Average — CMS composite of the measures below.
Past the typical resurvey interval — a standard survey could occur at any time
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 Cross Country Healthcare Center during CMS and state inspections, most recent first.
Surveyors found that caregiver hospitality aides were used as nurse aides for more than four months without completing a CNA training and competency evaluation program and without any competency check-offs. Two full-time hospitality aides, both uncertified, reported performing direct care tasks such as incontinent care and sit-to-stand transfers, sometimes without a CNA or nurse present. The DON and ADMN acknowledged that hospitality aides lacked competency checklists, were not supposed to provide hands-on care, and that staff providing direct care should be certified within four months of hire, but this had not occurred, creating potential for residents to receive improper care from individuals whose skills had not been validated.
A resident with severe cognitive impairment and a history of wandering was able to exit the secure unit by opening a window and removing fence pickets, leaving the premises without staff knowledge. Staff did not realize the resident was missing until law enforcement returned him hours later. The resident's care plan identified him as a high elopement risk, but required supervision and environmental safeguards were not consistently implemented.
Surveyors found that kitchen staff failed to maintain cleanliness, properly store food, and separate clean and dirty dishes. Open and expired food items were present, cleaning logs were incomplete, and drinks were delivered uncovered. Staff interviews confirmed that these actions did not meet facility policies for food safety and sanitation.
A resident with severe cognitive impairment and a history of falls experienced a fall resulting in hip bruising. After an x-ray revealed a right femoral neck fracture, the results were faxed to the physician instead of being communicated by phone as required by facility protocol. The delay in direct notification led to a postponement in medical intervention, with the physician only being informed the following morning, after which the resident was sent to the ER for treatment.
The facility did not ensure its activities program was led by a qualified professional, as the Activity Director was hired without the required certification or experience and only began necessary training months after starting. Interviews revealed that administration and HR lacked clear oversight of certification requirements, and the AD's personnel file was missing key documentation.
A facility failed to maintain accurate records of lorazepam, a controlled substance, leading to a discrepancy in the medication count. A resident with severe cognitive impairment received lorazepam for seizures, but one dose was not documented, resulting in an inaccurate count. Staff interviews revealed that medication was not consistently counted during shift changes, contrary to facility policy.
The facility failed to securely store controlled drugs, such as lorazepam, in a permanently affixed compartment within the medication room refrigerator. The locked box was easily removable, and keys were improperly stored outside the refrigerator, accessible to anyone with access to the medication room. Staff interviews revealed that recent changes in the medication room setup and replacement of the controlled substance box contributed to this oversight.
A resident with severe cognitive impairment and a history of seizures and anxiety was administered lorazepam, but the administration was not documented in the MAR. The LVN admitted to forgetting to document due to distraction. The DON and ADON emphasized the importance of accurate documentation to prevent errors. The facility's policy requires detailed documentation of medication administration, which was not followed in this instance.
Uncertified Hospitality Aides Providing Direct Care Beyond 4 Months Without Competency Evaluation
Penalty
Summary
The deficiency involves the facility’s use of caregiver hospitality aides as nurse aides beyond four months of employment without completion of a nurse aide training and competency evaluation program, and without competency check-offs. Record review showed that one caregiver hospitality aide was hired on 08/06/2025 and another on 07/30/2025, both working full time, with employability status checks indicating neither had CNA certification. The facility’s job description for hospitality aides, dated 03/2020, listed a range of non-nursing, non-direct care duties under the supervision of licensed nursing personnel, but also included tasks such as providing personal care (e.g., combing hair, washing face and hands) and staying with residents while in the bathroom. During interviews, one caregiver hospitality aide reported performing incontinent care without a CNA or nurse at bedside and stated she had taken courses but had not taken the certification test. Another caregiver hospitality aide stated he performed sit-to-stand transfers with residents and, when the only CNA on night shift was busy, he would obtain help from another hospitality aide to perform incontinent care and transfers; he reported having been shown how to do these tasks at another facility but confirmed he was not certified. The DON stated that hospitality aides did not have competency check-off lists, were not supposed to perform peri-care or transfers, and were not to do anything involving touching residents because they were not certified. The DON and the administrator both acknowledged there were no competency check-off lists for caregiver hospitality aides, that uncertified staff were not supposed to provide direct care unless paired with a nurse or CNA, and that staff performing direct care should have certification within four months of hire, identifying this as a system failure between nurses and staff with potential for residents to receive improper care from uncertified aides.
Failure to Prevent Elopement of High-Risk Resident
Penalty
Summary
A deficiency occurred when a resident with severe cognitive impairment and a history of wandering and elopement was able to exit the secure unit without staff knowledge. The resident, who had diagnoses including dementia, late-onset Alzheimer's disease, anxiety, bipolar disorder, and psychosis, was admitted to the secure unit due to his wandering risk. Despite interventions in his care plan such as frequent location checks, redirection, and activity engagement, the resident managed to open a window in a common room, remove three wood fence pickets, and leave the premises undetected by staff. On the night of the incident, staff did not realize the resident was missing until law enforcement returned him several hours later. The window in the common room was found open beyond the intended limit, and the fence pickets removed by the resident were not visible from a direct line of sight. The staff on duty included a nurse and a CNA, with the CNA being new to the unit and having only partial training. Rounds were reportedly conducted every two hours, but staff avoided entering the resident's room at night to prevent agitation, resulting in the resident not being checked as frequently as policy required. The facility's policy required staff to physically check on residents every two hours to ensure safety, but this was not consistently followed for the resident involved. The resident's care plan identified him as a high elopement risk, and he had a documented history of attempting to leave other facilities. The failure to provide adequate supervision and maintain a secure environment allowed the resident to leave the facility undetected, placing him at risk for harm.
Deficient Food Storage, Preparation, and Sanitation Practices in Kitchen
Penalty
Summary
Surveyors observed multiple failures in the facility's kitchen related to food storage, preparation, and cleanliness. The kitchen staff did not follow daily cleaning lists, resulting in soiled equipment and surfaces, such as a box of biscuits contaminated with an orange liquid, crumbs and unknown substances in refrigerators and on shelves, and dirty areas behind the stove and on walls. The cleaning checklist had not been completed since February, and the kitchen had been without a dietary manager for about a month, during which time cleaning logs were not maintained. Food items were not stored properly, with several bags of cheese, cookies, and cereal left open to air in various storage areas. Expired food, such as peach cobbler, was found in the refrigerator. Staff interviews confirmed that it was everyone's responsibility to ensure food was sealed, dated, and checked for expiration, but these practices were not consistently followed. The lack of proper food storage and failure to remove expired items increased the risk of serving unsafe food. During meal service, clean and dirty dishes were not kept separate, as used lids were returned to racks with clean pans, and drinks sent to residents were not covered. Staff acknowledged that these practices could lead to cross-contamination and illness. Facility policies required all food service areas and equipment to be kept clean and all food to be properly sealed and dated, but these standards were not met during the survey period.
Failure to Promptly Notify Physician of Abnormal X-ray Results After Resident Fall
Penalty
Summary
A deficiency occurred when the facility failed to promptly notify a resident's physician by phone, as required by facility protocol, after receiving x-ray results that indicated a right femur fracture. The resident, an elderly female with multiple diagnoses including schizoaffective disorder, dementia, osteoporosis, and a history of falls, was found on the floor with hip bruising. Initial assessments were performed, and the on-call physician, DON, and family were notified of the fall. However, after a portable x-ray was ordered and completed due to post-fall pain, the results showing a mildly displaced fracture of the right femoral neck were received and only faxed to the physician, not communicated by phone as required. The x-ray results were received during the night, but there was no immediate phone notification to the physician. The abnormal findings were instead faxed, and it was not until later the following morning that the ADON called the physician's office to report the fracture and increased pain. The physician then ordered the resident to be sent to the ER, where she was admitted and underwent a right hip arthroplasty. Interviews with staff confirmed that the facility's expectation and protocol were to immediately call the physician with abnormal x-ray or lab results, especially those indicating a fracture, and not to rely on fax communication for critical findings. Facility policy required prompt diagnostic action and direct communication with the physician in the event of a fall with suspected injury, particularly for residents with dementia. The failure to follow this protocol resulted in a delay in notifying the physician about the resident's fracture, as the abnormal x-ray was not reported by phone as required. This delay was confirmed through interviews and record review, and staff acknowledged that the expected process was not followed in this instance.
Unqualified Activity Director Led Activities Program
Penalty
Summary
The facility failed to ensure that the activities program was directed by a qualified professional, as required. Record review showed that the Activity Director (AD) was hired without the necessary certification or qualifications as a therapeutic recreation specialist or activities professional meeting state licensing requirements. The AD began employment without prior experience or certification and only started the required training several months after hire, with completion projected to be nearly a year after starting the position. The delay in certification was attributed to a change in the course provider, which postponed the start of the training. Interviews with the AD, the administrator (ADMN), and HR revealed a lack of clear oversight and understanding regarding the certification requirements and timelines. The AD acknowledged not having the required certification upon hire, and the ADMN assumed certification could be obtained within the first year but was not aware of specific timeframes. HR did not have a checklist or awareness of the AD's certification status. Documentation in the AD's application and personnel file was incomplete, with unanswered fields regarding licensure and certification.
Failure to Maintain Accurate Controlled Substance Records
Penalty
Summary
The facility failed to maintain accurate drug records and an account of all controlled drugs, specifically lorazepam, in the medication room refrigerator. This deficiency was identified during an observation, interview, and record review process. The issue was discovered when the controlled substance record count sheet did not match the actual amount of lorazepam stored, as one dose administered to a resident was not documented. This discrepancy could potentially lead to the misappropriation of medications. The resident involved was an elderly male with severe cognitive impairment, diagnosed with conversion disorder with seizures and anxiety. He had a care plan that included administering medications as ordered and monitoring for seizures. On a specific date, the resident received multiple doses of lorazepam, but one dose was not recorded on the controlled substance count sheet, leading to an inaccurate count of the medication on hand. Interviews with staff revealed that the medication was not counted during shift changes as required by facility policy. The Director of Nursing (DON) and Assistant Director of Nursing (ADON) were responsible for monitoring the accuracy of controlled substance counts, but the failure to document the administration of lorazepam was attributed to staff distraction. The facility's policy required controlled substances to be counted and documented at each shift change to prevent medication misappropriation, but this was not consistently followed by the staff.
Improper Storage of Controlled Substances in Medication Room
Penalty
Summary
The facility failed to ensure that controlled drugs, specifically lorazepam, were stored in a securely locked and permanently affixed compartment within the medication room refrigerator. During an observation, it was noted that the locked box inside the refrigerator was not secured and could be easily removed. Additionally, the keys to this locked box were stored on a hook outside the refrigerator, accessible to anyone with access to the medication room. This improper storage practice was confirmed during an interview with the Assistant Director of Nursing (ADON), who acknowledged that the locked box should be secured to the refrigerator and that the keys should not be stored outside the refrigerator. Interviews with various staff members, including the Director of Nursing (DON) and the pharmacy consultant, revealed that the facility had recently moved the medication room, which may have contributed to the oversight in securing the controlled substances appropriately. The DON mentioned that the controlled substance box had been replaced recently due to rust, which might have led to the failure of affixing the new box. The facility's policy on controlled substances, dated July 2024, clearly states that controlled substances should be stored in separately locked, permanently affixed compartments, and that keys should be maintained by the charge nurse on duty. The failure to adhere to these policies could potentially lead to the misappropriation of medications.
Failure to Document Medication Administration
Penalty
Summary
The facility failed to maintain accurate medical records for a resident, specifically regarding the administration of Ativan (lorazepam) for anxiety and seizure management. The resident, who had severe cognitive impairment and a history of seizures and anxiety, was administered lorazepam intramuscularly on multiple occasions. However, the administration of the medication on one specific date was not documented in the Medication Administration Record (MAR), despite being noted in the nursing progress notes. During interviews, the Licensed Vocational Nurse (LVN) who administered the medication admitted to forgetting to document the administration in the MAR due to being distracted. The Director of Nursing (DON) and Assistant Director of Nursing (ADON) both expressed expectations that medication administration should be documented accurately and timely to prevent medication errors and ensure continuity of care. The facility's policy on medication administration requires documentation of the date, time, dosage, route, and effectiveness of medications administered. The failure to document the administration of lorazepam in the MAR could lead to other nurses being unaware of the medication given, potentially affecting the monitoring of its effectiveness and side effects. The pharmacy consultant also noted that not documenting on the MAR could interfere with the ability of staff to monitor for side effects such as lethargy. The facility's lack of a specific clinical documentation policy and reliance on the medication administration policy was highlighted during the interviews.
What surveyors are citing around you — mapped
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Repeat citations, what's rising near you, and quality measures — ranked so department heads know exactly where to look first.
Illustrative
What surveyors actually found near you
We read the 40 citations issued within 25 miles in the last 12 months — and tell you exactly what happened, in plain English, matched to your record.
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.
Illustrative
A prioritized, do-first checklist
Every risk area becomes concrete audit steps drawn from real citations at facilities like yours — run them this week, before your window opens.
Illustrative
Risk indicators are statistical estimates from public CMS data — not predictions, findings, or compliance advice.
Nursing homes near Brownwood
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Pecan Bayou Nursing And Rehabilitation | 1.6 mi | ★★★★★ | 6 | 0 |
| Songbird Lodge | 1.7 mi | ★★★★★ | 15 | 0 |
| Oak Ridge Manor | 1.8 mi | ★★★★★ | 5 | 0 |
| Brownwood Nursing And Rehabilitation | 1.9 mi | ★★★★★ | 11 | 0 |
| Care Nursing & Rehabilitation | 5.7 mi | ★★★★★ | 3 | 0 |
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Trusted data, never guesswork. Every citation, penalty, rating and Plan of Correction on this page is sourced from public CMS records (latest release July 2026) and official state health department websites.