Fallbrook Rehabilitation And Care Center
Fallbrook Rehabilitation and Care Center in Houston, TX — inspection on April 29, 2026.
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
During an interview on 4/28/2026 at 5:25pm, the DON stated care should be completed before the call light was turned off.The DON stated the adverse effect for not answering call lights could be residents are in pain and need a nurse, or they could attempt to get out of bed by themselves and fall.
The DON stated the definition of neglect is not providing care within standards of practice; and if we don't do it, then it is neglect. An additional adverse effect of neglect is a patient can feel abandoned psychologically or physical impairment, bed sores, patient may try to get up by themselves and possibly fall.Record Review of Resident Rights policy dated February 2021 revealed, Employee show treat all residents with kindness, respect, and dignity.1. federal and state laws that guarantee certain basic rights to all residents of this facility.
These rights include the residents' right to:a dignified existence.be treated with respect, kindness, and dignity.f.
Communications with access to people and services, both inside and outside the facility.h. Be supported by the facility in exercising his or her rights.
455815 04/29/2026
Fallbrook Rehabilitation and Care Center 10851 Crescent Moon Dr Houston, TX 77064
asked him why does it take him over 40 minutes to answer the call light and he stated he actually has
pushed her call light and when CNA A came in her room, she asked him to help her to the bathroom
arrived for his night shift (10:00am-6:00am), she pushed her call light and it took 30-40 minutes for him to come.
She stated he did not come right away.
She stated she sat in her feces from 1:00am-3:00am. CR#1 stated she called FM A during this time and told her she was still sitting in her poop.
She stated this was humiliating and she was traumatized.
She stated FM B came to pick her up on Monday 3/30/26 early morning.
She stated she felt disgusting and nasty.
She stated she never wants to return to a place (Nursing facility) like this.
During an interview on 4/28/2026 at 5:17pm with Administrator he stated he gets phone calls in the middle of the night from residents that staff are not answering call lights. He stated he has left his own home and came to the facility to answer call lights. He stated based on census there are enough staff. He stated they have terminated staff for not doing their jobs. He stated good workers are difficult to find. He stated call lights are a challenge and a work in progress. He stated in-service training is completed monthly for the quality of care.
Administrator stated adverse effect of not answering call lights is bad because residents depend on light for their needs. He states he is in continuous communication with staff for call lights.
The administrator stated the facility generated report was not confirmed but could not provide a reason why he confirmed it on his investigation.
The Administrator stated he spoke with the FM regarding CR#1 and her leaving. He stated the FM stated CR#1 stated that the CNA took over and hour each time she pushed her call button for assistance. He stated he spoke with CNA A who denied the incident. He stated all staff and residents have his personal number and called him regarding call lights. He stated the call lights are a continuous issue and he is working on it. He stated he has terminated some staff, completed in-service training on others and has hired some as well. He stated call light have been an ongoing problem.
The administrator stated he is the abuse coordinator.
Regarding CNA A, the Administrator stated he had returned to work.
During an interview on 4/28/2026 at 5:25pm with DON, care should be completed before the call light is turned off.
Adverse effect with not answering call lights. It could be pain, get out of bed by themselves.
States definition of neglect is to provide care within standards of practice and if we don't then it is neglect.
The adverse effect of neglect a patient can feel abandoned psychologically or physical impairment, bed sores, patient may try to get up by themselves and possibly fall.Several attempts to contact CNA A were unsuccessful; however, Administrator stated CNA A is out of the country at this time and is not available by telephone.Record
Review of the facility's abuse, neglect, and exploitation dated 2024 reveals:Neglect is the failure of the facility, its employees or service providers to provide goods and services to a resident [NAME] are necessary to avoid physical harm, pain, mental anguish or emotional distress.
Frequently Asked Questions
More Reports
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.