Windsor Nursing And Rehabilitation Center Of Mcall
Inspection Findings
F-Tag F0610
F 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
09/29/25 revealed diagnosis of Trochanteric fracture of right femur During an interview on 11/04/25 at 2:22 PM, CNA B stated she and CNA A had transferred Resident #1 from his wheelchair into the shower chair.
CNA B stated she had turned around to pick up a soap bottle when she heard a hit. CNA B stated when
she turned to look, Resident #1 was on the floor. CNA B stated she and CNA A lifted Resident #1 off the floor and placed him back into the shower chair. During an interview on 11/04/25 at 3:10 PM, the DON stated on the day of the reported incident, Resident #1 had a light syncope (a temporary loss of consciousness caused by a decrease in blood flow to the brain) episode. The DON stated that upon investigation, CNA A and CNA B were asked if any body part of Resident #1 had changed surfaces, in other words, had Resident #1 fallen to the floor. The DON stated that CNA A had stated no but CNA B had stated yes. The DON stated the investigation moved forward with CNA A's statement that it was not a fall.
The DON stated she could not confirm as to how Resident #1 sustained the fracture. The DON stated that CNA B's statement was followed up by conducting abuse/neglect and fall prevention in-services (trainings).
The DON stated she was unaware as to why CNA B's statement that Resident #1 had sustained a fall was not investigated. The DON stated that the Administrator conducts all investigations. During an interview on 11/04/25 at 3:33 PM, the Administrator stated he was not able to determine whether Resident #1 had sustained a fall or not. The Administrator stated that CNA A had stated that Resident #1 had not fallen while CNA B had stated that Resident #1 had. The Administrator stated he opted to follow through with the investigation using CNA A's statement that Resident #1 had not fallen and let State' tell him what really happened. The Administrator stated he did not follow up with CNA B's statement that Resident #1 had fallen because he just wasn't sure. The Administrator stated he did not know how Resident #1 sustained the fracture since CNA A had stated he had not fallen. During an interview on 11/05/25 at 2:36 PM, CNA B stated that a fall is when a resident is on the floor. CNA B stated she was not lying about Resident #1 falling. CNA B stated she had no reason to lie. Record review of the facility's policy titled Abuse, Neglect and Exploitation, with a date of 07/11/25, revealed:Policy: It is the policy of this facility to provide protection for the health, welfare and rights of each resident by developing and implementing written policies and procedures that prohibit and prevent abuse, neglect, and exploitation and misappropriation of resident property.Definitions: Alleged Violation is a situation or occurrence that is observed or reported by staff, resident, relative, visitor or others but has not yet been investigated and if verified, could be indication of noncompliance with the Federal requirements related to mistreatment, exploitation, neglect, or abuse, including injuries or unknown source, and misappropriation of resident property.V. Investigation of Alleged Abuse, Neglect and ExploitationA. An immediate investigation is warranted when suspicion of abuse, neglect or exploitation, or reports of abuse, neglect or exploitation occur.
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
11/21/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Windsor Nursing and Rehabilitation Center of McAll
900 S 12th St McAllen, TX 78501
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 F0689
F 0689 Level of Harm - Actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
changed surfaces, in other words, had Resident #1 fallen to the floor. The DON stated that CNA A had stated no but CNA B had stated yes. The DON stated the investigation moved forward with CNA A's statement that it was not a fall. The DON stated she could not confirm as to how Resident #1 sustained the fracture. The DON stated that CNA B's statement was followed up by conducting abuse/neglect and fall prevention in-services (trainings). The DON stated she was unaware as to why CNA B's statement that Resident #1 had sustained a fall was not investigated. The DON stated that the Administrator conducts all investigations. During an interview on 11/04/25 at 3:33 PM, the Administrator stated he was not able to determine whether Resident #1 had sustained a fall or not. The Administrator stated that CNA A had stated that Resident #1 had not fallen while CNA B had stated that Resident #1 had. The Administrator stated he opted to follow through with the investigation using CNA A's statement that Resident #1 had not fallen and let State' tell him what really happened. The Administrator stated he did not follow up with CNA B's statement that Resident #1 had fallen because he just wasn't sure. The Administrator stated he did not know how Resident #1 sustained the fracture since CNA A had stated he had not fallen. During an
interview on 11/05/25 at 2:36 PM, CNA B stated that a fall is when a resident is on the floor. CNA B stated
she was not lying about Resident #1 falling. CNA B stated she had no reason to lie. Record review of the facility's policy titled Abuse, Neglect and Exploitation, with a date of 07/11/25, revealed:Policy: It is the policy of this facility to provide protection for the health, welfare and rights of each resident by developing and implementing written policies and procedures that prohibit and prevent abuse, neglect, and exploitation and misappropriation of resident property.Definitions: Alleged Violation is a situation or occurrence that is observed or reported by staff, resident, relative, visitor or others but has not yet been investigated and if verified, could be indication of noncompliance with the Federal requirements related to mistreatment, exploitation, neglect, or abuse, including injuries or unknown source, and misappropriation of resident property.V. Investigation of Alleged Abuse, Neglect and ExploitationA. An immediate investigation is warranted when suspicion of abuse, neglect or exploitation, or reports of abuse, neglect or exploitation occur.
Event ID:
Facility ID:
If continuation sheet
Windsor Nursing and Rehabilitation Center of Mcall in Mcallen, 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 Mcallen, 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 Windsor Nursing and Rehabilitation Center of Mcall or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.