Palma Real
Inspection Findings
F-Tag F0880
F 0880
Provide and implement an infection prevention and control program.
Level of Harm - Minimal harm or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, interview, and record review, the facility failed to maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment, and to help prevent the development and transmission of communicable diseases and infections for 1 (Resident #1) of 5 residents reviewed for infection control practices. The facility failed to ensure CNA A performed hand hygiene for at least 20 seconds prior to assisting Resident #1's transfer from her bed to the wheelchair. This failure could place residents at risk for healthcare associated cross-contamination and infections caused by improper wound care. Findings include: Record review of Resident #1's face sheet dated 10/27/25 reflected a [AGE] year-old-female with an original admission date of 06/10/21. Diagnoses included arteriovenous malformation of cerebral vessels (abnormal tangle of blood vessels in the brain that creates irregular connections between arteries and veins), cerebral infarction (ischemic stroke occurs when the blood flow to
a part of the brain is obstructed), high blood pressure, and COPD (chronic obstructive pulmonary disease).Record review of Resident #1's quarterly MDS assessment dated [DATE REDACTED] reflected a BIMS score of 10 (cognition moderately impaired). Resident #1 required substantial/maximal assistance (helper does more than half the effort) with bed to chair transfer. During an observation of handwashing before the bed to chair transfer of Resident #1 on 10/27/25 at 11:20am, CNA A was observed lathering her hands for approximately 6 seconds. In an interview on 10/27/25 at 11:30am, CNA A stated she was nervous and believed she washed her hands for 20 seconds or more. CNA A stated handwashing should be 20 seconds to prevent cross contamination to residents. CNA A stated the last hands-on in-service for handwashing was in September 2025. In an interview on 10/27/25 at 2:39pm, the DON stated all staff should lather their hands for at least 20 seconds to prevent cross contamination. The DON stated washing hands inappropriately could put residents at risk for infection. In an interview on 10/27/25 at 2:50pm, the ADON who was the Infection Preventionist stated, staff should scrub their hands for at least 20 seconds to ensure all germs were washed off and to prevent cross contamination to the residents. The ADON stated it could put residents at risk for infection. The ADON stated there was a hands-on handwashing skills in-service on 09/22/25 and CNA A had no issues. The ADON stated CNA A was probably nervous. Record review of the facility's Handwashing/Hand Hygiene policy dated and reviewed in August 2019 reflected: Policy StatementThis facility considers hand hygiene the primary means to prevent the spread of infections.Washing Hands2. Rub hands together vigorously for at least 15 seconds, covering all surfaces of
the hands and fingers.
Residents Affected - Few
Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date
these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE
TITLE
(X6) DATE
FORM CMS-2567 (02/99) Previous Versions Obsolete
Facility ID:
If continuation sheet
Event ID:
PALMA REAL in MATHIS, 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 MATHIS, 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 PALMA REAL or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.