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F0577
C

Survey Results Binder Not Accessible to Residents or Public

Waco, Texas Survey Completed on 06-15-2025

Penalty

Fine: $10,765
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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 residents were aware of where to locate the State Agency (SA) survey inspection results, including surveys, certifications, and complaint/incident investigations. On the date of the survey, observations of the front door area, receptionist desk, and administrative offices revealed there was no survey results binder or notice indicating where such a binder could be found. Interviews with eleven residents confirmed that they did not know where or how to access survey results and had never seen a binder labeled with that information in common areas. Multiple residents expressed interest in knowing the results of previous surveys and investigations. Further investigation revealed that the administrator (ADM) kept the survey binder in his office and only brought it out for state surveyors. The ADM acknowledged that this practice prevented residents and the public from seeing the results of the facility's surveys and investigations. Review of facility policy indicated that the survey binder should be maintained in an area frequented by most residents, such as the main lobby or resident activity room, but this was not being followed at the time of the survey.

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