Above average — CMS composite of the measures below.
The next survey window likely opens around November 2026
Estimate from public CMS data, current as of July 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Country Care Manor during CMS and state inspections, most recent first.
Incomplete and inaccurate clinical records were found for two residents. One resident’s facesheet, care plan, and MD orders did not match because the care plan listed depression even though the antidepressant-class med was ordered for appetite stimulation and the diagnosis was not in the chart. Another resident’s diet order was missing from the record for a month, even though staff said the kitchen used the EMR and the resident was receiving the ordered diet.
Environmental maintenance deficiencies were identified in multiple resident rooms and common areas. Bathroom ceiling vents in several rooms and the hallway shower room had rust, one bathroom light in a resident room did not work, the laundry room had an uncovered overhead light fixture and cracked floor tiles, and the Maintenance office ceiling vent had dirt and rust. The Maintenance Director said he was aware of the needed vent repairs and that they were noted on the TELS work order list.
A resident with an indwelling Foley catheter, urinary retention, HF, and DM2 was observed in bed with the catheter bag on the floor. The resident said the bag should not be on the floor because it could allow urine to travel back up and cause infection. The CNA said she forgot to attach the bag to the movable part of the bed after perineal care, and the LVN and DON stated the bag should not have been on the floor.
A resident with lung cancer and intact cognition was not informed that his chosen physician did not meet facility requirements and was not given the chance to select a new physician while hospitalized. The facility refused to readmit the resident after hospitalization due to concerns about the physician's responsiveness, without notifying the resident or family, and communicated only with the ombudsman. This led to delayed hospital discharge and emotional distress for the resident.
A resident with intact cognition and a diagnosis of lung cancer was not allowed to return to the facility after hospitalization, despite being clinically stable and ready for discharge. The facility refused readmission due to concerns about the resident's physician's responsiveness, did not provide a formal discharge notice to the resident or family, and did not offer the opportunity to select a different physician. The refusal to readmit was communicated only to the ombudsman, resulting in delayed discharge from the hospital and emotional distress for the resident.
The facility failed to provide necessary oral care assistance to four residents, all of whom had cognitive impairments and physical limitations. Despite being dependent on staff for oral hygiene, these residents did not receive assistance with brushing their teeth, as confirmed by observations, interviews, and record reviews. Staff cited short staffing as a reason for the lack of care, and there was no documentation of oral care being offered or performed.
The facility failed to document oral care services for four residents due to a lack of designated areas in medical records and a CNA's inability to access the electronic system. Residents with cognitive impairments and total dependence on staff had no documented oral care, despite physician orders. The issue was exacerbated by a CNA's loss of access to the electronic records, which was not promptly resolved, leading to incomplete documentation.
The facility failed to maintain a clean and safe environment, with black mildew and rust found in shower rooms, and damage in the laundry room due to flooding. Additionally, a resident's room had a dirty and rusted ceiling vent and a damaged bathroom door. The Maintenance Director confirmed these issues, which were not previously reported.
Three staff members, including two CNAs and an LVN, did not complete their mandatory annual QAPI training, as revealed by a review of training records. Interviews with the HR Director, Regional HR Director, and Administrator confirmed the lack of completed training, which could affect the quality of resident care.
Incomplete and Inaccurate Clinical Records
Penalty
Summary
The facility failed to maintain complete and accurate clinical records for Resident #3 because the resident’s facesheet, care plan, and physician orders did not match. The facesheet and quarterly MDS listed diagnoses including cerebral infarction, type 2 diabetes mellitus without complications, and chronic obstructive pulmonary disease, while the care plan stated the resident required antidepressant medication related to depression. However, the physician order for mirtazapine 7.5 mg indicated it was ordered at bedtime for appetite stimulant, and the clinical record did not list depression among the resident’s diagnoses. During interview, the DON confirmed the resident had not been diagnosed with depression and stated the care plan incorrectly listed that diagnosis. The facility also failed to keep Resident #50’s diet order current in the clinical record for one month. The resident’s facesheet listed diagnoses including aftercare following explantation of hip joint prosthesis, unspecified fall subsequent encounter, and acute kidney failure, and the care plan identified risk for nutritional deficits and/or dehydration related to chronic comorbidity and a therapeutically restricted diet with no animal meat. The order summary showed no active diet order, and the diet order history showed the most recent order had ended one month earlier. Staff stated kitchen staff relied on the electronic medical record and the last recorded order if no current diet order was present, and the DON confirmed the diet order had been missing for one month and should have been present.
Environmental Maintenance Deficiencies in Resident Areas and Support Spaces
Penalty
Summary
The facility failed to provide a safe, functional, sanitary, and comfortable environment for residents, staff, and the public in 5 of 12 resident rooms and 3 of 3 other areas reviewed for environmental concerns. During observation with the Administrator and Maintenance Director, bathroom ceiling vents in rooms 101, 105, 107, 108, and 110 were observed with rust on the vents. In room 110, 1 of 2 bathroom lights did not come on when engaged. A ceiling vent in the resident hallway shower room #100 also had rust on the vents. Additional observations identified an overhead light fixture in the laundry room with two 4-foot fluorescent lights that did not have a cover and 10 cracked 1x1 foot floor tiles. In the Maintenance office, a 6x12 inch ceiling vent had dirt and rust on the ceiling vents. During interview, the Maintenance Director stated he was aware of the resident room ceiling vents needing repair and that the repairs had been noted on the TELS work order list. The Administrator stated that making all of the facility repairs would promote a better facility building appearance.
Catheter Bag Left on Floor
Penalty
Summary
The facility failed to ensure appropriate treatment and services to prevent urinary tract infections for Resident #25, who had an indwelling Foley catheter. Resident #25 was a [AGE]-year-old male admitted with diagnoses including urinary retention, heart failure, and type 2 diabetes, and his quarterly MDS indicated moderate cognitive impairment with an indwelling Foley catheter in place. His care plan directed staff to check for kinks each shift. During observation, Resident #25 was found in bed sleeping with his indwelling urinary catheter bag on the floor. The resident stated the bag should not be on the floor because urine could travel back up the urinary system and cause an infection, and he did not know how long it had been there. The CNA assigned to the resident stated she forgot to attach the catheter bag to the movable part of the bed after providing perineal care, and the assigned LVN stated the bag should not have been on the floor and that this was not good nursing practice. The DON stated the bag should not have been on the floor and that staff had already been in-serviced on not allowing catheter tubing or bags to touch the floor.
Failure to Inform Resident of Physician Ineligibility and Denial of Readmission
Penalty
Summary
The facility failed to inform a resident that his chosen physician did not meet the facility's requirements and did not provide the resident with an opportunity to select a new physician while he was hospitalized. The resident, an adult male with a diagnosis of malignant neoplasm of the lung and intact cognition, was initially under the care of the facility's medical director, who terminated the physician-patient relationship due to conflicts with the resident's family. The facility then instructed the resident to identify a new physician or face discharge, and the resident subsequently selected his outpatient physician to oversee his care at the facility. During a subsequent hospitalization, the facility determined that the new physician was not responsive to urgent communications and decided not to readmit the resident upon discharge from the hospital. The facility did not notify the resident or his family of this decision during the hospitalization, nor did they provide written or verbal communication regarding the refusal of readmission. The resident and his family only learned of the refusal through the hospital's case manager, and the facility communicated solely with the ombudsman regarding the situation. Despite the resident's family expressing satisfaction with the new physician and the physician's office confirming ongoing oversight, the facility maintained that the physician did not meet their expectations for responsiveness and refused readmission. The resident's appeal of the discharge was not honored, and the facility did not provide the resident with an opportunity to select another physician prior to the refusal. The lack of communication and failure to allow physician selection led to a delay in the resident's hospital discharge and caused emotional distress.
Failure to Permit Resident Return After Hospitalization
Penalty
Summary
The facility failed to permit a resident to return after a hospitalization, despite the resident being clinically stable and ready for discharge from the hospital. The resident, who had a diagnosis of malignant neoplasm of the lung and demonstrated intact cognition, was initially admitted to the facility and later transferred to an acute care hospital. Upon stabilization and readiness for discharge, the hospital attempted to coordinate the resident's return, but the facility refused readmission, citing concerns about the responsiveness of the resident's chosen physician. There was no discharge summary signed by the resident's physician, nor was there a physician order to discharge the resident from the facility. Communication records show that the facility administrator informed the ombudsman that the resident would not be allowed to return due to issues with the resident's physician, specifically a lack of responsiveness to urgent messages. The ombudsman clarified that the facility was responsible for ensuring physician coverage at all times and that a backup physician should be available if the primary physician was unavailable. Despite this, the facility did not respond to the ombudsman's request for clarification and did not issue a formal notice of discharge to the resident or their family. The resident's family member, who acted as power of attorney, was not notified by the facility about the refusal to readmit and only learned of it through the hospital's case manager. Interviews with the ombudsman and the facility administrator confirmed that the resident was not given an opportunity to select a different physician prior to the refusal of readmission. The administrator acknowledged that the facility did not notify the resident or family of the discharge and communicated only with the ombudsman. The resident's family attempted to appeal the discharge, but the facility maintained its refusal to readmit the resident during the appeal process. The facility's actions resulted in a delayed hospital discharge and emotional distress for the resident, who remained under the care of the same physician throughout the incident.
Failure to Provide Oral Care Assistance
Penalty
Summary
The facility failed to ensure that residents who were unable to perform activities of daily living received necessary services to maintain good oral hygiene. This deficiency was observed in four residents who were not assisted with brushing their teeth on a specific date. The lack of assistance with oral care was documented through observations, interviews, and record reviews, indicating a systemic issue in providing adequate oral hygiene care. Resident #46, who had polyarthritis and contracted limbs, was totally dependent on staff for oral care. Despite having oral care supplies provided by family members, these remained unused, and the resident reported not receiving assistance with oral care for weeks. Interviews with staff and the resident's representative confirmed the lack of oral care, with staff citing short staffing as a reason for not providing the necessary assistance. Similarly, Residents #40, #12, and #24, all with varying degrees of cognitive impairment and physical limitations, were not provided with the required oral care. Record reviews showed that there was no documentation of oral care being offered, performed, or refused for these residents. Interviews with the residents and their family members revealed concerns about the lack of assistance with oral hygiene, and staff admitted to not having time to provide oral care due to workload constraints.
Deficiency in Documentation of Oral Care Services
Penalty
Summary
The facility failed to maintain accurate and complete medical records for four residents regarding the documentation of oral care services. Specifically, the Certified Nursing Assistants (CNAs) did not document oral care that was offered, performed, or refused for these residents. This lack of documentation was due to the absence of a designated area in the medical records for such entries, as well as a CNA's inability to access the electronic medical record system due to a missing log-in ID number. Resident #46, a female with moderate cognitive impairment and total dependence on staff for oral care, had no documented oral care services in her medical record for September 2024. Similarly, Resident #40, who had severe cognitive impairment and required substantial assistance with oral care, also had no documentation of oral care services. Both residents had physician orders for oral care as needed, yet the records did not reflect any such care being documented. The issue was compounded by CNA B's lack of access to the electronic medical record system, which prevented her from documenting care provided to residents. Despite having reported the loss of access to the Assistant Director of Nursing (ADON), the issue remained unresolved, leading to incomplete records. Interviews with facility staff, including the Administrator and Director of Nursing (DON), revealed that the expectation was for CNAs to document care immediately and report any access issues promptly. However, the failure to address CNA B's access issue resulted in a lack of documentation for the care provided.
Environmental Deficiencies in Shower and Laundry Rooms
Penalty
Summary
The facility failed to maintain a safe, functional, sanitary, and comfortable environment for residents, as evidenced by the conditions observed in two shower rooms and a laundry room. In the shower rooms on Halls 100 and 200, there was black mildew and rust on the doorframe, black mildew along the bottom of the shower rooms, and orange sediment on the shower chairs. The Maintenance Director confirmed these observations and noted that the shower rooms should be cleaned by housekeeping, with CNAs responsible for spraying down the rooms after each resident use. Additionally, the laundry washroom was found to have missing drywall due to previous flooding and a significant gap under the exit door, which could allow pests to enter. The Maintenance Director acknowledged the damage and the need for repairs. Further deficiencies were noted in a resident's room, where the bathroom ceiling vent was covered in dirt and rust, and the bathroom door had a large indention on its surface. The Maintenance Director was unaware of these issues until the survey and agreed that repairs were necessary to promote a homelike environment. The facility's policy on maintaining a safe and sanitary environment was not adhered to, as evidenced by the lack of preventive maintenance and the failure to address these environmental issues promptly.
Failure to Complete Mandatory QAPI Training
Penalty
Summary
The facility failed to ensure that three staff members, two Certified Nursing Assistants (CNAs) and one Licensed Vocational Nurse (LVN), completed their mandatory annual Quality Assurance Performance Improvement (QAPI) training. The CNAs were hired on July 7, 2023, and the LVN on August 16, 2016. A review of the training records revealed that these staff members had not completed the required QAPI training, which is essential for understanding the elements and goals of the facility's QAPI program. Interviews with the Human Resources (HR) Director, the Regional HR Director, and the Administrator confirmed the lack of completed training records for these staff members. The HR Director acknowledged her responsibility for coordinating the training program and stated that it was the staff's responsibility to complete their training assignments. The absence of this training could potentially impact the quality of care provided to residents, as the staff would not be fully informed about the processes for improving resident care services.
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Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
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How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Prairie Meadows Rehabilitation And Healthcare Cent | 14.4 mi | ★★★★★ | 23 | 3 |
| Harmony Care At Floresville | 15 mi | ★★★★★ | 18 | 0 |
| Frank M. Tejeda Texas State Veterans Home | 15.2 mi | ★★★★★ | 12 | 0 |
| Silver Tree Nursing And Rehabilitation Center | 16.9 mi | ★★★★★ | 25 | 1 |
| Southeast Nursing & Rehabilitation Center | 17 mi | ★★★★★ | 16 | 1 |
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