Mitchell County Nursing and Rehabilitation Center

Inspectors wroteBased on interview and record review, the facility failed to ensure it received registry verification for 1 (CNA A) of 5 employees reviewed for registry verification prior to allowing an applicant to serve as a nurse aide. The facility failed to ensure CNA A had a current nurse aide certification while employed at the facility, while actively providing care for residents. This failure could result in residents being provided with care by staff who have not provided documentation of training and competency in providing care.

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 promoted the maintenance or enhancement of their quality of life, recognizing each resident's individuality and the facility failed to protect and promote the rights of 7 of 20 confidential residents reviewed for resident rights. The facility failed to ensure staff were not on their personal cell phones while providing care, which included assisting residents with their showers. This failure could place residents at risk for a diminished quality of life and loss of dignity and self-worth.

Inspectors wroteBased on interview and record review, the facility failed to ensure residents had the right to participate in the development and implementation of his or her person-centered plan of care for 13 of 13 residents (Residents #1, #2, #20 and 10 confidential residents) reviewed for comprehensive care plans. The facility failed to record any documentation inviting Resident #1 or their representative to the care plan meetings. The facility failed to record any documentation inviting Resident #2 or their representative to the care plan meetings. The facility failed to record any documentation inviting Resident #20 or their representative to the care plan meetings. The facility failed to ensure 10 confidential residents of the facility were provided with prior notice to participate in their care plan meetings. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to make information on how to file a grievance or complaint available to the residents for 9 of 10 confidential residents reviewed for grievances. The facility failed to ensure 9 of 10 residents were provided, through postings in prominent locations, the Grievance Procedure, 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 residents at risk of unresolved grievances and decreased quality of life.

Inspectors wroteBased on observation, interview and record review, the facility failed to provide food and drink that was palatable, attractive and at a safe and appetizing temperature for one of one kitchen. A. Resident #8, #11, #13, #32 voiced concerned of cold food, flavor and/or texture. B. Five of the 9 foods sampled on the meal tray were cold. C. One of the 9 foods sampled on the meal tray was mushy. D. One of the 9 foods sampled on the meal tray was sticky. E. One of the 9 foods sampled on the meal tray was chunky. These failures could affect the forms of food provided in the facility (regular, mechanical chopped and pureed) and could result in a decline in residents' consumption of food and residents to have unwanted weight loss.

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 facility 1 of 1 kitchen reviewed for food safety. 1) The facility failed to ensure food items in the refrigerator (x1), and freezer (x1), were labeled and stored in accordance with the professional standards for food service. 2) The facility failed to ensure the garbage can used for food waste was covered unless in use. These failures could place residents at risk for food-borne illness and cross contamination.

Inspectors wroteBased on interviews and record reviews, the facility failed to ensure residents had the right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive for 1 of 6 residents (Residents #20) reviewed for advanced directives. The facility failed to ensure Resident #20 who was listed as DNR (Do Not Resuscitate), had an Out-of-Hospital Do Not Resuscitate form that did not have missed required information. These failures could place residents at risk of not having their end of life wishes honored and incomplete records.

Inspectors wroteBased on interview and record review, the facility failed to ensure residents do not receive psychotropic drugs pursuant to a PRN order unless that medication is necessary to treat a diagnosed specific condition that is documented in the clinical record; and PRN orders for psychotropic drugs are limited to 14 days for 2 of 20 (Resident #21 and #40) residents reviewed for unnecessary medications. The facility failed to ensure Resident #21 was free from unnecessary anxiolytic medication (prescription drugs that treat anxiety disorder symptoms, such as fear, dread, and physical tension, by balancing brain chemicals or calming the nervous system ) and failed to ensure a PRN order for Lorazepam (medication used to treat anxiety disorders) dated 9/19/2025 had a stop date and did not extend beyond 14 days. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to establish and maintain an Infection Control Program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of disease and infection for 2 out of 4 residents (Resident #20 and Resident #1) observed for perineal care. 1. CNA A failed to change gloves or utilize hand hygiene prior to putting a clean brief under Resident #20. 2. CNA B failed to utilize hand hygiene prior to putting on a clean pair of gloves before assisting Resident #1 to stand to pull up her brief and pants. This failure could result in residents contracting infections or spreading infections to others by direct contact with contaminated surfaces.

Inspectors wroteBased on interviews and record review, the facility failed to utilize the services of a registered nurse for at least eight consecutive hours per day, seven days per week for 4 days out of 33 days (1/25/25, 1/26/25, 2/8/25 and 2/9/25) reviewed for nursing services. The facility failed to ensure a registered nurse was scheduled for eight consecutive hours per day, seven days per week on the following dates: 1/25/25, 1/26/25, 2/8/25 and 2/9/25. This deficient practice could place residents at risk of not receiving adequate care.

Inspectors wroteBased on observation, interview, and record review, the facility must store, prepare, and serve food under sanitary conditions, as required by the Texas Department of State Health Services food service sanitation requirements. in 1 of 1 kitchen reviewed for dietary services, in that: 1. The facility failed to ensure canned foods were not expired and dented. 2. The kitchen staff member failed to use proper hand washing while preparing eating utensils. 3. The facility failed to label and properly date foods. These failures could place residents at risk for food contamination and foodborne illness.

Inspectors wroteBased on observation, interview and record review, the facility failed to develop a comprehensive care plan for each resident that includes measurable objectives and timeframes to meet a resident's medical, nursing, mental, and psychosocial needs, as well as describes the services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being for 6 of 14 residents (Resident #10, #24, #27, #34, #36 and #39) reviewed for care plans in that: The facility failed to ensure that Resident #10's care plan was revised, updated and individualized with interventions and goals to address Resident #10's vison and communication. The facility failed to ensure that Resident #24's care plan was revised, updated and individualized with interventions and goals to address Resident #24's vision and communication. [...]

Inspectors wroteBased on observations, interviews, and record review, 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 2 of 14 residents (Resident #35 and Resident #41) reviewed for resident rights. The facility failed to ensure RN C provided privacy during wound care for Resident #35 and Resident #41. 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 inform residents in advance of the risks and benefits of proposed care and treatment for 1 of 14 residents (Resident #39) reviewed for resident rights. The facility failed to obtain a signed consent for antipsychotic medication, Trazadone, administered to Resident #39 for depressive episodes. The failure affected residents who received psychoactive medications without informed consents and placed them at risk of receiving treatments without informed consent.

Inspectors wroteBased on record review and interview, the facility failed to ensure residents have the right to formulate an advance directive and determine the choice to receive or not receive CPR (cardiopulmonary resuscitation) for 1 of 14 residents (Resident #27) whose records were reviewed for code status. The facility failed to obtain a DNR order and update the EMR for Resident #27 based on his completed DNR, dated [DATE]. This failure could place residents at risk for having their end of life wishes dishonored, and of having CPR performed against their wishes.

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 on 1 of 1 medication cart (cart for hall 100) reviewed for pharmaceutical services. The facility failed to ensure the medication cart for hall 100 did not contain expired medication. This failure could place residents at risk of not receiving prescribed medications as ordered and receiving medications that are less effective or have altered composition.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure all drugs and biologicals were stored properly for 1 of 1 medication carts (medication cart for Hall 100), reviewed for medication storage. The medication cart assigned to Hall 100 contained loose pills. This failure could place residents at risk of not receiving prescribed medications as ordered, receiving medications that are less effective or have altered composition, and drug diversions.

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 4 residents (Residents #35, and Resident #151) and 2 of 4 staff (RN C and CNA E) reviewed for infection control. RN C failed to sanitize her hands between gloves changes during wound care for Resident #35. CNA E failed to wear PPE during catheter care for Resident #151 who was on EBP. These failures could place residents at risk for spread of infection and cross contamination.

Inspectors wroteBased on the interview and record review the facility failed to provide each resident or the resident's representative education regarding pneumococcal immunization and failed to document evidence of receiving, refusal, or education regarding pneumococcal immunization, for 2 of 14 residents (Residents #10 and #39). The facility failed to document the influenza immunization status for Resident #10 The facility failed to document the influenza immunization status for Resident #39 This failure placed residents who wanted but did not receive the pneumococcal vaccine, who are at risk for infections and decreased quality of life.

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 1 out of 48 days (12/25/23) reviewed for RN coverage. The facility failed to ensure they had RN coverage 8 hours a day, 7 days a week for the following day: 12/25/23 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 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, stored, and pureed under sanitary conditions. 2) The facility failed to ensure foods were not beyond manufacturer's use dates. 3) The facility failed to ensure foods were in sound condition. 4) The facility failed to ensure food were accurately dated and labeled. 5) The facility failed to protect foods from potential contamination. 6) The facility failed to ensure staff used good hygienic practices. 7) The facility failed to ensure staff facial hair was restrained, and 8) The facility failed to ensure sanitizer levels were maintained at manufacturer's recommended levels. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents who were incontinent of bladder or had a urinary catheter received appropriate treatment and services to prevent urinary tract infections and to restore continence to the extent possible for 1 of 1 Resident (Resident #30) reviewed for incontinent care, in that: Resident #30 was observed to have a 16 french silicone foley catheter and had physician orders for a 14 french coude (slightly bent) catheter. This failure could affect residents by placing them at increased risk of discomfort, skin ulcerations and improper medical treatment.

Inspectors wroteBased on interview and record review, the facility failed to ensure all residents had the right to formulate an advance directive for 2 of 15 residents (Residents #6 and #13) reviewed for advance directives. 1. Resident #6's Out-of-Hospital Do Not Resuscitate (OOH-DNR) form was in the physical paper chart, but the resident was listed as a Full Code in the Electronic Health Record (EHR). 2. Resident #13's Out-of-Hospital Do Not Resuscitate (OOH-DNR) form was in the physical paper chart and uploaded in the EHR documents, but the resident was listed as a Full Code in the Electronic Health Record (EHR). 3. The facility failed to ensure Residents #6 and #13's OOH-DNR and care plan advanced directives were consistent. 4. The facility failed to ensure Residents #6 and #13's OOH-DNR and physician orders were consistent. 5. [...]