Tomball Rehab & Nursing

Inspectors wroteBased on record review and interview, 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 (Resident #1) reviewed for pharmaceutical services. The facility did not administer Resident #1's medication as prescribed. This failure placed residents at risk of experiencing worsening conditions, infection, and further decline.

Inspectors wroteBased on record review and staff interview, the facility failed to ensure laboratory services were obtained and reported in a timely manner for 1 of 5 residents (Resident #4) reviewed for laboratory services. The facility failed to ensure prompt communication of Resident #4's stat laboratory order which delayed further medical assessment and treatment. This failure placed residents at risk of experiencing delays in clinical decision-making and treatment.

Inspectors wroteBased on interviews and record reviews, 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 all 89 residents. The facility failed to demonstrate its measures to minimize the risk of legionella (bacteria naturally found in water that can cause a type of lung infection called legionellosis (legionnaires' disease and Pontiac fever; [...]

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 2 of 7 residents (Resident #33, Resident #85) reviewed for medication storage and labeling. The facility failed to ensure nurses dated Residents #33 and 85's opened insulin glargine (a medication prescribed to help the body manage blood sugar levels) pens and discarded them within 28 days of opening, on [DATE]. This failure could place residents at risk of receiving medications that were less effective or expired and the risk of contamination or chemical degradation (change of a substance into something else, often making it weaker, useless, or harmful).

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure the medication error rate did not exceed 5% for 3 of 7 residents (Residents #41, #46, #96) reviewed during medication administration. Staff administered 26 medications with 3 errors, which resulted in a medication error rate of 11.54%.The facility failed to ensure physician orders were followed for preparing MiraLAX with a specific amount of water for Resident #41 and Resident #46 on 02/18/2026 and 02/19/2026. The facility failed to ensure staff followed physician orders for IV medication administration by not obtaining flushing orders before and after IV medication administration for Resident #96 on 02/19/2026. The failure could place residents at risk of receiving less than optimal results from their medication regimen, stomach irritation and fluid overload (when body retains too much water). [...]

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 in 1 of1 kitchen reviewed for food procurement. The facility failed to ensure leftover food to be used later with temperature in the danger zone foods were discarded. The facility failed to ensure that food past the use by date were discarded which included 1 bag lunch dialysis used by date 2-12-26, 1 bag lunch dialysis used by date 2-13-26 .A pan of corn niblets no used by date, a package of sausage use by date 2-14-26, a package of sliced swiss cheese no label no used date. The facility failed to ensure foods were stored 6 inches off the floor. Dirty can opener blade. Observation of the facility on 2-17-26 at 7:45 am revealed the following. 1. A dialysis lunch bag used by date 2-11-26 and 2-13-26. 2. [...]

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure housekeeping services necessary to maintain a sanitary, orderly, and comfortable interior for 1 of 9 residents (Resident #91) on the 200 hall. The facility failed to create a sanitary environment by leaving two soiled briefs on the floor, in Resident #91's room on 02/17/2026. This failure could result in high risk of cross-contamination.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure a comprehensive plan is reviewed and revised by the interdisciplinary team after each assessment, including both the comprehensive and quarterly review assessments reviewed for 1 of 23 (Resident #94) residents. The facility failed to revise Resident #94's care plan after completing the comprehensive assessment to reflect Resident #94 pocketing food in the mouth, being lethargic, and having a decreased appetite. The failure could result in the resident not receiving proper care.

Inspectors wroteBased on observation, record review, and interviews, the facility failed to ensure that each resident received adequate supervision to prevent accidents for 1 of 23 residentsResident #43) reviewed. The facility failed to ensure adequate supervision was provided for Resident #43 while smoking. Resident #43 was outside smoking without staff supervision on 2/17/26. This failure could place the residents at risk for burns, injury, and fire hazards.

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 one of one kitchen reviewed for dietary services. 1. The facility failed to ensure foods were not stored past their use by date. 2. The facility failed to ensure all food and drinks in storage were labeled. 3. The facility failed to ensure the dishwasher was maintained and effectively sanitizing dishware. These failures could place residents at risk of foodborne illness.

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 of 1 resident (Resident #51) reviewed for gastrostomy tube management. - The facility failed to ensure LVN D mixed crush medications with water as ordered by MD to Resident #51 by pouring dry powder medication into the resident's G-tube. This failure could place residents at risk for adverse effects, pain, discomfort and not receiving the therapeutic effects of the medication.

Inspectors wroteBased on observation, interviews and record reviews, 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 (R #1) reviewed for medication administration The facility failed to ensure Resident #1 was administered the 6:30am Lantus Solution-Insulin injection for a metabolic disorder that affects glucose metabolism (a medication used to treat pain) by LVN A. This failure could place residents at risk for a delay in medication administration and medication error and could result in a decline in health.

Inspectors wroteBased on interviews and record reviews, the facility failed to maintain clinical records in accordance with accepted professional standards and practices that are complete and accurately documented for 1 of 5 Residents (R #1), reviewed for medical records accuracy, in that: 1. The facility failed to document Resident #1's 8:00am blood sugar levels were checked by AccuCheck two times day for diabetes mellitus by LVN A. 2. The facility failed to document Resident #1 received his Vital signs and record in PCC during LVN A 6:00am-2:00pm shift. 3. The facility failed to document Resident #1 was monitored for an Adverse Drug Effects during LVN A 6:00am-2:00pm shift. 4. The facility failed to document Resident #1 was monitored for an Adverse Drug Effects Anticoagulant Monitoring during LVN A 6:00am-2:00pm shift. 5. [...]

Inspectors wroteBased on interviews and record reviews, the facility failed to provide basic life support, including CPR (Cardiopulmonary Resuscitation), to a resident requiring such emergency care and subject to related physician orders and the resident's advance directives for 1 of 2 residents (CR #1) reviewed for basic life support, including CPR. The facility failed to ensure that a resident received CPR in accordance with professional standards of practice. The facility failed to immediately initiate CPR at about 3:28 AM on 2/4/24 when CR#1 was found unresponsive, by waiting an additional 7 minutes. The facility failed to ensure CPR was performed appropriately and accurately for approximately 10 minutes once initiated by staff. An Immediate Jeopardy (IJ) was identified on 02/07/24 at 3:20pm. [...]

Inspectors wroteBased on 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 residents medical, nursing, and mental and psychosocial needs that were identified in the comprehensive assessment for 3 of 7 residents (Resident #1, #2 and #3) reviewed for care plans . 1. The facility failed to develop a care plan for Resident #1 after the resident had several incidents of observed unsafe smoking practices. 2. The facility failed to appropriately implement Resident #2' s care planned safe smoking goals and interventions when the resident was smoking outside of scheduled hours unsupervised. 3. [...]

Inspectors wroteBased on observation, interview and record review the facility failed to ensure each resident received adequate supervision and assistance devices to prevent accidents for 3 of 7 residents (Resident #1, Resident #2, Resident #3) reviewed for accidents, hazards, and supervision. The facility failed to ensure Resident #1, Resident #2 and Resident #3 were supervised while smoking during unscheduled smoking hours. This failure could place residents at risk of burns and other serious injuries.

Inspectors wroteBased on interview and record review, the facility failed to complete an assessment that accurately reflected the resident's status for 1 of 6 residents (Resident #6) whose records were reviewed for MDS accuracy, in that: The facility failed to ensure Resident #6's admission MDS accurately reflected his hearing loss and use of hearing aids. This failure by the facility placed the resident at risk of not receiving the care and services to meet his needs.

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 2 (Resident #1 and #2) out of 2 residents reviewed for infection control, in that The facility failed to ensure CNA B changed glove and performed hand hygiene during incontinent care for Resident #1 and Resident #2. The facility failed to ensure CNA B cleaned Resident #1's anus during incontinent care. These failures could place residents living in the facility at risk of exposure to infections.

Inspectors wroteBased on observations, interviews and record reviews, the facility failed to provide a safe, functional, sanitary, and comfortable environment for residents, staff, and the public for two facility hallways reviewed for environment, in that. The facility failed to ensure they repaired the bulging and chipped floor which exposed the rough and uneven concrete on the 400 hallway. The facility failed to ensure the 100 hallway was free of strong urine odor. This deficiency could expose residents living in the facility to an uncomfortable living environment and to safety hazards such as falls, fractures, and hospitalization.

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 2 of 3 residents reviewed (Residents #3 and #4) for infection control., in that: 1. CNA B failed to wash her hands after performing incontinent care for Resident #3. 2. LVN A failed to don PPE when entering Resident #4's room. These failures could place residents at risk of contracting a communicable disease.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure, based on the comprehensive assessment of a resident, a resident with pressure ulcers received necessary treatment and services, consistent with professional standards of practice, to promote healing, prevent infection and prevent new ulcers from developing for 1 of 15 residents (Resident #1) reviewed for pressure ulcers. 1. The facility failed to ensure Resident #1, who admitted on [DATE] with a stage 4 pressure wound of the sacrum, stage 3 pressure wound of the right heel, stage 3 pressure wound of the left heel, stage 3 pressure wound of the right elbow, and skin tear wound of the left elbow, had documented and individualized wound care orders until 08/17/2023. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure 3 of 3 residents (Resident #13, Resident #69, Resident #303) reviewed for reasonable accommodation of needs. -The facility failed to ensure Resident #13, Resident #69, Resident #303 timely smoke breaks to meet the needs of the resident This failure could place residents at risk of not receiving care or attention needed. Findings Included: 08/25/2023 at 10:00 am Record review of the facility's smoke break times and the list of residents who requested smoke breaks at the facility. 08/25/2023 at 10:05 am Record review of resident evaluations conducted by the facility for residents to safely smoke without staff monitoring or assistance. Observed on 08/25/2023 at 1:28 pm 10 residents in the smoking area waiting for 24 minutes in the 102 degrees Fahrenheit temperature for smoking task to start. [...]

Inspectors wroteBased on interview, and record review, the facility failed to coordinate assessments with the (PASRR) program under Medicaid in subpart C to the maximum extent practicable to avoid duplicative testing and effort for 2 of 2 residents (Resident #98 and #46) reviewed for PASRR in that: -The facility failed to update/receive/create the PASRR Level 1 form for Resident #98 with a diagnoses of mental illness -The facility failed to correct the PASRR Level I Screening for Resident #46 with a diagnosis of mental illness and obtain a PASRR Level II Evaluation from the LMHA (Local Mental Health Authority). This failure could place residents requiring PASRR services at risk of not having their special needs assessed and met by the facility.

Inspectors wroteBased on observation, interview and record review, the facility failed to provide the necessary services to maintain grooming and personal care for 11 of 12 residents (Residents #4, #13, #90, #98, #46, #81, #75, #34 #203, #204, #304) reviewed for ADL care, in that: -Residents #4, #13, #90, #98, #46, #81, #75, #34 #203, #204, #304 were all found without adequate nail care, oral care and bathing completed This failure placed residents at risk of not receiving assistance with ADL care and services resulting in a decreased quality of life and an increased risk of infection.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure the facility had sufficient nursing staff with the appropriate competencies and skills sets to provide nursing and related services to maintain the highest practicable physical and psychosocial well-being for 11 of 12 residents (Residents #4, #13, #34, #90, #98, #46, #81, #203, #204, #304, #75) reviewed for ADL care, in that: -Residents #4, #13, #34, #90, #98, #46, #81, #203, #204, #304, #75 were all found without adequate nail care, oral care and bathing completed. This failure placed residents at risk of not receiving assistance with ADL care and services resulting in a decrease quality of life and an increased risk of infection.

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 8 resident (Resident #81) reviewed for infection control. -LVN O failed to wipe Resident #81's perineal area using only a front to back motion during incontinent care. -LVN O failed to cleanse the tip of Resident #81's penis during incontinent care -LVN O failed to perform hand hygiene after removing gloves during incontinent care These failures could place residents at risk for infection, injury, and hospitalization.