Care Nursing & Rehabilitation: Missing Hospice Contracts - TX
The inspection, completed May 28, 2026, was triggered by a complaint. What investigators found at the center of it was a paper trail that stopped cold: hospice agreements for at least two residents, Resident 10 and Resident 60, that the facility either never secured or could no longer locate.
For a resident receiving hospice care, that contract is not an administrative formality. It is the document that defines who is responsible for what, which provider is managing end-of-life medications, and who gets called when something goes wrong. Without it in hand, those lines blur.
The Director of Nursing told inspectors she believed the document for Resident 10 had been obtained before admission but that the facility simply could not find it now. She said she was not responsible for making sure hospice contracts were in place before a resident's referral was approved. She also told inspectors she had not ensured the ordering provider, Resident 10's hospice, was notified when that resident's medication was refused, which is a separate documentation requirement tied directly to the missing oversight structure.
The interim administrator, reached by phone during the inspection at 3:50 p.m., said she had assumed all contracts would be in the contract binder. She had not realized Resident 60's hospice agreement was missing from it. When asked where else it might be, she said she did not know.
The facility's own hospice services policy, undated, states plainly that a legally binding written agreement must exist between the facility and any recognized hospice provider, that authorized representatives of both must sign it, and that the facility is responsible for maintaining a copy. The policy further requires the Director of Nursing or a designee to immediately notify the hospice of any significant changes in a resident's condition and to document that notification in the medical record.
On both counts, the record showed the facility had not held to what its own policy required.
A second violation documented during the same inspection concerned medication administration records. When a scheduled dose of medication is not given, whether because a resident refused it, was off-site, or for any other reason, staff are required under the facility's own written guidelines to initial and circle the space on the medication administration record, enter an explanatory note, and notify the physician. For electronic records, the entry must be date and time stamped with the caregiver's initials.
Inspectors found that process had broken down as well, specifically in connection with Resident 10's refused medication and the failure to notify the hospice provider who had ordered it.
CMS rated both deficiencies at a level of minimal harm or potential for actual harm, with some residents affected. That rating reflects the lower end of the federal scale, but it applies to a category of failure, missing contracts, undocumented refusals, providers not notified, that tends to surface only after something has already gone wrong.
The interim administrator, on the afternoon of the inspection, still did not know where Resident 60's hospice contract was.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Care Nursing & Rehabilitation from 2026-05-28 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: August 8, 2026 · Our methodology
CARE NURSING & REHABILITATION in BROWNWOOD, TX was cited for violations during a health inspection on May 28, 2026.
The inspection, completed May 28, 2026, was triggered by 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.