River Hills Health And Rehabilitation Center
RIVER HILLS HEALTH AND REHABILITATION CENTER in KERRVILLE, TX — inspection on February 8, 2025.
Found 7 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
DON/ADON/ADON].
jeopardy to resident health or Interview on 2/08/2025 with 11 of 27 FT/PRN Nurses and 4 of 4 Agency Nurses on duty 2/08/2025 safety verified they received in-service from DON or ADON regarding medication reconciliation process for admissions.
Inservice Training and Training log for 27 of 27 FT/PRN Staff review and 8 of 8 Agency Nurses for completion. [6 FT 6a-6p, 5 FT 6p-6a, 12 PRN with varying shifts, 3 Administrative Nurses to include DON/ADON/ADON].
Interviews on 2/8/2025 with 11 of 27 FT/PRN Nurses and 4 of 4 Agency Nurses on duty 2/08/2025 verified they received in-service from DON or ADON regarding medication availability, who to contact and how to access Emergency medication system.
Inservice Training & Training log for 27 of 27 FT/PRN Staff reviewed and 8 of 8 Agency Nurses for completion. [6 FT 6a-6p, 5 FT 6p-6a, 12 PRN nurses with varying shifts, 3 Administrative Nurses to include DON/ADON/ADON].
Record review on 2/08/2025 of In-service log and training provided reviewed.
All nurses interviewed were able to identify how to complete a Change of Condition assessment, how to verify orders for new admissions according to discharge instructions by transcribing and verbalizing to physician (or designee) to include how to input information in EMR including parameters and sliding scale needs for insulin orders.
Through interview and observation, staff members were able to demonstrate they received identified inservices and demonstrated knowledge of subject matter through surveyor questions.
Record review on 2/08/2025 of admission Drug Regimen and Reconciliation Tracker that will be kept by the Administrator and/or DON during clinical meeting. DON verbalized she will review MAR in clinical meetings to ensure medication availability. On 2/08/2025, Administrator confirmed admission Drug Regimen Review and Reconciliation tracker will be reviewed at least quarterly in QAPI meeting.
- On 2/08/2025, Administrator confirmed QAPI meeting was completed 2/07/2025.
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 02/08/2025
River Hills Health and Rehabilitation Center 2091 Bandera Hwy Kerrville, TX 78028
jeopardy to resident health or completed with no errors. safety Confirmed with 11 of 21 FT/PRN Nurses that they received competency training for insulin
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].
- 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 02/08/2025
River Hills Health and Rehabilitation Center 2091 Bandera Hwy Kerrville, TX 78028
completed with no errors.
jeopardy to resident health or Confirmed with 11 of 21 FT/PRN Nurses that they received competency training for insulin safety 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
6p-6a, 12 PRN with varying shifts, 3 Administrative Nurses to include DON/ADON/ADON].
- Administrator verified QAPI meeting was completed with PIP in place in conjunction with this Plan
of Removal.
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 02/08/2025
River Hills Health and Rehabilitation Center 2091 Bandera Hwy Kerrville, TX 78028
During a telephone interview on 02/05/2025 at 3:15 PM, RN F stated when he received the verbal order from Resident #2's physician he told the floor CNA working the floor to collect the urine specimen but she had difficulty obtaining it as the resident was uncooperative.
She was confused and resistant to following directions. He passed the information along to the incoming charge nurse.
Record review of facility policy Lab and Diagnostic Test Results - Clinical Protocol dated November 2018 revealed, Assessment and Recognition: 1.
The physician will identify and order diagnostic and lab testing based on the resident's diagnostic and monitoring needs. 2.
The staff will process test requisitions and arrange for tests. 3.
The laboratory.
Diagnostic radiology provider, or other testing source will report test results to the facility.
Record review of facility policy Telephone Orders dated February 2014 revealed, Verbal telephone orders may be accepted from each resident's attending physician. 1.
Verbal telephone orders may only be received by licensed personnel (e.g., RN, LPN/LVN, pharmacist, physician, etc.).
Orders must be reduced to writing, by the person receiving the order and recorded in the resident's medical record. 2.
The entry must contain the instructions from the physician, date, time, and the signature and title of the person transcribing the information. 3.
Telephone orders must be countersigned by the physician during his or her next visit.
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
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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.