The Plaza at Edgemere: Wrong-Size Briefs Caused Wounds - TX
Federal inspectors cited the facility following a complaint inspection on March 27, 2026. The citation was rated at actual harm, meaning inspectors concluded real injury had occurred, not just a risk of it. The facility is disputing the finding.
One of the residents, identified in inspection records only as Resident 1, developed her wound from two sources: a brief that was too small and a mechanical lift sling that was also too small. The wound care nurse told inspectors both were contributing factors. The other resident, Resident 2, developed a wound on his right ischium, the lower part of the pelvis, from a brief that was too small. That wound was documented as developing on March 3, 2026.
By the time inspectors interviewed Resident 2 on March 26, he already knew what had caused it. He said he had developed the wound because he was wearing a brief that was too small. He said the wound care nurse was now taking care of it. He said his briefs were now the correct size.
The wound care nurse confirmed both accounts. Resident 1's wound came from the small brief and the small lift sling. Resident 2's wound on his right ischium came from a brief that was very small. She described it as a non-pressure wound, meaning it was caused by friction or compression from ill-fitting equipment, not from prolonged immobility.
The director of nursing told inspectors that both residents had briefs that were tight and had areas that were really red. Staff changed the briefs to a larger size. She said nurses and CNAs were responsible for making sure residents had the right size.
That responsibility, according to the inspection record, was not met before the wounds developed.
Wound care notes from March 24, 2026, documented what inspectors found when they reviewed Resident 2's records: a full-thickness wound on the left posterior upper thigh, measuring six centimeters long, 4.2 centimeters wide, and 0.4 centimeters deep. A full-thickness wound means the damage extended through all layers of the skin. A physician had ordered treatment with xeroform gauze and a dry dressing, changed daily and as needed.
The inspection record also references earlier skin tears described as old, suggesting wound documentation had been ongoing before the complaint inspection was triggered.
The facility's own wound care policy, revised as recently as January 2, 2026, states that the facility will provide evidence-based treatments in accordance with current standards of practice. Its resident rights policy, dated 2026, states that residents have a right to a safe, clean, comfortable, and homelike environment, including receiving treatment and supports for daily living safely.
The briefs were changed. The wounds remained.
The Plaza at Edgemere is disputing the citation. That dispute does not change what the wound care nurse said, what the director of nursing said, or what Resident 2 himself described when inspectors sat down with him on a Tuesday afternoon in late March. He told them plainly what had happened to him. He was wearing the wrong size. Now he had a wound.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for The Plaza At Edgemere from 2026-03-27 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 19, 2026 · Our methodology
The Plaza at Edgemere in Dallas, TX was cited for violations during a health inspection on March 27, 2026.
Federal inspectors cited the facility following a complaint inspection on March 27, 2026.
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.