Wharton Nursing and Rehab: Dialysis Meal Failures - TX
The resident, identified in inspection records only as Resident 2, received dialysis at an outside center and was transported there on a regular schedule. Before leaving, he was supposed to receive breakfast or a shake. Whether he actually got either was a different matter.
The facility used a dialysis communication form to track what happened before and during each transport, including whether the resident received food, any medications given, and his condition at departure. When inspectors reviewed those forms, some sections covering snacks or food were blank.
The assistant director of nursing told inspectors that a blank section on the food line meant, in her reading, that nothing had been given. She said the expectation was that if a resident refused a meal, staff were to call the family and arrange an alternative. She said the forms were supposed to be filled out correctly to reflect the resident's condition before leaving.
The director of nursing told a different story. She said the forms were never blank and were always completed with vitals and updates. She said Resident 2 had no issues getting meals and she was not aware of any missed meals or problems resulting from missed meals. She said the resident was given a shake before dialysis as an alternative to a full meal during his morning transport window.
Both administrators were describing the same forms. They reached opposite conclusions about what those forms showed.
The director of nursing also acknowledged that the facility had dialysis contracts with an outside provider but no internal policy for dialysis care, on the grounds that the facility itself did not administer the treatment. Her stated expectations for staff were narrow: make sure the resident is dressed appropriately, complete the communication sheet, and ensure he gets breakfast or lunch before leaving.
Resident 2 had the same dialysis chair time for most of his treatment period, but his chair time was not documented in his care plan. The director of nursing said this was because chair times could change, with any changes communicated by the transportation provider calling the facility. The assistant director of nursing said care plans would not include timeframes for non-pharmaceutical interventions like meals, and that those details would appear in the medication administration record instead.
Inspectors noted the harm level as minimal or potential for actual harm, with some residents affected.
For a dialysis patient, the timing and content of meals around treatment is not incidental. Dialysis removes fluid and waste from the blood over several hours, and patients arrive nutritionally depleted. Missing a meal before a session compounds that. The facility's own staff understood this well enough to build a shake alternative into the routine. What they had not done was create a consistent record of whether it happened.
The gap between the two administrators' accounts, one saying blank meant nothing given, the other saying nothing was ever blank, was not resolved in the inspection report. Neither was the question of how many times, across how many transport days, the food section of the form had been left empty.
Resident 2's chair time stayed the same for most of his treatment. His meals, on paper, did not always show up at all.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Wharton Nursing and Rehabilitation Center from 2026-05-28 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 8, 2026 · Our methodology
Wharton Nursing and Rehabilitation Center in Wharton, TX was cited for violations during a health inspection on May 28, 2026.
The resident, identified in inspection records only as Resident 2, received dialysis at an outside center and was transported there on a regular schedule.
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.