Cibolo Creek

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the resident environment remains as free of accident hazards as is possible; and to ensure resident receives adequate supervision to prevent accidents for 1 of 2 residents (Resident #70) reviewed for accidents and hazards. The facility failed to ensure Resident #70 received adequate supervision when Resident #70 was missing on 8/28/2025 for approximately 45 minutes and found lying next to her wheelchair outdoors on an enclosed, outdoor patio. An IJ was identified on 9/3/2025. The IJ template was provided to the facility on 9/3/2025 at 12:10 PM. [...]

Inspectors wroteBased on interviews, and record reviews the facility failed to implement written policies and procedures that Prohibit and prevent abuse, neglect, and exploitation of residents and misappropriation of resident property, by not screening staff annually for 3 of 7 staff (MA AG, FSM, AD) employed longer than 1 year in that: Medication Aide (MA AG did not have a current EMR/NAR. FSM did not have a current EMR/NAR. AD did not have a current EMR/NAR. The failure could place residents at risk of being abused, neglected, or exploited by unemployable staff.

Inspectors wroteBased on observation, interview, and record review, the facility failed to store, prepare, distribute, and serve food for 1 of 1 kitchen in accordance with professional standards for food service safety. 1. The facility failed to maintain the temperature of walk-in refrigerator at or below 41 degrees F for the last 3 months2. The facility failed to take temperatures for the cold foods (to include milk for 09/05/25 breakfast and fresh fruit cups for 09/05/25 lunch). 3. The facility failed to ensure food products were labeled with discard dates. These failures could place residents at risk for food borne illness.

Inspectors wroteBased on interviews, and record reviews the facility failed to ensure the medical records. In accordance with accepted professional standards and practices, the facility must maintain medical records on each resident that are Complete; Accurately documented; Readily accessible; and systematically organized for 3 _of 16 (#20, #38, #5) residents reviewed for clinical records in that:1. Resident #20 did not have a current care plan conference meeting documented in her file. 2. Resident #38 did not have a current care plan conference meeting documented in her file. 3. The facility failed to ensure accurate documentation of Resident #5's July MAR per doctor's orders. These failures could place residents at risk of not receiving the care and services needed due to inaccurate or incomplete clinical records.

Inspectors wroteBased on interview and record review, the facility failed to maintain all mechanical, electrical, and patient care equipment in safe operating condition for 1 of 1 walk-in refrigerators reviewed for essential equipment. The facility failed to ensure the walk-in refrigerator in the kitchen was functioning properly. This failure could place residents at risk for foodborne illness.

Inspectors wroteBased on interview, observation, and record review, the facility failed to ensure a comprehensive care plan was reviewed and revised by the interdisciplinary team after each assessment, including both the comprehensive and quarterly review assessments for 1 of 8 residents (Resident #9) reviewed for care plans. The facility failed to revise Resident #9's comprehensive care plan to reflect the resident's ADL self-care performance for transfers. These deficient practices could place residents at risk of receiving improper care.

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 when there was a significant change in the resident's physical, mental, or psychosocial status in life-threatening conditions for 1 of 5 residents (Resident #1) reviewed for change of condition, in that; The facility failed to notify Resident #1's physician and family on 11/18/2024 when she was found sleepier than usual or notify Resident #1's physician and the resident's family when the resident was found unresponsive and twitching with a significant alteration in mental status at approximately 5:00 a.m. on 11/19/2024 and was treated for altered mental status at the hospital. The noncompliance was identified as PNC. The IJ began on 11/18/2024 and ended on 11/19/2024. [...]

Inspectors wroteBased on interviews and record reviews, the facility failed to ensure that residents receive treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the resident's choices for 1 of 5 residents (Resident #1) reviewed for quality of care, in that; The facility failed to immediately assess and intervene when Resident #1 was found unresponsive and twitching on 11/19/2024 at 5:00 a.m. by LVN A until the next shift arrived and LVN B intervened. This change of condition required treatment in a local hospital for altered mental status. The noncompliance was identified as PNC. The IJ began on 11/19/2024 and ended on 11/19/2024. The facility had corrected the noncompliance before the survey began. [...]

Inspectors wroteBased on interviews and record review, the facility failed to ensure that each resident received adequate supervision to prevent accidents for 1 of 5 residents (Resident #1) reviewed for supervision, in that; The facility failed to adequately supervise Resident #1, who had a history of bringing multiple medications including narcotics into the facility without notifying staff, when she consumed a marijuana laced brownie and was found to have both Ambien and trazadone in an unmarked unlabeled container at bedside on 11/19/2024. On 11/19/2024, Resident #1 was found unresponsive and twitching in her room after staff failed to check on her between 11:00 p.m. on 11/18/2024 to 5:00 a.m. on 11/19/2024 despite seeing an unknown visitor in Resident #1's room on the evening of 11/18/2024 . This failure resulted in the identification of an Immediate Jeopardy (IJ) on 11/22/2024 at 12:50 p.m. [...]

Inspectors wroteBased on observation, interview, and record review the facility failed to provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of each resident for 2 of 6 residents (Residents #2 and #3) reviewed for medications and pharmacy services, in that: The facility failed to ensure Resident #2 clobetasol propionate 0.05% prescription shampoo and over-the-counter polysporin were secured when they were left in the resident's room. The facility failed to ensure Resident #3's Simbrinza ophthalmic suspension x 2 bottles and 5 medication cups of an unknown ointment were secured when the resident was not in the room. These deficient practices could put residents at risk for inaccurate or inappropriate administration of medications.

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 objective and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment for 1 of 5 residents (Resident #1) reviewed for care plans, in that; The facility failed to develop a person-centered care plan with interventions that addressed Resident #1's behaviors of bringing in medications from home, from other providers and from visitors and self-medicating without telling staff. This failure could place residents at risk for not having their needs and preferences met.

Inspectors wroteBased on interviews, and record review, the facility failed to maintain medical records, in accordance with accepted professional standards and practices, that are complete; and accurately documented for 1 of 5 residents (Resident #1) reviewed for medical records, in that; The facility failed to ensure staff documented Resident #1's unresponsiveness and SBAR assessment, the pills found in her room on 11/19/2024 or interventions for her change of condition including notification/activation of 911 and transfer to the hospital for treatment. This failure could result in residents not having an accurate overall view of their care and services.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure residents received services in the facility with reasonable accommodation of resident needs for 3 of 8 residents (Residents #19, #21 and #49) who were observed for call light placement. The facility failed to ensure the call light was within reach for Residents #19, #21, and #49. This deficient practice could affect any resident and keep them from calling for help as needed.

Inspectors wroteBased on observation, interview, and record review, the facility failed to store and prepare food in accordance with professional standards for food service safety for 1 of 1 kitchen reviewed, in that: 1. [NAME] I was not wearing a moustache or beard guard while preparing food. 2. The walk-in refrigerator and walk in freezer both contained improperly stored food items. These deficient practices could place residents who consumed meals and/or snacks from the kitchen at risk for food borne illness.

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 and to help prevent the development and transmission of communicable disease and infection for 3 of 9 residents (Residents #4, #30 and, #24) reviewed for infection control, in that: 1. Medication Aide F did not sanitize the blood pressure cuff between Residents #4 and #30. 2. While providing catheter care for Resident #24, CNA G and CNA H did not change their gloves or wash their hands after touching the privacy curtain and the environment outside of the room. These deficient practices could place residents at-risk for infection due to improper care practices.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents have a right to personal privacy for 1 of 6 residents (Resident #18) reviewed for privacy, in that: ADON A did not close completely Resident #18's privacy curtain while providing wound care. This deficient practice could place residents at-risk of loss of dignity due to lack of privacy.

Inspectors wroteBased on interviews and record reviews, the facility failed to ensure the assessment accurately reflected the resident's status for 1 of 18 residents (Resident #52) whose assessments were reviewed, in that: Resident #52's Significant change MDS, dated [DATE], incorrectly documented the resident as receiving an injection of insulin. This failure could place residents at-risk for inadequate care and services due to an inaccurate assessments.

Inspectors wroteBased on interview and record review the facility failed to ensure residents had the right to be free from abuse, neglect, misappropriation of resident property, and exploitation for 1 of 3 residents (Resident #1) reviewed for misappropriation. The facility failed to prevent misappropriation of property when CNA B took money via cash app and directly from a bank card from Resident #1 in the amount of $920.99 dollars. The non compliance was identified as past noncompliance. The noncompliance began on 09/29/23 and ended on 09/29/23. The facility had corrected the noncompliance before the survey began. This failure could place residents at risk of misappropriation which could lead to further exploitation of other residents.

Inspectors wroteBased on interview and record review, the facility failed to follow its written policies and procedures to prohibit and prevent abuse, neglect, and exploitation of residents and misappropriation of property . The facility failed to follow its hiring policy and hired a nurse aide who had an extensive criminal history of theft and had a bar to employment of robbery on her record which resulted in the misappropriation of property of Resident #1. The non compliance was identified as past noncompliance. The noncompliance began on 09/29/23 and ended on 09/29/23. The facility had corrected the noncompliance before the survey began. This failure could place residents at risk of abuse, neglect, and exploitation due to staff not properly screened for employability.

Inspectors wroteBased on observation, interviews and record reviews, the facility failed to provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of each resident for two of two residents (Residents #2 and #3) out of 13 residents reviewed for medication administration., in that: The facility failed to ensure Resident #2 was discharged from the facility with only his prescribed medication. The facility failed to ensure Resident #3 was given his prescribed medication prior to his discharge. The non compliance was identified as past noncompliance. The noncompliance began on 10/05/23 and ended on 10/07/23. The facility had corrected the noncompliance before the survey began. [...]

Inspectors wroteBased on record review and interview the facility failed to ensure the Arbitration Agreement contained all the required elements for 1 of 1 facility. The facility failed to ensure the arbitration agreement contained the required elements: 1. The non-compulsory condition of admission in signing the arbitration agreement. 2. The acknowledgment of understanding the arbitration agreement. 3. The right to rescind the agreement within 30 calendar days of signing. 4. The retained ability to contact advocates and government representatives. This failure could place the residents and their representatives at risk of being uninformed about their rights regarding binding arbitration and less able to defend their rights related to disputes, controversy or claims arising out of or related to the services provided by the nursing facility.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure that residents were free of any significant medication errors for 3 (Resident #234, #233, and #75) of 6 residents reviewed for safe administration of midodrine [a medication intended to raise systolic blood pressure], in that: 1. Resident #234 was administered midodrine on 4 instances outside of the parameters established by the Primary Care Physician (PCP) to hold if greater than 160 systolic blood pressure between 5/01/2023-5/25/2023; 2. Resident #233 was administered midodrine on 3 instances outside of the parameters established by the Primary Care Physician (PCP) to hold if greater than 160 systolic blood pressure between 5/01/2023-5/25/2023; 3. [...]

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure residents who were unable to carry out activities of daily living [ADLs] were provided with the necessary services to maintain good personal hygiene for one resident of six reviewed (Resident #44) for ADL care, in that The facility failed to ensure Resident #44 was provided bathing as scheduled: Resident #44 was not provided 6 of 11 scheduled showers. This deficient practice could place residents who require assistance from staff for personal hygiene at risk of not receiving care and services to meet their needs and not reaching their highest practicable physical and psychosocial well-being.

Inspectors wroteBased on observation, interviews and record reviews, the facility failed to assure that residents receive a therapeutic diet as prescribed by the physician for 1 of 1 resident (#52) reviewed for diets in that: Resident #52 was prescribed a renal diet (A renal diet is one that was low in sodium, phosphorous, and protein. A renal diet also emphasizes the importance of consuming high-quality protein and usually limiting fluids. Some patients may also need to limit potassium and calcium) and was provided a regular diet which did not meet his special dietary needs. This failure could affect residents who are prescribed renal diets and could result in potassium building up in the blood stream and could result in a heart attack.

Inspectors wroteBased on observation, interview, and record review, the facility failed to store, prepare, distribute and serve food in accordance with professional standards for food service safety for 1 of 1 kitchen reviewed for kitchen sanitation in that: 1. The facility failed to maintain the cleanliness of the ice maker found within the kitchen. 2. The facility failed to prevent residents from receiving food that had made contact with an un-sanitized work surface. These failures could place residents at risk for cross-contamination and foodborne illnesses.

Inspectors wroteBased on record review and interview the facility failed to ensure the Arbitration Agreement contained all the required elements for 1 of 1 facility. The facility failed to ensure the arbitration agreement contained the selection of a neutral venue that is convenient for both parties. This failure could place the residents and their representatives at risk of being uninformed about their rights regarding binding arbitration and less able to defend their rights related to disputes, controversy or claims arising out of or related to the services provided by the nursing facility.