Palma Real
PALMA REAL in MATHIS, TX — inspection on August 20, 2025.
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
said neither resident had altercation with any other residents or staff before this incident occurred.
said as she spoke with Resident #1, he stated Resident #2 had the vase and he took it away from him.
ADON said the last time she had abuse training was 2 weeks ago.
The stated staff is trained to deescalate situations that can turn into altercations between residents or staff and residents.
The abuse coordinator is to be told immediately of any abuse that occurs in the facility. In an interview on 08/19/25 at 5:20 PM with LVN A she stated she was there during the altercation but understood from conversations in the dining room Resident #1 had walked in the dining room and saw Resident #2 was sitting in Resident #1 spot he likes to sit in and the altercation began. CNA A stated she heard the Social Worker began yelling for help as she quickly made her way to the dining room and tried to help separate the residents. LVN A stated she could not recall what exactly occurred or what happened afterward the dining room clearly but did recall Resident #1 was terribly upset and Resident #2 was taken to his room. CNA A said she assisted with calming Resident #1 and recalled he stated he was going to hit Resident #2.
When Resident #1 was asked if he hit Resident #2, he said he did not hit him with plastic vase. In an interview on 08/19/2025 5:45 PM with Social Work was in her office heard scuffle and someone yelled leave me alone! The SW quickly ran into the dining room and when she arrived and saw Resident #1 and Resident #2 had hands on each other. Resident #2 was in his wheelchair and had his breaks on and could not move backward to get away.
Resident # 2 was trying to get way from Resident #1as he was standing in front of him and shoved resident #2 away Resident #1 then stumbled back and almost fell.
The SW stated Resident #1 had a plastic vase in his hands and tried to take away. SW stated she was calling for help and could not confirm that Resident #1 stuck Resident #2 with the vase.
The SW stated as help arrived, she was able to take the vase away from Resident #1. Resident #2 had a old scratch and scab on his forehead.
The SW stated she just saw the forehead injuries was not aware of the hand injury.
The SW stated no other altercations before this one and after the staff just try to keep him away from each other.
The SW stated neither resident has had any other altercations with other residents.
The SW said she followed up with the family, resident physician, psychological evaluations, and how both residents continued with their care.
The SW stated Resident #1 continues to be territorial about his dining room spot, so staff try to make sure it is available for him if he eats in the dining room.
Record review of the facility's Abuse Protocol dated 04/2019 Indicated: The Patient has the right to be free from Abuse, neglect mistreatment of resident property, and exploitation.
This includes but is not limited to freedom from corporal punishment, involuntary seclusion, and any physical or chemical restraint not required in treating the Patient's symptoms.
Our facility will not condone Patient Abuse, neglect, mistreatment misappropriation of patient property and exploitation (collectively Patient Abuse by anyone, including staff members, other Patients, consultants, volunteers, staff of other agencies serving the Patient consultants volunteers, staff of other agencies serving eh Patient, family members, legal guardians, sponsors, friends or other individuals.
Abuse is defined as the willful infliction of injury unreasonable confinement, intimidation, or punishment with resulting physical harm or pain or mental anguish, or deprivation by a individual, including a caretaker, of goods or services that are necessary to attain or maintain physical or mental and psychosocial well-being.
Instances of abuse of all Patient/Resident, irrespective of any physical or mental condition, cause physical harm pain or mental anguish.
Willful as used in this definition of abuse, means the individual must have acted deliberately, not that the individual must have intended to inflict injury or harm.
675312 08/20/2025
Palma Real 1220 Loop 459 Mathis, TX 78368
a psychiatric/psychogeriatric consult as indicated.
The DON called into dining room due to a
Resident #2 refused full head to toe. MD and RP were notified by charge nurse LVN E.
And the SW to
06/20/2025 revealed the nurse was at the nurse's station and heard someone call for help from the dining room.
When the nurse got to the dining room it was noted the resident had an altercation with another resident, employees had already separated the residents, and Resident #2 was being wheeled out of dining room.
Resident#2 had not complained of pain or discomfort voiced and tried to do head to toe assessment resident refused. LVN E did note the resident had a small scratch to top of his right-hand, a small blood blister between his index finger and thumb, a small scab like area to left side of forehead.
The MD informed. Resident #2 had new orders for UA, CBC, and CMP.
The orders were noted, and the resident was also started on every 15 min frequent monitoring to prevent any further incidents.
Record review of Resident #2 progress notes dated 06/20/25 revealed the DON was called into the dining room due to a resident-to-resident altercation and other employees had already separated both residents. Resident #2 was noted with a scratch to the point where left side of head, scratch and small blood blister to right hand. Resident #2 refused a full head to toe and the MD and RP were notified by the charge nurse LVN E and the social worker was to follow up with psych. Resident #2 progress notes dated 06/20/25 revealed and the social worker noted Resident #2 was seen being confrontational with another resident and the social worker stepped in and attempted to redirect as other staff came to aid as well and the PCS was notified.
Record review of Residents #2 progress notes dated 06/23/25 Resident #2 was being monitored every 15 minutes for an altercation with another resident.
Resident # 2 progress notes dated 06/23/2025 revealed team members were keeping the Resident #1 and Resident#2 separated so there was no altercation.In an interview with on 08/20/25 at 6:00pm The ADON stated the IDT team was responsible for the entry any new information to the care plans like change in condition and incidents.
The SW was responsible for any behavior updates for each resident's care plan.
The importance of updating the care plans is to ensure the resident is getting the appropriate care and the documentation of any change in condition and new orders from the physician are implemented.
The ADON could not say why the altercation between Resident #1 and Resident #2 was not documented,.
The preventive measure of the 15 min checks for each resident was implemented, and the preventive measure of keeping the two residents apart so that another incident did not occur between the two residents were not documented in the care plan interventions as well. In an interview on 09/20/25 at 9:23 AM the DON stated the nurse managers, ADON, and DON were responsible for updating the care plan for the residents.
The DON stated the social worker is responsible for the behavior updates.
The DON stated the team was documenting the falls with the intervention and incidents documented.
The DON stated social worker and IDT as a whole are responsible for updating care plans for falls, incidents or any significate changes.
The DON stated any changes in condition or incidents are discussed as a team and documented.
The DON stated there was no updates or interventions for the care plans for these two residents and could not say why the care plans were not updated for Resident #1 and Resident #2.
The DON stated will do in-service with IDT team ensure all documentation of any the change of condition and an incident of any type occurs is entered into the care plan with the interventions.
The DON stated the incident was not an abuse allegation because both residents had dementia and was reported to the abuse coordinator. Resident #1 stays in his room seldomly comes out and Resident #2 stays on his side of the facility and close to room and the staff keeps an eye on him as he was a fall risk.
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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.