Average — CMS composite of the measures below.
The next survey window likely opens around January 2027
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 Harlingen Nursing And Rehabilitation Center during CMS and state inspections, most recent first.
Medication carts on multiple halls contained opened medications without Open Date labels, including ophthalmic products, inhalation solution, nasal spray, and sevelamer pouches. One med cart also had loose pills inside it, including sertraline, memantine, losartan, and furosemide. The CMA said he was in a hurry and overlooked labeling, while the DON stated nurses and medication aides were responsible for dating opened meds and that all shifts were responsible for checking labels.
Dirty Juice Dispenser Nozzle: The facility failed to keep a juice dispenser gun clean when surveyors observed a reddish slimy substance and brownish stains on the nozzle. The DM said the juicer had been used earlier for breakfast and should be cleaned daily, while kitchen staff and the Administrator stated staff cleaned appliances and equipment daily, including the juicer and nozzle. The facility’s sanitation policy required food-contact surfaces and equipment to be cleaned and sanitized after each use.
Incomplete Person-Centered Care Plans: A resident with severe cognitive impairment and multiple diagnoses had no activities goals or interventions in the care plan despite documented preferences for cartoons, movies, and in-room visits. Another resident with HF, dysphagia, and bipolar disorder had ADL care needs documented by CNA staff, but the care plan did not include her ADL level of care. Interviews showed the AD and MDS staff each believed the other was responsible for the missing care plan details, and the DON confirmed the ADL level of care should have been included.
A resident with severe cognitive impairment, hemiplegia, hemiparesis, and a history of acute respiratory failure had an active oxygen order for 2 LPM via NC every shift, but the care plan still listed 5 LPM via NC. The DON and MDS staff member acknowledged the care plan was not revised to reflect the current oxygen intervention, despite the facility policy requiring review and revision when a resident has a status change.
Failure to provide an ongoing activities program for a resident with severe cognitive impairment and multiple diagnoses, including metabolic encephalopathy, tracheostomy, Down syndrome, and communication deficits. The resident liked cartoons, movies, and family contact, but the care plan had no activity goals or interventions, the activity record had no entries, and observations showed the resident in bed with the TV off and no other stimulation. The AD said activities were not documented and the care plan was not updated because she believed MDS was responsible.
A resident with severe cognitive impairment, hemiplegia/hemiparesis, and respiratory failure was ordered oxygen at 2 LPM via NC every shift, and the care plan identified oxygen therapy as part of her treatment. During observation, the NC was found on the resident's cheek instead of in her nostrils while the concentrator was running. An LVN checked the O2 sat, repositioned the NC, and the saturation increased. The LVN and CNA stated they had not checked the resident again after the start of the shift, and the DON stated oxygen should have been checked more frequently.
Late Breakfast Service and Missed Evening Snacks: Two residents who ate in their rooms did not receive an evening snack, and breakfast was delayed beyond the usual time because CNA staffing on the hall was reduced when one CNA was reassigned and another was sent to the dining room. One resident had DM and received morning insulin and oral DM medication before breakfast, while both residents were assisted with breakfast only after the trays remained on the cart until late morning. The Dietician and facility policy stated meals should not exceed 14 hours between the evening meal and breakfast.
Inaccurate documentation of O2 tubing change: An LPN initialed the MAR for a resident's weekly O2 tubing change even though the tubing was not changed because supplies were unavailable. The resident had COPD and moderate cognitive impairment, and later observation showed the tubing was still labeled with an earlier date. The ADON and another LPN confirmed the MAR should reflect when the task was actually completed.
The facility failed to post the most recent survey results in a location readily accessible to residents, family members, and legal representatives. During observation, the survey binder was found on a desk in a back corner near the receptionist area, covered by two other binders and not labeled as a survey binder, even though it contained the last survey. Six residents said they did not know how to access survey results and had never seen a labeled binder with that information, while the Administrator stated the binder had always been in the front area and that he was responsible for updating it.
A resident with advanced dementia, type 2 DM with multiple complications, CKD, and malnutrition experienced progressively and then critically elevated blood glucose levels over several days, as shown by repeated lab results. Despite a care plan noting a history of DM and the need to monitor for hyperglycemia, there were no orders for routine glucose checks, and no treatment orders were obtained for the high glucose values. Nursing staff reported the abnormal and critical labs to the NP on multiple occasions but received no new orders and did not advocate for treatment, while the NP acknowledged focusing on hydration, weight loss, and a suspected infection rather than addressing the rising glucose. The resident ultimately required hospitalization for hyperglycemia along with other diagnoses.
A resident with quadriplegia and other medical conditions did not receive necessary nasal grooming services, leading to excessive nasal hair. Despite being dependent on staff for all ADLs, the resident was not offered nasal hair trimming, and staff were unaware of their responsibility to provide this service. Facility policy required maintaining grooming and personal hygiene, which was not followed.
The facility failed to label and date food items in the freezer, as observed with a bag of chicken nuggets that were not labeled or dated. The Dietary Manager confirmed these were leftovers from the previous day and acknowledged that staff had been trained to follow proper labeling and dating procedures. This oversight could place residents at risk of foodborne illnesses.
A facility failed to maintain an effective infection prevention and control program. An LVN was observed touching surfaces without hand hygiene before checking a resident's blood sugar and improperly storing an insulin pen. An RN failed to perform hand hygiene between glove changes during a g-tube feeding. Both staff had received recent infection control training, but deficiencies indicate non-adherence to established practices.
A resident with dementia and a history of wandering eloped from an LTC facility due to inadequate supervision. The resident, identified as a moderate risk for wandering, was found by police two miles away. Staff interviews revealed that the facility's elopement protocol was not effectively implemented, leading to the resident's unsupervised departure.
Medication carts contained unlabeled opened medications and loose pills
Penalty
Summary
The facility failed to ensure drugs and biologicals were stored in accordance with accepted professional principles for 3 of 4 medication carts reviewed: the Hall 400 Med-Aide cart, Hall 300 Med-Aide cart, and Hall 100 Nurse Med-Cart. On observation, two boxes of Cyclosporine Ophthalmic emulsion 0.05% for two different residents in the Hall 400 Med-Aide cart did not have an Open Date label, and the boxes contained open pouches with eye drop vials. In the Hall 300 Med-Aide cart, a box of Xiidra 5% ophthalmic solution and an opened box of Sevelamer Carbonate 2.4 g pouches did not have Open Date labels, and in the Hall 100 Nurse Med-Cart, two opened boxes of Ipratropium/Albuterol 2.5 MG inhalation solution and an open box of Fluticasone Propionate nasal spray did not have Open Date labels. The Hall 300 Med-Aide cart also contained five loose pills identified as sertraline 25 mg, memantine 5 mg (2 pills), losartan 5 mg, and furosemide 40 mg. During interview, the CMA stated he had checked his cart for expired medications and dates but was in a hurry and did not label a box of eye drops he had just opened, and he overlooked the missing dates on other medication boxes. The DON stated nurses and medication aides were responsible for dating medications when opened and that all shifts were responsible for labeling medications. She also stated medication aides were responsible for cleaning medication carts and that loose pills found in a cart would be reported and destroyed.
Dirty Juice Dispenser Nozzle
Penalty
Summary
The facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety for 1 of 1 kitchen reviewed for sanitation. During an initial kitchen tour, the juice dispenser gun was observed with a reddish slimy substance adhered to it and brownish stains on one side of the nozzle. Record review of the facility’s Daily Cleaning Schedule for February 2026 showed the juicer had been cleaned each day from the 1st through the 21st. In an interview, the DM said the juicer had been used earlier that morning for breakfast and stated the juicer and nozzle would be cleaned daily, but he would not say whether the substance on the nozzle was from that day’s use or an accumulation over several days. He was also unable to state the negative outcome to residents if the juicer nozzle was not clean. Two DA staff members stated kitchen staff were responsible for cleaning their assigned areas at the end of their shifts and then assisting with cleaning all equipment, including the juicer and its nozzle. The Administrator also stated kitchen staff cleaned all appliances daily but was unable to state the negative outcomes to residents if the juicer nozzle was not clean. The facility’s General Kitchen Sanitation policy required all food-contact surfaces and equipment to be cleaned and sanitized, and after each use, all food-contact surfaces of equipment were to be cleaned and sanitized.
Incomplete Person-Centered Care Plans
Penalty
Summary
The facility failed to develop and implement comprehensive person-centered care plans for 2 of 9 residents reviewed. For Resident #1, who was admitted with metabolic encephalopathy, a tracheostomy, cognitive communication deficit, generalized muscle weakness, Down syndrome, and mixed receptive-expressive language disorder, the quarterly MDS showed a BIMS of 00 and dependence for activities such as bed mobility, transfers, and oral hygiene. Her comprehensive care plan initiated on 01/02/26 did not include goals or interventions for activities, even though the admission activities review documented that she liked watching cartoons and movies on TV, wanted to be close to her family, and was appropriate for in-room visits. During interviews, the AD stated she had not added activities to Resident #1’s care plan because she believed that was not her responsibility and said MDS staff were responsible for it. The AD later said she would update MDS on resident activities and that they would add it to the care plan. The MDS staff member stated she was responsible for updating care plans, that activities were discussed with the AD, and that it was an oversight that activities had not been added to Resident #1’s care plan. The DON stated Resident #1 not having activities done could possibly have had negative outcomes but was not sure. For Resident #69, who had diagnoses including heart failure, dysphagia, and bipolar disorder, the annual MDS showed a BIMS of 14 and substantial/maximal assistance with eating. CNA interviews stated she required a 1-person assist for all ADLs and assistance with all meals. However, the comprehensive care plan dated 12/31/25 did not include her level of care for ADLs, and the MDS staff member stated that her care plan had not included her ADL level of care since 09/01/25 because the section had been resolved in error. The DON stated a resident’s care plan should include the level of care for ADLs and said she was not sure why the omission was not identified.
Care Plan Not Updated for Changed Oxygen Order
Penalty
Summary
The facility failed to review and revise the comprehensive care plan for one resident when the resident’s oxygen order changed. Resident #106 had diagnoses including hemiplegia and hemiparesis following cerebral infarction, acute respiratory failure with hypoxia, pneumonia, muscle wasting, and atrophy. The quarterly MDS showed a BIMS score of 00 indicating severe cognitive impairment and noted that the resident was receiving oxygen therapy. The active order summary showed an order for oxygen at 2 LPM via NC every shift related to moderate persistent asthma. The resident’s care plan, however, still listed oxygen at 5 LPM via NC every shift related to acute respiratory failure with hypoxia, with the intervention last revised on 07/30/25. The care plan was dated 01/30/26 and did not reflect the current oxygen order. In interviews, the DON stated care plans are revised quarterly or when there is a change in condition and acknowledged the resident had changes that required revision but the update was not done. The MDS staff member stated she was responsible for care plan revisions and took responsibility for the care plan not being updated during the quarterly revision. The facility policy stated the comprehensive care plan will be reviewed and revised as necessary when a resident experiences a status change, and the care plan will be updated with new or modified interventions.
Failure to Provide In-Room Activities
Penalty
Summary
The facility failed to provide an ongoing activities program to support residents in their choice of activities, including facility-sponsored group and individual activities and independent activities, for 1 of 3 residents reviewed for activities. Resident #1 was admitted with diagnoses including metabolic encephalopathy, tracheostomy, cognitive communication deficit, generalized muscle weakness, Down syndrome, and mixed receptive-expressive language disorder. The resident’s Quarterly MDS showed a BIMS of 00, indicating severely impaired cognition, and the resident was dependent for sit-to-lying, chair/bed-to-chair transfer, and oral hygiene. Resident #1’s comprehensive care plan, initiated on 01/02/26, contained no goals or interventions for activities, even though the Activities Initial Review stated the resident liked to watch cartoons and movies on TV and be close to family, and that the resident was appropriate for in-room visits and would benefit from them. The hard copy activity record for February 2026 had no activity entries for the resident. During observations on 02/22/26 and 02/23/26, the resident was in bed, alert, non-verbal, and non-responsive, with the television off and no other stimulation observed in the room. The AD stated she had done activities with the resident but had not documented them because she had been busy with new staff, and said she had not added activities to the care plan because she believed that was MDS responsibility. The DON said the resident may have benefited from stimulation activities but could not answer for certain, and the Administrator stated the AD and MDS work together to create activities for residents.
Oxygen Not Properly Applied to Resident on Ordered Therapy
Penalty
Summary
Resident #106, a [AGE]-year-old female with diagnoses including hemiplegia and hemiparesis following cerebral infarction, acute respiratory failure with hypoxia, pneumonia, muscle wasting and atrophy, and severe cognitive impairment, was ordered oxygen at 2 LPM via nasal cannula every shift for respiratory failure/moderate persistent asthma. Her care plan also identified oxygen therapy every shift related to acute respiratory failure with hypoxia. During observation on 02/22/26 at 3:50 pm, the resident was in bed with the head of the bed slightly elevated, and the nasal cannula was found on her left cheek rather than in her nostrils while the oxygen concentrator was running at 2 LPM. At 3:51 pm, the LVN observed the cannula was not placed in the nostrils, checked the resident's oxygen saturation at 94%, and then repositioned the cannula, after which the saturation rose to 96%. The LVN stated she had entered the room at the start of her shift at 2:00 pm but had not returned to check on the resident. The CNA stated she had passed by the room several times but did not notice the cannula was out of place and had not yet entered the room since arriving on the hall. The DON stated nurses and CNAs were to round every 2 hours and as needed, that oxygen was considered a treatment and should have been checked more frequently, and that the facility did not have a policy on oxygen.
Late Breakfast Service and Missed Evening Snacks
Penalty
Summary
The facility failed to ensure that no more than 14 hours elapsed between a substantial evening meal and breakfast the following day for two residents who ate in their rooms. Resident #84 was a female with diagnoses including type 2 diabetes, legal blindness, adult failure to thrive, and dysphagia. Her MDS reflected a BIMS score of 10 and that she was dependent for eating. Her care plan identified an ADL self-care performance deficit and noted she was dependent for eating. Her snack history showed she did not receive an evening snack on 02/21/26. On 02/22/26, Resident #84 received breakfast later than usual. A CNA observed delivering and feeding her breakfast at 9:47 a.m., and the resident stated the meal was later than usual but still warm and palatable. The CNA said the breakfast cart had arrived on the hall at about 7:45 a.m., but staffing on the hall was reduced because one CNA was pulled to another hall and another was assigned to the dining room, leaving her alone to cover six residents who stayed in their rooms and needed assistance with meals. The CNA stated that when the hall was fully staffed, residents who stayed in their rooms and needed assistance usually received breakfast by 8:30 a.m. Resident #84 had also received diabetes medications that morning, including Lantus at 6:43 a.m. and Farxiga at 6:00 a.m., with a blood sugar of 99. Resident #69 also ate in her room and did not receive an evening snack on 02/21/26. Her diagnoses included heart failure, dysphagia, and bipolar disorder. Her MDS reflected a BIMS score of 14 and that she required assistance with eating. Her care plan identified an ADL self-performance deficit and stated she required sub/max assistance for eating. On 02/22/26, she was observed in bed requesting food, and her breakfast tray was delivered at 9:45 a.m. by a CNA who said she had been assigned to assist residents in the dining hall and returned to the hall at about 9:40 a.m., when only Resident #69's tray remained on the cart. The CNA then delivered the tray and assisted her with breakfast. The DM stated the facility's protocol was for a dietary aide to deliver breakfast carts to the halls for residents who preferred to eat in their rooms, and the Dietician stated meals should have been served with no more than 14 hours between the evening meal and breakfast the following day. The facility's Meal Times policy also stated meals would be served according to state and federal regulations, with no more than fourteen hours between the evening meal and breakfast the following day.
Inaccurate documentation of O2 tubing change
Penalty
Summary
The facility failed to maintain an accurate medical record for Resident #70 by documenting that oxygen tubing had been changed when it had not been changed. Resident #70 was admitted on 12/30/2025 with hypertensive urgency and COPD, and her MDS assessment dated 1/1/2026 reflected a BIMS score of 11, indicating moderate cognitive impairment. The physician order summary showed an order to change O2 tubing weekly on Sunday and as needed, and the February MAR was initialed on 2/15/2026 by LVN J for the tubing change. During observation on 2/22/2026, Resident #70's O2 tubing was labeled 2/9/26. The resident said she did not recall when the tubing had been changed, and staff had recently been in the room checking the O2 concentrator because it was making a loud noise. The ADON stated the tubing should have been documented on the MAR when changed and did not know how it was overlooked. LVN K said night nurses changed the O2 tubing and that weekly reminders were given. LVN J later stated she signed the MAR by mistake and had not changed the tubing on 2/15/2026 because she ran out of tubing wrap, adding that the MAR should only be signed once the order was carried out.
Survey Results Not Readily Accessible
Penalty
Summary
The facility failed to post the results of the most recent survey in a place readily accessible to residents, family members, and legal representatives, and failed to post notice of the availability of those reports in prominent and accessible areas of the facility. During an observation at the front door area near the receptionist desk, the survey binder was found on top of a desk set toward a back corner wall, covered by two other binders, and it did not have visible lettering identifying it as a survey binder, although it contained the last survey. In a confidential interview, six residents stated they did not know where or how to access survey results in the facility and said they had never seen a binder labeled with that information anywhere in the facility. The Administrator stated the survey binder had always been located in the front area by the receptionist desk and that residents were aware of its location, and he said he was responsible for updating the binder. The facility did not provide a policy for survey results.
Failure to Treat Critically Elevated Blood Glucose Levels in Diabetic Resident
Penalty
Summary
The deficiency involves the facility’s failure to ensure that a resident with multiple diabetes-related diagnoses received treatment and care in accordance with professional standards of practice when experiencing significantly elevated blood glucose levels. The resident, an elderly female with Alzheimer’s disease, type 2 diabetes mellitus with multiple complications (including diabetic retinopathy, chronic kidney disease, cataracts, and peripheral angiopathy), and moderate protein-calorie malnutrition, had a care plan noting a history of diabetes and the need to monitor, document, and report signs and symptoms of hyperglycemia. Despite this, there were no physician or practitioner orders in place for routine glucose monitoring or blood sugar checks. Laboratory results showed progressively elevated glucose levels over several days. A comprehensive metabolic panel on 02/04/26 showed a glucose level of 310 mg/dL, on 02/06/26 a level of 336 mg/dL, and on 02/13/26 a critically high level of 625 mg/dL. Nursing notes and the medication orders revealed that no new orders were requested or obtained for treatment of these high glucose levels, and there were no orders for glucose checks. Progress notes documented that lab results, including critical values, were communicated to the nurse practitioner on multiple occasions (02/05/26, 02/09/26, and 02/13/26), yet no new orders were issued to address the hyperglycemia. Interviews confirmed that nursing staff and the nurse practitioner were aware of the elevated glucose levels but did not initiate treatment for hyperglycemia. LVNs reported that they had communicated the lab results to the nurse practitioner and received no treatment orders, and they did not make recommendations for treatment, stating they followed practitioner orders. The nurse practitioner acknowledged reviewing the labs, being aware of the increasing glucose levels, and focusing on hydration, weight loss, and a suspected infection, without placing new orders for the rising glucose. The DON stated that the resident was being treated for weight loss and other medical conditions, that no orders were received for high glucose levels, and that staff did not ask if anything should be ordered. The resident ultimately experienced an episode of high blood sugar over several days that led to hospitalization with a diagnosis including hyperglycemia.
Failure to Provide Nasal Grooming for Resident
Penalty
Summary
The facility failed to provide necessary grooming services to a resident who was unable to perform activities of daily living independently. The resident, a male with a history of Guillain-Barre Syndrome, quadriplegia, and other medical conditions, was observed to have excessive nasal hair protruding from his nostrils. Despite being dependent on staff for all activities of daily living, the resident reported that he had not requested nasal hair trimming because he believed staff could not perform this task, and staff had not offered this service to him. Interviews with facility staff revealed a lack of awareness and responsibility regarding nasal grooming. A CNA responsible for the resident's showering and grooming did not notice the nasal hair and stated that such grooming was not part of her duties. Similarly, an LVN admitted to not noticing the nasal hair and stated that he had never been asked to trim nasal hair, believing it was a task for nurses. Another LVN confirmed that nasal grooming was the responsibility of nurses and acknowledged that staff should offer grooming services to residents. The facility's policy on activities of daily living emphasized the need to provide necessary services to maintain grooming and personal hygiene, which was not adhered to in this case.
Failure to Label and Date Food Items in Freezer
Penalty
Summary
The facility failed to adhere to professional standards for food service safety by not labeling and dating food items in the freezer. During an observation of the facility's freezer, a plastic bag containing what appeared to be chicken nuggets was found without any label or date. The Dietary Manager confirmed that these were leftover, uncooked chicken nuggets from the previous day's dinner service. He acknowledged that the staff had been trained to label, date, and store such items in a zip-top bag, but this procedure was not followed in this instance. Interviews with staff revealed that they were trained to label and date all opened food items in the refrigerator, freezer, or dry storage to ensure proper tracking of when the items were opened and to determine their usability. The facility's policy on food storage, revised in June 2019, mandates that frozen foods be stored in moisture-proof wrap or containers that are labeled and dated. Despite this policy and the training provided, the failure to label and date the chicken nuggets could potentially place residents at risk of foodborne illnesses.
Infection Control Deficiencies in LTC Facility
Penalty
Summary
The facility failed to maintain an effective infection prevention and control program, as evidenced by the actions of LVN A and RN B. LVN A was observed touching multiple surfaces without performing hand hygiene before checking a resident's blood sugar. Additionally, LVN A placed an insulin pen inside his scrub top pocket before administering insulin to the resident. During an interview, LVN A acknowledged the importance of not keeping the insulin pen in his pocket and the need to sanitize hands to prevent cross-contamination. RN B was observed failing to perform hand hygiene between glove changes during a g-tube feeding administration for another resident. In an interview, RN B admitted the importance of sanitizing hands between glove changes to prevent cross-contamination. Both LVN A and RN B had received recent in-service training on infection control, including hand hygiene and enhanced barrier precautions. The Director of Nursing (DON) and Assistant Director of Nursing (ADON) confirmed the facility's policy requiring staff to change gloves and sanitize hands to prevent cross-contamination. The facility's infection prevention and control program policy and hand hygiene policy emphasize the importance of hand hygiene and the use of personal protective equipment. Despite these policies and training, the observed deficiencies indicate a failure to adhere to established infection control practices.
Resident Elopement Due to Inadequate Supervision
Penalty
Summary
The facility failed to provide adequate supervision to prevent the elopement of a resident with a history of dementia, Type 2 diabetes, depression, and cerebrovascular disease. The resident, who had severely impaired cognition and was identified as a moderate risk for wandering, eloped from the facility and was found by the police approximately two miles away. The incident occurred shortly after the resident was admitted to the facility, and the resident had previously exhibited wandering behavior. On the night of the incident, the resident was last seen in her room at 9:31 p.m. and was discovered missing at 10:05 p.m. Staff initiated a search and contacted the police, who had already picked up the resident near a supply store. The resident was found confused but without injuries. The facility's records indicated that the resident had previously walked out of a hospital and had expressed a desire to leave her home. Interviews with staff revealed that the facility had an elopement protocol in place, but it was not effectively implemented in this case. The staff was aware of the resident's moderate risk for wandering, but the facility's measures to prevent elopement were insufficient, leading to the resident's unsupervised departure from the premises.
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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 Harlingen
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Windsor Nursing And Rehabilitation Center Of Harli | 0.8 mi | ★★★★★ | 4 | 0 |
| Treasure Hills Healthcare And Rehabilitation Cente | 0.9 mi | ★★★★★ | 10 | 0 |
| Golden Palms Rehabilitation And Retirement | 1.2 mi | ★★★★★ | 7 | 0 |
| Sun Valley Rehabilitation And Healthcare Center | 1.3 mi | ★★★★★ | 0 | 0 |
| Windsor Atrium | 1.7 mi | ★★★★★ | 17 | 1 |
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