Above average — CMS composite of the measures below.
The next survey window likely opens around February 2027
Estimate from public CMS data, current as of August 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Farmersville Health And Rehabilitation during CMS and state inspections, most recent first.
Failure to maintain privacy and confidentiality during resident care: an LVN connected a resident’s enteral feeding with the roommate present and no privacy curtain, a CNA transferred another resident without closing the door or curtain, an LVN left a laptop open in the hallway displaying a resident’s PHI, and an RN disclosed that she was about to check a resident’s blood sugar in front of the roommate’s family member. Interviews confirmed the staff recognized these actions as privacy and HIPAA violations.
Medications and topical treatments were found unsecured in resident rooms and on an unattended cart. A resident with dementia had antifungal powder and TUMS left in his room, another resident had eyedrops without an order, and other residents had antifungal powder, wound cleanser, barrier cream, and nystatin powder left at bedside or on furniture. A Treatment Nurse also left a medicated dressing unattended during wound care, and an unlocked treatment cart with topical antibiotics was observed in the hallway.
Kitchen Food Storage and Sanitation Deficiencies: Surveyors found multiple food safety issues in the kitchen, including improperly labeled and dated foods, expired ready-to-eat items that should have been discarded, a dirty deep fryer, an unclean ice machine, and a red sanitizer bucket that tested at 0 PPM during lunch service. The DM acknowledged the labeling and sanitation concerns and stated the fryer grease was not strained daily.
A resident with COPD and moderate cognitive impairment had physician orders for nebulizer treatment and weekly tubing care, but the comprehensive care plan did not include a specific plan for nebulizer use. Staff observed a nebulizer mask sitting unbagged on the resident's nightstand, and the DON, MDS nurse, and ADON B acknowledged the care plan was not specific to the nebulizer.
Failure to Flush G-Tube Before Bolus Feeding: A resident with dysphagia, moderate cognitive impairment, and a feeding tube was observed receiving a bolus feeding without the G-tube being flushed first. The LVN checked placement and residual, then poured formula into the syringe attached to the tube and only flushed after the feeding was completed. The LVN said she forgot to flush before the formula, and the ADON and DON stated the tube should be flushed before bolus feedings and before meds.
A resident with COPD and moderate cognitive impairment had a nebulizer mask observed sitting unbagged on her nightstand while not in use. RN D, the DON, and the ADON all stated that masks and nasal cannulas should be bagged when not in use to prevent contamination, and the facility policy required respiratory equipment to be kept clean and sanitary and stored until next use.
Medication Left Unattended in Resident Room: A resident with dementia and severe cognitive impairment had a dose of TUMS found in a cup on top of his drawer after staff had administered morning meds. The resident had no self-administration assessment, and interviews with MA, ADON, and DON confirmed meds should not be left with residents unattended; the facility policy also required staff to observe residents to ensure meds are swallowed.
An LVN failed to perform hand hygiene and change gloves after touching a trash can while preparing enteral feeding for a resident with a g-tube, then used the same tray for another resident without sanitizing it after it contacted resident tables. The residents had feeding tubes and cognitive impairment, and the DON, ADON, and Administrator stated the actions involved improper hand hygiene and failure to disinfect reusable equipment, creating cross-contamination concerns.
An RN left an opened container of germicidal wipes on top of a nurse's cart unattended while providing care to a resident with DM and checking blood sugar. The wipes were visible in the hallway, and the RN later stated residents might take them and use them to wipe their face. The ADON, DON, Administrator, and Dietary and Housekeeping Manager stated the wipes should be secured inside the cart because they contain chemicals and could be harmful if accessed by residents.
Multiple-resident rooms failed to meet the required minimum of 80 square feet per resident. The ADM stated the facility had a room size waiver in place and that nothing had changed in the room dimensions over the past years. Review of the bed classification form showed all bedrooms were double-occupancy, and the room measurement listing identified numerous rooms below the required standard. The ADM provided a signed room size waiver request and stated the facility did not have a policy for the waiver.
A resident with Parkinson's disease and moderate cognitive impairment reported that a CNA was rude and mean during care, describing the behavior as disrespectful and upsetting. The resident's family reviewed in-room surveillance video and observed the CNA speaking to the resident in a rude, demeaning manner, including religious comments about God not helping mean people and implying the family did not care because they did not visit. Facility leadership and a Regional Nurse later confirmed, based on the video and interviews, that the CNA's conduct constituted inappropriate and verbally abusive statements toward the resident, in violation of the facility's abuse/neglect and resident rights policies.
The facility failed to properly store nasal cannulas for four residents on oxygen therapy, risking respiratory infections. A resident with COPD had a nasal cannula on her wheelchair seat, not bagged. Another resident, cognitively intact, had a nasal cannula coiled on his wheelchair without a bag. A third resident with severe cognitive impairment had a nasal cannula hanging from her wheelchair. A fourth resident on hospice care had a nasal cannula hanging from an oxygen concentrator. The facility lacked a specific policy for bagging nasal cannulas, and staff did not consistently follow infection control protocols.
A CNA in a LTC facility failed to follow proper hand hygiene and glove-changing protocols while providing incontinent care to a resident with acute kidney failure and incontinence. The CNA did not sanitize hands before putting on gloves and did not change gloves after cleaning the resident's bottom, risking cross-contamination and infection. Facility policies on hand washing and perineal care were not adhered to during the incident.
The facility did not ensure that 34 multiple-resident rooms met the required minimum of 80 square feet per resident. Despite having a room size waiver, the rooms were below the required size, potentially placing residents at risk. The Administrator confirmed no changes in room sizes, and no policy was provided before the survey exit.
Failure to Maintain Privacy and Confidentiality During Resident Care
Penalty
Summary
The facility failed to maintain resident privacy during care and treatment for multiple residents. Resident #1 had a gastrostomy tube and required enteral feeding. During an observation, LVN E entered the room to connect the resident’s formula to the g-tube while the roommate was present, but she did not pull the privacy curtain. LVN E later stated she should have pulled the curtain because the roommate was in the room, and the resident did not respond when asked whether it was okay for the roommate to see the treatment. The facility also failed to provide privacy during a transfer for Resident #36. The resident had muscle weakness, severe cognitive impairment, and required maximal assistance for transfers. During an observation, CNA J transferred the resident from a wheelchair to the bed while the roommate was awake in the room, but she did not pull the privacy curtain or close the door. CNA J stated she should have pulled the curtain and closed the door because the roommate was inside the room, and the resident shrugged when asked if it was okay to be transferred with the door open. The facility failed to protect Resident #69’s medical information when LVN E left a cart in the hallway with a laptop screen open and facing the hallway. The screen displayed the resident’s name, date of birth, physician name, location, code status, allergies, special instructions, vital signs, weight, pain level, and medications. LVN E stated she had gone to check on a resident and acknowledged that exposing the information was a HIPAA violation. The facility also failed to maintain confidentiality for Resident #75 when RN D told the resident and the roommate’s family member that she needed to pull the privacy curtain because she was going to check the resident’s blood sugar. RN D stated that checking blood sugar was a medical treatment and should not be disclosed to anyone not involved in the resident’s care. Interviews with the ADON, DON, and Administrator confirmed that staff should close the door and/or pull the privacy curtain during care and treatment and should not disclose resident medical information to others.
Medications and treatment supplies left unsecured in resident rooms and an unlocked cart
Penalty
Summary
The facility failed to ensure drugs and biologicals were stored in locked compartments and were not left inside resident rooms. During observations, multiple medications and topical products were found in resident rooms or on resident furniture, including antifungal powder, TUMS, eyedrops, wound cleanser, barrier cream, and nystatin powder. Staff interviews reflected that these items should not have been left in resident rooms and should have been secured in medication or treatment carts, especially because some residents had cognitive impairment and could use the products inappropriately. Resident #4, a male with dementia and severe cognitive impairment, was observed with antifungal powder on top of his drawer while he was not in his room. The same resident was also observed with a small plastic cup containing a TUMS tablet on top of his drawer. Staff stated the antifungal powder and the TUMS should have been secured in the cart and not left with the resident unattended. Resident #17, a cognitively intact female with depression, was observed with a container of eyedrops on her windowpane even though there was no physician order for eyedrops in the record. The resident stated the eyedrops had always been in her room and she was not using them. Resident #38, a male with dementia and a non-pressure ulcer of the left foot, was observed with antifungal powder and wound cleanser on top of his shelf. Resident #51, a male with dementia and bowel and bladder incontinence, had a small cup of white cream on top of his side table. Resident #67, a female with dementia and moisture-associated skin damage, had a container of antifungal powder on a bedside cart in her room. In addition, the Treatment Nurse left a dressing with medication on the resident's bedside table during wound care for Resident #38 when she left the room to call the nurse station, and a treatment cart in the hallway was observed unlocked and unattended with topical antibiotics in a drawer. Facility staff and leadership stated medications, biologicals, and treatment carts should be locked and not left accessible in resident rooms or unattended.
Kitchen Food Storage and Sanitation Deficiencies
Penalty
Summary
The facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety in its only kitchen. During observation on 03/15/26, surveyors found a deep fryer with extremely dark grease and built-up brownish staining along the inside walls. In the refrigerator, one plastic bag of sliced cheeses was dated 2/16/26 and another 3/10/26, a silver container labeled sandwiches was dated 3/11/26 to 3/14/26 and should have been discarded, and a large bag containing scrambled eggs was not labeled or dated. In the freezer, a large container of frozen apple streusel coffee cake was dated 9/03/25. Surveyors also observed an ice machine with reddish stains along the inside white panel wall and white stains along the inside of the opening door. During observation and interview on 03/16/26, the DM and [NAME] O tested the red bucket used for sanitizer at the serving table and the test strip showed no sanitizer fluid was present. [NAME] O stated the solution had tested at 200 PPM during breakfast but was not sure why it tested at 0 PPM for lunch. The DM stated the solution was tested every meal before serving and that if it did not have the appropriate amount of sanitizer fluid, it would not decontaminate the surface. During interview, the DM stated she had spoken with staff about the concerns and acknowledged that some foods were not labeled and dated. She also stated she cleaned the fryer every two weeks, but the cooks forgot to strain the grease daily, and she was unsure of the expiration date for food when there was no expiration date on them. The Administrator was informed of the kitchen concerns and stated she expected the kitchen to meet guidelines to avoid infection and food contamination. The facility policy required food to be labeled and dated, and the cited food code required proper labeling and date marking for ready-to-eat refrigerated foods.
Failure to Care Plan Nebulizer Use
Penalty
Summary
The facility failed to develop and implement a comprehensive person-centered care plan for Resident #20 that included measurable objectives and timeframes for her medical, nursing, mental, and psychosocial needs. Resident #20 was an [AGE]-year-old female admitted to the facility with a diagnosis of COPD. Her quarterly MDS assessment dated 02/10/26 reflected a BIMS score of 11 and moderate cognitive impairment, and physician orders dated 03/16/26 included Ipratropium-Albuterol Solution 0.5-2.5 (3) MG/ML, 1 vial inhaled every 6 hours for COPD, along with an order for a nebulizer to be cleaned and tubing changed every Sunday. Record review of the comprehensive care plan dated 01/25/26 did not reflect a plan of care for the resident's use of a nebulizer. During observation on 03/15/26 at 10:29 a.m., Resident #20 had a nebulizer mask sitting on top of her nightstand unbagged. During interviews, the DON, MDS nurse, and ADON B were informed that the resident was not care planned for nebulizer use; the DON and ADON B stated it was the MDS nurse's responsibility to ensure care plans were updated, and the MDS nurse stated she believed a broad reference to aerosol/bronchodilator use was sufficient, but acknowledged the care plan should have specifically included the nebulizer.
Failure to Flush G-Tube Before Bolus Feeding
Penalty
Summary
The facility failed to provide appropriate treatment and services to prevent complications of enteral feeding for one resident with a feeding tube. Resident #2 was a male admitted with dysphagia, moderate cognitive impairment with a BIMS score of 08, and a feeding tube noted on the MDS assessment. His care plan required PEG care, including checking tube placement and gastric residual before initiating feeding, and the physician order directed staff to flush the G-tube with 200 cc of water every 4 hours, keep the head of bed elevated 30 to 45 degrees, and check tube placement and residual before each feeding, medications, and fluids. During observation, LVN E prepared to administer a bolus feeding and checked placement and residual, but did not flush the G-tube before pouring the formula into the syringe attached to the tube. She then added water during the feeding and flushed the tube only after the formula was completed. In interview, LVN E stated she forgot to flush the tube before giving the formula and acknowledged the tube should be flushed prior to feeding to ensure it was working and not obstructed. The ADON and DON both stated that flushing should be done before bolus feeding and before medication administration, and the DON said the expectation was for staff not to forget to flush before giving the bolus. The facility policy for G-tube medication administration also reflected checking placement and residual and flushing with warm water before administering medication.
Nebulizer Mask Left Unbagged When Not in Use
Penalty
Summary
The facility failed to ensure safe and appropriate respiratory care for Resident #20, a female resident with COPD and moderate cognitive impairment. Her physician orders included Ipratropium-Albuterol inhalation every 6 hours for COPD and instructions to clean and change nebulizer tubing weekly. During an observation, her nebulizer mask was found sitting on top of her nightstand unbagged while not in use. When the surveyor showed the unbagged nebulizer mask to RN D, she stated that masks and nasal cannulas should be bagged when not in use to avoid contamination and that it was the nurse's responsibility to ensure the devices were bagged. The DON and ADON later confirmed that breathing devices should be bagged when not in use and stated it was the nurse's responsibility to do so. The facility policy stated that oxygen therapy equipment should be maintained in a clean and sanitary manner and that when a mask or cannula is temporarily not being used, it should be covered loosely to prevent contamination from airborne microorganisms; nebulizer equipment should be stored, cleaned, and dried until next use.
Medication Left Unattended in Resident Room
Penalty
Summary
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist was not met when medication was left with a resident to take unattended. Resident #4 was a male admitted to the facility with diagnoses of gastro-esophageal reflux disease and dementia. His MDS assessment reflected severe cognitive impairment with a BIMS score of 05, and his care plan identified impaired cognitive function with monitoring for changes in cognition. His physician’s order included Calcium Carbonate chewable tablets, given as needed for indigestion and also scheduled three times daily as a phosphorus binder with meals. Record review showed Resident #4 did not have an assessment for self-administration of medication. During observation, the resident was not in his room, and a small plastic cup with a pill was seen on top of his drawer. When staff were interviewed, MA F stated that medication administration staff should stay with the resident to ensure the medication is taken and said she found the TUMS in the cup in the resident’s room. She stated she had given the resident his morning medications, including TUMS, and did not know who left the medication there. ADON A and the DON both stated medications should not be left with residents to take later and that staff should remain with the resident until the medication is taken. The resident later stated staff would bring him the medication and tell him to take it if he wanted to or not. The facility policy on Medication Administration stated residents are to be observed to ensure medications are swallowed and that medications are not left on top of the cart or at the resident’s bedside. The deficiency occurred because a dose of TUMS was found left in the resident’s room unattended despite the resident’s cognitive impairment and lack of a self-administration assessment, and staff interviews confirmed that leaving medications with residents was not the expected practice.
Hand Hygiene and Tray Disinfection Failures During G-Tube Care
Penalty
Summary
The facility failed to establish and maintain an infection prevention and control program for two residents receiving g-tube care. One resident had a gastrostomy tube, severe cognitive impairment with a BIMS score of 03, and an order for continuous enteral feeding via g-tube. During observation, an LVN prepared the resident’s enteral feeding supplies, sanitized her hands, and put on a gown, but after pulling the trash can toward her with a gloved hand, she continued the feeding process without sanitizing her hands or changing her gloves before connecting the formula to the g-tube. The same LVN also used a tray while providing g-tube care to a second resident who had dysphagia, moderate cognitive impairment with a BIMS score of 08, and an order for g-tube flushes and tube placement checks. After using the tray for the first resident and placing it on the first resident’s side table, she later used the same tray for the second resident and placed it on the second resident’s overbed table. She did not sanitize the bottom of the tray after it contacted the residents’ tables or between use for the two residents. During interview, the LVN stated she should have changed her gloves after touching the trash can and said she did not know what microorganisms might have been on the tables or tray. The ADON and DON stated staff should sanitize hands and change gloves after touching something dirty and that the tray should have been sanitized because it touched resident tables. The Administrator stated staff should be vigilant with hand hygiene and that the tray should have been sanitized to prevent cross contamination. The facility policy stated employees are required to wash hands after direct resident contact when indicated and that routine cleaning and disinfection of resident care equipment shared among residents is implemented.
Unsecured germicidal wipes left on nurse's cart
Penalty
Summary
The facility failed to provide a safe, functional, sanitary, and comfortable environment when RN D left an opened container of germicidal wipes on top of her nurse's cart unattended during resident care. During an observation, RN D prepared supplies to check Resident #75's blood sugar, including a glucometer, alcohol wipes, test strips, and push-button safety lancets. Before entering the room, she used a germicidal wipe to clean the glucometer, then brought the testing supplies into the resident's room and left the opened container of germicidal wipes on top of the cart. Resident #75 was a cognitively intact female with diabetes mellitus, and her care plan included administering diabetic medications as ordered. While RN D was inside the room and then returned to the cart to get gauze, the opened container remained on the cart with wipes visible. RN D later stated she should have put the wipes back inside the cart because residents might take them and use them to wipe their face. The ADON, DON, Administrator, and Dietary and Housekeeping Manager all stated the germicidal wipes should be secured inside the cart because residents could access them and use them inappropriately. The facility policy stated poisonous items and other items with cautionary labels are to be kept secured and only accessible to employees.
Multiple-Resident Rooms Did Not Meet Required Square Footage
Penalty
Summary
The facility failed to ensure that multiple-resident bedrooms met the required minimum of 80 square feet per resident. During the survey entrance conference, the ADM stated the facility had a room size waiver in place for bedrooms measuring less than the required square footage and said nothing had changed in the past years regarding resident room square footage. Review of Form DADS 3740 showed all 37 bedrooms in the facility had two beds and were classified as Medicare and Medicaid, and the facility license showed 74 beds. Review of the resident bedroom measurements listing showed several rooms measured below the required standard for multiple-resident rooms, including rooms 2, 3, 4, 6, 8, 10, 12, 14, 15, 16, 17, 19, 20, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, and 39. During interview, the ADM provided a signed Form 3762 room size waiver request and stated the facility would request continuation of the same waiver for the next year. The ADM also stated there had been no change in the number or size dimensions of the affected rooms, and stated the facility did not have a policy regarding the room size waiver.
Failure to Protect a Resident From Verbal Abuse by CNA
Penalty
Summary
The facility failed to protect a resident from verbal abuse when a CNA spoke to the resident in a rude, demeaning, and inappropriate manner, including making unnecessary and offensive comments. The resident was an adult male with Parkinson's disease and a cognitive communication deficit, with a BIMS score of 11 indicating moderate cognitive impairment. During an interview, the resident reported that the CNA was rude and mean during care, describing the behavior as disrespectful and inappropriate and stating the interaction was upsetting and should not have occurred. A family member, after being informed by the resident, reviewed surveillance video from a camera in the resident's room and observed the CNA speaking to the resident in a rude and demeaning manner, including comments about God not helping mean people and implying the resident's family did not visit because they did not care about him. The family reported the incident and video to facility leadership, and the Administrator and Regional Nurse later confirmed that the CNA made inappropriate verbal comments, including religious statements implying blame for the resident's condition, which they determined to be verbally abusive. Progress notes documented that the physician was notified of verbal abuse by a staff member toward the resident, and a subsequent note indicated the resident later reported he was doing fine with no residual issues related to the incident. The Social Worker became aware of the allegation after notification by the Administrator and conducted facility-wide safety surveys, but there is no indication in the report that she spoke directly with the resident about the incident. The facility's Abuse/Neglect and Resident Rights policies state that residents have the right to be free from verbal abuse and that all allegations must be immediately reported, investigated, and addressed to ensure resident safety, yet the incident of verbal abuse by the CNA toward the resident occurred despite these policies.
Improper Storage of Nasal Cannulas for Residents on Oxygen Therapy
Penalty
Summary
The facility failed to ensure proper storage of nasal cannulas for four residents who required oxygen therapy, potentially placing them at risk for respiratory infections. Resident #20, diagnosed with respiratory infections, emphysema, and COPD, was observed with a nasal cannula on her wheelchair seat, not stored in a plastic bag as required. The resident was unaware of the need to bag the cannula when not in use, and her care plan did not specify that she was responsible for removing it. Resident #27, who was cognitively intact and diagnosed with COPD, had a nasal cannula coiled on his wheelchair seat without a plastic bag. The resident relied on staff for assistance with transfers and was unaware of the storage protocol for his nasal cannula. Similarly, Resident #36, with severe cognitive impairment and COPD, had a nasal cannula hanging from her wheelchair, not bagged, with the prongs nearly touching the wheel, indicating a lack of proper storage. Resident #57, on hospice care with Alzheimer's disease, had a nasal cannula attached to an oxygen concentrator, left hanging without a bag. The facility's RN and DON acknowledged the oversight, noting that nasal cannulas should be bagged to prevent cross-contamination and infection. However, the facility lacked a specific policy for bagging nasal cannulas, and staff did not consistently follow infection control protocols during their rounds.
Infection Control Breach During Incontinent Care
Penalty
Summary
The facility failed to maintain an effective infection prevention and control program, as evidenced by an incident involving a certified nursing assistant (CNA) who did not adhere to proper hand hygiene and glove-changing protocols while providing incontinent care to a resident. The resident, a female with acute kidney failure and incontinence, was observed receiving care from CNA B, who did not sanitize or wash her hands before putting on gloves. During the care process, CNA B failed to change gloves after cleaning the resident's bottom and before handling a new brief, which could lead to cross-contamination and infection. The resident's medical records indicated she was always incontinent for both bowel and bladder, necessitating regular perineal care. The facility's policies on hand washing and perineal care were not followed, as CNA B did not perform hand hygiene before and after the procedure, nor did she change gloves when moving from a soiled to a clean task. This oversight was acknowledged by both the CNA and the Director of Nursing (DON), who emphasized the importance of hand hygiene in preventing infection spread.
Facility Fails to Meet Room Size Requirements
Penalty
Summary
The facility failed to ensure that 34 multiple-resident rooms met the required minimum of 80 square feet per resident. During the survey, it was revealed that the facility had a room size waiver in place for these rooms, which were all classified as Medicare and Medicaid. The Administrator confirmed that there had been no changes in the room sizes over the past years. The survey included a review of the facility's license, which indicated it was licensed for 74 beds, and a review of the resident bedroom measurements provided by the Administrator. The measurements showed that the rooms varied in size, with some as small as 127 square feet for two residents, which is below the required minimum of 160 square feet for two residents. Despite the waiver, the facility's failure to meet the square footage requirement could place residents at risk of not having sufficient space. No policy was provided by the facility prior to the exit of the surveyors.
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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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Nursing homes near Farmersville
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Lexington Medical Lodge | 1.3 mi | ★★★★★ | 2 | 0 |
| Princeton Medical Lodge | 9.7 mi | ★★★★★ | 5 | 0 |
| Royse City Medical Lodge | 12.9 mi | ★★★★★ | 6 | 0 |
| Wylie Oaks Healthcare And Rehabilitation | 13.6 mi | ★★★★★ | 2 | 0 |
| Greenville Health & Rehabilitation Center | 13.6 mi | ★★★★★ | 3 | 0 |
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