Lone Star Rehab: Staff Background Check Failures - TX
A social worker hired in March 2022 never received a criminal history check or screening through the Employee Misconduct Registry and Nurse Aide Registry, records show. The worker provided direct care to vulnerable residents for more than three years without any verification that they were safe to work in a nursing home.
Three other employees also worked without annual registry checks that are supposed to flag workers who have committed abuse, neglect, or other misconduct at healthcare facilities. The violations affected an administrator hired in February 2023 and two certified nursing assistants hired in March 2023 and November 2022.
Federal inspectors discovered the screening failures during a September complaint investigation. The facility's written policy explicitly requires criminal history checks before hiring and annual misconduct registry checks on each employee's anniversary date.
"Residents could have been affected by being exposed to staff who should not have been hired," the administrator told inspectors during a September 4 interview.
The social worker's case represents the most serious lapse. Employee files contained no evidence that criminal history or registry checks were ever completed before the March 2022 hire date. The position requires direct contact with residents who may be cognitively impaired or physically vulnerable.
Background screening requirements exist because nursing home workers have committed serious crimes against residents. The Employee Misconduct Registry tracks healthcare workers who have been found to have abused, neglected, or stolen from patients. The Nurse Aide Registry maintains similar records specifically for certified nursing assistants.
Annual checks are required because workers can be added to misconduct registries after they're hired if violations are discovered at their current or previous jobs.
The administrator acknowledged ultimate responsibility for ensuring the checks were completed. She blamed the failures on "turnover in the payroll position" and suggested that documents may have been lost during a transition to electronic employee files.
The current payroll employee, identified as Payroll E, started in March 2025 and told inspectors she was responsible for completing both criminal history and registry checks. She said she had been instructed to upload existing employee documents to electronic files when she started but could only upload "all the documents she could find."
Payroll E confirmed that criminal history and registry checks should be completed before hiring and that registry checks should be done annually. Her comments suggest the facility may have been operating without proper screening procedures for an extended period before she arrived.
The facility's own written policy, dated February 17, 2023, clearly outlines the requirements. It states that confidential personnel folders must contain criminal history checks completed before hiring and misconduct registry and nurse aide registry checks completed both before hiring and annually.
The policy was in effect when three of the four employees were hired, yet none received the required annual screenings. The social worker was hired before the policy was written but should have received initial screening under federal regulations that have been in place for years.
The administrator's interview responses reveal awareness of the requirements but apparent breakdown in implementation. She told inspectors that her expectation was that criminal history and registry checks "were supposed to be ran prior to hire" and that registry checks "should have been ran annually at date of hire."
She specifically identified the payroll position as responsible for ensuring the checks were completed but said she was "ultimately responsible."
The failure to maintain proper employee screening records violates federal regulations designed to prevent facilities from hiring workers who pose risks to residents. The regulations require facilities to develop and implement policies and procedures to prevent abuse, neglect, and theft.
Federal inspectors classified the violations as causing "minimal harm or potential for actual harm" but noted that "some" residents were affected. The designation reflects the risk created by employing unscreened workers rather than evidence of actual harm to specific residents.
The social worker's three-year employment without any background screening represents a particularly significant regulatory failure. Social workers in nursing homes often work with residents' most sensitive information and may have access to their rooms, personal belongings, and financial information.
Certified nursing assistants provide hands-on personal care including help with bathing, toileting, and moving residents. The two CNAs worked for approximately two years and one year respectively without annual registry checks that could have revealed misconduct at other facilities.
The administrator worked for more than two years without annual registry screening. Administrators have broad access to resident information and oversight of care policies that could affect resident safety.
The facility's explanation that documents may have been misplaced during digitization of employee files suggests broader problems with personnel record management. Proper background screening creates a paper trail that should be maintained throughout an employee's tenure.
The payroll employee's March 2025 start date indicates the facility may have operated for months without anyone specifically responsible for ensuring compliance with screening requirements. Her statement that she could only find some existing documents to upload raises questions about what other personnel records may be incomplete or missing.
The violations place residents at ongoing risk until proper screening is completed for all employees. Registry checks can reveal patterns of misconduct that would disqualify workers from employment in healthcare settings.
The administrator's acknowledgment that residents "could have been affected" understates the potential consequences of employing unscreened workers in positions of trust and authority over vulnerable populations.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Lone Star Rehabilitation & Wellness Center from 2025-09-04 including all violations, facility responses, and corrective action plans.
Additional Resources
Data source: Official federal inspection data from the Centers for Medicare & Medicaid Services (CMS).
Editorial process: AI-synthesized regulatory data, reviewed for accuracy by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: June 20, 2026 · Our methodology
LONE STAR REHABILITATION & WELLNESS CENTER in STEPHENVILLE, TX was cited for violations during a health inspection on September 4, 2025.
The worker provided direct care to vulnerable residents for more than three years without any verification that they were safe to work in a nursing home.
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.