Magnolia Crossing Nursing And Rehabilitation Cente
Inspection Findings
F-Tag F0684
F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
room and let CR #1 relax. LVN A said she saw LVN B enter CR #1's room and LVN A told her Leave my patient alone. LVN B told her the family member called and told her CR #1 was short of breath and she was
in distress. LVN A said the Hospice nurse came and checked on CR #1 as well. LVN A said she was suspended and then let go from the facility. LVN A said she did her job and took care of CR #1, she did not think she did anything wrong. Interview with LVN B on 10/28/25 at 2:47 pm. She said CR #1's family member called the facility that night and asked her to check on CR #1. LVN B said CR #1 was fine at the time of her assessment. LVN B said the family member would call her sometimes and if there were any concerns with CR #1, she would go to her room and CR #1 would tell her what was wrong. LVN B said the family member would always watch through the camera and made sure CR #1 was ok. LVN B said she was not in the room at the time to witness what anyone did or did not do. Interview with the DON, on 10/28/25 at 3:05 pm, he said MA D, went into CR #1's room to give her medication and CR #1 said she had shortness of breath. The DON said MA D reported this to LVN A. The DON said LVN A immediately went in CR #1's room and told her she needed to take her medications, and she did not see any shortness of breath. The DON said there may have been some confusion LVN A thought MA D was reporting the resident was refusing to take their meds. The DON said the family member showed the Administrator the video of the incident. He said LVN A was fired, and the incident was reported to the state. The DON said the risk to the resident when they are truly having respiratory distress could be detrimental. Interview with the Administrator on 10/30.25 at 9:44 am, she said the footage that she saw was CR #1 stating I can't breathe.
She said MA D alerted LVN A. The Administrator said in the video, she saw LVN A tell CR # 1 I just gave you your pain medication, you have to give it time to work, just calm down and then she left the room. The Administrator said MA D stayed in the room. The Administrator said in the video CR #1 appeared to be in pain; she did not see shortness of breath. She said MA D ended up giving meds to CR #1. She said CR #1 calmed down and fell asleep. The Administrator said LVN B assessed CR #1 after the family member called her. The Administrator said LVN B alerted her of the incident. She said LVN A was terminated and did not come back after her suspension. The Administrator said LVN A should have assessed the resident. She said the risk to the resident when O2 is not checked, the resident could become non-responsive. Record
review of the policy titled Nursing Service and Sufficient Staff dated 10/24/22 read in part . providing care included, but is not limited to, assessing, evaluating, planning and implementing resident care plans and responding to resident's needs .
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Magnolia Crossing Nursing and Rehabilitation Cente in Houston, TX inspection on recent inspection.
Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.
Frequently Asked Questions
- What is an F-tag violation?
- F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
- Were these violations corrected?
- Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
- How often do nursing home inspections happen?
- CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
- What should families do about these violations?
- Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in Houston, TX, (5) Report new concerns to state authorities.
- Where can I see the full inspection report?
- Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from Magnolia Crossing Nursing and Rehabilitation Cente or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.