The Chateau Waco

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. The facility failed to properly discard dented/damaged cans and take them out of use for resident consumption. This failure could place residents at risk of foodborne contamination.

Inspectors wroteBased on interviews, observations, and record reviews, the facility failed to ensure residents had the right to a dignified existence for 1 of 16 (Resident #39) residents reviewed. The facility failed to treat Resident #39 with dignity and respect when MA F had called her little girl and asked, what is wrong with you?.This failure could place residents at risk for psychosocial harm and isolation. [...]

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 1 of 3 residents (Resident #69) observed for infection prevention. The facility failed to ensure Enhanced Barrier Precautions (EBP) were followed when CNA C and CNA D performed catheter and peri care for Resident #69. This deficient practice could place residents at risk for the spread of infection. Findings Included: Record review of Resident #69's face sheet revealed she was a [AGE] year-old female who was admitted to the facility on [DATE]. Diagnoses included: [...]

Inspectors wroteBased on interview and record review the facility failed to ensure, in accordance with accepted professional standards and practices, medical records were maintained on each resident that were complete and accurately documented for 1 of 5 residents (Resident #1) for complete and accurate records. The facility failed to ensure Resident #1's wound treatment for sacrum(base of spine that forms the posterior wall of the pelvis), coccyx(tailbone), left hip, left distial(further from the center of the body) medial(closer to the midline of the body) foot ,and left lateral(away from midline of the body) foot was documented in Matrix on January 10th and January 12th. This failure could place residents at risk for the possibility of not verifying the needed care and services to meet their needs.

Inspectors wroteBased on interview and record review the facility failed to ensure that residents are free of any significant medication errors for 1 of 6 residents (Resident #1) reviewed for significant medication errors in that Resident #1 's hospital Discharge summary dated [DATE] stated Stop taking Valacyclovir 1000mg. Resident #1 received 5 doses of Valacyclovir 1000mg after the medication had been discontinued, resulting in readmission to the hospital for altered mental status and metabolic encephalopathy due to Valacyclovir toxicity. The resident had been prescribed Valacyclovir for HSV Opthalmicus (infection of the eye by Herpes Simplex Virus). The noncompliance was identified as PNC. The Immediate Jeopardy (IJ) began on 09/20/2025 and ended on 09/22/2025. The facility had corrected the noncompliance before the investigation began. [...]

Inspectors wroteBased on observation, interviews, and record review, the facility failed to ensure the resident environment remained as free of accident hazards as was possible and each resident received adequate supervision and assistance devices to prevent accidents for 1 of 6 residents (Resident #4) reviewed for accidents, hazards, and supervision, in that: The facility failed to provide adequate supervision to prevent injury for an incident that occurred on on 08/09/2025 at 4:30PM in the Dining Room, Resident #4 was attempting to get a cup of coffee. The cup overflowed and spilled coffee in Resident #4's lap and resulted in urns with 3 blisters to the left upper thigh. The facility failed to take the temperature of the coffee and keep temperature logs of the coffee. The facility failed to assess other residents for hot liquids An (IJ) Immediate Jeopardy was identified on 08/26/2025. [...]

Inspectors wroteBased on interview and record review, the facility failed to immediately notify the resident's physician following an incident that occurred on 08/09/2025 at 4:30PM in the Dining Room, when Resident #4 was attempting to get a cup of coffee. The cup overflowed and spilled coffee in Resident #4s lap, resulting in Resident #4 sustaining 3 blisters to the left upper thigh. The facility failed to notify Resident #4's physician when he sustained burns from hot coffee, he spilled in his lap. This deficient practice could place residents at risk of not receiving adequate and timely intervention.

Inspectors wroteBased on interview and record review, the facility failed to permit Resident #1 to remain in the facility and failed to document the reason or notice of the discharge in the resident's medical record or implement policies to allow the resident to return to the facility upon discharge from the hospital for 1 of 1 resident reviewed for discharges (Resident #1). The facility failed to allow Resident #1 to return to the facility after his hospitalization. The facility failed to appropriately notify the resident, his representative, and the Long-term Care Ombudsman in writing of the discharge. This failure placed residents at risk of an extended, unnecessary hospitalization and a traumatic psychosocial adjustment to a new facility. Record review of Resident #1's undated face sheet, revealed he was a [AGE] year-old male admitted [DATE] and discharged [DATE] at 04:15 PM. [...]

Inspectors wroteBased on interview and record review, the facility failed to incorporate the recommendations from the PASARR level II determination and the PASARR evaluation report into a resident's assessment, care planning, and transitions of care for one (Resident #2) of 3 residents reviewed for PASARR services. The facility failed to submit a NFSS request within 20 days of the IDT meeting that was held on 2/4/2025 and failed to resubmit a NFSS request when it was initially denied ensuring the request was approved for specialized services for PASARR for Resident #1. This failure could place residents at risk of not receiving the needed care and services to attain or maintain their highest practicable physical, mental, and psychosocial well-being.

Inspectors wroteBased on interview and record review, the facility failed to immediately notify the resident's representative(s) when there was a significant change in the resident's physical status for one (Resident #1) of ten residents reviewed for changes in condition. The facility failed to notify the CHF clinic or the MD of Resident #1's weight gain per providers orders. On 3/7/25 Resident #1 exhibited signs of shortness of breath and required IV Lasix a diuretic (medication used to reduce extra fluid in the body, also known as edema, caused by heart failure) to be administered on her visit to the CHF clinic 03/07/25 for a greater than 10-pound weight gain in a week from 02/27/25 to 03/07/25. An Immediate Jeopardy (IJ) was identified on 03/19/25. The Administrator was notified of the Immediate Jeopardy and provided with the IJ Template on 03/19/25 at 05:36 PM. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure the residents receive treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the residents' choices for 1 of 10 residents (Resident #1) reviewed for quality of care. The facility failed to notify the CHF clinic of Resident #1's weight gain per providers orders. On 3/7/25 Resident #1 exhibited signs of shortness of breath and required IV Lasix a diuretic (medication used to reduce extra fluid in the body, also known as edema, caused by heart failure) to be administered on her visit to the CHF clinic 03/07/25 for a greater than 10-pound weight gain in a week from 02/27/25 to 03/07/25. An Immediate Jeopardy (IJ) was identified on 03/19/25. The Administrator was notified of the Immediate Jeopardy and provided with the IJ Template on 03/19/25 at 05:36 PM. [...]

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure that a resident who needed respiratory care was provided such care, consistent with professional standards of practice and the resident's goals and preferences for 1 of 6 residents (Resident#1) reviewed for respiratory care. The facility failed to supply oxygen to Resident #1 while she was out on pass to a medical clinic appointment on 02/13/2025 and 02/21/25 resulting in increased shortness of breath, anxiety, and an inability to breath. An Immediate Jeopardy (IJ) was identified on 2/25/25 at 6:07 p.m. The IJ template was provided on 02/25/2027 at 6:07PM. [...]

Inspectors wroteBased on interviews and record review, the facility failed to implement a comprehensive care plan to meet the medical and nursing needs and the services to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being of 1 (Resident #1) of 6 residents reviewed for care plans. The facility failed to complete an accurate comprehensive care plan for Resident #1, by not care planning her required need for oxygen, monitoring her for shortness of breath related to her disease process of Chronic Obstructive Pulmonary. The facility failed to complete an accurate comprehensive care plan for Resident #1, by not care planning her required need for specialty medical appointment related to her disease process of Congestive Heart Failure. [...]

Inspectors wroteBased on interviews and record review, the facility failed to ensure based on the comprehensive assessment of a resident, that residents received treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the residents' choices for three (Resident #1, Resident #2, and Resident #3) of six residents reviewed for quality of care. The facility failed to weigh Residents #1, #2, and #3 according to physician orders. This failure could place residents at risk of not receiving necessary medical care, harm, and hospitalization.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure that residents who needed respiratory care were provided with such care, consistent with professional standards of practice for three (Resident #2, Resident #4, and Resident #6) of six residents reviewed for respiratory care. The facility failed to: - Ensure Resident #2 had an order for oxygen therapy or had an Oxygen in Use sign on the door to his room. - Ensure Residents #4's oxygen tubing not in use was bagged and off the floor of their room. - Ensure Resident #4 was not eating lunch in the dining room utilizing oxygen with an empty oxygen tank. - Ensure Resident #6's nasal cannula tubing was connected to the concentrator and water was in the cannister. These deficient practices could place residents that receive oxygen therapy at risk for inadequate care and respiratory infection. Findings Included: [...]

Inspectors wroteBased on observations, interviews, and record review, the facility failed to maintain an infection control program designed to prevent the development and transmission of infection for two of five residents (Resident #3 and Resident #6) reviewed for infection control. CNA D failed to wear PPE while providing care to resident #3 who was on Enhanced Barrier Precautions. LVN C used a pulse oximeter (a device that measures the amount of oxygen in the blood) on Resident #6, who was on Enhanced Barrier Precautions, then failed to clean or sanitize the oximeter before placing it back in her pocket. These failures could place residents at risk for spread of infection.

Inspectors wroteBased on observation, interviews and record reviews, the facility failed to develop and implement a comprehensive person-centered care plan for each resident, which included measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs for 4 of 6 residents (Residents #10, #12, #39, and #57) reviewed for care plans. The facility failed to include anticoagulant medication in Resident #10 and #39's comprehensive care plan. The facility failed to include opioid medication in Resident #12's comprehensive care plan. The facility failed to include antiplatelet medication in Resident #57's comprehensive care plan. This failure could place residents at risk for not receiving necessary care and services or having important care needs identified and met.

Inspectors wroteBased on observations, interview, and record review the facility failed to ensure that a resident who was unable to carry out activities of daily living received the necessary services to maintain good personal hygiene for 4 of 6 residents (Resident #3, Resident #37, Resident #41, and Resident #52) reviewed for hygiene. The facility failed to ensure Resident #3 Resident #37, Resident #41, Resident #52 received a shower or bath as scheduled. This deficient practice could place residents who were dependent on staff for ADL care at risk for loss of dignity, and/or a diminished quality of life.

Inspectors wroteBased on interview, and record review, the facility failed to ensure residents receive care, consistent with professional standards of practice, to prevent pressure ulcers and a resident with pressure ulcers receives the necessary treatment and services, based on the comprehensive assessment and consistent with professional standards of practice, to promote healing, prevent infection, and prevent new ulcers from developing for 3 (Resident #3, Resident #41, and Resident #52) of 6 residents reviewed for quality of care. The facility failed to complete weekly skin assessments according to their orders and for Residents # 3, # 41, and # 52. These failures could place residents at risk for developing pressure ulcers or wounds.

Inspectors wroteBased on interview and record review, the facility failed to ensure the resident assessment accurately reflected the resident's status for 3 of 5 residents (Residents #39, #42, and #57) reviewed for comprehensive assessments. The facility failed to complete an accurate quarterly comprehensive assessment dated [DATE] for Resident #39 by not including hospice services. The facility failed to complete an accurate annual comprehensive assessment dated [DATE] for Resident #42 and failed to complete an accurate admission comprehensive assessment dated [DATE] for Resident #57 by not including an antiplatelet medication and incorrectly including an anticoagulant medication. This failure could place residents at risk of not having their care and treatment needs assessed to ensure necessary care and services were provided.

Inspectors wroteBased on observation, interview, and record review the facility failed to label drugs and biologicals in accordance with currently accepted professional principles, and include the appropriate accessory and cautionary instructions, and the expiration date when applicable for 1 of 5 medication carts reviewed in that: The medication cart for the 100 hall, 200 hall and 300 halls had thirteen unidentified loose pills and a personal purse was stored in the bottom drawer of medication cart for the 200 and half of 300 hall. These deficient practices could affect residents and result in a drug diversion due to medications not being properly disposed and secured.

Inspectors wroteBased on interviews and record reviews the facility failed to ensure each resident receives adequate supervision with assistance devices to prevent accidents for 1 (Resident #1) of 3 residents reviewed for accidents. The facility failed to ensure Resident #1 received assistance, in an appropriately sized space, while being lifted out of her wheelchair using a mechanical lift, as specified in the care plan. CNA B did not ensure Resident #1 was positioned in the center of the lift sling and CNA D failed to stay by Resident #1's side with hand on assistance. The noncompliance was identified as PNC. The IJ began on 11/4/24 and ended on 11/23/24 The facility had corrected the noncompliance before the survey began. This failure could place residents at risk of injuries, falls, and a decline in quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that each resident received, and the facility provided at least three meals daily, at regular times comparable to normal mealtimes in the community for five (Resident #1, Resident #2, Resident #3, Resident #4, and Resident #5) out of five residents reviewed for timely meals, in that: Resident #1 did not get his lunch tray on time, and he was hungry. Resident #2 sometimes did not get breakfast before she left for dialysis. Resident #3 felt unimportant and hungry when he did not get his meals on time. Resident #4 received her meal late. Resident #5 felt lossy when she did not get her meals on time. The failures placed residents at risk of unplanned weight loss, altered nutritional status, decreased feelings of self-worth. [...]

Inspectors wroteBased on observation, interview, and record review the facility failed to provide special eating equipment and utensils for residents who need them and appropriate assistance to ensure that the resident can use the assistive devices when consuming meals and snacks for 4 (four) residents (Residents #1, #6, #7, and 8) of five residents reviewed. The facility failed to provide Resident #1 with finger foods. The facility failed to provide Resident #6 with a built-up fork, built- up spoon, a right-angled fork, a right-angled spoon, and a two handled cup. (Built up utensils are designed with molded plastic handles to assist individuals with limited or weakened grasping strength. They are non-slip utensils to allow maximum control with minimum effort during mealtimes.) The facility failed to provide Resident #7 with a built-up fork and a built-up spoon. [...]

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 two (2) of 2 residents (Resident #10 and Resident #11) reviewed for blood sugar checks. LVN A failed to use a clean gauze to wipe Resident #10's and Resident #11's fingers after the blood sample was taken for a blood glucose check. LVN A failed to properly clean Resident #11's skin surface before administering insulin. This failure could result in the spread of diseases to residents which could result in decreased quality of life, illness, and hospitalization.

Inspectors wroteBased on interview and record review, the facility failed to inform the Responsible Party of a decision to transfer a resident to another facility for one (Resident #9) of one resident reviewed for notification of changes, in that: The facility failed to ensure Resident #9's Responsible Party was involved in the decision to transfer her to another facility. This failure placed residents at risk of not having their preferred responsible party represent them in medical and care decisions.

Inspectors wroteBased on interview and record review, the facility failed to provide pharmaceutical services which includes the accurate acquiring and administering of medications to meet the needs for three (Residents #2, #3, and #5) of seven residents reviewed for pharmacy services. The facility failed to ensure Residents #2, #3, and #5 received their mediations in the timeframe ordered from 1/1/24 to 1/5/24. This failure placed residents at risk for medical complications, decreased quality of life and hospitalization.

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 one of one kitchens reviewed for sanitation. The facility failed to ensure all food items were dated and discarded prior to their use-by date. The facility failed to ensure all utensils were sanitized properly. The facility failed to ensure hot foods were served at a temperature of 135° F or higher. These failures placed residents at risk of foodborne illness.

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 includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment for 5 (Resident's #3, #6, #17, #28 and #42) of 12 residents reviewed for care plans. The facility failed to develop and implement a comprehensive person-centered care plan to address Residents #3, #6, #17's skin concerns, #28's weight loss and # 42's use of splint to right wrist. This failure could place residents at risk of not having their individual care needs met, which could cause a decline in physical health, psychosocial health, and quality of care.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure that residents The resident environment remains as free of accident hazards as is possible for 1/1 (Resident #42) residents reviewed for accidents and hazards The facility failed to ensure Resident #42's splint was replaced after being damaged from the facility staff to prevent potential occurrence of right forearm contracting. This failure could place residents at risk of potential injury and/or skin damage.

Inspectors wroteBased on interview, observation, and record review, the facility failed to ensure the care plan reflects individualized interventions for 2 of 5 residents (Resident #1 and #2) reviewed for care plans. A) The facility failed to ensure Resident #1's care plan reflected falls and individualized interventions for the fall on 8/15/23. B) The facility failed to ensure Resident #2's care plan reflected falls and individualized interventions for the falls on 08/02/23, 08/04/23, and 08/07/23. This failure could place residents at risk for needs not being identified and interventions put in place.