Laredo Nursing and Rehabilitation Center

Inspectors wroteBased on interview and record review the facility failed to Incorporate the recommendations from the PASARR Level II determination for 1(Resident #1) out of 4 residents reviewed for services received from the PASARR II recommendations. The facility failed to initiate an NFSS within the 20 business days following the date the services were agreed on in the IDT meeting on 12/19/25 for Resident #1. This failure could cause residents with mental health disorders and psychiatric conditions to have a delay in services or not receive specialized services or equipment that may be needed.

Inspectors wroteBased on interview and record review the facility failed to ensure residents received treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan and the residents' choices for one (Resident #1) of five residents reviewed for quality of care. The facility failed to ensure LVN B accurately assessed and documented Resident #1's newly identified skin impairment including but not limited to characteristics such as measurements, shape, or condition of the surrounding tissue on 02/01/26, in accordance with facility policy. On 02/02/26, record review revealed the wound had progressed and was identified as a Stage IV pressure ulcer (full thickness skin and tissue loss with exposed or directly palpable fascia, muscle, tendon, ligament, cartilage, or bone). [...]

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 diseases and infections for one (Resident #2) of five residents reviewed for infection control practices. 1) The facility failed to ensure the WCN performed hand hygiene for at least 20 seconds prior and after performing Resident #2's wound care. 2) 1)The facility failed to ensure the WCN performed hand hygiene in between glove changes during Resident #2's wound care.3) The facility failed to ensure CNA A performed hand hygiene in between glove changes while aiding in Resident #2's wound care. These failures could place residents that require wound care at risk for healthcare associated cross-contamination and infections.

Inspectors wroteBased on interview and record review, the facility failed to maintain medical records on each resident that were complete and accurately documented in accordance with accepted professional standards and practices for 4 of 8 residents (Resident #1, Resident #2, Resident #6, and Resident #14) reviewed for medical records.1. The facility failed to ensure RN C did not document a blood sugar of 2 on Resident #1's MAR when she refused finger sticks and insulin on 23 of 23 opportunities from 02/01/26 to 03/05/26.2. The facility failed to ensure LVN B, RN C, LVN D, LVN F, LVN G, and LVN H documented accurate Neuro Check vital signs for Resident #2 after he fell on [DATE].3. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that residents who needed respiratory care were provided such care consistent with professional standards of practice, the comprehensive person-centered care plan, and the resident's goals and preferences for 1 (Resident #87) of 3 residents reviewed for respiratory care. The facility failed to ensure Resident # 87's oxygen was administered at the correct setting of 2 liters per minute on 3/03/2026 as ordered by the physician. This deficient practice could place residents at an increased risk of developing respiratory complications and a decreased quality of care.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure all drugs and biologicals were stored in locked compartments and labeled in accordance with currently accepted professional principles reviewed for medications stored in 1 of 1 medication refrigerators in the medication storage room. The facility failed to ensure medications in the medication room refrigerator were stored at an appropriate temperature. The failure could place residents in the facility at risk of receiving expired medications from staff.

Inspectors wroteBased on observation, interview and record review, the facility failed to maintain an infection control program designed to prevent the development and transmission of disease and infection for 1 (Resident #118) of 2 residents observed for contact precautions. SW did not don PPE before entering Resident #118's room on 3/03/2026. Resident #118 was under Contact Precautions as per physician orders. This failure could place residents who resided in the facility, as well as employees and visitors, at risk of communicable diseases.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure each resident received adequate supervision and assistance devices to prevent accidents, for one of four residents (Resident #1) reviewed for accidents and supervision. The facility failed to ensure CNA A performed a 2-person assist while conducting incontinent and bed mobility care for Resident #1 on 03/18/2025 which led to Resident #1 sustaining a fall. This failure could place residents at risk for falls, injuries and a decline in health.

Inspectors wroteBased on observations, interviews and record reviews the facility failed to maintain an infection control and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable disease and infections for 3 of 5 residents (Residents #53, #44, and #79) observed for infection control practices. CNA D, E, B, and A failed to properly change gloves, as well as wash or sanitize hands when moving from a dirty area to a clean area when incontinent care was observed for Residents #53, #44, and #79. These failures and deficient practices could place residents at risk for cross contamination and infection.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, consistent with the resident's comprehensive assessment and plan of care for 3 of 4 Residents (Resident's #87, #61 and #26) reviewed for care plans. The facility failed to have quarterly care plan and Interdisciplinary Team Meetings to review Residents #87, #61 and #26's care plans. This failure could place residents at risk for not receiving the required care. The Findings for Resident #87 included: Record review of face sheet revealed Resident #87 as a [AGE] year-old male with an original admission date of 1/26/2024, and a current admission date of 8/9/2024. [...]

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure residents who needed respiratory care was provided such care, consistent with professional standards of practice, person centered care plans, and resident's goal and preferences for 2 of 2 residents (Resident #13 and #44) reviewed for respiratory care. 1. The facility failed to ensure Resident #44's oxygen was provided continuously. 2. The facility failed to ensure Resident #13's respiratory exercises were consistent with the physician's orders. These failures could place residents who receive respiratory care at risk of developing respiratory complications and a decreased quality of life.

Inspectors wroteBased on observations, interviews, 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 8% based on 2 errors out of 25 opportunities, which involved 1 of 4 residents (Resident #38) reviewed for medication errors. - RN B failed to administer medication as ordered to Resident #38 by preparing only one 25mg tablet of sertraline instead of three 25mg tablets as ordered. - RN B failed to administer medications as ordered to Resident #38 by not preparing a 20mg tablet of isosorbide dinitrate as ordered. These failures could place residents receiving medication at risk of inadequate therapeutic outcomes.

Inspectors wroteBased on interviews and record review, the facility failed to maintain clinical records on each resident that were complete and accurately documented in accordance with accepted professional standards and practices for 1 (Resident #70) of 10 residents reviewed for accuracy and completeness of clinical records. The facility failed to accurately document in the treatment administration record when Resident #70 received their dose of vancomycin (antibiotic) on 01/05/25. This failure could result in residents' records not accurately reflecting the administration of medications and could result in further error and a decline in heath.

Inspectors wroteBased on interview and record review, the facility failed to ensure residents were free from abuse for 2 of 8 residents (Residents #39 and #4) reviewed for abuse. The facility did not take measures to prevent physical abuse between R#4 and R#39; R#39 was bit on the upper thigh and struck with a bed remote and call light by R#4. This failure could place residents at risk of physical harm, mental anguish, or emotional distress. An IJ was identified on 10/13/23. The IJ template was provided to the facility on [DATE] at 3:53pm. While the IJ was removed on 10/16/23, the facility remained out of compliance at a scope of isolated and a severity level of actual harm.

Inspectors wroteBased on interview and record review, the facility failed to ensure residents were free from abuse for 2 of 8 residents (Residents #39 and #4) reviewed for abuse. The facility did not take measures to prevent physical abuse between R#4 and R#39; R#39 was bit on the upper thigh and struck with a bed remote and call light by R#4. This failure could place residents at risk of physical harm, mental anguish, or emotional distress. An IJ was identified on 10/13/23. The IJ template was provided to the facility on [DATE] at 3:53pm. While the IJ was removed on 10/16/23, the facility remained out of compliance at a scope of isolated and a severity level of actual harm.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure each resident received adequate supervision to prevent accidents for 1 of 8 residents (Resident #100) reviewed for accidents and hazards: The facility failed to develop and implement interventions to prevent Resident #100's elopement from the facility. Resident #100 eloped from the facility and was found by the road having sustained abrasions, lacerations and a hematoma. An IJ was identified on 10/13/23. The IJ template was provided to the facility on [DATE] at 3:53pm. While the IJ was removed on 10/16/23, the facility remained out of compliance at a scope of isolated and a severity level of actual harm. This deficient practice could place the residents at risk for harm, serious injury or death.

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 sanitation in that: 1. The facility failed to ensure utensils were clean 2. The facility failed to keep accurate temperature and chemical logs 3. The facility failed to ensure dry storage foods were sealed 4. The facility failed to maintain items in the dry storage area properly 5. The facility failed to remove expired items in the nutrition room These failures could place residents at risk of foodborne illnesses.

Inspectors wroteBased on observation, interview, and record review, the facility failed to develop and implement a person-centered care plan for each resident that included measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that were identified in the comprehensive assessment for 3 of 8 residents (Resident #'s 4, #13, and #17) reviewed for comprehensive care plans in that: 1. The facility did not identify or implement interventions for Resident #4's history of aggression. 2. The facility did not implement the comprehensive person-centered care plan set forth for R #13 (care plan did not state R #13 was on a renal diet). 3. R #17's code status was not updated in the care plan to reflect current physician orders. This deficient practice could place residents at risk for not receiving appropriate treatment and services.

Inspectors wroteBased on interviews and record review, the facility failed to develop, implement, and maintain annually an effective training program for individuals providing services, consistent with their expected roles for 7 of 7 employees (CNA L, Restorative Aide (RA) G, DON, RD, SW, PT, and the BOM) reviewed for training. The facility failed to ensure that required training was provided for CNA L, Restorative Aide (RA) G, the DON, the RD, the SW, PT , and the BOM for the review period of October 2022 to October 2023. The facility failed to ensure that required training was provided for 1 CNA, 1 restorative aide, and the BOM for the review period of October 2022 to October 2023. This failure could place residents at risk of being cared for by staff who have been insufficiently trained.

Inspectors wroteBased on interview and record review the facility failed to ensure all alleged violations involving abuse, neglect, exploitation or mistreatment, including injuries of unknown source and misappropriation of resident property were reported immediately, but not later than 2 hours after the allegation was made, if the alleged violation involved abuse or resulted in serious bodily injury, to the administrator of the facility and to other officials (which included to the State Survey Agency) in accordance with State law through established procedures for 1 of 8 residents (Resident #5) reviewed for reporting alleged allegation of abuse. The facility did not report, within 2 hours, when Resident #5's responsible party reported on 06/23/23 to the Social Worker (SW) that LVN M had been rude to Resident #5 on 06/22/23. [...]

Inspectors wroteBased on interview, and record review, the facility failed to ensure for 1 of 11 residents (Resident 13) was admitted with physician order for thier care reviewed for admission orders. 1. There were no physician orders for R #13 to receive dialysis treatment. This deficient practice could affect residents and place them at risk of not receiving the care and services to meet their needs.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that residents requiring respiratory care were provided such care, consistent with professional standards of practice for 1 of 3 residents reviewed for respiratory care (Resident #160). The facility did not ensure Resident #160 was receiving supplemental oxygen as ordered. Resident #160 was without supplemental oxygen for more than an hour. This deficient practice could affect residents who receive oxygen and result in respiratory compromise.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that one (1) of four (4) CNAs (CNA M) was able to demonstrate competency in the provision of skills and techniques necessary to care for one (1) of three (3) residents (Resident # 160) reviewed for competent staff in that: CNA in training M failed to connect Resident #160 to an oxygen concentrator after disconnecting it from an oxygen bottle. Resident #160 was left without prescribed oxygen for more than an hour. This deficient practice could lead to respiratory distress or hypoxia. Hypoxia is a state in which oxygen is not available in sufficient amounts at the tissue level to maintain adequate homeostasis.

Inspectors wroteBased on interview and record review, the facility failed to maintain clinical records in accordance with accepted professional standards and practices that are complete and accurately documented for 1 of 8 Residents (Resident #60) reviewed for medical records accuracy, in that: Resident #60's April Medication Administration Record (MAR) did not reflect documentation for identified pain and acetaminophen that was administrated by LVN C on 04/20/23. This deficient practice could affect residents whose records are maintained by the facility and could place them at risk for errors in care, and treatment.

Inspectors wroteBased on observation, interview, and record review the facility failed to establish and maintain an Infection Prevention and Control Program designed to help prevent the standard and transmission-based precautions to be followed to prevent the spread of infections or diseases for 1 of 3 residents (R #13) observed for infection control, in that; 1. LVN D placed an open, uncovered wound on a soiled pad while providing wound care on R #13. This failure could place residents at risk for healthcare associated cross-contamination and infections.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that 1 (R#1) of 30 residents with diagnoses of diabetes reviewed for professional standards, received care in accordance with professional standards of practice and the comprehensive person-centered care plan. During R #1's admission medication reconciliation process and throughout his stay, the facility failed to attempt to attain an order for blood glucose monitoring, despite his daily administration of three different diabetic oral medications and decreased appetite. R #1 became lethargic with an altered mental status on 08/31/23 at approximately 7:30 AM until he was transferred to the hospital at 3:42 PM without appropriate physician intervention. [...]

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure a physician supervised the care of a resident for one (Resident #1) of five residents reviewed for physician services. The facility failed to ensure the physician supervised and monitored Resident #1's blood glucose monitoring since Resident #1 was diagnosed with diabetes and was prescribed and administered three different oral diabetic medications. R #1 became lethargic with an altered mental status on 08/31/23 at approximately 7:30 AM until he was transferred to the hospital at 3:42 PM without any appropriate physician intervention. R #1 was admitted to the intensive care unit of the hospital with a blood glucose level of 1160 mg/dL (normal reference range 70-100), required an IV medication intervention for his low blood pressure, and positive pressure ventilation to assist with his breathing. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure nursing staff demonstrated appropriate competencies and skills sets to provide nursing and related services to assure resident safety and attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, for one (R #1) of four residents that were diagnosed with diabetes mellitus. 1. Multiple nursing personnel who cared for R#1 did not consult with R#1's Physician, in attempt to retrieve instructions for blood glucose monitoring. 2. LVN A cared for R#1 for multiple days and stated she did not know he was a diabetic. 3. DON assessed R#1 on 8/31/23 and despite of his change in condition of lethargy and altered level of consciousness, the DON did not conclude that R#1's change in condition was urgent enough to require emergent medical treatment. [...]