oz twice daily at lunch and dinner, and her meal ticket listed a regular diet, mechanical soft diet, fortified pudding/ice cream, fortified enhanced food, and mighty shake. At a lunch observation, she was self-feeding potatoes, fish, and hush puppies, with no mighty shake, ice cream, or fortified pudding on her tray, and her meal appeared the same as regular meals. Another female resident with anemia, hypertension, renal insufficiency, Alzheimer’s disease, anxiety disorder, depression, dysphagia, and vitamin D deficiency had an MDS showing severe cognitive impairment, pain with swallowing, and a mechanically altered diet. Her physician orders included mighty shake 4 oz twice daily at lunch and dinner and fortified pudding 4 oz twice daily at lunch and dinner, and her meal ticket listed a regular diet, mechanical soft diet, fortified pudding/ice cream, and mighty shake. During a lunch observation, she was self-feeding a cheese sandwich with juice, milk, and water, with no mighty shake, ice cream, or fortified pudding on the tray. A fourth female resident with depression, dysphagia, GERD, hyperlipidemia, hypertension, and diabetes had an MDS indicating severe cognitive impairment and a mechanically altered diet. Her physician orders included a fortified meal plan diet with mechanical soft texture and thin consistency, and super pudding 4 oz twice daily at lunch and dinner. Her meal ticket listed a regular diet, mechanical soft diet, fortified pudding/ice cream, fortified enhanced food, and mighty shake. At a lunch observation, she was self-feeding potatoes, fish, and hush puppies, with no fortified meal plan or fortified pudding present, and her meal looked the same as those of residents receiving regular meals. In interviews, the Dietary Manager stated she usually prepared fortified pudding and sometimes added extra butter and sour cream to potatoes for fortified meals but had not done so that day, and an LVN acknowledged that residents with fortified meal orders were receiving meals that looked like regular meals and that diets were ordered for specific health and safety reasons.
Deficient Food Storage, Sanitation, and Staff Hygiene in Kitchen
Penalty
Summary
Surveyors observed multiple failures in the facility's kitchen regarding food storage, preparation, and sanitation. A storage rack for canned goods had an orange-brownish substance spilled on it and on the floor beneath, which had not been cleaned despite the Dietary Manager (DM) being aware of the spill. Storage bins for flour and sugar were found with residues and holes that could allow insect entry, and the DM acknowledged the inadequacy of the containers but cited lack of funding for replacements. Shelves holding clean pots and pans were lined with foil and mesh coverings that were coated in a greasy, dusty film, and the DM admitted these had not been cleaned as required by the facility's cleaning schedule. Further observations revealed that kitchen equipment, including the grill, fryer, convection oven, and toaster, were not cleaned after use, with visible grease, food particles, and residue present. The DM confirmed that these items should have been cleaned after each use but had not been. Additionally, food service staff did not adhere to proper hygiene standards: the cook wore a baseball cap that did not restrain his long hair, lacked a beard restraint despite having a full beard, and had long fingernails. The cook also wore gloves while serving food but touched the inside of plates and other surfaces, which could lead to cross-contamination. The DM was unaware that glove use in this manner was problematic and acknowledged the issue with the cook's long nails. Interviews with the DM and Registered Dietitian (RD) confirmed that staff were not following established policies for food safety, including the use of airtight containers, proper cleaning schedules, and personal hygiene practices such as wearing hairnets, beard restraints, and keeping fingernails trimmed. The facility's own dietary policy required adherence to safe food handling practices, prevention of cross-contamination, and maintenance of sanitary conditions, all of which were not consistently followed as evidenced by the surveyor's findings.
Failure to Provide Required RN Coverage
Penalty
Summary
The facility failed to provide the services of a registered nurse (RN) for at least 8 consecutive hours a day, 7 days a week, as required. Review of the CMS Payroll Based Journal (PBJ) staffing data for the first quarter of 2025 revealed that there were no RN hours recorded for 12 specific days, including multiple Saturdays, Sundays, and one Thursday. The facility staffing list indicated that a new RN was hired on 11/27/24, but prior to this, there was no weekend RN coverage. The Director of Nursing (DON) stated she covered shifts when an RN was unavailable, including weekends and holidays, but did not use a time clock and was salaried. The DON was unable to explain why the PBJ report did not reflect RN hours for the 12 days in question. Interviews with the DON and the Administrator confirmed the lack of consistent RN coverage on weekends prior to the hiring of the new RN. The Administrator acknowledged that the facility did not have a policy regarding the requirement for RN coverage 8 hours a day, 7 days a week, and stated that they simply followed the regulation. No specific residents or patient conditions were mentioned in relation to the deficiency.
Failure to Post Daily Nurse Staffing Information
Penalty
Summary
The facility failed to post the daily nurse staffing information at the beginning of each shift as required. Observations on two consecutive days showed that the staffing information displayed at the main entrance was not current, with postings dated for the previous day. On the second day, multiple observations throughout the day confirmed that the outdated posting remained in place until late in the afternoon. Interviews with facility leadership, including the DON, Administrator, and AD, revealed confusion regarding who was responsible for posting the daily staffing information. The AD eventually updated the posting after being reminded, stating that the current staffing sheet had been prepared but was left on her desk due to being occupied with resident care. The DON clarified that the ADON was responsible for preparing the posting, but it had not been displayed in a timely manner.
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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 Sealy
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Harmony Care At Brookshire | 13 mi | ★★★★★ | 19 | 0 |
| Avir At Bellville | 13.8 mi | ★★★★★ | 11 | 0 |
| Arbor Hills Rehabilitation And Healthcare Center | 16.5 mi | ★★★★★ | 0 | 0 |
| Paradigm At Katy | 20.2 mi | ★★★★★ | 15 | 0 |
| Heritage Park Of Katy Nursing And Rehabilitation | 20.5 mi | ★★★★★ | 7 | 0 |
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