Central Texas Nursing & Rehabilitation

Inspectors wroteBased on interview and record review, the facility failed to develop and implement a comprehensive person-centered care plan for each resident, consistent with the resident rights, that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment for 1 of 8 residents (Resident #1) reviewed for care plans: The facility failed to ensure Residents #1's Care Plan reflected he was a DNR. This failure could cause confusion for staff members responsible for providing direct care to the residents and place residents at risk of receiving improper care and services.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure each resident received and the facility provided food prepared in a form designed to meet individual needs for 2 of 4 (Resident #1 and #2) residents reviewed for dietary needs. Resident #1 and Resident #2 did not receive food to meet their needs as reported by staff and family since there is no order for special textures or are textures specifically identified. This failure could place residents who received improper diets at risk of difficulty swallowing, possibly resulting in choking. Findings Included:Record review of Resident #1's admission record, dated 7.7.26, revealed a [AGE] year-old male resident was admitted to the facility on 6.15.26. He had diagnoses including Parkinson disease, hypertension, and hypothyroidism. [...]

Inspectors wroteBased on interview and record review the facility failed to ensure that all alleged violations involving abuse, neglect, exploitation or mistreatment, including injuries of unknown source and misappropriation of resident property, were reported immediately, but no later than 2 hours after the allegation was made, if the events that caused the allegation involved abuse or resulted in serious bodily injury, or no later than 24 hours if the events that caused the allegation did not involve abuse and did not result in serious bodily injury to the administrator of the facility and to other officials (including to the State Survey Agency and adult protective services where state law provides for jurisdiction in long-term care facilities) in accordance with state law through established procedures for 1 of 3 residents (Resident #1) reviewed for neglect. [...]

Inspectors wroteBased on interview and record review the facility failed to ensure a resident who was unable to carry out activities of daily living received the necessary services to maintain good nutrition, grooming and personal and oral hygiene for 1 of 3 residents (Resident #1) reviewed for ADL care. The facility failed to ensure Resident #1 was provided with timely incontinent care by facility staff. This failure could place residents at risk for discomfort, skin breakdown, and urinary tract infections.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure drugs and biologicals used in the facility were labeled with currently accepted professional principles, and included the appropriate accessory and cautionary instructions, and the expiration date when applicable for and 1 of 3 medication carts (Hall 400 nurse medication cart) reviewed for medication storage. The facility failed to ensure the nurses cart #1 for the 400 Hall did not contain nebulizers and inhalers that were opened and not labeled with the open date. This failure could place residents at risk of adverse medication reactions.

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment to help prevent the development and transmission of communicable diseases and infections for 2 of 2 residents (Resident #52, Resident #161) reviewed for incontinent care. CNA A failed to change her gloves after they became contaminated during incontinent care while assisting Resident #52 and Resident #161. CNA A failed to follow Enhanced Barrier Precautions (EBP) while performing incontinent care for Resident #161. These failures could place residents at risk for cross contamination and the spread of infection.

Inspectors wroteBased on interviews and record reviews the facility failed to ensure the residents had the right to participate in his or her treatment which included the right to be informed in advance, by the physician or other practitioner or professional, of the risks and benefits of proposed care of treatment and treatment alternatives or treatment options and to choose the alternative or option he or she preferred, for 1 of 5 residents (Resident #14) reviewed. The facility failed to obtain a signed informed consent based on information of the benefits, risks, and options available for Resident #14 prior to administering increased dose of Seroquel, a psychotropic medication, (a psychoactive drug taken to exert an effect on the chemical make-up of the brain and nervous system). [...]

Inspectors wroteBased on interviews and record reviews, the facility failed to develop and implement a comprehensive person-centered care plan based on assessed needs with measurable objectives that could be evaluated or quantified to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being for 1 (Resident #1) of 5 residents reviewed for comprehensive person-centered care plans. The facility failed to develop care plans based on the assessed needs with measurable objectives and timeframes for hospice services for Resident #1. This failure could place the residents at risk for decreased quality of life and not having their needs met.

Inspectors wroteBased on interviews and record reviews the facility failed to ensure the resident's had the right to be informed of the risks, and participate in, his or her treatment which included the right to be informed in advance, by the physician or other practitioner or professional, of the risks and benefits of proposed care, of treatment and treatment alternatives or treatment options and to choose the alternative or option he or she preferred, for 2 of 15 residents (Resident #22 and Resident #31) reviewed for resident rights . The facility failed to obtain informed consent based on information of the benefits, risks, and options available from Resident #22 prior to administering Buspirone, an anxiolytic (antianxiety medication) used to treat anxiety. [...]

Inspectors wroteBased on interview and record review the facility failed to develop and implement a comprehensive, person-centered care plan for each resident that included measurable objectives and time frames to meet, attain, and/or maintain the resident's highest practicable physical, mental, and psychosocial well-being for 2 of 15 residents (Residents #22 and Resident #56) reviewed for care plans. The facility failed to ensure that Resident #22 had a care plan in place for the use of psychotropic medications. The facility failed to ensure that Resident #56 had a care plan in place for his orthotic flexion gloves (therapy gloves used to help the resident curl his fingers into a fist) or his PEG tube (percutaneous endoscopic gastrostomy - tube inserted into the stomach used for nutrition due to swallowing difficulties). [...]

Inspectors wroteBased on observation, interview and record review the facility failed to ensure residents had the right to be free from any physical or chemical restraints imposed for purposes of discipline or convenience, and not required to treat the resident's medical symptoms for 1 of 1 resident (Resident #2) reviewed for restraints. The facility failed to ensure Resident #2 had documented, ongoing monitoring of her lap belt use and that she used her lap belt for the least amount of time possible. This failure could place the resident at risk of unnecessarily inhibiting the resident's freedom of movement, and the possibility of skin breakdown if not released from the lap belt at regular intervals.

Inspectors wroteBased on observation, interview and record review the facility failed to provide pharmaceutical services, including procedures that ensure the accurate administering of all drugs to meet the needs of the residents, for 1 (medication cart in secure unit) of 3 medication carts reviewed for pharmacy services, in that: The medication cart used for the secure unit had an insulin pen that had expired as indicated by the manufacturers recommendations. This failure could place residents at risk of receiving medications that were expired and not produce the desired effect.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure all controlled drugs and biologicals were stored in separately locked and permanently affixed compartments for the facilities only medication room reviewed for labeling/storage of drugs and biologicals. The facility failed to provide separately locked, permanently affixed compartments for the storage of controlled drugs. These failures could place the facility at risk of drug diversion and access to medications.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to ensure the resident environment remained free of accident hazards as was possible and that each resident received adequate supervision and assistive devices to prevent accidents for 1 (Resident #3) of 7 residents who were reviewed for accidents and supervision in that: The facility failed to ensure Resident #3 did not elope after she was identified to be of high risk for elopement based on pre-admission documentation received from Resident #3's previous nursing home placement that was submitted prior to Resident #3's admission on [DATE]. Resident #3 eloped on 12/23/2023 around 12:33 p.m., and was found on 12/23/2023 around 2:00 p.m. The noncompliance was identified as Past Noncompliance. The Immediate Jeopardy (IJ) began on 12/18/2023 and ended 01/10/2024. [...]

Inspectors wroteBased on interviews and records reviews, the facility failed to develop and implement a baseline care plan for each resident that included the instructions needed to provide effective and person-centered care of the resident that meet professional standards of quality of care for 1 (Resident #3) of 5 residents reviewed for base-line care plans. The facility failed to ensure Resident #3 had a baseline care plan developed within 48-hours after admission with goals and interventions. The non-compliance was identified as PNC. The noncompliance began on 11/30/2023 and ended on 12/26/2023 when the comprehensive care plan was developed. The facility had corrected the noncompliance before the survey began. This failure could place newly admitted residents at risk of not receiving individualized care and continuity of services.

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment to help prevent the development and transmission of communicable diseases and infections for four (Resident #2, Resident #12, Resident #39, and Resident # 44) of 23 residents reviewed for infection control. 1. The facility failed to ensure CNA A changed her gloves after they became contaminated during incontinent care while assisting Resident #44 and Resident #39. 2. The facility failed to ensure CNA B changed her gloves after they became contaminated during incontinent care while assisting Resident #12. 3. The facility failed to ensure CNA C changed her gloves after they became contaminated during incontinent care while assisting Resident #12. 4. [...]