Latest reports, citations, and penalties from CMS data
Federal inspectors found Estates at Shavano Park operating without a policy for assessing nurse competencies during a complaint investigation in November....
The Social Worker acknowledged during an October 28 interview that she had addressed the family's previous concern about the call light placement....
The staffing shortage created a cascade of care failures....
Resident 1 had been admitted to the facility after experiencing falls....
The falsified documentation at Lutheran Home came to light when an outside infusion clinic contacted facility administrators....
The missed 6 AM dose was never mentioned during shift report, the nurse told inspectors....
But staff were following incomplete orders anyway....
The resident had intact cognition with a score of 15 on cognitive testing....
The facility's director of nursing pulled the complete staff list and found no employee assigned those initials....
The resident, identified as Resident #1 in the November inspection report, scored 15 on a cognitive assessment indicating he was mentally intact....
The facility terminated Dietary Manager B on October 6 following 28 formal complaints about the dietary department in just two months....
The violation centered on Resident #2, who required continuous oxygen therapy with humidification....
The violations put residents at risk for bacterial infections and cross-contamination between patients, according to the inspection report....
Yet when inspectors arrived at 10:18 AM, they found the bag sitting uncovered on the bed....
Resident #1 at Ridgewood at the Woodlands needed the specialized wheelchair for "upper trunk adjustment and comfort," according to inspection records....
The incident at Rockwall Nursing Care Center occurred on a Saturday in the television room while CNA C was bent over cleaning fluids from the floor....
The facility's own resident council documented the problem weeks earlier....
The chemical-soaked wipes were discovered during a complaint inspection at Denton Rehabilitation and Nursing Center on October 7, 2025....
Resident #2 requires blood sugar checks twice daily due to Type 2 diabetes, with results over 300 requiring immediate physician notification....
The nursing assistant's comment was documented in the facility's own SBAR record, a standard medical communication tool used to track significant incidents....