Shiner Nursing and Rehabilitation Center

Inspectors wroteBased on observation, interview, and record review, the facility failed to employ staff with the appropriate competencies and skill sets to carry out the functions of the food and nutrition service, taking into consideration resident assessments, individual plans of care, and the number, acuity and diagnoses of the facility's resident population in accordance with the facility assessment required for 1 of 1 facility reviewed for dietary requirements. The Dietary Manager did not have the appropriate certification, education, or qualifications to serve as the Director of Food and Nutrition Services, to include not following policy to substitute foods for 03/17/2026 lunch and not storing a container [whipped topping] appropriately on 03/17/2026. [...]

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure each resident received and the facility provided food that accommodates residents' food preferences and foods of similar nutritive value for 2 of 8 residents (Resident #5 and Resident #16) reviewed for food preferences and nutritive value. The facility failed to ensure Resident #5 received an entree that was of equal nutritive value as what was originally served for Tuesday 03/17/2026's lunch meal (chicken and sausage gumbo) instead of loaded potato soup. The facility failed to ensure that Resident #5 was not served fried food Friday 03/20/2026 meal as was noted on her dislikes. The facility failed to update Resident #16's meal tray ticket to reflect she could have a regular diet instead of a mechanical soft diet as was reflected in her Negotiated Risk Agreement, dated 06/24/2025. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to store, prepare, distribute, and serve food for 1 of 1 kitchen in accordance with professional standards for food service safety.1. The facility failed to keep the kitchen's ice machine free of black circular spots on the inside of the ice machine.2. The facility failed to ensure containers of [whipped topping] were stored properly in the reach-in refrigerator in the food preparation area on 03/17/2026.3. The facility failed to ensure raw protein food products were not stored right next to fully cooked food products.4. The facility failed to ensure a food product had the name of it on its label.5. The facility failed to label 3 buckets of food products in the food preparation area. These failures could place residents at risk for food borne illness.

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 disease and infection for 2 of 5 residents (Residents #3 and #7) reviewed for infection control, in that: 1. The facility failed to ensure CNA C sanitized between their fingers while providing incontinent care for Resident #3. 2. The facility failed to ensure LVN D wore a gown while providing wound care for Resident #7 who was on enhanced barrier precaution. LVN D also failed to sanitize her hands between change of gloves after cleaning the wound and before applying the treatment, while providing wound care for Resident #7. These failures could place residents at-risk for infection due to improper care practices.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents have a right to personal privacy for 1 of 16 residents (Residents #8 and unknown resident) observed for nursing care, in that: 1. CNAs A and B did not completely close Resident #8's privacy curtain while providing perineal care for the resident.2. The facility failed on 03/17/2026 to ensure the privacy of unknown residents by not locking the laptop screen on the medication cart (1 of 3), so the residents' information could not be seen and/or accessed by someone walking by. This deficient practice could place residents at risk of embarrassment, lack of self-worth, and feeling disrespected.

Inspectors wroteBased on interview and record review, the facility failed to ensure the assessment accurately reflected the resident's status for 1 of 6 residents (Residents #1) reviewed for assessments. The facility failed to ensure Resident #3's quarterly MDS assessment, dated 12/08/2025, reflected his diagnosis of colon cancer. These failures could place residents at risk for inadequate care due to inaccurate assessments.

Inspectors wroteBased on observation, interview and record review, the facility failed to develop and implement a comprehensive person-centered care plan for each resident, that include measurable objectives and time frames to meet residents' medical, nursing, and mental and psychosocial needs that were identified in the comprehensive assessment and to ensure that the comprehensive care plan described the services that were to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being, including the right to refuse treatment for 2 of 6 residents (Residents #3 and #16) reviewed for care plans. The facility failed to update Resident #3's care plan to reflect that Resident #3 had colon cancer and was going to chemotherapy after his 12/04/2025 re-admission. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure incontinent care was provided in accordance with appropriate treatment and service practices to prevent urinary tract infections and to restore continence to the extent possible for 1 of 2 residents (Residents #3) reviewed for incontinent care and catheter care, in that: While providing incontinent care for Resident #3, CNA C did not clean Resident #3's lower abdomen area and the left and right groin areas. These deficient practices could place residents at-risk for infection and skin break down due to improper care practices.

Inspectors wroteBased on interview, and record review the facility failed to ensure a physician, physician assistant, nurse practitioner, or clinical nurse specialist provided orders for the resident's immediate care and needs for 2 of 6 residents (Resident #3 and Resident #5) reviewed for physician services. The facility failed to ensure Resident #5's RD recommendations, dated 02/27/2026, were signed by a doctor so that the facility could implement interventions for Resident #5's significant weight loss. The facility failed to ensure another doctor oversaw Resident #3's care when Dr. K did not provide clarification in a timely manner for the resident's pharmacy recommendations that he signed on 03/09/2026. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to store all drugs and biologicals in locked compartments under proper temperature controls for 1 of 3 medication carts (medication cart #1) reviewed for medication storage. The facility failed to ensure medication cart #1 that was stationed right outside of the dining room, in the facility's entrance hallway, was locked when not in use. These failures could lead to residents having unintended access to medications and ingestion.

Inspectors wroteBased on interview and record review, the facility failed to maintain medical records on each resident that were complete, accurately documented, readily accessible, and were systematically organized, for 1 of 6 residents (Resident #3) reviewed for medical records. The facility failed to ensure Resident #3's admission record, care plan, and MDS assessment included his diagnosis of colon cancer since 12/04/2025. These failures could place residents at risk for inaccurate medical records.

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: 1. The ice machine in the kitchen was leaking. 2. The double door standing refrigerator was leaking water from the mechanism at the top, with containers of food in standing water at the bottom of the unit. 3. The silver refrigerator had an accumulation of ice inside the walls. The lid, base, and inside seal were visibly soiled with a black substance. 4. The white deep freezer had an accumulation of ice inside the walls. The lid, base, and inside seal were visibly soiled with a black substance. 5. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide a safe, functional, and sanitary environment for 1 of 1 dining room reviewed, in that: The dining room air conditioning vents were visibly soiled. This deficient practice could result in residents living, staff working, and families visiting in an unclean and unpleasant environment.

Inspectors wroteBased on interview and record review, the facility failed to use the services of a registered nurse for at least 8 consecutive hours a day, 7 days a week for 42 days (5/11/24, 6/4/24, 6/5/24, 6/6/24, 6/7/24, 6/8/24, 6/10/24/, 6/12/24, 6/13/24, 6/14/24, 6/17/24, 6/18/24, 6/21/24. 6/22/24. 6/25/24, 6/27/24, 6/28/24, 6/29/24,7/1/24, 7/3/24, 7/5/24, 7/8/24, 7/9/24, 7/10/24, 7/11/24, 7/12/24, 7/13/24, 7/15/24, 7/16/24, 7/17/24, 7/18/24, 7/19/24, 7/20/24, 7/21/24, 7/22/24, 7/23,24, 7/24/24, 7/27/24, 7/28/24, 8/1/24, 8/2/24 and 8/12/24) of 184 days reviewed for nursing services. The facility had no RN coverage for 5/11/24, 6/4/24, 6/5/24, 6/6/24, 6/7/24, 6/8/24, 6/10/24/, 6/12/24, 6/13/24, 6/14/24, 6/17/24, 6/18/24, 6/21/24. 6/22/24. [...]

Inspectors wroteBased on observation, interviews, and record review, the facility failed to ensure the residents had the right to formulate an advanced directive and determine the choice to recieve or not recieve CPR (cardiopulmonary resuscitation) for 3 (Resident #5, Resident #25, Resident #40) of 8 residents reviewed for accuracy and completeness of clinical records. 1 The facility failed ensure Resident #5's OOH DNR was not missing the physicians printed name. 2 The facility failed to ensure Resident #25's OOH DNR was signed a 2nd time by the resident representative. 3. The facility failed to ensure Resident #40's OOH DNR was signed a 2nd time by the resident. This failure could affect any residents who have medical records and could result in misinformation about professional care provided.

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 3 of 3 medication carts (medication A hall cart, medication B hall cart, and medication C hall cart) and 1 of 1 medication storage room reviewed for medications and pharmacy services, in that 1. The facility failed to maintain glucometer logs. 2. The facility failed to ensure expired supplies were discarded. 3. The facility failed to ensure loose pills were not stored in the medication cart. 4.) The facility failed to ensure staff administered Resident #39's omeprazole (antacid) and the ordered dose of polyethylene glycol (laxative). [...]

Inspectors wroteBased 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 3 (Resident #25, Resident #26, Resident #43) of 16 residents and 1 (Hall A Medication cart) of 3 medication carts observed for infection control. 1. The facility failed to initiate enhanced barrier precautions for Resident #25, #26 and #43 who all required enhanced barrier precautions. 2. The facility failed to ensure an employee's name tag was not stored in a box of clean disposable wooden spoons used to mix crushed medications with food. These failures could place residents at risk for spread of infection and cross contamination.

Inspectors wroteBased on observations, interviews, and record reviews the facility failed to develop and implement a comprehensive person-centered care plan that included measurable objectives and time frames to meet a resident's medical and nursing needs and described the services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being for 1 of 8 residents (Resident #25) reviewed for comprehensive care plans: The facility failed to ensure Resident #25's care plan reflected that she had a chronic wound and was on enhanced barrier precautions. This deficient practice could place residents at risk of not being provided with the necessary care or services and having personalized plans developed to address their specific needs.

Inspectors wroteBased on observations, interviews and record reviews, the facility failed to ensure that a resident received treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the resident's choices for 1 (Resident #5) of 8 residents reviewed for quality of care. The facility failed to follow provider orders and care plan interventions by not placing knee high compression socks on Resident #5 for edema (swelling caused by too much fluid trapped in the body's tissues). This failure could prevent the resident from receiving treatments and worsening of edema.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the resident environment remains as free of accident hazards as is possible for 2 (Resident #5 and Resident #40) of 8 residents reviewed for environment, in that: 1. The facility failed to ensure Resident #5 did not have medicated chest rub and a bottle of hair spray on a dresser in her room. 2. The facility failed to ensure Resident #40 did not have a beer in his room without staff's knowledge of it. This deficient practice could result in residents encountering potentially hazardous materials.

Inspectors wroteBased on observation, interviews, and record review, the facility failed to ensure that a resident who needs respiratory care, including tracheostomy care and tracheal suctioning, is provided such care, consistent with professional standards of practice for 2 of 6 (Resident #25 and Resident #34) residents reviewed for respiratory care. The facility failed to ensure Resident #25 and Resident #34 had an oxygen sign posted on their door to alert they had an oxygen tank and concentrator in their room. This deficient practice could place residents at risk for an increase in respiratory complications and make other unaware oxygen is in use.

Inspectors wroteBased on interview and record review, the facility failed to ensure residents' pharmacist medication regimen review recommendations were reviewed by the resident's attending physician and what, if any, action has been taken to address them, for 2 of 4 residents (Residents #4 and #16) reviewed for pharmacy services. The facility failed to ensure the pharmacist's recommendations to Residents' #4's and #16's physician were reviewed by the physician for medication regimen review. This failure could place residents at risk for significant health status declines and could place residents on psychoactive medications at risk for possible adverse side effects, adverse consequences, and decreased quality of life.

Inspectors wroteBased on observation, 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 # 5) of 8 residents reviewed for accuracy and completeness of clinical records. 1. The facility failed to ensure nursing staff did not document they put on compression stocking on Resident #5 when they did not put them on. This failure could affect any residents who have medical records and could result in misinformation about professional care provided.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure residents who were unable to carry out activities of daily living were provided with the necessary services to maintain good personal hygiene for 2 of 2 residents (Residents #5 & #31) reviewed for assistance with ADL care, in that: 1. The facility failed to prevent Resident # 5 from missing 2 of 13 scheduled showers between 09/29/23 - 10/26/23. 2. The facility failed to prevent Resident #31 from missing 9 of 11 scheduled showers between 10/01/23 and 10/26/23. This failure could place residents who require assistance from staff for personal hygiene at risk of not receiving care and services contributing to overall poor hygiene, risk of experiencing a diminished quality of life, and possible skin infections.

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 facility reviewed for food storage sanitation in that: 1. The facility failed to maintain the cleanliness of the ice maker found within the kitchen. 2. The facility failed to remove past dated items from the dry food storage. 3. The facility failed to remove past dated items from a combined resident/staff refrigerator within the medication storage room. These failures could place residents at risk for cross-contamination and foodborne illnesses.

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 to help prevent the development and transmission of infections for 2 of 6 staff (MA F & LVN A) reviewed for infection control, in that: 1. MA F did not sanitize her hands prior to administering eye drops to Resident #37. 2. LVN A did not sanitize her hands prior to administering insulin to Resident #45, removed gloves from a box, and placed them in her pocket to use. These deficient practices could place residents at-risk for infections.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure that residents who required dialysis received such services, consistent with professional standards of practice for 1 of 2 residents (Resident #27) reviewed for dialysis in that: The facility did not maintain communication, coordination, and collaboration with the dialysis facility for Resident #27. This deficient practice could affect residents who received dialysis treatments and place them at risk for complications and not receiving proper care and treatment to meet their needs.

Inspectors wroteBased on interview and record review, the facility failed to ensure an irregularity noted by the pharmacist was acted upon for 3 (Residents #3, #12, & #36) of 5 residents reviewed for pharmacy review in that: 1. The facility failed to implement or provide reasoning for not implementing the recommendation by the licensed pharmacist to add a maximum daily dose of acetaminophen to the routine acetaminophen prescription order for Resident #12. 2. The facility failed to implement or provide reasoning for not implementing the recommendation by the licensed pharmacist to update the diagnosis for Risperdal for Resident #3. 3. [...]

Inspectors wroteBased on interviews and record reviews the facility failed to maintain medical records that were complete and accurate on 1 (Residents #3) of 13 residents reviewed for resident records. The facility failed to ensure Residents #3 had a consent and diagnosis for risperidone (an antipsychotic used to treat certain mental/mood disorders) filled out correctly. This failure could place residents at risk of involuntary receiving psychotropic medication and not consenting to dosage changes.