Rambling Oaks Courtyard: Medication Left in Reach - TX
Inspectors arrived on September 2, 2025, responding to a complaint. What they found was straightforward and repeated: a topical cream that staff themselves described as a medication, left in plain view of residents who might mistake it for food.
The first resident, identified in inspection records as Resident 2, was described as having moderate cognitive impairment. She had a physician's order for zinc oxide barrier cream to address incontinence-related skin breakdown. When inspectors observed her room that morning, a tube sat on her bedside table. When asked about it, she responded with words inspectors could not understand.
CNA B, assigned to Resident 2 that day, said she hadn't noticed the tube. She acknowledged it shouldn't be there. "The zinc oxide should be inside the nurse's cart and not at bedside," she told inspectors, "because the resident might eat it." She said she would go check if it was still in the room.
Down the hall, a similar scene. Resident 3, a male resident with moderate cognitive impairment and a BIMS score of 10, was lying in bed with his eyes closed when inspectors observed a tube of zinc oxide on his side table at 8:51 in the morning. His care plan, written in August 2024, noted his risk for pressure ulcers related to incontinence and called for barrier cream to be applied per physician order. CNA C, assigned to his hall that day, said she hadn't noticed the tube either. She said she had changed the resident and applied some barrier cream earlier, but couldn't remember whether she had put the tube in a drawer or left it out. "It should not be accessible to the residents," she said, "because they might confuse it as food and put it in his mouth."
LVN A, interviewed later that morning, was direct about what zinc oxide is and what can happen if it's swallowed. She called it a form of medication used to prevent rashes, irritations, and minor burns. She said it should never be left in residents' rooms because confused residents might consume it. Her instruction for how to handle it was simple: keep it in the cart, or pour a small amount into a cup for use. She said she would go retrieve the tubes from both rooms and check the rest of the hall.
The Director of Nursing said zinc oxide, when ingested, can cause allergic reactions, stomach upset, nausea, and vomiting. She said the CNAs and nurses were responsible for scanning residents' rooms to make sure tubes weren't left behind, and that the expectation had always been to store them in the cart or somewhere out of reach. She said she had already made rounds once she was informed about the findings. She said she would conduct an in-service on proper storage.
The Administrator said the same thing in slightly different terms. Residents, she said, "confused or not," could access and consume the cream, with potential for allergic reactions or interactions with other oral medications. She said she would coordinate with the Director of Nursing on where the tubes should be stored going forward.
The facility's own medication administration policy, last revised in October 2017, states that after medication administration is completed, medications must be stored in a locked medication room or otherwise secured.
Nobody disputed any of this. Every staff member interviewed agreed the tubes shouldn't have been where they were. Every staff member said they would go check. The question inspectors left unanswered, because no one could answer it, was how long the tubes had been sitting there before anyone looked.
Resident 3 had his eyes closed when inspectors walked in. The tube was on the table beside him.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Rambling Oaks Courtyard Extensive Care Community from 2025-09-02 including all violations, facility responses, and corrective action plans.
Additional Resources
Data source: This article is based on inspection data downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases inspection reports in bulk; we publish the findings as documented by state surveyors in the official Form CMS-2567 Statement of Deficiencies.
Plan of correction: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to state survey agencies and those responses may not be reflected in CMS data at the time of publication. The absence of a plan of correction in our data does not mean one was not filed. Readers who want information about corrective steps taken are encouraged to contact the facility directly or their state survey agency.
Corrections may have occurred: Inspection reports reflect conditions observed on the date of the survey. Facilities may have implemented corrections, staffing changes, additional training, or other remediation since the report was issued. We report what CMS provides and encourage readers to seek current information from the facility.
Editorial process: Inspection findings are extracted from CMS source documents and synthesized using AI, reviewed for factual accuracy against the original report by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: September 27, 2026 · Our methodology
RAMBLING OAKS COURTYARD EXTENSIVE CARE COMMUNITY in HIGHLAND VILLAGE, TX was cited for violations during a health inspection on September 2, 2025.
Inspectors arrived on September 2, 2025, responding to a complaint.
Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. Review the full report below for specific details and facility response.