Val Verde Nursing and Rehabilitation Center

Inspectors wroteBased on interview and record review the facility failed to ensure the activities program was directed by a qualified professional who was a qualified therapeutic recreation specialist or an activities professional who was licensed or registered by the State for 1 of 1 facility reviewed for qualifications of activity professionals. The facility failed to have a qualified Activities Professional direct their activities program. This deficient practice could place residents at risk of not receiving approaches that were individualized to match the skills, abilities, and interests/preferences of each resident for activities.

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 #20, Resident #23) of 3 residents reviewed for infection control in that:1. The facility failed to ensure CNA C performed hand hygiene before applying clean gloves while providing incontinence care to Resident #20.2. LVN E did not change gloves from clean to dirty during ostomy care for Resident #23. This failure could lead to infection or illness.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure the assessment accurately reflected the resident's status for 3 of 8 (Resident #3, Resident #40 and Resident #56) residents whose records were reviewed for assessments. Nursing staff failed to code Resident #3 had musculoskeletal Other Fracture, exhibited behavioral symptoms, including physical behavioral symptoms toward others, and inaccurately documented active diagnoses on his MDS assessment. Nursing staff failed to code Resident #40 had falls, frequency of falls, and falls with no injury and with injury on her MDS assessment. Nursing staff failed to code Resident #56 had falls and musculoskeletal other fracture on her MDS assessment. These failures could place residents at risk of not identifying care areas and result in residents not receiving needed care and services.

Inspectors wroteBased on interview and record review, the facility failed to incorporate the recommendations from PASARR level II determination and the PASARR evaluation report into a resident's assessment, care planning, and transitions of care. for 1 of 3 (Resident #57) PASRR resident in that:Resident #57's PASRR II recommendations for a customized manual wheelchair (10/10/2025) and Occupational Therapy (8/4/2025)/Physical Therapy (7/28/2025) NFSS was submitted after 20 days. This could affect all residents on PASRR services and could result in residents on PASRR services not provided with DME or specialized services.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure preadmissions screening for individuals with a mental disorder and individuals with intellectual disability for 1 of 6 (Resident #3) residents reviewed for PASARR accuracy. The MDS Nurse failed to accurately screen Resident #3 for mental illness upon admission to the facility. This failure could place the residents at risk of not receiving the necessary care and services.

Inspectors wroteBased on interviews and record reviews, the facility failed to develop and implement a comprehensive person-centered care plan for each resident, consistent with the resident rights and 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 2 of 8 (Resident, #3 and Resident #25) residents in that:Resident #25 was not care planned for his full code status. Nursing staff failed review and revise Resident # 3's comprehensive person-centered care plan following recent behaviors prompting psychiatric assessment on 7/23/2026 that documented Resident #3 as unstable and direction to Employ use of redirection at this time. This failure could affect all residents and could result in residents not having their wants and needs identified and met.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide activities based on the comprehensive assessment and care plan, designed to meet the interests of and support the physical, mental and psychosocial well-being of 2 of 8 (Resident #40 and Resident #56) residents who were reviewed for activities. The facility failed to consistently provide individualized activities and did not meet the needs of Resident #40 and Resident #56 on a weekly basis. This failure placed the residents at risk of becoming apathetic (marked indifference to the environment), isolated from others, having a depressed mood, boredom, loneliness, and a decreased quality of life.

Inspectors wroteBased on observation, interviews and record reviews, the facility failed to ensure a resident who was incontinent with bladder received appropriate treatment and services to prevent urinary tract infections and to restore continence to the extent possible for 1 (Resident #58) of 1 resident reviewed for catheter care. The facility failed to ensure Resident #58 had a leg strap to secure her indwelling urinary catheter tubing. This deficient practice could place residents at risk of complications and infection from movement at the insertion site.

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 #35) of 7 residents reviewed for medication administration in that:The facility failed to accurately transcribe a physician-ordered medication onto Resident #35's Medication Administration Record. As a result, the medication was reflected on the MAR with an incorrect route of administration. This failure could place residents at risk of injury due to incorrect medication administration and inaccurate orders.

Inspectors wroteBased on observations, interviews and record reviews, the facility failed to ensure the Nurse Staffing Information. Data requirements. The facility must post the following information on a daily basis. The total number and the actual hours worked by the following categories of licensed and unlicensed nursing staff directly responsible for resident care per shift and Resident census. Posting requirements. The facility must post the nurse staffing data of this section on a daily basis at the beginning of each shift. Data must be posted as follows: Clear and readable format. In a prominent place readily accessible to residents, staff, and visitors. Public access to posted nurse staffing data. Facility data retention requirements. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure all alleged violations involving mistreatment, neglect, abuse or misappropriation of resident property were reported immediately, but not later than 2 hours if the alleged violation involved abuse or resulted in serious bodily injury, to other officials (including to the State Agency) for one (1) of five (5) residents (Resident #1) reviewed for abuse. The ADMIN, who is the Abuse Coordinator, failed to immediately report (within 2 hours) an allegation of abuse made by Resident #1's family member on 01/21/2026 to HHSC. The failure could affect 46 residents and could result in undetected abuse and/or decline in feelings of safety and well-being.

Inspectors wroteBased on observation and interview, the facility failed to post on a daily basis information that included the facility name, current date, total number and actual hours worked by registered nurses, licensed practical or licensed vocational nurses, certified nurse aides directly responsible for resident care per shift and the resident census for 4 of 4 days (01/31/2026 - 02/03/2026) reviewed for posting of required information. The facility failed to post the required current nurse staffing and census information from 01/31/2026 to 02/03/2026. This failure could place all residents, their families, and facility visitors at risk of not having access to information regarding staffing data and the facility census.

Inspectors wroteBased on interviews and record review, the facility failed to ensure all alleged violations involving abuse, neglect, exploitation or mistreatment, including injuries of unknown source and misappropriation of resident property, are reported immediately, but not later than 2 hours after the allegation is made, if the events that cause the allegation involve abuse or result in serious bodily injury, or not later than 24 hours if the events that cause the allegation do not involve abuse and do not result in serious bodily injury, to the administrator of the facility and to other officials (including to the State Survey Agency) in accordance with State law through established procedure. [...]

Inspectors wroteBased on interviews and record review, the facility failed to have evidence all allegations of abuse, neglect, or mistreatment were thoroughly investigated and documented for 2 of 10 residents (Resident #1 and Resident #2) reviewed for a fall injury. The facility failed to have evidence that a thorough investigation was conducted following the allegation Resident #1 had an unwitnessed fall with injury on 10/07/2025 and Resident #2 had an unwitnessed fall with injury on 11/12/2025. These failures could place residents at risk for abuse and neglect by not investigating injuries of unknown origin.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure drugs and biologicals were stored in accordance with currently accepted professional principles for, 1 of 4 medication carts observed, in that: The Nurse Medication Cart in the 300 hall contained five loose medication pills. This failure could place residents who receive medications at risk for not receiving the intended therapeutic effects of medications.

Inspectors wroteBased on 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 Food Service Director did not have the appropriate certification, education, or qualifications to serve as the Director of Food and Nutrition Services. This deficient practice could place the residents who consume food prepared from the kitchen at risk of food borne illness and not receiving adequate nutrition.

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 in that: 1. The facility failed to clean an overhead ceiling vent in the main kitchen area. 2. The facility failed to close an attic trap door on the outside kitchen patio area. 3. The facility failed to paint over a peeling ceiling area located over the dish machine conveyor line. These failures could place residents at risk for food borne illness.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents had the right to personal privacy and confidentiality of his or her personal and medical records for 1 of 5 residents (Resident #37) reviewed for privacy, in that: MA (A) did not lock the computer after she walked away and left it unattended, which exposed Resident #37's morning medication list. This failure could place residents at risk of having their medical information exposed to others and cause residents to feel uncomfortable and disrespected.

Inspectors wroteBased on interview and record review, the facility failed to accurately complete assessments for 1 of 6 residents reviewed (Resident #20) for accuracy of assessments, in that: Resident #20's MDS assessment was inaccurate. This deficient practice could result in diminished quality of care due to inaccurate resident assessment.

Inspectors wroteBased on interview and record review, the facility failed to maintain clinical records that were complete and accurate, in accordance with accepted professional standards and practices, for 1 of 6 residents (Resident #159) reviewed for complete and accurate medical records in that: Resident #159's diagnoses list was incomplete. This deficient practice could result in errors in care and treatment.

Inspectors wroteBased on interview, and record review, the facility failed to provide the required 80 square feet per resident in 23 of 37 resident rooms (Rooms 7-8, 20-40) reviewed for bedroom mearsurement. The facility failed to ensure rooms measured the required 80 square feet per resident. This failure could impede the ability of residents living in these rooms to attain their highest practicable well-being. Record review of previous citation noted on the 2567 document dated 4/08/23 revealed an observation was made on 4/3/23 at 12:28 pm noting for rooms 7-8, 20-21, 24, 26-32, 34, 36, 39 (which had two beds) was calculated to be between 144-155 square feet resulting between 72 and 77.5 square feet per resident. Record review of the Provider History Profile which was updated on 2/2/23 revealed an existing room size waiver from the re-certification survey with an exit date of 4/08/23. [...]

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 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 2 of 16 residents (Resident #24, #46) reviewed for care plans, in that: 1. The facility failed to ensure wound care management was included on the Care Plan for Resident #24 when he developed pressure injury wounds on 4/17/2024. 2. The facility failed to ensure significant weight loss was included on the Care Plan for Resident #46 after she lost 7.14% of her body weight from 3/6/2024 to 4/8/2024. [...]

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure that residents were offered a therapeutic diet when there was a nutritional problem, and the health care provider orders a therapeutic diet for 1 of 8 Residents (Resident #46) reviewed for nutritional status in that: The facility failed to ensure Resident #46 was receiving the ordered therapeutic diet. These failures could place residents who are dependent on staff for their nutrition and hydration at risk for nutritional deficit, weight loss, skin breakdown, and overall decline in quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure all drugs and biologicals were stored in locked compartments under proper temperature controls and permitted only authorized personnel to have access to the keys for 1 of 4 medication carts (the Nurses Medication Cart) reviewed for medication storage, in that; The facility failed to ensure the Nurses Medication Cart was locked when it was left unattended in the common area of in front of the nurses' station. This deficient practice could place residents at risk of medication misuse or drug diversion.

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 resident (Residents #1) out of 8 residents reviewed for medication administration in that: The facility failed to ensure Resident #1 was administered medications according to physician parameters. This deficient practice could place residents at risk of not receiving the intended therapeutic benefit of the medications, could result in a worsening or exacerbation of chronic medical conditions, hospitalization and or a diminished quality of life.

Inspectors wroteBased on the comprehensive assessment of a resident, the facility failed to ensure that 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 6 residents (Resident #1) reviewed for pressure sores, in that: The facility failed to ensure Resident #1 received wound care and treatment as ordered by a physician. -Resident #1's right great toe was not monitored daily for changes once per day as ordered by a physician. -Resident #1's right heel was not monitored daily for changes once per day as ordered by a physician. -Resident #1's skin tear to the left upper leg was not monitored every shift for signs of infection as ordered by a physician. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that residents received treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the residents' choices for 4 of 4 residents (Residents #1, 2, 3, 4) reviewed for quality of care 1. The facility failed to ensure Resident #1 received wound care and treatment as ordered by a physician. -Resident #1's right great toe was not monitored daily for changes once per day as ordered by a physician. -Resident #1's right heel was not monitored daily for changes once per day as ordered by a physician. -Resident #1's skin tear to the left upper leg was not monitored every shift for signs of infection as ordered by a physician. [...]

Inspectors wroteBased on interviews, and record reviews, the facility failed to maintain medical records on each resident that are complete, accurately documented, readily accessible, and systematically organized for 3 of 4 residents (Resident #s 2,3,and 4) reviewed for resident records, in that: 1. The facility failed to accurately document Resident #s 2, 3, and 4's September 2023 wound treatments. 2. The facility failed to ensure Resident #3's physician progress notes from July 2023 and September 2023 were in the resident's electronic clinical record. This deficient practice could affect all residents whose records are maintained by the facility and could place them at risk for errors in care and treatment.

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 infection for 1 of 4 residents (Resident #2) reviewed for infection control LVN B failed to maintain a sterile environment when performing wound care for Resident #2 These deficient practices could place residents at-risk for infection due to improper care practices.