Deficiencies (over last year)
Deficiencies (over last year)
18 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
414% worse than Texas average
Texas average: 3.5 deficiencies/yearDeficiencies per year
20
15
10
5
0
Inspection Report
Life Safety
Deficiencies: 18
Date: Oct 7, 2021
Visit Reason
State-compiled facility profile showing multiple inspections including a comprehensive inspection on 2021-10-07 and enforcement actions through 2024 with deficiency and penalty history.
Findings
The facility had no health code violations but multiple life safety code violations on 2021-10-07 related to fire safety, maintenance, and emergency preparedness. Enforcement actions from 2023-2024 cited failures in medication administration, restraint authorization, emergency notifications, and resident protection from abuse and neglect.
Deficiencies (18)
The facility failed to maintain outdoor areas in good condition and to keep outdoor areas free of fire or health hazards.
The facility failed to provide water drainage away from structures to prevent ponding or standing water at or near a building.
The facility failed to have and enforce a smoking policy.
The facility failed to have a program to inspect, test, and maintain the fire sprinkler system and keep records of inspection, testing, and maintenance of the fire sprinkler system.
The facility failed to train staff in the use of fire extinguishers, failed to inspect and maintain fire extinguishers, and failed to keep records of inspection and maintenance of fire extinguishers.
The facility failed to have an ongoing and effective pest control program and to provide insect screens on operable windows.
The facility failed to ensure doors in the facility met the referenced codes and standards.
The facility failed to provide required exit signs.
The facility failed to provide required emergency lighting.
The facility failed to provide smoke compartmentation where required.
The facility failed to provide a fire sprinkler system that met the referenced codes and standards.
The facility failed to conduct and document a risk assessment for potential emergencies or disasters.
The facility failed to provide the required emergency preparedness and response plan training and conduct drills.
553.261(a)(1)(A) — The facility failed to ensure that a licensed person or a trained, authorized, and delegated person administered medications according to physician's orders.
553.261(g)(1)(A) — The facility failed to obtain written authorization from a physician for the use of physical or chemical restraints.
553.261(b)(1)(B) — The facility failed to immediately notify the resident's physician and next of kin, responsible party, or agency as required in case of emergency or death.
553.267(a)(3)(E)(ii) — The facility failed to ensure each resident was free from abuse, neglect, and exploitation.
553.267(a)(3)(E)(ii) — The facility failed to ensure each resident was free from abuse, neglect, and exploitation.
Report Facts
Inspections on page: 1
Enforcement actions: 3
Total fines: 10250
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