Caraday of Houston

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure the residents environment remained free of accident hazards as is possible to ensure residents receiving adequate supervision to prevent accidents for 1 of 6 residents (Resident #46) reviewed for accidents and supervision. The facility failed to provide appropriate and sufficient supervision to prevent avoidable accidents when Resident #46, despite her recent history of falls and documented fall risk, was left unattended and had an unwitnessed fall. The fall resulted in fracture to Resident #46's cervical spine requiring hospitalization and surgery from 05/07/26 to 05/18/26. The facility further failed to mitigate the risk for falls and accidents when they failed to revise her care plan with post-surgical instructions upon her re-admission to the facility. [...]

Inspectors wroteBased on interview, and record review the facility failed to designate a registered nurse to serve as the director of nursing on a full-time basis at least 8 consecutive hours a day, 7 days a week for 2 of 60 (05/18/2026 and 05/25/2026) days reviewed. The facility failed to provide RN coverage for 05/18/2026 and 05/25/2026 to meet the requirements of an RN working a full 8 hours a day. These failures could result in periods without required RN oversight and placed residents at risk for unmet care needs, delayed assessments, and inadequate supervision of licenses and unlicensed staff.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to develop and implement a comprehensive person-centered care plan that included services that were to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being for 1 of 6 residents (Resident #46) reviewed for care plans. The facility failed to review and revise Resident #46 care plan despite her history of four recent falls (2/1/26, 2/15/26, 2/23/26, and 3/10/26) before she had a major fall on 05/07/26 and when she was re-admitted to the facility on [DATE] with a neck fracture and with post-surgical needs. This deficient practice could place residents at risk of harm as qualified staff responsible for carrying out interventions were not notified of their roles and responsibilities of the specific are and services implemented for the resident.

Inspectors wroteBased on observation, interview, and record review, the facility did not maintain an infection prevention program designed to provide a safe, sanitary and comfortable environment to help prevent the development and transmission of communicable diseases and infections for 1 of 2 residents (Resident #7) reviewed for infection control.- CNA X failed to change gloves, wash, or sanitize hands after cleaning Resident #7's buttocks, and before handling the clean brief and bed linens. CNA Y failed to change gloves, wash, or sanitize hands after cleaning Resident #7's peri-area during incontinent care and before handling the clean brief, bed linens, and touching Resident #7's face. These failures could place residents who required assistance with toileting needs at risk for cross contamination and infection. [...]

Inspectors wroteBased on interview and record review, the facility failed to immediately consult with the resident's physician; and notify, consistent with his or her authority, the resident representative(s) when there was a significant change in the resident's physical, mental, or psychosocial status (that is, a deterioration in health, mental, or psychosocial status in either life-threatening conditions or clinical complications) for 1 (Resident #1) of 5 residents reviewed for resident rights.- Nurse A did not respond to the Dr.'s text message on 05/01/26 at 10:12 p.m. when she asked him if it looked like Resident #1 had a stroke.-Nurse B failed to report Resident #1's change in condition for approximately 12 hours and 36 minutes beginning on 05/01/26 around 10:12 p.m. NP was notified on 05/02/26 at about 10:48 a.m. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure that residents received treatment and care in accordance with professional standards of practice for 1 (Resident #1) of 5 residents reviewed for quality of care.-Nurse A noticed a change in Resident #1's speech on 05/01/26 around 9:30 p.m. He sent a text message to the Dr. at 9:37 p.m. and at 10:12 p.m., the Dr. asked if it looked like resident had a stroke, but Nurse A did not follow up with the Dr. The Dr. did not follow up with Nurse A.-Nurse B failed to report Resident #1's change in condition for approximately 12 hours and 36 minutes beginning on 05/01/26 around 10:12 p.m.-It took Resident #1 a total of 13 hours and 30 minutes to receive care for a possible stroke. Nurse A noticed a change in condition on 05/01/26 around 9:30 p.m. and Resident #1 was transferred to the hospital by EMS on 05/02/26 around 11:42 a.m. [...]

Inspectors wroteBased on interviews and record review, the facility failed to promote and facilitate resident self- determination through support of resident choice for 1 of 6 residents (CR#1) reviewed for resident rights. The facility failed to ensure that CR#1had the opportunity to exercise rights regarding those things that were important in their life. The facility failed to promote self-determination by not having hot water in the facility, which prevented each from taking showers. This failure could place residents at risk of decreased self-worth due to their preferences not being met.

Inspectors wroteBased on interview and record review the facility failed to ensure the resident had the right to be free from abuse, neglect, misappropriation of resident property, and exploitation for 2 of 4 residents (Resident #1 and Resident #2) reviewed for abuse. The facility failed to ensure Resident #1 and Resident #2 were not involved in a resident-to-resident altercation on 04/07/2024. This deficient practice could place residents at risk of physical injury and/or psychosocial harm.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure, in accordance with State and Federal laws, all drugs and biologicals were stored in locked compartments under proper temperature controls and permitted only authorized personnel to have access to the keys for 1 of 3 medication carts reviewed for medication storage. The facility failed to ensure medications were properly stored and labled when Resident #4's medications were popped into a pull cup and left unattended. This failure could place residents at risk for drug diversion, lack of drug efficacy, and adverse reactions.

Inspectors wroteBased on observation, interview and record review the facility failed to maintain an effective pest control program so the facility was free of pest and rodents for 2 of 2 residents reviewed for environment. The facility failed to ensure resident rooms were free of gnats. This failure could place residents at risk of infection, skin irritation, allergies, which could result in unsanitary living conditions and decline in health and well-being.

Inspectors wroteBased on interview and record review, the facility failed to use the service of a Registered Nurse (RN) for at least eight consecutive hours a day, seven days a week in the facility for 36 of 92 days (09/11/2023, 09/12/2023, 09/13/2023, 09/14/2023, 09/15/2023, 09/17/2023, 09/18/2023, 09/19/2023, 09/20/2023, 09/21/2023, 09/22/2023, 09/23/2023, 09/25/2023, 09/26/2023, 09/27/2023, 09/28/2023, 09/29/2023, 09/30/2023, 10/02/2023, 10/03/2023, 10/04/2023, 10/05/2023, 10/06/2023, 10/07/2023, 10/08/2023, 10/09/2023, 10/10/2023, 10/11/2023, 10/12/2023, 10/13/2023, 11/02/2023, 12/05/2023, 12/06/2023, 12/07/2023, 12/08/2023, and 12/11/2023) reviewed during a look back period from 09/11/2023 to 12/11/2023. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide a safe, functional, sanitary, comfortable, and homelike environment for one of twelve residents (Resident #2) reviewed for a safe, clean, and homelike environment. -The facility failed to ensure Resident #2 had a working light in her room above her sink. -The facility failed to ensure the residents who smoked cigarettes had a safe, comfortable seating area available as the bench in the smoking area was broken. These failures could place the residents at risk of injury from the visible nails on the bench in the smoking area and could place the residents at risk of decreased quality of like due to the lack of a well-maintained environment.

Inspectors wroteBased on observation and interview, the facility failed to ensure that drugs and biologicals used in the facility were stored and labeled in accordance with currently accepted professional principles for 1 of 1 medication aide cart, 1 of 1 medication room refrigerator, and 1 of 1 nurse's carts reviewed for medications. -1 of 1 medication aide cart had two opened undated eye drops and two discontinued medications. -1 of 1 medication rooms had a water bottle(Ozarka) 700ml sport cover in the freezer section of the refrigerator. -1 of 1 nurse's medication cart had opened and undated medications. These failures could affect residents, placing them at risk for altered effectiveness of the medication and worsening of the resident's symptoms, requiring medical intervention.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure residents who needed respiratory care were provided such care, consistent with professional standards of practice for 1 (Resident #290,) of 3 resident reviewed for respiratory care. -The facility administered oxygen to Resident #290 without a physician order. These failures placed residents who received oxygen therapy at risk of respiratory complications.

Inspectors wroteBased on observation and interview, the facility failed to ensure that drugs and biologicals used in the facility were stored in accordance with currently accepted professional principles for 1 of 1 medication aide cart and 1 of 1 medication room refrigerator reviewed for medications. -1 of 1 medication aide cart had two discontinued medications. -1 of 1 medication rooms had a water bottle (Ozarka) 700 ml sport cover in the freezer section of the refrigerator. These failures could affect residents, placing them at risk for altered effectiveness of the medication and worsening of the resident's symptoms, requiring medical intervention.

Inspectors wroteBased on interviews, and record review, the facility failed to act upon the recommendations of the pharmacist report of irregularities for 1 of 6 residents (Resident #2), reviewed for the Medication Regimen Review (MRR). -The facility failed to review and act on the pharmacist's Resident #2's to utilize the correct consent form. This failure could place residents at risk from maintaining their highest practicable level of physical, mental, and psychosocial well-being, and could place them at risk for not providing informed consent to a psychotropic medication.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure that the medication error rate was not five percent or greater. The facility had a medication error rate of 7 % based on 2 errors out of 27 opportunities, which involved 1 of 11 residents (Resident #31) reviewed for medication errors. - MA B was going to administer Metoprolol and Lisinopril (used to treat high blood pressure) and not follow the blood pressure parameters according to the physician's orders for Resident #31. This failure could place residents at risk for increased negative side effects and a decline in health.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure residents were free from any significant medication errors for 1 of 11 residents (Residents #31) reviewed for significant medication errors. - MA B failed to administer medications as ordered by the physician to Resident # 31. These failures could place residents at risk of not receiving the desired therapeutic effect of their medications and negative outcomes.