The assistant director of nursing told inspectors she knew about several couples among residents. Resident #11 brought his girlfriend from another facility specifically to be near him. Residents #7 and #8 go on dates and "sometimes come back drunk," she said.
When Residents #7 and #8 tried to sign out overnight, the assistant director questioned them about when they'd return. Resident #8 said "in the morning, when the room they had arranged closed." She told them an overnight stay wasn't a good idea because of his health condition.
His response: "What are you going to do when we get married?"
The assistant director notified his responsible party about the relationship. The responsible party said "she hoped they did get married so they could take her name off the contact list."
Federal inspectors investigated after receiving a complaint about resident sexual activity. They found the facility had no systematic approach to evaluating whether residents could consent to sexual relationships or managing intimate partnerships.
The MDS coordinator told inspectors he'd been asked to do "acute careplans about resident relationships" but it had been "a long time ago." He said the nursing directors usually handled acute care plans about sexual activity.
Even though he hadn't created care plans for relationships, he'd been asked to do quick cognitive assessments "to decide if they were competent to make the decision to be in a sexual relationship."
The director of nursing said she'd done relationship care plans before, but "never thought to care plan the couples having sex." She acknowledged care plans were important because "staff would know how to care for residents, and what the interventions were for helping them reach their goals."
Resident #3 flatly denied having any relationship with Resident #1 when inspectors called her. When asked about staff witnessing sexual contact, she said "the staff were lying." She also said staff never talked to residents about consent and safe sex "because they were not having sex."
But Resident #1 told inspectors he thought staff had talked to residents about consent and safe sex, contradicting his alleged partner's account.
The assistant director knew about other couples beyond the disputed relationship. Residents #9 and #10 originally asked to room together but were later moved to separate rooms. She didn't know if they requested the separation or if staff moved them for other reasons.
Resident #11 and Resident #12 used to room together when she arrived from another facility. They're "still a couple, though they do not room together any more," the assistant director said.
The facility's care planning policy requires individualized comprehensive care plans based on resident assessments. The policy encourages residents and their families to participate in developing and revising care plans.
However, the policy doesn't address acute care plans for issues not covered in comprehensive assessments. Sexual relationships appear to fall into this gap.
The assistant director thought the management team knew about all the relationships and assumed "there were probably care plans in place for them, but she was not sure."
The social worker could also create relationship care plans, the director of nursing said, but she'd have to review individual care plans to see what existed.
The inspection found the facility failed to ensure residents received necessary care and services to attain or maintain their highest practicable physical, mental and psychosocial well-being. Multiple resident couples were engaging in intimate relationships without proper assessment of their capacity to consent or care planning to address their needs.
Federal regulations require nursing homes to assess residents' decision-making capacity and create individualized care plans addressing all aspects of their well-being. Sexual health and intimate relationships can be significant components of psychosocial wellness for nursing home residents.
The facility's haphazard approach left residents without proper protections or support. Some couples were navigating complex intimate relationships while staff remained uncertain about their cognitive capacity to consent or what interventions might help them maintain healthy partnerships.
Resident #7's casual question about marriage highlighted the disconnect. While he and his partner were planning a future together, facility leadership couldn't say whether anyone had assessed his ability to make such decisions or created plans to support their relationship goals.
The responsible party's wish to remove her name from contact lists suggested family members were also struggling with how to handle intimate relationships among cognitively impaired residents without clear facility guidance.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Dfw Nursing & Rehab from 2025-09-10 including all violations, facility responses, and corrective action plans.