River Hills Health And Rehabilitation Center
RIVER HILLS HEALTH AND REHABILITATION CENTER in KERRVILLE, TX — inspection on February 8, 2025.
Found 3 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
The facility failed to acquire, receive, dispense, and administer Resident #1's scheduled insulin 17u Insulin Glargine daily as ordered for 6 days from 1/31/25-2/5/25.
An IJ was identified on 2/07/2025.
The IJ Template was provided to the facility on [DATE] at 5:01 PM.
While the IJ was removed on 2/08/2025, the facility remained out of compliance at a scope of isolated and severity level of no actual harm with potential for more than minimal harm that is not IJ, due to the need for the facility to evaluate the effectiveness of the corrective action.
This deficient practice could place resident at risk for adverse side effects of hyperglycemia.
Findings include:
Record review of Resident #1's face sheet printed 02/06/2025 revealed a [AGE] year-old female admitted on [DATE] after recent hospitalization with a diagnosis of UTI and new on-set CHF exacerbation with co-morbidity of DMII (a long-term condition in which the body does not make enough insulin).
Record review of Resident #1's Baseline Care Plan, dated 01/30/2025, revealed resident was a Type II Diabetic and was receiving insulin.
Record review of Resident #1's hospital discharge instructions dated 01/30/2025 revealed Resident #1 had an order for 17units Insulin Glargine 1 x daily.
Hospital discharge instructions dated 01/30/2025 did not include orders to check blood glucose levels.
Record review of Resident #1's February 2025 MAR dated 02/06/2025 revealed the facility failed to transcribe orders for daily insulin until 02/05/2025.
Record review of Resident #1's blood glucose levels revealed the following results: 2/5/25 @ 6:21 PM 233 mg/dL, 2/6/25 @ 9:28 AM 446 mg/dL, 2/6/25 @ 4:52 PM 274 md/dL, and 2/6/25 @ 5:13 PM 274 mg/dL.
Blood glucose levels were not checked prior to 2/5/25.
Record review of Resident #1 blood sugar levels after receiving 17units of insulin glargine revealed 2/7/25 at 10:30 AM blood sugar level of 219 mg/dL.
In an interview with LVN G on 2/5/25 at 4:30: PM, LVN G stated she was notified by Resident #1's family member that Resident #1 received daily insulin. LVN G stated she confirmed the hospital discharge medication listing and that the admitting nurse had failed to transcribe the order for 17units Insulin Glargine daily.
676114
Form Approved OMB
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.
Building 676114 B.
Wing 02/08/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
River Hills Health and Rehabilitation Center 2091 Bandera Hwy Kerrville, TX 78028
Observation on 2/08/2025 at 11:45 AM of insulin administration for 1 of 1 residents (Resident #3) completed with no errors.
Confirmed with 11 of 21 FT/PRN Nurses that they received competency training for insulin administration and order implementation. 1 PRN nurse LVN Q had not received competency training and has not worked since November 2025. LVN Q is aware that he will need to complete competency training prior to start of next scheduled shift (no shift identified at this time). [6 FT 6a-6p, 5 FT 6p-6a, 12 PRN with varying shifts, 3 Administrative Nurses to include DON/ADON/ADON].
4.
Interview with Administrator on 2/08/2025 confirmed that tracking system will be reviewed at least quarterly during QAPI meeting.
The Administrator was informed the Immediate Jeopardy was removed on 2/08/2025 at 7:37 PM.
The facility remained out of compliance at a severity level of no actual harm with the potential for more than minimal harm that is not immediate jeopardy and a scope of isolated due to the facility's need to evaluate the effectiveness of the corrective systems that were put into place.
676114
Form Approved OMB
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.
Building 676114 B.
Wing 02/08/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
River Hills Health and Rehabilitation Center 2091 Bandera Hwy Kerrville, TX 78028
Observation completed on 2/08/2025 at 12:00 PM for 1 of 1 residents (Resident #3) insulin administration for accuracy of order and medication available.
Verified with each nurse interview that they understood how to input orders into the EMR system, understood the process for following insulin orders and recording data accurately and timely. [6 FT 6a-6p, 5 FT 6p-6a, 12 PRN with varying shifts, 3 Administrative Nurses to include DON/ADON/ADON].
Interviews on 2/08/2025 between hours of 7:30 AM - 7:00 PM with 17 of 27 FT/PRN Nurses:
LVN H stated understands how to input insulin orders in EMR and complete change of condition assessments.
RN I stated understand insulin parameters, how to input into EMR and notify MD for change of condition.
LVN J stated understands how to input insulin parameters in EMR and how to complete change of condition assessments.
676114
Form Approved OMB
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.
Building 676114 B.
Wing 02/08/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
River Hills Health and Rehabilitation Center 2091 Bandera Hwy Kerrville, TX 78028