Rambling Oaks Courtyard Extensive Care Community
RAMBLING OAKS COURTYARD EXTENSIVE CARE COMMUNITY in HIGHLAND VILLAGE, TX — inspection on September 2, 2025.
Found 2 citations. Severity: Standard violations.
Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.
Inspection Findings
order for it.
She said the nasal spray should be inside the nurses' cart and should be administered by
and consume it leading to allergic reactions.
She said she also checked the rooms of other residents
members to let the nursing staff know if they were bringing any medication. In an interview on 09/02/2025 at 11:50 AM, the DON stated Resident #1's nasal spray should be administered by nurses and there should be a physician's order for it.
She said the expectation was for the staff to check if there were any medications inside the residents' room.
She said if a resident was administering medications unsupervised, for this incident a nasal spray, there could be adverse effects if the nasal spray was overused such as nose irritation or allergic reactions.
She said if the resident was the one administering the nasal spray, there should be an assessment that the resident was able to do so.
She said if the resident was deemed able to administer his nasal spray, the nasal spray should still not be on top of the side table were other confused residents could assess it and consume it.
The DON said that since the resident was using it, she would check if a physician order was already in place.
The DON said she would do an in-service about not leaving any medication inside the residents' room and scanning the room if there were any medications accessible to the residents. In an interview on 09/02/2025 at 12:39 PM, the Administrator stated residents could not administer their own medications unless there was an assessment that the residents were competent enough to do it.
She said the resident might overuse the medication resulting to the resident being overmedicated.
She said the expectation was for the staff to scan the room if there were any medications at bedside.
She said there would be some family members that would bring medications, but still, those medications should not be inside the room and the facility should be aware.
She said she would coordinate with the DON on how to make sure that there were no medications inside the residents' room and that no resident was administering any medication by himself.
Record review of the facility's policy, Medication Administration Procedures Pharmacy Policy & Procedure Manual 2003, revised 10/25/17 reflected, 1.
All medications are administered by licensed medical or nursing personnel . 14. A specific order must be obtained from the Physician
Record review of the facility's policy, Medication and Treatment Orders 2001 MED-PASS, Inc revised July 2016 reflected Policy Interpretation and Implementation . 1.
Medications shall be administered only upon the written order . 3.
Drug and biological orders must be recorded on the physician's order sheet in the resident's chart.
676168 09/02/2025
Rambling Oaks Courtyard Extensive Care Community 112 Barnett Blvd Highland Village, TX 75077
Observation on 09/02/2025 at 8:51 AM revealed Resident #3 was in his bed with eyes closed. It was observed that a tube of zinc oxide was on top of the resident's side table. In an interview on 09/02/2025 at 10:31 AM, CNA C stated she was assigned on Resident #3' hall for the day.
She said she did not notice the zinc oxide on Resident #3's side table.
She said it should not be accessible to the residents because they might confuse it as food and put it in his mouth.
She said she would check if the zinc oxide was still inside the resident's room.
She said she would also check the residents' rooms on her assigned hall.
She said she did change the resident and applied some barrier cream, but she could not remember if she put it inside the drawer or not. In an interview on 09/02/2025 at 11:08 AM, LVN A stated zinc oxide was a form of medication because it was used to prevent skin issues such as rashes, irritations, and minor burns.
She said it should not be left inside the rooms of the residents as confused residents might consume it.
She said the cream should be stored in the cart and just put some in a cup for use or place it somewhere not accessible to the residents.
She said she would go to Resident #2 and Resident #3's rooms to get the zinc oxide.
She said she would also check the rooms of the other residents to see if there were zinc oxides inside the room In an interview on 09/02/2025 at 11:50 AM, the DON stated zinc oxides should not be left or stored inside the resident's room because some residents might be able to get hold of the zinc oxide because the tubes were in plain view.
She said the CNAs and the nurses were responsible in checking if there were zinc oxides were inside the residents' rooms.
She said she already made her round when she was made aware about the zinc oxides being inside the rooms of the residents.
She said zinc oxide was applied topically and could be harmful when ingested.
She said, when ingested, some of its ingredient might cause allergic reactions or some adverse reactions such as stomach upset, nausea, and vomiting.
She said the expectations were for the staff to always scan the residents' rooms to make sure they were not leaving the tubes of zinc oxide inside the room, putting them where the resident could not access them, or just put them in the cart.
She said she would do an in-service about storing the zinc oxide accordingly. In an interview on 09/02/2025 at 12:39 PM, the Administrator stated the expectation was for the staff not to leave the zinc oxides inside the room of the residents after use.
She said the residents, confused or not, could access and consume them and could result to untoward outcomes such as allergy or interaction with other oral medications.
She said she would coordinate with the DON about storing the tubes of zinc oxide inside the carts or somewhere not accessible to the residents.
Record review of the facility's policy, Medication Administration Procedures Pharmacy Policy & Procedure Manual 2003, revised 10/25/17, revealed, 8.
After the medication administration process is completed . stored in a locked medication room, or otherwise secured.
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Source: This inspection report was downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases nursing home inspection reports in bulk. The findings reflect what state surveyors documented in the official Form CMS-2567 Statement of Deficiencies on the date of the inspection.
Plan of correction not included: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to their state survey agency and those responses may not appear in CMS public data at the time of release. The absence of a plan of correction in this report does not mean one was not filed. Readers who want information about corrective steps taken by the facility are encouraged to contact the facility or their state survey agency directly.
Corrections may have been made: This report reflects conditions observed on the date of the survey. The facility may have implemented staffing changes, additional training, policy revisions, or other corrective actions since this report was issued. We publish what CMS provides and encourage readers to seek current information from the facility.