Mi Casita Nursing and Rehabilitation

Inspectors wroteBased on interviews and record reviews, the facility failed to treat each resident with respect, dignity, and care for each resident in a manner and in an environment that promotes the maintenance or enhancement of their quality of life, recognizing each resident's individuality. The facility failed to protect and promote the rights of 4 of 24 confidential residents in that: The facility failed to ensure staff were not on their personal cell phones while providing care, which included peri-care to residents. This could place residents at risk for diminished quality of life and loss of dignity and self-worth.

Inspectors wroteBased on observation, 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 included measurable objectives and timeframes to meet a resident's medical, nursing, mental, and psychosocial needs that were identified in the comprehensive assessment for 2 (Residents #7 and #40) of 22 residents reviewed for care plans. 1. The facility failed to develop a care plan for oxygen administration for Resident #7.2. The facility failed to implement the smoking care plan for Resident #40. This failure could place residents at risk of not receiving the care required to meet their individualized needs.1. [...]

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure that each resident received adequate supervision and assistance devices to prevent accidents for 1 of 4 residents (Resident #40) reviewed for smoking. The facility failed to ensure Resident #40's smoking items were kept at the nursing station. This failures could place the residents at risk of inadequate supervision, accidents, and burns which could result in injury. Findings Included: Record review of the admission record for Resident #40, dated 03/25/26, revealed a [AGE] year-old male who was admitted to the facility on [DATE] and readmitted on [DATE] with the following diagnoses: chronic atrial fibrillation (irregular heart rate), acute lower respiratory infection, and chronic obstructive pulmonary disease (lung disease). [...]

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 residents' goals and preferences for 2 (Resident #1 and #17) of 8 residents reviewed for respiratory care. The facility failed to ensure that Resident #1 and Resident #17's oxygen tubing were replaced every seven (7) days, according to physician's orders. This failure could place residents at risk for respiratory compromise and infectionResident #1 Record review of Resident # 1's face sheet dated 03/27/26 reflected a [AGE] year-old male with an original admission date of 07/14/15. Resident #1 had diagnoses which included: [...]

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure that its medication error rate was less than 5 percent. The facility had a medication error rate of 6.06% based on 2 out of 33 opportunities, for 2 of 3 Residents (Residents #33 and #36) reviewed for medication administration, in that:-The facility failed to ensure Med Aide C provided a full dose of the medication Polyethylene Glycol 3350 Powder (MiraLAX) 17 grams to Resident #36. -The facility failed to ensure Med Aide C provided the correct eye drop medication to Resident #33. These failures could place residents at risk of incomplete therapeutic outcomes, increased negative side effects, and decline in health.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure all drugs and biologicals were stored in accordance with currently accepted professional principles for 2 of 4 medication carts (Med Cart A and Med Cart B) and 1 of 2 medication rooms (Med Room C) reviewed for medication storage. The facility failed to ensure Med Cart A did not have loose pills in the drawers. The facility failed to ensure Med Cart A, Med Cart B and Med Room C did not have expired medications and supplies. These failure could place residents at risk of medication errors or adverse effects.

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 in 1 of 1 kitchen reviewed for dietary services.1. The facility failed to ensure red onions with sprouts and mold were removed from the dry pantry. These failures could place residents at risk for foodborne illness. On 3/25/26 an initial kitchen observation tour from 9:47 AM to10:30 AM revealed the following:The dry pantry had a plastic bin dated 2/24/26 with red onions in it. There were 6 red onions found to have green sprouted shoots and were soft to touch. There were 4 red onions with dark black and grey molded areas and were soft to touch. During an interview on 3/25/26 at 10:05 AM the DS stated that staff were to check the red onions every day. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to maintain clinical records in accordance with accepted professional standards and practices that were complete and accurately documented for 2 (Residents #1 and #17) of 22 residents reviewed for clinical records. The facility failed to accurately document oxygen tubing changes for Residents #1 and #17 This failure could place residents at risk of inaccurate and incomplete care. Resident #1 Record review of Resident # 1's face sheet dated 03/27/26 reflected a [AGE] year-old male with an original admission date of 07/14/15. Resident #1 had diagnoses which included: [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to establish and 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 1 of 4 residents (Resident #32) reviewed for infection control. The facility failed to ensure LVN B washed her hands after entering the room to provide wound care to Resident #32. This failure could place residents at risk for cross contamination and infection.

Inspectors wroteBased on observation, interview, and record review the facility failed to provide 80 square feet of floor space per resident in 10 of 40 semi-private resident rooms containing two beds (Rooms #1, 3, 5, 8, 27, 29, 30, 31, 32, and 33) in that: Rooms #1, 3, 5, 8, 27, 29, 30, 31, 32, and 33 semi- private rooms did not have 80 square feet per resident. This failure could result in overcrowding in resident rooms and possible diminished quality of life.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to provide information to resident's and their representatives on their rights related to filing grievances or concerns for 9 of 15 confidential residents. The facility failed to ensure 9 of 15 confidential residents were provided, through postings in prominent locations, the Grievance Procedure, were provided access to the Grievance form, were provided information who the facility grievance official was, their contact information, how to file an anonymous grievance, and their right to obtain a written decision related to their grievance. This failure could place the residents at risk of unresolved grievances and decreased quality of life.

Inspectors wroteBased on observation, interview, and record review the facility failed to provide each resident with a diet that met his or her daily nutritional and special dietary needs, taking into consideration the preferences of each resident for 3 (Resident #16, Resident #40, and Resident #25) of 15 residents reviewed for dietary services. The Facility did not provide Resident #16 or Resident #25 with their dietary preferences for 1 of 2 meals reviewed (Lunch on 01/07/25). The Facility did not provide Resident #40 with double portions or his dietary preferences for 1 of 2 meals reviewed (Lunch on 01/07/25). This failure could place residents, who ate meals from the kitchen, at risk for weight loss, altered nutritional status and diminished quality of life.

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 in 1 of 1 kitchen reviewed for dietary services. 1) The facility failed to keep refrigerator, freezer and oven handles clean. 2) The facility failed to properly store food in the pantry and refrigerator. These failures could place residents at risk for food contamination and foodborne illness.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to ensure each resident was treated with respect, dignity, and care for each resident in a manner and in an environment that promoted the maintenance or enhancement of their quality of life, recognizing each resident's individuality. The facility failed to protect and promote the rights of the resident for 1 of 18 (Resident #33) residents reviewed for resident rights. CNA D failed to provide Resident #33 privacy during incontinent care. This failure could place residents at risk for diminished quality of life and loss of dignity and self-worth.

Inspectors wroteBased on interviews and record review, the facility failed to ensure all residents had the right to formulate advance directives for 1 of 15 residents (Resident #11) reviewed for advanced directives. The facility failed to ensure Residents #11, who was listed as DNR (Do Not Resuscitate), had an Out-of-Hospital Do Not Resuscitate (OOH-DNR) form that did not have missed required information on the OOH-DNR. These failures could place residents at risk for not having their end of life wishes honored and incomplete records.

Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to provide a safe, clean, comfortable, and homelike environment for 1 (Resident #10) of 4 residents reviewed for ADL care. The facility failed to ensure Resident #10's wheelchair was clean. This deficient practice could place residents at risk of neglect, infection, and a diminished quality of life.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure that the resident environment remained as free of accident hazards as was possible for 1 of 15 Residents (Resident #16). The facility failed to store Resident #16's portable oxygen tank properly when not in use. These failures could place residents at risk for avoidable injuries related to improperly storing a portable oxygen tank.

Inspectors wroteBased on observations, interviews, and record review the facility failed to ensure that its medication error rate was less than 5 percent. The facility had a medication error rate of 6.52% based on 3 out of 46 opportunities, which involved 3 of 5 residents (Residents #43, #44, and #23) reviewed for medication administration. MA A failed to administer Resident #43's ordered Fluticasone medication (given for allergies), resulting in a missed dose. MA B failed to verify the dose on Resident #44's ordered medication Gabapentin (given for nerve pain), resulting in Resident #44 being underdosed. MA B failed to properly verify and dispense Resident #23's ordered medication Methylphenidate (given for nervous system disorder). These failures could place residents at risk of incomplete therapeutic outcomes, increased negative side effects, and decline in health.

Inspectors wroteBased on observation, interviews, and record review, the facility failed to ensure all drugs and biologicals were stored in locked compartments for 1 of 1 medication room reviewed for storage, in that: The facility had a Schedule IV narcotic stored improperly in the medication storage room refrigerator. This failure could result in medication diversion, leading to a resident not receiving ordered treatment, affecting the resident's treatment and care, which could result in deterioration of their health.

Inspectors wroteBased on observation, interview and record review, the facility failed to maintain an infection control program designed to provide a safe, comfortable, and sanitary environment to help prevent the development and transmission of communicable diseases for 2 of 5 (Resident #10 and Resident #31) residents and 2 of 6 (CNA E, and LVN B) staff reviewed for infection control. CNA E failed to perform hand hygiene between glove changes while providing incontinent care for Resident #10. LVN B failed to wear proper PPE when providing wound care for Resident #31 who was on Enhanced Barrier Precautions (EBP). These failures could place residents at risk for spread of infection and cross contamination.

Inspectors wroteBased on interview, and record review, the facility failed to implement a comprehensive person-centered care plan for each resident, consistent with the resident rights set forth at §483.10(c)(2) and §483.10(c)(3), that including 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 5 residents (Resident #1) reviewed for care plans. The facility failed to ensure staff implemented Resident #1's comprehensive care plan for the behavior of becoming combative during incontinent care. This failure placed residents at risk of not having their individual care needs met.

Inspectors wroteBased on observations, interviews, 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 1 of 5 residents reviewed for medications (Resident #1). 1)The facility failed to ensure Resident #1 did not receive another resident's medication during her medication pass. These failures could place residents at risk of experiencing side effect of medications which could result in the exacerbation of their medical conditions and a decline in health status.

Inspectors wroteBased on interview and record review the facility failed to ensure allegations of abuse, neglect, or mistreatment, including injuries of unknown origin was reported immediately but not later than 24 hours after the allegations was made for residents reviewed for reporting alleged abuse and neglect, for 1/1 incident not reported to HHSC. The Facility failed to report to HHSC allegations of a weapon (gun) found in the public restroom in the facility with residents having access to this restroom. This failure could affect all residents by placing them at risk of abuse, physical harm, pain, mental anguish, emotional distress, and serious harm. Findings Include: During an interview with CNA B via telephone on 02/10/2024 at 12:09 pm. CNA B stated he had heard from staff talking that they had found a gun in the front restroom (north side), last Saturday 02/03/2024. [...]

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 in 1 of 1 kitchen reviewed for dietary services 1)The facility failed to ensure foods were processed and pureed under sanitary conditions. 2) The facility failed to ensure foods were stored in a manner to prevent contamination. These failures could place residents at risk for food contamination and foodborne illness.

Inspectors wroteBased on interview and record review, the facility failed to use the services of a Registered Nurse (RN) for at least eight consecutive hours a day, seven days a week for 2 out of 30 days (11/25/23 and 11/26/23) reviewed for RN coverage. The facility failed to ensure they had RN coverage 8 hours a day, 7 days a week for the following days: 11/25/23 and 11/26/23 This failure could place residents at risk for inconsistency in care and services.

Inspectors wroteBased on observation, interview and record review, the facility failed to maintain an infection control program designed to provide a safe, comfortable and sanitary environment to help prevent the development and transmission of diseases for 4 of 5 residents (Residents #3, #13, #18, and #199) and 5 of 6 (RNA B, LVN C, LVN D, CNA E, and CNA F) staff reviewed for infection control. 1. LVN D failed to perform hand hygiene between glove changes or use a clean field during wound care for Resident #199. 2. CNA E failed to perform hand hygiene or glove changes when providing incontinent care for Resident #18. 3. CNA F failed to perform hand hygiene between glove changes when providing incontinent care for Resident #13. 4. RNA B failed to perform hand hygiene when observed passing 4 residents meal trays during a dining observation. 5. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that residents who need respiratory care were provided such care consistent with professional standards of practice for 2 of 15 residents (Resident #3 and Resident #19) reviewed for Respiratory Care. The facility failed to follow MD orders for initial and dating oxygen supplies for Resident #3 and Resident #19. This deficient practice has the potential to affect residents by placing them at an increased risk of respiratory compromise, infections, pneumonia, respiratory distress, and sepsis.

Inspectors wroteBased on interview and record review, the facility failed to provide at least 80 square feet per resident in multiple resident bedrooms for 10 (Rooms #1, 3, 5, 8, 27, 29, 30, 31, 32, and 33) of 40 semi-private rooms reviewed for physical environment. The facility failed to ensure resident Rooms #s 1, 3, 5, 8, 27, 29, 30, 31, 32 and 33 met the required minimum of 80 square feet per resident. This failure could place residents at risk of crowding and cause difficulty in providing resident care.