Below average — CMS composite of the measures below.
The next survey window likely opens around March 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 Hearthstone Nursing And Rehabilitation during CMS and state inspections, most recent first.
Three residents had MDSs that did not document current tobacco use even though care plans and smoking assessments identified them as smokers requiring supervision while smoking. Surveyors observed the residents outside smoking with staff, and interviews with the MDS nurse and ADM confirmed smoking status should have been included on the MDS but was omitted.
Kitchen staff failed to follow food safety and hygiene practices during puree food preparation and tray distribution. An employee did not wash hands before using the puree process, did not sanitize the prep counter or puree machine before placing chicken in it, and later had hair exposed outside the hairnet while distributing food. The DM also entered the kitchen without sanitizing hands, despite stated training and policy expectations for hand hygiene and hair covering.
Failure to perform hand hygiene during meal service: DM, MDSN, and CNAs were observed serving drinks and meal trays without using hand sanitizer between residents. Interviews confirmed staff had been trained on hand hygiene and food safety, and facility policy required hand hygiene before and after handling food.
An effective pest control program was not maintained when roaches were found in a resident’s room and another resident reported seeing roaches in her room as well. Staff and management acknowledged resident complaints about roaches, and the pest control log showed several complaints with only one spraying over two months. The facility policy stated it shall maintain an effective pest control program.
A resident with severe cognitive impairment and multiple comorbidities exhibited ongoing physical and verbal aggressive behaviors documented in MDS assessments and nursing progress notes, including hitting staff, throwing items, and pushing another resident. Despite these documented behaviors, the comprehensive care plan did not include aggression as a problem area or outline related goals and interventions. The DON, ADON, and ADM acknowledged that the care plan should have been updated in accordance with the facility’s care planning policy, which requires the IDT to revise care plans as resident conditions and behaviors change.
A resident with a newly diagnosed Major Depressive Disorder was not referred for a Level II PASARR evaluation after a significant change in condition. Despite facility policy and staff acknowledgment that a new diagnosis should trigger a PASARR review, the required referral was not completed, and the resident was not listed among PASARR-positive individuals.
A resident with a diagnosis of Major Depressive Disorder and a positive Level II PASARR screening did not receive a timely referral for specialized services, as required. Despite recommendations and approvals for therapies, the facility failed to notify the appropriate authorities and initiate PASARR services within the mandated timeframe, as confirmed by staff interviews and record review.
A facility failed to include hospice services in a resident's care plan, despite documentation of hospice admission in the resident's records. The MDS nurse, responsible for care plans, was unaware of this omission, which could delay necessary care. The resident, an elderly female with multiple health issues and severe cognitive impairment, was not care planned for hospice services, contrary to facility policy.
The facility failed to maintain proper infection control practices during medication administration, as observed with two residents. The MA did not perform hand hygiene or sanitize the blood pressure cuff between residents, increasing the risk of infection. Both residents had significant medical conditions, making them vulnerable to infections. Interviews confirmed the facility's policies on hand hygiene and equipment sanitation, which were not followed during the incidents.
A resident with severe cognitive impairment and a history of bipolar disorder was slapped on the head by a CNA during a wheelchair transfer in the facility's lobby. The incident was witnessed by the receptionist and a van driver from another facility. The resident was assessed with no apparent injury, and the CNA was removed from duty and terminated. Local law enforcement found probable cause for assault, resulting in a warrant for the CNA's arrest.
A facility failed to document follow-up observations for a resident with severe cognitive impairment and a tracheostomy stoma, who experienced uncontrolled coughing and respiratory distress. Despite interventions ordered by the NP, the resident's condition did not improve significantly, and he was sent to the ER. The nurse did not document changes in the resident's condition, and the facility's policy lacked guidance on nursing documentation.
A resident with severe cognitive impairment was observed spitting out her morning medication, which was not confirmed by the administering LVN. The LVN was unaware of the resident's history of pocketing/spitting out medication and did not ensure consumption, contrary to facility policy.
MDSs Did Not Reflect Smoking Status
Penalty
Summary
The facility failed to ensure that the MDS accurately reflected smoking status for three residents. Resident #22’s annual MDS did not mark current tobacco use, even though the care plan identified the resident as a smoker and the smoking assessment stated the resident required supervision during smoke breaks. Resident #22’s record also showed diagnoses including schizophrenia, dementia, dorsalgia, insomnia, and osteoarthritis, and the BIMS score on the annual MDS was 14, indicating intact cognitive response. Resident #34’s admission MDS also did not mark current tobacco use, although the care plan identified the resident as a smoker and the smoking assessment stated the resident required supervision while smoking. Resident #34’s record included diagnoses of protein-calorie malnutrition, type 2 diabetes mellitus without complications, muscle weakness, muscle wasting, difficulty walking, unsteadiness on feet, and cognitive communication deficit. The admission MDS showed a BIMS score of 15, indicating intact cognitive response. Resident #61’s admission MDS likewise did not mark current tobacco use, despite the care plan identifying the resident as a smoker and the smoking assessment stating the resident required supervision when smoking. Resident #61’s diagnoses included bipolar disorder, hypertension, muscle wasting, obstructive pulmonary disease, and repeated falls. Surveyors observed Residents #22, #34, and #61 outside smoking with staff during the survey. During interviews, the MDS nurse said smoking status was supposed to be included on the MDS and that if it was not, the MDS did not accurately reflect the resident; the administrator also stated smoking status should be included and said the missing entries might have been an oversight.
Kitchen Food Safety and Hand Hygiene Lapses
Penalty
Summary
The facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety in the kitchen. During observation on 04/01/26 at 10:45 a.m., CK H was preparing puree food for chicken and did not wash her hands before starting the puree process. She also did not wash or sanitize the preparation counter or the puree machine before placing the chicken in the machine. The facility’s General Kitchen Sanitation policy stated that all food preparation areas, food-contact surfaces, and equipment were to be cleaned and sanitized, including multi-use utensils and food-contact surfaces used in the preparation of potentially hazardous food prior to each use. During observation on 04/01/26 at 12:45 p.m., CK H was distributing food to trays and her hair restraint was not properly positioned; approximately 3 inches of hair were exposed outside the hairnet on the front and both sides of her head. During another observation on 04/01/26 at 12:25 p.m., the DM entered the kitchen without sanitizing her hands. The DM stated she had been trained in infection control and that staff were supposed to wash their hands before and after using the food processor, and everyone was supposed to wear hair covering from when they entered the kitchen until they left. CK H also stated she had been trained in infection control and understood that improper hand hygiene could spread infections, and that hair net use was part of the food safety policy.
Failure to Perform Hand Hygiene During Meal Service
Penalty
Summary
The facility failed to maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment to help prevent the development and transmission of disease and infection for 19 of 103 residents reviewed for infection control. During observation of meal service, DM was seen distributing drinks on 04/01/26 at 12:16 p.m. without using proper hand hygiene between serving drinks to residents. Later that day at 12:25 p.m., MDSN, CNA B, and CNA C were observed not using hand sanitizer between serving trays to residents. During interviews, CNA B stated she had been trained on hand hygiene but did not know why she had not used hand sanitizer after serving each resident. CNA C stated she had been trained in proper hand sanitation and demonstrated the use of hand sanitizer before serving the next resident. MDSN stated she had been trained on food safety and hand washing and that staff were to use hand sanitizer prior to delivering a tray to a resident. RN A stated CNAs were expected to use hand sanitizer between serving each tray to residents and that failure to do so could cause food borne illness. RD stated his role was clinical and that staff were expected to use hand sanitizers between tray passes. The facility's hand hygiene policy stated hand hygiene was the primary means to prevent the spread of infections and required hand hygiene before and after eating or handling food.
Pest Control Program Not Effective
Penalty
Summary
The facility failed to maintain an effective pest control program and was not free of roaches in resident rooms. Resident #23, a cognitively intact female with unspecified dementia and dependence on staff for ADLs, reported seeing roaches in her room and stated she had previously complained about them. During observation, a roach was seen crawling up the closet door and another roach was seen on the floor in her room. Resident #35, also dependent on staff for ADLs and with diagnoses of cardiovascular and coagulation conditions, stated she had seen roaches in her room before and had previously complained about them as well. Staff interviews reflected that employees and management were aware of resident complaints about roaches and that pest control was called to spray when roaches were reported. The MAIN director stated the last complaint was a week earlier and that the facility had been sprayed for roaches two times over the past 2 months, while also stating the issue had been going on for a month and a half. Review of the pest control book showed several resident complaints about roaches, but pest control came only one time to spray for roaches in two months. The facility policy stated that the facility shall maintain an effective pest control program.
Failure to Update Care Plan for Ongoing Aggressive Behaviors
Penalty
Summary
The deficiency involves the facility’s failure to review and revise a resident’s person-centered comprehensive care plan to reflect current aggressive behaviors. The resident, a 75-year-old female admitted with diagnoses including severe unspecified dementia without behavioral disturbance, type 2 diabetes mellitus, delusional disorder, depression, and hypertension, had an MDS assessment showing a BIMS score of 2, indicating severe cognitive impairment. The same MDS documented physical behavioral symptoms directed toward others, verbal behavioral symptoms, and other behavioral symptoms occurring multiple days during the look-back period. Despite these documented behaviors, the comprehensive care plan dated 10/31/2025 did not include an aggressive behavior problem area, related goals, or interventions. Nursing progress notes documented multiple episodes of escalating aggressive behavior over several weeks. On 9/17/2025, staff documented the resident throwing items off the counter, hitting staff, cussing at staff, throwing offered water on the floor, and being on 1:1 observation. On 9/24/2025, notes indicated physically aggressive behavior toward staff and that the resident pushed another resident down when touched, with reports of increased aggressive behaviors during the day. On 10/3/2025, documentation showed the resident was physically aggressive toward nursing staff when they attempted to redirect her. These entries demonstrated ongoing and increasing aggressive behaviors that were recorded in the nursing notes but not incorporated into the resident’s care plan. Interviews with facility leadership confirmed that the care plan was not updated to reflect the resident’s aggressive behaviors despite policy requirements. The DON stated she was familiar with the Care Planning policy, acknowledged that the MDS coordinator was responsible for completing care plans with input from the IDT, and agreed that the resident’s aggressive behaviors should have been documented in the care plan but did not know why this had not occurred. The ADON reported recent training on the Care Plans policy and stated that the resident’s care plan needed to be updated as soon as behaviors were reported by staff. The ADM also confirmed prior training on care planning, stated that the resident’s physical aggression should be documented in the care plan as soon as it was noticed or as soon as possible, and noted that while the behaviors were documented in nursing progress notes, they were not reflected in the care plan. Review of the facility’s Care Planning policy showed that care plans must incorporate identified problem areas, risk factors, measurable goals, and be revised as residents’ conditions change, which did not occur in this case.
Failure to Refer Resident for Level II PASARR After New Mental Health Diagnosis
Penalty
Summary
The facility failed to refer a resident for a Level II PASARR (Preadmission Screening and Resident Review) following a new diagnosis of Major Depressive Disorder. Record review showed that the resident was admitted with no prior diagnosis of mental disorder, intellectual disability, or related condition, as indicated by a negative Level I PASARR screening. However, subsequent documentation, including the resident's face sheet, MDS record, and care plan, confirmed a diagnosis of Major Depressive Disorder. Despite this significant change in condition, there was no evidence that the resident was referred for a Level II PASARR evaluation, nor was the resident listed among PASARR-positive residents. Interviews with facility staff, including the MDS Coordinator, DON, and Administrator, confirmed that the facility's policy requires a new PASARR screening upon a significant change in condition or new diagnosis of mental illness, intellectual disability, or related condition. Staff acknowledged that failure to conduct an accurate PASARR screening could result in residents not receiving appropriate services. The MDS Coordinator was identified as responsible for PASARR screenings, but the required referral for Level II PASARR was not completed for the resident after the new diagnosis.
Failure to Timely Refer Resident for PASARR Specialized Services
Penalty
Summary
The facility failed to notify the appropriate state mental health or intellectual disability authority promptly after a significant change in the condition of a resident with a mental illness, as required for PASARR (Preadmission Screening and Resident Review) processes. Record review showed that a male resident with a diagnosis of Major Depressive Disorder had a positive Level II PASARR screening and was recommended for specialized services, including physical, occupational, and speech therapy. Despite these recommendations and approvals for services, the facility did not ensure that the resident was referred to PASARR services within the required timeframe. The care plan did not indicate whether the resident received PASARR services, and documentation revealed the resident had been PASARR positive for several years. Interviews with facility staff, including the MDS Coordinator, DON, and Administrator, confirmed that the referral for PASARR services was not sent within the required 20-day period following the IDT meeting. Staff acknowledged that this delay or omission could result in the resident not receiving necessary specialized services. Facility policy required notification to the Local Intellectual and Developmental Disability Authority (LIDDA) within two days of admission for positive PASARR screenings, but this process was not followed for the resident in question.
Failure to Include Hospice Services in Resident's Care Plan
Penalty
Summary
The facility failed to develop and implement a comprehensive person-centered care plan for a resident who was receiving hospice services. Despite the resident's admission to hospice being documented in the physician's orders and the Admission MDS assessment, the care plan did not reflect this critical aspect of the resident's care. The MDS nurse, who was responsible for completing care plans, acknowledged awareness of the resident's hospice status but was unaware that the care plan did not include hospice services. This oversight could potentially lead to a delay in care or interventions for the resident. The resident in question was an elderly female with multiple diagnoses, including diabetes, hyperlipidemia, dementia, and hypertension, and was severely cognitively impaired with a BIMS score of 07. The Director of Nursing (DON) confirmed that the MDS nurse was responsible for care planning hospice services and that the omission of hospice services from the care plan was not in line with the facility's policy. The facility's policy mandates that care plans include measurable objectives and timeframes to meet the resident's needs, and the failure to include hospice services in the care plan was a deviation from this policy.
Inadequate Infection Control Practices During Medication Administration
Penalty
Summary
The facility failed to establish and maintain an effective infection prevention and control program, as evidenced by the improper hand hygiene and equipment sanitation practices observed during medication administration for two residents. The medication aide (MA) did not perform hand hygiene or sanitize the blood pressure cuff between residents, which is a critical step in preventing the transmission of communicable diseases and infections. This oversight was observed during the administration of medications to two residents, both of whom had significant medical conditions that increased their vulnerability to infections. Resident #17, a female with severe cognitive impairment and multiple diagnoses including encephalopathy, acute respiratory failure, diabetes, pneumonia, anxiety, and major depressive disorder, was one of the residents affected. Her care plan included a focus on resolving an acute infection without complications. The MA used an unsanitized blood pressure cuff on Resident #17 and failed to perform hand hygiene before and after administering medications. Similarly, Resident #44, who had moderate cognitive impairment and a history of dementia, depression, high blood pressure, and urinary tract infections, was also at risk. Her care plan highlighted the risk of infection, particularly COVID-19. The MA repeated the same unsanitary practices with Resident #44, using the same blood pressure cuff without cleaning it and neglecting hand hygiene. Interviews with the MA, DON, RN, and ADM confirmed the facility's policies on hand hygiene and equipment sanitation, emphasizing their importance in infection control, yet these were not adhered to during the observed incidents.
Resident Abuse Incident Involving CNA
Penalty
Summary
The facility failed to protect a resident from abuse, as evidenced by an incident involving a Certified Nursing Assistant (CNA) who slapped a resident on the head in the presence of witnesses. The incident occurred in the facility's front lobby while the resident was being transferred to another wheelchair. The resident, who has severe cognitive impairment and a history of bipolar disorder, was reportedly making a kicking movement when the CNA responded by slapping him. This action was witnessed by the facility's receptionist and a van driver from another facility. The resident involved in the incident is an elderly male with a history of cerebral infarction, hemiplegia, hemiparesis, acute respiratory failure, and bipolar disorder. His care plan indicated a severe cognitive impairment with a BIMS score of 0, and he had not exhibited any physical or verbal behaviors prior to the incident. The resident's care plan also noted a self-care deficit and potential for physical aggression due to his bipolar disorder, with specific interventions outlined for staff to manage his behavior. Following the incident, the resident was assessed by a nurse, who found no apparent injury on his head. The facility's administrator, who serves as the abuse and neglect coordinator, was notified, and an investigation was initiated. The CNA involved was removed from duty and subsequently terminated. The incident was reported to local law enforcement, who found probable cause for assault, leading to a warrant for the CNA's arrest.
Failure to Document Follow-Up Observations for Resident with Respiratory Distress
Penalty
Summary
The facility failed to ensure accurate documentation of medical records for a resident with severe cognitive impairment and a tracheostomy stoma. The resident was experiencing uncontrolled coughing and respiratory distress, which was reported by his roommate. LVN C assessed the resident and noted foam-like secretions from the trach, elevated pulse, and complaints of dizziness and tiredness. The nurse contacted the NP on-call, who ordered a nebulizer treatment, suctioning, and monitoring. Despite these interventions, the resident's condition did not improve significantly, and he was eventually sent to the emergency room for further evaluation. The deficiency arose because LVN C did not document follow-up observations or assessments after initiating treatments for the resident's condition. Although the nurse recalled the resident's condition improving temporarily, she failed to record these changes in the progress notes. The DON confirmed that she expected all assessments to be documented to ensure timely and appropriate care. The facility's Change of Condition Policy did not address nursing documentation, contributing to the lack of proper record-keeping.
Failure to Ensure Resident Consumed Medication
Penalty
Summary
The facility failed to ensure that a resident consumed her morning medication, as observed on 04/03/24. The resident, who has severe cognitive impairment and no swallowing disorders, was seen spitting her medication into a trash can. LVN A, who was administering the medication, witnessed the incident but did not confirm the resident's consumption of the medication. LVN A mentioned it was her first day in the Memory Care Unit (MCU) and was unaware of the resident's history of pocketing or spitting out medication. She attempted to mix the medication with apple sauce, which the resident found too tart, and planned to try again with chocolate pudding. The Director of Nursing (DON) from a sister facility stated that the expectation during medication pass is for the nurse or medication aide to ensure that each resident consumes their medication. The facility's Medication and Preparation Administration Policy also requires staff to confirm resident consumption of the medication. The failure to ensure the resident consumed her medication could result in the resident not receiving the intended therapeutic benefits and potentially exacerbating her chronic medical conditions.
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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 Round Rock
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Park Valley Inn Health Center | 0.5 mi | ★★★★★ | 10 | 0 |
| Ignite Medical Resort Round Rock, Llc | 1.8 mi | ★★★★★ | 12 | 0 |
| The Center At Parmer | 1.9 mi | ★★★★★ | 18 | 0 |
| Trinity Care Center | 2.6 mi | ★★★★★ | 9 | 0 |
| San Gabriel Rehabilitation And Care Center | 3.8 mi | ★★★★★ | 5 | 2 |
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