Below average — CMS composite of the measures below.
A standard survey is most likely before around August 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 Focused Care At Humble during CMS and state inspections, most recent first.
A medication cart was found unlocked and unattended in a hallway, with a lidocaine patch and two unidentified pills left on top, accessible to residents. Nursing and administrative staff confirmed that medications and carts are expected to be locked at all times, but the lapse occurred when an RN left the cart to assist another staff member. The facility could not provide its medication storage policy when requested.
A resident with dementia and a history of wandering exited the facility unattended, despite having a wander guard device and being identified as an elopement risk. Staff interviews revealed gaps in supervision, unclear responsibilities, and confusion about elopement protocols and the wander guard system. Security measures were in place but did not prevent the resident from leaving, resulting in a deficiency related to inadequate supervision and accident prevention.
A resident experienced significant health decline, including weight loss and physical decline, without the facility notifying the physician or family. Despite interventions, the resident continued to lose weight, and the facility relied on an NP rather than involving the physician. The lack of communication led to inadequate medical interventions.
A resident with multiple medical conditions, including COPD and malnutrition, was found in a neglected state upon transfer to a hospital. The resident was covered in feces and urine, indicating a lack of personal hygiene care. Despite interventions for weight loss, the resident continued to decline, ultimately leading to multi-organ failure and death shortly after hospital admission.
A resident in an LTC facility complained of pain during peri care but was not assessed or sent to the hospital until over 18 hours later, resulting in a delayed diagnosis of a hip fracture. The resident, with a history of cognitive and physical impairments, was not properly evaluated by the nursing staff, leading to a significant delay in medical treatment.
A resident with multiple health issues experienced a delay in receiving medical attention after complaining of leg pain. Despite an X-ray revealing a fracture, the results were not promptly communicated to the medical team, leading to an 18-hour delay before the resident was sent to the hospital. Miscommunication and misinterpretation of the X-ray report contributed to the delay.
The facility failed to store and serve food under sanitary conditions, with staff not following proper sanitation and food handling practices. Observations revealed staff without hairnets, handling food and sanitized silverware with bare hands, and incomplete dishwasher logs. Additionally, the ice machine used for residents was found dirty, with no cleaning log maintained.
The facility failed to ensure that a CNA was appropriately certified to practice in the State of Texas, resulting in the CNA working many hours with an expired license. Miscommunication regarding the State's licensing extension policy contributed to this oversight.
The facility failed to document and administer wound care orders for a resident with multiple stage 3 pressure injuries. Despite physician's orders, the treatments were not properly entered into the electronic health record, leading to inadequate care. Interviews revealed that the Wound Care Nurse was behind on documentation, and the Director of Nursing acknowledged the importance of timely documentation to prevent delays in treatment.
A facility failed to develop and implement a comprehensive care plan for a resident receiving hospice care services. Despite the resident's multiple medical conditions and the requirement to include hospice care in the care plan, this was not done, leading to potential confusion among staff about the resident's care needs.
The facility failed to develop and implement a comprehensive person-centered care plan for a resident within 21 days of admission. The care plan, initiated 40 days after admission, was not signed by any entity, placing the resident at risk for unmet medical, physical, and psychosocial needs. Interviews revealed the delay was due to the MDS Nurse's workload and oversight.
A facility failed to provide proper incontinent care for a resident, as CNA did not separate the labia and wiped from back to front, risking contamination and infection. The resident, with multiple diagnoses and requiring extensive ADL assistance, was not cleaned according to facility policy, despite recent staff training.
The facility had a medication error rate of 10%, involving two residents. One resident received the wrong allergy medication, and another did not receive prescribed Vitamin D due to unavailability and was given an incorrect multivitamin. Both errors were due to staff not following physician orders and facility policies.
The facility failed to ensure proper storage and administration of medications for two residents. One resident was self-administering Salonpas patches without authorization, and another had Nystatin powder applied by CNAs, contrary to facility policy requiring licensed nurses to administer prescribed topical medications.
Unsecured Medication Cart and Unattended Medications
Penalty
Summary
The facility failed to ensure that all drugs and biologicals were stored securely in locked compartments, as required by professional standards. During an observation, a lidocaine patch and two unidentifiable pills were found left unattended on top of an unlocked medication cart in a hallway accessible to residents. The medication cart was not under the direct observation of authorized staff at the time. Interviews with nursing staff and administration confirmed that the expectation is for medication carts to be locked and for medications not to be left unattended. Staff acknowledged the risk of residents accessing unsecured medications and described the proper procedures for medication administration and cart security. Despite these expectations, the incident occurred when a registered nurse left the cart unlocked and medications unattended while assisting another staff member. Other staff interviewed stated they would secure the cart and report any lapses if observed. The facility was unable to provide its Medication Storage/Labeling policy when requested. No medications were reported taken by residents, but the potential for harm existed due to the unsecured medications and unlocked cart.
Failure to Prevent Elopement Despite Wander Guard and Supervision Protocols
Penalty
Summary
A deficiency occurred when a resident with a history of dementia, cognitive impairment, and exit-seeking behaviors was able to leave the facility unattended despite being identified as an elopement risk and having a wander guard device in place. The resident, who was a new admission and had not adjusted to the facility, was independently ambulatory and had a care plan that included interventions for wandering and elopement risk. On the day of the incident, the resident exited the building and was found at a neighboring business approximately 20 minutes later. The wander guard device was in place at the time of the incident, and the resident was last seen in the facility about 20 minutes before being located outside. Staff interviews revealed gaps in supervision and monitoring, particularly during times when the receptionist was not present at the front desk. Some staff were not fully aware of the elopement protocols or the specific residents at risk, and there was confusion regarding the operation of the wander guard system, especially when doors were already open. The receptionist and other staff members could not recall seeing the resident leave, and there was uncertainty about who was responsible for monitoring the doors at the time of the incident. Additionally, some staff were unclear about the functionality of the wander guard system and their roles in preventing elopement. Observations and interviews indicated that while the facility had security measures such as magnetic locks, coded entry, and wander guard alarms, these systems did not prevent the resident from leaving the premises. The alarm system was tested and found to be functional, but it was not clear how the resident was able to exit without staff intervention. The lack of consistent supervision, unclear staff responsibilities, and insufficient training contributed to the failure to prevent the resident's elopement.
Failure to Notify Physician of Resident's Significant Health Decline
Penalty
Summary
The facility failed to immediately consult with a resident's physician when there was a significant change in the resident's physical, mental, or psychosocial status. This deficiency was identified for a resident who experienced a decline in health, including weight loss, physical decline in performing activities of daily living (ADLs), and a burning sensation in the throat. Despite these changes, the facility did not notify the resident's physician or family member, which could have led to inadequate medical interventions and a decline in the resident's health. The resident, a 66-year-old male, was admitted with multiple health issues, including chronic obstructive pulmonary disease, protein-calorie malnutrition, and dysphagia. The resident was on a mechanically altered diet and had a history of weight loss. Despite interventions such as dietary supplements and appetite stimulants, the resident continued to lose weight. The facility's records did not show any physician notes or notifications regarding the resident's change in condition, indicating a lack of communication with the physician. Interviews with facility staff revealed that the Director of Nursing (DON) and other staff members were aware of the resident's condition and weight loss but did not contact the physician. The facility relied on a nurse practitioner (NP) for resident care, and the physician was not actively involved. The resident's responsible party expressed concerns about the lack of communication and the resident's weight loss, which was not addressed until shortly before the resident's passing.
Neglect of Resident Leading to Severe Health Decline
Penalty
Summary
The facility failed to provide adequate care and assistance for a resident who was unable to perform activities of daily living, leading to neglect. The resident, a 66-year-old male with multiple medical conditions including chronic obstructive pulmonary disease (COPD), protein-calorie malnutrition, and cognitive communication deficit, was found in a severely neglected state when transferred to a local hospital. Upon arrival at the hospital, the resident was covered in fresh and dried feces and urine, indicating a lack of personal hygiene care at the facility. The resident's medical records revealed a significant weight loss over several months, with interventions such as dietary supplements and regular monitoring of food intake documented but seemingly ineffective. Despite being on a mechanically altered diet and receiving nutritional supplements, the resident continued to lose weight, dropping to 64 pounds from an initial weight of 85 pounds at admission. The resident's care plan required substantial assistance for daily activities, including toileting and personal hygiene, which were not adequately provided, as evidenced by the resident's condition upon hospital admission. The hospital records indicated that the resident was in a critical state upon arrival, with severe cachexia, labored breathing, and suspected neglect. The resident was found to be severely malnourished and in pain, requiring immediate medical intervention, including increased oxygen support and emergency transport. The lack of adequate care and monitoring at the facility contributed to the resident's rapid health decline, ultimately leading to multi-organ failure and septic shock, resulting in the resident's death shortly after hospital admission.
Failure to Provide Timely Assessment and Care for Resident's Pain
Penalty
Summary
The facility staff failed to provide appropriate treatment and care according to professional standards of practice, the comprehensive care plan, and the resident's choices for one resident reviewed for quality of care. The deficiency involved a resident who complained of pain during peri care but was not assessed or sent to the hospital until over 18 hours later. The resident was eventually diagnosed with an intertrochanteric fracture of the right femoral neck. The resident, who had a history of cognitive communication deficit, contracture of muscle, hemiplegia, and other conditions, was bed-bound and required assistance with activities of daily living. On the morning of the incident, a CNA reported the resident's complaint of pain to an LVN, who offered pain medication that the resident refused. However, the LVN did not conduct a pain assessment or further evaluate the resident's condition, as the resident was not exhibiting visible signs of pain. The facility's failure to promptly assess and address the resident's pain led to a delay in medical treatment. The resident's X-ray, which revealed the fracture, was not communicated effectively to the necessary medical personnel, resulting in a significant delay in the resident being sent to the hospital. This oversight placed the resident at risk of further injury and pain.
Delayed Notification of Diagnostic Results Leads to Resident Harm
Penalty
Summary
The facility failed to promptly notify the ordering physician or nurse practitioner of diagnostic results that fell outside of clinical reference ranges, as required by their policies and procedures. This deficiency was identified in the case of a resident who complained of pain during peri care at 5:00 am on June 6, 2024, but was not sent to the hospital until over 18 hours later. Upon hospital admission, the resident was diagnosed with an intertrochanteric fracture of the right femoral neck of indeterminate age. The resident, an elderly female with a history of cognitive communication deficit, muscle contracture, aneurysm, constipation, hemiplegia, hemiparesis, and insomnia, was bed-bound and required assistance with activities of daily living (ADLs). On June 6, 2024, the Assistant Director of Nursing (ADON) was informed by a Certified Occupational Therapy Assistant (COTA) that the resident was experiencing pain in her right leg. The ADON conducted a brief assessment and reported the issue to the Director of Nursing (DON), who ordered an X-ray. The X-ray was performed, and the results, which indicated a fracture, were available by 2:25 pm the same day. Despite the availability of the X-ray results, there was a delay in notifying the appropriate medical personnel. The Licensed Vocational Nurse (LVN) misinterpreted the X-ray report and sent it to the nurse practitioner via text message, but the nurse practitioner did not receive it. The DON eventually reviewed the X-ray report at 11:00 pm and instructed another LVN to contact the on-call doctor to arrange for the resident's transfer to the hospital. The resident was finally sent to the hospital at 12:02 am on June 7, 2024, highlighting a significant delay in addressing the resident's medical needs.
Failure to Maintain Sanitary Conditions in Food Service
Penalty
Summary
The facility failed to store and serve food under sanitary conditions per professional standards for food service safety. Observations revealed multiple instances where staff did not follow proper sanitation and food handling practices. Staff members were seen in the kitchen without hairnets, and one staff member was observed transporting food trays without a beard net. Additionally, staff members were observed handling food and sanitized silverware with bare hands, which could lead to cross-contamination. The facility's dishwasher logs were incomplete, and staff did not measure water temperature and PPM as required before and during the sanitizing process. Instead, they measured it after sanitizing, contrary to the facility's policy and training. The logs for several days were missing, and the DFS admitted to filling in the missing information without knowing the actual measurements. This practice could compromise the effectiveness of the sanitization process and increase the risk of foodborne illnesses among residents. Furthermore, the ice machine used to distribute ice to residents was found to be dirty, with white and yellowish stains, and there was no cleaning log maintained for it. Staff members admitted to not verifying the cleanliness of the machine before use, and the housekeeper responsible for cleaning it had only started working at the facility recently. The facility's failure to maintain proper sanitation and food handling practices could put all 65 residents who received meals from the facility kitchen at risk of foodborne illnesses.
Failure to Ensure CNA Certification
Penalty
Summary
The facility failed to ensure that CNA O was appropriately certified to practice and provide CNA care in the State of Texas. Despite CNA O's belief that her license was current, it was discovered that her license had expired. CNA O had worked many hours at the facility since the expiration of her license. The facility's corporate HR department did not have CNA O on the list of expired licenses, and there was a misunderstanding regarding the State's CNA license extension policy. The extension granted by the State did not apply to CNA O as her license had expired before the extension period began. This resulted in CNA O working without a valid license for an extended period, which was confirmed through interviews and record reviews, including timecard statements and the State's license verification website. The facility's administration and corporate HR designee acknowledged the oversight and the miscommunication regarding the State's licensing extension. The facility's records showed that CNA O had worked a significant number of hours while her license was expired. The facility's undated staff roster and EMR review also confirmed that CNA O was listed as an active Resident Care Provider despite her expired license. This failure to ensure proper certification could place residents at risk of receiving care from staff who were not properly trained and certified.
Failure to Document and Administer Wound Care Orders
Penalty
Summary
The facility failed to ensure clinical records were maintained in accordance with accepted professional standards and practices for Resident #37. Specifically, the facility did not input treatment orders and document the administration of those orders into the electronic health record for Resident #37's stage 3 pressure injuries. This failure was observed in the treatment of pressure injuries on the right ischium, right posterior thigh, and left posterior thigh, which were not properly documented or administered as per the physician's orders. Resident #37, a [AGE] year-old female with diagnoses including type 2 diabetes, end-stage renal disease, morbid obesity, bipolar disorder, and heart failure, was admitted to the facility with multiple pressure injuries. Despite the physician's orders for specific wound care treatments, the facility's records showed no active wound orders for the stage 3 pressure injuries on the right posterior thigh and left posterior thigh. Additionally, the treatment for the stage 3 pressure injury to the right ischium was inconsistently documented, with discrepancies in the order creation and discontinuation dates. Interviews with the Wound Care Nurse (WCN) and the Director of Nursing (DON) revealed that the wound orders were not entered into the system in a timely manner, leading to a lack of proper documentation and administration of the treatments. The WCN admitted to being behind on documentation, which resulted in the orders not being entered or administered as required. The DON acknowledged the importance of timely documentation and indicated that failure to do so could delay treatment and worsen the resident's condition.
Failure to Include Hospice Care in Resident's Care Plan
Penalty
Summary
The facility failed to develop and implement a comprehensive person-centered care plan for a resident receiving hospice care services. The resident, who had multiple medical conditions including senile degeneration of the brain, generalized anxiety disorder, hypertension, GERD, pressure ulcers, contractures, muscle wasting, lack of coordination, amputation of the left leg below the knee, colostomy status, and type 2 diabetes mellitus, was admitted to the facility and was receiving hospice care services. Despite this, the resident's care plan did not include any focus on the hospice care services he was receiving, which is a requirement for ensuring that all medical, nursing, and psychosocial needs are met in a timely manner. This omission was confirmed through interviews with the resident, the Wound Care Nurse (WCN), the Director of Nursing (DON), and the MDS Nurse, all of whom acknowledged that the care plan should have included hospice care services but did not. The MDS Nurse admitted that the oversight might have been due to the high number of admissions at the time. The DON also stated that while the care plan is essential for guiding staff on how to care for a resident, the nurses would still know to follow the physician's orders in the EHR. However, the lack of documentation in the care plan could lead to confusion among staff about the resident's care needs and who to contact for hospice care services. The facility's Comprehensive Care Plan policy mandates that every resident should have an individualized interdisciplinary plan of care, which should be updated with any new information as needed. The failure to include hospice care services in the resident's care plan is a clear violation of this policy and places the resident at risk of not receiving the required medical and end-of-life care in a timely manner.
Failure to Timely Develop and Implement Comprehensive Care Plan
Penalty
Summary
The facility failed to ensure comprehensive care plans were reviewed and revised by the Interdisciplinary Team after each assessment for one of twelve residents reviewed for care plans. Specifically, the facility did not develop and implement a comprehensive person-centered care plan to address the needs of a resident within 21 days of admission. The care plan for this resident, initiated 40 days after admission, was not signed by any entity, the resident, or his representative. This failure placed the resident at risk for not receiving care and services to meet his medical, physical, and psychosocial needs. The resident in question was a male with multiple diagnoses, including secondary hypertension, Type 2 diabetes mellitus, atherosclerotic heart disease, hyperlipidemia, chronic kidney disease, chronic obstructive pulmonary disease, mood disorder, unspecified dementia, psychotic disturbance, anxiety, cerebral infarction, muscle weakness, abnormalities of gait and mobility, lack of coordination, cognitive communication deficit, frontotemporal neurocognitive disorder, and muscle wasting and atrophy. Interviews with the MDS Nurse and the DON revealed that the care plan was not completed on time due to the MDS Nurse's workload and oversight. The facility's policy required the comprehensive care plan to be developed within 21 days of admission and updated as needed, which was not adhered to in this case.
Improper Incontinent Care Leading to Potential UTI Risk
Penalty
Summary
The facility failed to ensure that a resident who is incontinent of urine received appropriate treatment and services to prevent urinary tract infections. Specifically, during an observation, CNA CC did not separate the resident's labia and wiped from back to front during incontinent care. This improper technique was confirmed by CNA N, who assisted during the care and noted that the correct procedure was not followed. Both CNAs had recently received in-service training and skills check-offs on incontinent care, but the proper technique was not applied during the observed care session. The resident involved, a female with diagnoses including hypertension, neuropathy, and heart failure, required extensive assistance with all activities of daily living (ADLs) due to moderately impaired cognition. Interviews with CNA CC, CNA N, RN A, and the Director of Nursing (DON) confirmed that the improper cleaning technique could lead to contamination and infection. The facility's policy on perineal care, which mandates cleaning from front to back and separating the labia, was not adhered to during the incident.
Medication Error Rate Exceeds Acceptable Threshold
Penalty
Summary
The facility failed to ensure that the medication error rate was not five percent or greater, resulting in a medication error rate of 10%. This was based on three errors out of 28 opportunities, involving two residents. One resident, a male with moderate cognitive impairment and multiple diagnoses including hemiplegia and type 2 diabetes, was administered Cetirizine instead of the prescribed Loratadine by MA I. The medication aide mistakenly believed the two medications were the same and did not verify the correct medication with the nurse, despite having Loratadine available on the medication cart. The Director of Nursing (DON) and the Administrator confirmed that the medication aide should have followed the physician's orders precisely. Another resident, a female with severe cognitive impairment and diagnoses including vitamin D deficiency and congestive heart failure, did not receive her prescribed Vitamin D 50,000 units. MA JJ documented that the medication was not administered due to vitals being outside of parameters, although the actual reason was the unavailability of the medication from the pharmacy. Additionally, MA JJ administered a multivitamin with minerals instead of the prescribed multiple vitamin without minerals. The DON confirmed that the correct medication was available on the cart and should have been administered as per the physician's order. The facility's Oral Medication Administration policy requires staff to review and confirm medication orders on the MAR before administering medications. Both medication aides failed to adhere to this policy, leading to the medication errors. The DON and the Administrator emphasized the importance of following physician orders and ensuring medication availability to prevent such errors. The deficiencies observed could place residents at risk of inadequate therapeutic outcomes and other health complications.
Medication Storage and Administration Deficiencies
Penalty
Summary
The facility failed to ensure that drugs and biologicals were stored in locked compartments and accessed only by authorized personnel for two residents. Resident #64 had two boxes of Salonpas patches at her bedside without a medical order to self-administer. Despite having severe cognitive impairment, she was applying the patches herself, which were meant to be applied by the medication aide. The medication aide and LPN were unaware of the correct application instructions and the resident's unauthorized self-administration, leading to improper medication management and potential health risks for the resident. Resident #21 had a prescription box of Nystatin powder on her TV stand, which was being applied by CNAs during brief changes. The CNAs were not authorized to administer prescribed topical medications, and the LPN and DON confirmed that only licensed nurses should apply such medications. The CNAs were applying the Nystatin powder based on the resident's instructions, without proper oversight from licensed nursing staff, leading to a breach in medication administration protocols. Interviews with the DON and Administrator revealed that the facility's policy required a self-administration assessment for residents to self-administer medications, which was not conducted for either resident. The facility's failure to adhere to medication storage and administration protocols placed residents at risk of inadequate therapeutic outcomes and potential health decline.
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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 Humble
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Oakmont Healthcare And Rehabilitation Of Humble | 1 mi | ★★★★★ | 16 | 0 |
| Park Manor Of Humble | 1.1 mi | ★★★★★ | 9 | 0 |
| Crimson Heights Health & Wellness | 1.2 mi | ★★★★★ | 15 | 0 |
| Deerbrook Skilled Nursing And Rehab Center | 1.7 mi | ★★★★★ | 14 | 3 |
| Fall Creek Rehabilitation And Healthcare Center | 4 mi | ★★★★★ | 2 | 0 |
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