Deficiencies (over last year)
Deficiencies (over last year)
12 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
243% worse than Texas average
Texas average: 3.5 deficiencies/yearDeficiencies per year
12
9
6
3
0
Inspection Report
Annual Inspection
Deficiencies: 12
Date: Apr 15, 2024
Visit Reason
State-compiled facility profile showing multiple inspections including a recent comprehensive inspection in 2024 with deficiency and enforcement history.
Findings
The facility had multiple violations across inspections including failure to conduct and document fire drills, insufficient staffing for safe evacuation, and noncompliance with safety and staffing regulations. Enforcement actions included administrative penalties related to abuse prevention and emergency preparedness.
Deficiencies (12)
The facility failed to conduct required fire drills and document fire drills on the required form.
The facility failed to ensure that all full-time attendants were at least 18 years old or high school graduates; or that a qualified attendant was present at all times that residents were in the facility.
The facility failed to have sufficient staff to ensure safe evacuation of the facility in the event of emergency.
The facility failed to immediately make an oral report of alleged ANE or send a written report of the investigation to HHSC when required.
The facility failed to ensure fire drills were conducted and documented to be in compliance with licensing standards for assisted living facilities.
The facility failed to ensure compliance with smoking regulations in the licensing standards for assisted living facilities.
The facility failed to ensure resident bedroom doors were in compliance with licensing standards for assisted living facilities.
The facility failed to ensure the required sprinkler system was inspected, tested, and maintained in compliance with NFPA 25.
The facility failed to ensure that all operable windows had insect screens.
The facility failed to ensure the building was kept in good repair.
The facility failed to provide acceptable building floor plans.
The facility failed to ensure the building and structure complied with other applicable chapters of the Life Safety Code, NFPA 101.
Report Facts
Inspections on page: 2
Total fines: 6800
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