Castle Hills Rehab: CPR Certification Lapse - TX
The lapse came to light during a complaint inspection completed November 25, 2025. Federal inspectors cited the facility under a standard requiring that a sufficient number of qualified staff be on hand at all times, with CPR certification being a core piece of that requirement.
The nurse, identified in inspection records as RN A, said she had been notified a few weeks before the inspection that her certification had lapsed. She kept working anyway. When inspectors interviewed her at 4:40 in the afternoon, she was direct about her reasoning: she felt competent to respond to a cardiac emergency and did not believe the expired certification would have affected the care she gave residents.
Feeling competent and being certified are not the same thing.
CPR certification for healthcare providers is not a formality. It requires hands-on training, either in person or through a virtual instructor-led session, with a recognized national provider. The certification has an expiration date because the training is meant to be refreshed, the techniques updated, and the muscle memory renewed. A nurse who let it lapse and continued working was not meeting the standard the facility's own policy required.
The director of nursing, interviewed at 5:07 that same afternoon, acknowledged she had no competencies checklist. Her method for verifying that staff were CPR and AED certified was simple: she looked for a certification document. If no one flagged a document as expired, the process had no way to catch a lapse before it became a problem. She had not caught this one.
The facility's own written policy, revised at some point before the inspection, stated that CPR-certified staff would be available at all times and that certifications would be maintained as current through a provider whose training included a hands-on component. The policy was clear. The gap was in whether anyone was watching to make sure it was followed.
Inspectors noted that during the shifts in question, RN A was not working alone. Other licensed and CPR-certified nurses were present on the floor. That detail factored into the citation's harm level, which was recorded as minimal harm or potential for actual harm, affecting a few residents. The presence of other certified staff meant that if a resident had gone into cardiac arrest, someone qualified to respond was in the building.
That is a narrow margin to rely on.
The question a lapse like this raises is not whether anything bad happened. Nothing in the inspection record indicates a resident coded during the period RN A was working without valid certification. The question is what the facility's oversight was actually built to catch. A process that depends on staff self-reporting expired credentials, or on documents surfacing on their own, is not a process. It is a hope.
RN A knew her certification had expired. She kept her schedule. The director of nursing, by her own account, had no checklist that would have flagged it. The facility's policy said certified staff would be available at all times. For some stretch of weeks, that was not verifiably true, and no one in a supervisory role knew it until a complaint brought inspectors through the door.
Castle Hills Rehabilitation and Care Center is a licensed skilled nursing facility in San Antonio. The November inspection was complaint-driven, meaning someone prompted regulators to take a look before a routine survey would have brought them there.
What they found was not a catastrophe. No resident was documented as harmed. But the conditions that allow a nurse to work through an expired certification for weeks, without a supervisor catching it, without a checklist flagging it, without any mechanism beyond the nurse's own judgment deciding it did not matter, are not conditions that disappear once an inspector leaves. They are conditions that require someone to decide to change them.
RN A believed she was competent. She may well have been. But in a facility caring for residents who can deteriorate without warning, the gap between a nurse who is certified and a nurse who believes she would do fine is the gap that a checklist exists to close.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Castle Hills Rehabilitation and Care Center from 2025-11-25 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: August 29, 2026 · Our methodology
Castle Hills Rehabilitation and Care Center in San Antonio, TX was cited for violations during a health inspection on November 25, 2025.
The lapse came to light during a complaint inspection completed November 25, 2025.
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.