Royse City Medical Lodge

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 in that:The facility failed to ensure food items in the facility walk-in refrigerator were dated and labeled on 2/10/2026. These failures could affect residents who received their meals from the facility's only kitchen, by placing them at risk for food-borne illness if consumed and food contamination.

Inspectors wroteBased on observation, interview and record review, the facility to all the residents 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. 2 (Resident #2 and Resident#59) of 8 residents reviewed advanced directives. 1- The facility failed to obtain a physician order for a DNR in a timely manner after Resident #2 signed a DNR on [DATE]. 2- The facility failed to obtain a physician order for a DNR in a timely manner after Resident#59 signed a DNR on [DATE]. The care plan did not reflect the correct code status. These failures could place residents at risk of not having a physician order followed and could affect the rights of residents that elected a DNR and could result in the facility not honoring the resident's wishes. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure the MDS assessment accurately reflected the resident's status for 1 of 9 residents (Resident #61) reviewed for accuracy of assessments. The facility failed to accurately complete Resident #61's Quarterly MDS Assessment on 12/12/25 related to prescribed opioid medication use. This failure could place the resident at risk of not appropriately monitoring her medicationsFindings included: Record review of Resident #61's face sheet dated 2/12/26 reflected an [AGE] year-old female with an original admission date of 12/10/11 and readmission date of 12/22/22. [...]

Inspectors wroteBased on interviews and record reviews, the facility failed to ensure residents received adequate supervision and assistive devices, which enabled residents to transfer independently, for one (Resident #7) of three residents reviewed for assistive devices. The facility failed to obtain physician's order prior to installing Resident #7's Trapeze bar used for mobility and transfers (trapeze bar is an overhead assistive device designed for residents, with limited mobility to safely lift, reposition, or transfer themselves in and out of bed)This failure could affect residents by placing them at risk for not having their physician orders followed and decline in resident's mobility.

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 infection for 1 (Resident #4) of 6 residents observed for infection control. The facility failed to ensure LVN D and CNA F wore appropriate PPE when transferring Resident #4 on EBP isolation from shower chair to bed on 02/10/26. This failure could place residents at risk for infection and cross contamination of pathogens and illness. [...]

Inspectors wroteBased on observation, interview, and record review the facility failed to provide the necessary services for residents who are unable to carry out activities of daily living to maintain good grooming and personal hygiene for 5 (Resident#34, Resident #36, Resident #39, Resident#55, and Resident #76) of 8 residents reviewed for ADLs. The facility failed to ensure Resident#34, Resident #36's, Resident #39's, Resident#55, and Resident #76's nails were cleaned and trimmed. This failure could place residents who were dependent on staff for ADL care at risk for loss of dignity, risk for infections and a decreased quality of life.

Inspectors wroteBased on observations, interviews and record review, the facility failed to store and label food in accordance with professional standards for food service safety for the facility's only kitchen in that: The facility failed to ensure food items in the facility refrigerator and freezer were covered, dated, or labeled. These failures could affect residents who received their meals from the facility's only kitchen, by placing them at risk for food-borne illness if consumed and food contamination. Findings Include: Observation in facility's kitchen walk-in refrigerator on 10/15/24 at 9:35am revealed 2 medium circular foiled covered items (about 9 inches) without a label or date used by. Observation in facility's kitchen walk-in refrigerator on 10/15/24 9:36am revealed 1 white and red square container labeled chicken with lid opened to about ¼ inch on one corner of the container. [...]

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 infection for 3 residents (Resident #5, Resident#69, and Resident #199) of 8 residents observed for infection control. The facility failed to ensure: 1- CNA A performed hand hygiene between change of gloves during incontinent care for Resident #5. 2- CNA H donned the appropriate PPE during Resident #69 interaction who was on droplet precautions. CNA H performed hand hygiene between Resident #69 and another resident's room. 3- CNA L and CNA O donned the appropriate PPE during incontinent care for Resident #199 who was on enhanced barriers precautions. These failures could place residents at risk for infection and cross contamination of pathogens and illness.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure residents receive adequate supervision and assistance devices to prevent accidents for one (Resident #11) of two residents observed during a transfer. The Facility failed to ensure CNA C used a gait belt when transferring Resident #11 from her bed to the wheelchair. This failure could affect the residents by placing the residents at risk for falls, discomfort, pain, and/or injury.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure that a resident who was incontinent of bladder received appropriate treatment and services to prevent urinary tract infections for one (Resident #11) of one resident reviewed for catheter care. The facility failed to ensure CNA C kept Resident #11's urine catheter bag below the level of the bladder during a transfer from bed to wheelchair. This failure could place residents at risk for urinary tract infections.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure a resident who needed respiratory care was provided such care, consistent with professional standards of practice, the comprehensive person-centered care plan and the residents' goals and preferences for 1 of 3 Residents (Resident #77) reviewed for respiratory care. The facility failed to ensure Oxygen (O2) in use signage was on Resident #77's room doorway. This failure could place residents at risk of not receiving appropriate respiratory care.

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 1 (Resident #3) of 4 residents reviewed for pharmacy services. The facility failed to ensure RN B followed physician ordered water flushes before and after medication administration given via the G-Tube for Resident #3. This failure could place residents at risk of tube obstruction and a decrease in hydration.

Inspectors wroteBased on observation, interview, and record review the facility failed to provide the necessary services for residents who are unable to carry out activities of daily living to maintain good grooming and personal hygiene for 2 (Resident #1, Resident #2) of 6 residents reviewed for ADLs. The facility failed to ensure: 1- Resident #1 had his fingernails trimmed and cleaned. 2- Resident #2 had his fingernails trimmed and cleaned. This failure could place residents who were dependent on staff for ADL care at risk for loss of dignity, risk for infections, injuries to self or other residents, and a decreased quality of life.

Inspectors wroteBased on observations, interviews, and record reviews the facility failed to provide a safe, clean, comfortable, and homelike environment in one facility (carpet throughout facility and Rooms 303, 305, 307, 309, 311, 315, and 317) of one observed for a clean and homelike environment. The facility failed to ensure that the facility carpet and resident rooms were cleaned daily, and in accordance with the facility's Housekeeping Checklist. This deficient practice could place residents at risk of infections and living in an uncomfortable environment leading to a decreased quality of life.

Inspectors wroteBased on observation, interviews and record reviews the facility failed to ensure food was stored, prepared, distributed and served in accordance with professional standards for food service safety for the facility's only kitchen reviewed for kitchen sanitation. The facility failed to ensure foods in the facility's dry storage area, refrigerator, and freezer were stored and dated according to guidelines. The facility failed to ensure proper discarding of expired and damaged food stored in the refrigerator and dry storage area. The facility failed to ensure the Ice Scooper Holder, located in the facility's only kitchen, was clean and sanitary. The facility failed to ensure the Iced Tea dispenser, prepared for residents, was covered, and sealed from air-borne diseases once prepared. The facility failed to ensure kitchen equipment was clean and sanitary. [...]

Inspectors wroteBased on observation and interview, the facility failed to ensure the right to reside and receive services in the facility with reasonable accommodation of resident needs and preferences for one (Resident #53) of five residents reviewed reasonable accommodations. The facility failed to ensure the call light system in Resident #53's room was in a position that was accessible to the resident. This failure could place residents who require reasonable accommodations at risk of being unable to obtain assistance and decreased dignity.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the services provided or arranged by the facility, as outlined by the comprehensive care plan meet professional standards of quality for 1 of 3 residents (Resident #27) reviewed for respiratory care. The facility failed to ensure Resident #27's oxygen concentrator filter was clean. This failure placed residents at risk of not receiving safe and sufficient respiratory care.