Granbury Rehab & Nursing

Inspectors wroteBased on interview and record review, the facility must not use any individual working in the facility as a nurse aide for more than four months on a full-time basis unless that individual has completed a training and competency evaluation program for 1 of 4 (NA C) non-certified nurse aides reviewed. The facility failed to ensure full-time NA C was certified within four months of the date of hire. This failure placed residents at risk of receiving inappropriate care from an individual whose skill level was not known.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure that residents were free of a med error rate of 5% or greater for 2 (Resident #7) of 25 medication pass opportunities reviewed for medication administration. The facility failed to ensure the medication error rate (8%) was less than 5% for Resident #7. This failure placed residents at risk of incorrect doses of medications and optimal therapeutic response.

Inspectors wroteBased on observation, interview and record review the facility failed to post nurse staffing information that included the resident census for 70 days of 70 days reviewed for required postings. The facility failed to update the daily nurse staffing required posting in a prominent location of the facility since April 16, 2026. This failure could place all residents, their families, and facility visitors at risk of not having access to information regarding staffing data and the facility census.

Inspectors wroteBased on interviews and record reviews, the facility failed to maintain medical records on each resident that were complete and accurately documented for 2 (Resident #2 and Resident #4) of 6 residents reviewed for administration.1. The facility failed to provide care as ordered to Resident #1's left lower leg wound on 06/01/2026.2. The facility failed to document Resident #2's72 hours surveillance, and notifications of the physician and representative in the chart following a fall on 5/27/2026. 3. The facility failed to document Resident #4's fall in nurses notes, 72 hours surveillance, and notifications of the physician and representative in the chart following a fall on 05/26/2026.4. The facility failed to document Resident #4 72 hours surveillance, and notifications of the physician and representative in the chart following a fall on 04/27/2026. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to make sure that its menus are followed and document any substitutions made to the menus on 4 of 4 halls reviewed for food and nutrition services. The facility failed to ensure residents who ate from the kitchen received all food items according to the menu or an approved alternative during lunch meal on 9/15/2025. This failure could place residents that eat out of the kitchen at risk of poor intake, chemical imbalance and/or weight loss.

Inspectors wroteBased on interview and record review, the facility failed to consider the views of the resident or family group and act promptly upon the grievances and recommendations of such groups concerning issues of resident care and life in the facility or to demonstrate their response and rationale for such response for 9 of 9 confidential resident council members reviewed for resident/group response. The facility failed to provide a verbal or written response to the Resident Council addressing the grievances reported from their meetings on February 2025, March 2025, and August 2025 which included issues with nursing services, dietary services, and housekeeping services. These failures could place residents at risk of unresolved grievances, a decreased sense of self-worth, and a decline in quality of life. [...]

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to include in the care plan services that will be provided to the resident for 3 (Resident #9, Resident #54, and Resident #72) of 22 residents reviewed for comprehensive care plans. 1. The facility failed to ensure Resident #9's comprehensive care plan had resident specific care needs for pressure ulcer.2. The facility failed to ensure Resident #54's comprehensive care plan had interventions care needs and interventions for dialysis.3. The facility failed to ensure Resident #72's comprehensive care plan had appropriate interventions for current transfer and sleeping status.4. The facility failed to ensure Resident #72's comprehensive care plan had correct code status and interventions to match her orders and wishes. [...]

Inspectors wroteBased on interviews and record review, the facility failed to ensure a qualified professional directs the activities program for 1 of 1 activity director (AD) reviewed for qualifications. The facility failed to ensure the AD, hired on July 17, 2024, was a qualified therapeutic recreation specialist or an activities professional that met state licensing requirements. This failure could place residents at risk for reduced quality of life due to lack of activities that were individualized to match the skills, abilities, and interests/preferences of each resident.

Inspectors wroteBased on observation, interview, and record review the facility failed to provide food prepared and served on time for 1 of 1 dining room and 4 (A, B, C, and D) of 4 halls. The facility failed to ensure that 1 of 1 lunch observed on 9/15/2025 was served at the posted mealtime 11:45 a.m. This failure could affect all residents who received meals served from the facility's only kitchen by placing residents at risk for unplanned weight loss, side effects from medication given without food, and diminished quality of life.

Inspectors wroteBased on observations, interviews, and record reviews the facility failed to make sure that all persons in food service meet local, state, and federal requirements for 1 of 1 kitchen reviewed. 1. The facility failed to ensure holding temperatures were taken on food served during lunch service on 9/15/2025.2. The facility failed to ensure pureed kielbasa sausage, pureed greens beans, and pureed macaroni salad were heated to appropriate temperature after mechanically altering the food on 9/15/2025 during lunch service. 3. [...]

Inspectors wroteBased on interviews and record reviews, the facility failed to follow their written policies and procedures that prohibit and prevent abuse, neglect, exploitation of residents and misappropriation of resident property 2 of 15 employees (RN J and DM) reviewed for employability. The facility failed to ensure the record of the initial EMR/NAR check was completed and maintained for DM hired on 7/1/2025 per facility policy. The facility failed to ensure the initial EMR check was completed and maintained for the DM hired on 06/2/2025 per facility policy. These findings placed residents at risk of receiving care by someone that was unemployable.

Inspectors wroteBased on interview and record review, the facility did not develop a baseline care plan, or comprehensive care plan with necessary information within 48 hours of the resident's admission for 2 (Resident #1 and Resident #54) of 24 residents reviewed for care plan completion. The facility failed to complete a new baseline care plan for Resident #1 upon admission. This failure could place residents who were newly admitted at risk for not receiving necessary care and services or having important care needs identified. Resident #1Review of Resident #1's Face Sheet revealed a [AGE] year-old male initially admitted on [DATE] with a recent admission date of 09/10/2025. Resident #1's medical diagnoses of Pneumonia, acute respiratory failure, depression, cognitive communication deficit and anemia. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure that a medication cart not being used was secured for 1 of 4 medication carts (Cart Hall D). The facility failed to ensure Cart Hall D was not left unlocked and unsecured while unattended. These failures could place all residents at risk of harm or decline in health due to lack of potency of supplies, medications/biologicals or misappropriation of medications, or drug diversions.

Inspectors wroteBased on observations, interviews and record reviews, the facility failed to establish and maintain an infection control program 2 of 2 (CNA-E and CNA-I) staff observed during incontinent care. The facility failed to ensure CNA E, and CNA I performed proper peri-care (incontinent care) and proper hand hygiene during peri-care for Resident #91. These failures placed residents of the facility at risk of infections from improper incontinent care and hand hygiene while performing incontinent care.

Inspectors wroteBased on interview, the facility failed to ensure the residents' right to receive their mail for seven of seven (confidential) residents interviewed regarding personal mail. The facility failed to distribute mail to residents on Saturdays. This failure could place residents at risk of not receiving mail in a timely manner and could result in a decline in resident's psychosocial well-being and quality of life.

Inspectors wroteBased on observation and interview, the facility failed to post the HHSC complaint number and a statement that the resident may file a complaint with the State Survey Agency concerning any suspected violation of a state or federal regulation, including but not limited to resident abuse, neglect, exploitation, misappropriation of property in the entire facility observed for required postings reviewed for resident rights. The facility failed to ensure the required posting of a HHSC complaint number and statement about how a resident may file a complaint with the State Survey agency. This failure placed residents at risk of being unaware of who and how to contact the State Survey Agency and their right to file a complaint with the State Service Agency concerning any suspected violation of state or federal regulation.

Inspectors wroteBased on interview and record review, the facility failed to ensure each resident received food that accommodated their preferences for seven residents in confidential group interview reviewed for food preferences. The facility failed to accommodate the residents' preference of spreading peanut butter on the peanut butter/jelly sandwich when served. This failure could place residents at risk for not having their choices and food preferences accommodated, possible weight loss and a diminished quality of life.

Inspectors wroteBased on observations, interviews and record review, the facility failed to store, prepare, distribute and serve food in accordance with professional standards for food service safety for the facility's only kitchen observed for kitchen sanitation. 1. The facility failed to ensure the fryer with grease was covered and cleaned when not in use. 2. The facility failed to ensure sugar container was sealed. The sugar and four containers in dry storage were not free from white powder on top. 3. Dietary Aide B failed to practice proper hand hygiene during lunch meal preparation on 07/31/24. 4. The facility failed to ensure icing container, chicken broth and beef broth containers were free of crumbs and particles. These failures could place residents at risk for food contamination and food-borne illness.

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, in that: The facility failed to ensure open items in the freezer, refrigerator, and dry food storage were dated and labeled and free from expired foods. These failures could place residents at risk for food borne illness and cross-contamination.

Inspectors wroteBased on interview and record review, the facility failed to ensure the comprehensive assessment accurately reflected the resident's status for 3 of 18 Residents (Resident # 15, Resident # 23, and Resident #20) reviewed for accuracy of assessments, in that: 1. The facility failed to update Resident #15's MDS when the resident had not had COVID since 02/01/2023 or sepsis since 11/01/2022. 2. The facility failed to update Resident #23's MDS when the resident had not had COVID since 01/23/2023. 3. The facility failed to update Resident #20's MDS when the resident had not had pneumonia since 03/11/2023. These failures place residents at risk of inaccurate assessments and not receiving appropriate care according to their current status.

Inspectors wroteBased on observation, interview and record review, the facility failed to develop and implement a baseline care plan for each resident that includes the instructions needed to provide effective and person-centered care of the resident that meet professional standards of quality care for 1 of 2 (Resident #131) reviewed for baseline care plans. The facility failed to develop a baseline careplan that included the needs of Resident #131's foley catheter. This failure placed residents that admitted to the facility with a foley catheter of having their needs met.