Lake Village Nursing And Rehabilitation Center
Inspection Findings
F-Tag F0644
F 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
authority completed quarterly assessment. The MDS Coordinator stated she was not working at the facility when the care plan meeting was held on 03/04/2025 and the previous MDS Coordinator was no longer employed at the facility. She stated she was not aware of the request for a positioning wedge. She stated if
a request for services required follow up, the MDS Coordinator was responsible for that. During an interview
on 09/16/2025 at 3:45 PM, the DON stated each morning staff met and discussed care plans and interventions to put in place. She stated resident #1 had been at the facility for a long time and received ongoing PASRR services. She stated she was unaware a positioning wedge was recommended for Resident #1 on 03/04/2025. She printed Resident #1's PCSP which reflected the recommendation for a repositioning wedge. She stated page 7 of the PCSP did not reflect any changes to his care plan. She stated if new needs were identified, they would be documented there. She stated Resident #1 had his last PCSP meeting on 08/25/2025 and it reflected a repositioning wedge was not needed. During an interview
on 09/16/2025 at 3:55 PM, the Administrator stated after an IDT meeting, staff members discussed any items that needed follow up and he followed up with the MDS Coordinator to ensure the PCSP was complete. The Administrator stated he was not told Resident #1 needed a positioning wedge or the facility would have already purchased one. He stated it was important for the facility to provide recommended services to ensure the resident's needs were met.During a telephone interview on 09/19/2025 at 4:30 PM,
the Habilitation Coordinator stated the repositioning wedge was recommended during the 03/04/2025 interdisciplinary team meeting, because Resident #1 leaned to one side, and she had approved it. She stated the nursing facility emailed her about the visit from a state surveyor requesting information about Resident #1. She stated the facility requested an interdisciplinary team meeting and she scheduled a meeting on October 1st to evaluate Resident #1's needs. Record review of the facility's policy Resident
Assessment
PASRR, reviewed 05/2021, reflected It is the policy of this facility to ensure that each resident is properly screened using the PASRR specified by the state. (A) That, because of the physical and mental condition of the individual, the individual requires the level of services provided by a nursing facility; and (B) If the individual requires such a level of services, whether the individual requires specialized services for
the intellectual disability.
Event ID:
Facility ID:
If continuation sheet
Printed: 04/13/2026 Form Approved OMB No. 0938-0391
Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
B. Wing
A. Building
(X3) DATE SURVEY COMPLETED
09/16/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Lake Village Nursing and Rehabilitation Center
169 Lake Park Rd Lewisville, TX 75057
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)
F-Tag F0880
Federal health inspectors cited LAKE VILLAGE NURSING AND REHABILITATION CENTER in LEWISVILLE, TX for a deficiency under regulatory tag F-F0880 during a complaint investigation conducted on 2025-09-16.
Category: Infection Control Deficiencies
The facility was found deficient in the following area: Provide and implement an infection prevention and control program.
Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 2 deficiencies cited during this inspection of LAKE VILLAGE NURSING AND REHABILITATION CENTER.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-10-15.
LAKE VILLAGE NURSING AND REHABILITATION CENTER in LEWISVILLE, 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 LEWISVILLE, 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 LAKE VILLAGE NURSING AND REHABILITATION CENTER or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.