Navasota Nursing & Rehabilitation
Inspection Findings
F-Tag F0689
F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
at 3:04 pm with Resident #5 reflected the staff treated her respectfully. She said two people always assisted when she was transferred by a mechanical lift. Interview on 08/12/25 at 3:08 pm with Resident #3 reflected
the staff treated her respectfully, she felt safe at the facility, and the staff used two people when they used a mechanical lift to transfer her. Interview on 08/12/25 at 3:17 pm with Resident #4 reflected she was transferred by a mechanical lift and felt safe when staff used a mechanical lift and staff always used two people when they transferred her using the mechanical lift. Interview on 08/12/25 at 2:54 pm with Resident #6 revealed the staff treated her respectfully and she felt safe at the facility. She said staff used a mechanical lift to transfer her, and they always had two people when they used the mechanical lift. She did not have any concerns about her care or treatment at the facility. During interviews on 08/12/25 from 4:25 pm - 6:23 pm, two RNs, two LVNs, and six CNAs from different shifts all stated they were in-serviced on 07/30/25 on Mechanical Lift Transfers, Abuse and Neglect, Trauma Informed Assessment, and how to use
the Kardex. All staff interviewed stated that if a person was care planned for a mechanical lift transfer, always use a mechanical lift to transfer the resident and always have two people to transfer the resident to ensure resident safety. All staff interviewed stated they knew where to locate the resident transfer information in the Kardex. Review of the facility's self-report to HHSC, dated 07/30/25 reflected the Administrator reported the incident with CNA A not using a mechanical lift to transfer Resident#1 as care planned the same day it occurred. Record review of CNA A's Employee Disciplinary Report dated 07/30/25 reflected CNA A was placed on investigatory suspension pending an investigation into allegations of not following a resident's care plan. CNA A would remain on investigatory suspension until the investigation was completed. Record review of in-service dated 07/30/25 given by the MDS Coordinator to the nursing and CNA staff on Mechanical Lift Transfer Skills Check and demonstration on using a mechanical lift was administered to 100 percent of facility nurses and CNAs included training for CNA A.Record review of in-services dated 07/30/25 on Abuse and Neglect administered to all facility staff at 100 percent staff completion rate included training for CNA A.Record review of in-service dated 07/30/25 on Trauma Informed Assessment administered to all facility staff at 100 percent completion rate. Record review of in-service dated 07/30/25 on how to use the Kardex located in the eMAR was administered to all nurses and CNAs at 100 percent completion including CNA A. Review of facility undated Hydraulic Lift Policy reflected the hydraulic lift is a mechanical device used to transfer a resident from and to the bed and chair.
It is reserved for those who are paralyzed, obese, or too weak to transfer without complete assistance.
Goals:a. The resident will achieve safe transfer to bed or chair via a mechanical lift device.b. The caregiver will demonstrate safe and correct transfer of the resident to the bed or chair via the hydraulic lift.The facility has a program to promote and assure safe patient handling for both the resident and the employee. The policy includes identification, assessment, and interventions to provide a comfortable, safe transfer.
Event ID:
Facility ID:
If continuation sheet
Navasota Nursing & Rehabilitation in Navasota, 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 Navasota, 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 Navasota Nursing & Rehabilitation or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.