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F0680
E

Unqualified Activity Director Leads to Deficiency in Activities Program

Weslaco, Texas Survey Completed on 05-20-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to ensure that its activities program was directed by a qualified professional, as required by regulations. Record review showed that the current Activity Director (AD) was not certified and did not meet the state requirements for the position, which include being licensed or registered, eligible for certification as a therapeutic recreation specialist or activities professional, having two years of relevant experience, or being a qualified occupational therapist or occupational therapy assistant. The AD had no previous experience in the role and had not yet enrolled in an approved AD program, despite being hired several months prior. The AD stated she had submitted paperwork and fees to enroll in an online program but was not officially enrolled as of the date of the survey. Interviews with the HR Coordinator and Administrator confirmed that the AD was not certified and had not met the qualifications outlined in the facility's job description or state requirements. The Administrator acknowledged responsibility for ensuring the AD enrolled in a program within six months of hire, as stipulated in a written agreement, but this had not occurred by the time of the survey. The facility did not have a policy on the requirements for an AD, only a job description, and all 61 residents were affected by the lack of a qualified professional directing the activities program.

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