Above average — CMS composite of the measures below.
The next survey window likely opens around November 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 Heritage House At Keller Rehab & Nursing during CMS and state inspections, most recent first.
A resident with severe cognitive impairment and documented ADL self-care deficits had a quarterly MDS completed by an LVN that failed to accurately and completely address Safety and Quality of Performance for multiple ADLs, including eating, oral hygiene, toileting hygiene, bathing, dressing, footwear, and personal hygiene, and did not indicate the type of wheelchair or scooter used. The resident’s care plan showed she required assist of one for personal hygiene and bathing and was at risk for unmet needs and emotional distress, yet these needs were not fully captured in the MDS. The ADON was unaware of the incomplete and inaccurate MDS, and the DON stated that comprehensive, timely MDS completion was expected per facility policy, which requires a comprehensive assessment process and timely quarterly assessments to identify care needs and guide the care plan.
A resident with intact cognition and multiple chronic conditions had antihistamine eye drops at the bedside and reported using them twice daily on his own. Staff were unaware the drops were in the room, and the charge nurse removed them. The ADON and DON stated residents should not keep medications in their rooms without an assessment, care plan update, and order, and the facility policy required medications to be secured or directly observed.
Expired medications were found on the Hall 300 nurse medication cart, including Nitroglycerin 0.4 mg and Oxycodone 10 mg past their expiration or use-by dates. The LVN said she was responsible for checking the cart and had last checked it two weeks earlier, while the DON said all nurses were responsible for removing expired meds and the ADON was to monitor labeling and disposal. Facility policy required routine inspection of medication carts for outdated or improperly labeled meds and removal for destruction.
Undated Open Insulin Vial in Medication Refrigerator: An opened, partially used vial of Lantus insulin was observed in a medication refrigerator without an open date. LVN A stated nurses were responsible for dating insulin when opened, and the DON and ADON both stated staff were expected to ensure insulin was labeled and dated. Record review showed the facility had training and a medication storage policy requiring opened multiple-dose vials to be dated.
A CNA failed to use a gait belt while transferring a resident with right-sided weakness and a history of stroke from the toilet to a wheelchair, despite care plan instructions and facility policy. The resident fell during the transfer, sustaining multiple fractures. Staff interviews confirmed that gait belts were required and available, and that the resident did not refuse its use.
A resident with a PICC line did not have her IV dressing changed according to physician orders and facility policy, as the dressing was found to be overdue during observation. Nursing staff failed to check the dressing date and only assessed the IV site for redness and swelling, while documentation indicated the task was completed when it was not. The care plan did not reflect the presence of a PICC line, and required monitoring and documentation were not consistently performed.
A CNA assisted an LVN with wound care for a resident with multiple wounds and a wound vac without wearing a gown, as required by Enhanced Barrier Precautions. Although the LVN wore appropriate PPE, the CNA only wore gloves and did not follow facility policy or posted instructions. Both the DON and administrator confirmed that all staff are expected to adhere to EBP protocols during high-contact care activities.
A resident with severe cognitive impairment and a history of falls suffered a skin tear during a transfer by a CNA who failed to use a gait-belt, contrary to facility policy. The resident's care plan required extensive assistance for transfers, but the CNA proceeded without the necessary equipment, leading to the injury. The incident was captured on video, and the CNA was subsequently terminated.
A facility failed to provide care according to professional standards when a Wound Care Nurse lifted a resident's leg during incontinence care, contrary to the facility's policy of repositioning residents on their side. The resident, who had multiple health issues and intact cognition, later complained of hip pain and was diagnosed with a hip fracture at the hospital. Staff interviews indicated the resident did not express pain during the procedure, and the fracture was believed to have occurred during hospital transport.
A facility failed to maintain an effective infection control program, as a caregiver provided improper incontinence care to a resident by wiping from back to front and not changing gloves between tasks. The resident, with multiple health conditions, was at risk of infection due to these practices. Despite training and policy, the caregiver cited difficulty due to the resident's lack of flexibility.
The facility failed to provide adequate grooming and personal hygiene care for two female residents, resulting in unshaved facial hair, and did not provide timely incontinence care for a male resident, leading to soiled bedding. The CNAs responsible cited busy workloads and lack of resources as reasons for these deficiencies, and the facility's policies did not adequately address these care needs.
A resident with multiple health issues, including respiratory failure, was on continuous oxygen therapy without a physician's order. Facility staff, including an LVN and the DON, were unaware of the missing order, despite the facility's policy requiring verification of such orders.
Inaccurate and Incomplete Quarterly MDS Assessment for ADL Status
Penalty
Summary
The deficiency involves the facility’s failure to ensure that a resident’s quarterly Minimum Data Set (MDS) assessment accurately reflected her functional status and care needs. The quarterly MDS, completed by an LVN, did not properly address the resident’s Safety and Quality of Performance in multiple Activities of Daily Living (ADLs), including eating, oral hygiene, toileting hygiene, shower/bathing, upper and lower body dressing, putting on/taking off footwear, and personal hygiene, and did not indicate the type of wheelchair or scooter used. The resident was an elderly female with a BIMS score of 03, indicating severe cognitive impairment, and her physician orders included the use of geri sleeves to both upper extremities every shift. Her quarterly care plan documented an ADL self-care performance deficit, risk for not having needs met in a timely manner, and risk for emotional distress, and specified that she required assist of one person for personal hygiene and bathing, along with scheduled and as-needed grooming and hygiene care and encouragement to use the call light for assistance with ADLs. Interviews with facility leadership confirmed that the incomplete and inaccurate MDS had not been identified or corrected. The ADON stated she was not aware that the resident’s MDS did not address her functional abilities and contained incomplete sections, and acknowledged that timely completion of the MDS was important because it reflected the resident’s daily care and needs to maintain the highest level of care. The DON stated it was her expectation that MDS staff conduct timely, comprehensive quarterly assessments to address the resident’s current status of care and prevent decline, and that it was the responsibility of the DON and MDS staff to ensure MDS assessments were completed comprehensively. The facility’s Clinical Practice Guidelines for MDS Completion required residents to be assessed using a comprehensive assessment process to identify care needs and develop an interdisciplinary care plan, with quarterly assessments completed within the required timeframe, but this process was not followed for the resident’s quarterly MDS.
Unassessed bedside self-administration of eye drops
Penalty
Summary
The facility failed to ensure the interdisciplinary team determined whether it was clinically appropriate for a resident to self-administer medication when antihistamine eye drops were found at the resident’s bedside. The resident was a male with an intact BIMS score of 15 and diagnoses including amputation, high blood pressure, renal insufficiency, diabetes, lack of coordination, and adequate vision without corrective lenses. During observation, the resident had a bottle of Olopatadine Hydrochloride Ophthalmic Solution at his bedside table and stated that a family member may have brought the eye drops because his eyes had been itching, especially the right eye. He said he used the eye drops once in the morning and again in the evening every day. Record review showed eye drop orders were entered later for Ketotifen Fumarate Ophthalmic Solution for the right eye and Blink Tears Ophthalmic Solution for dry eyes with unsupervised self-administration. The charge nurse stated he was not aware the resident had eye drops at the bedside and removed them, noting there should have been a prescription and that medications should be stored in the medication cart. The ADON and DON stated residents should not have medications in their rooms unless they had been assessed, had a care plan update, and had an order for bedside medication use. The facility policy stated medications must be stored securely, and during medication pass they must be under direct observation or locked in the medication storage area/cart.
Expired Medications Found on Medication Cart
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 surveyors observed expired medications on the Hall 300 nurse medication cart. On 09/24/2025 at 1:27 PM, the cart contained one bottle of Nitroglycerin 0.4 mg with an expiry date of July 2025 and 12 tablets of Oxycodone 10 mg with a use-by date of 09/04/25. The LVN responsible for the cart stated she was supposed to check the cart for expired medications, said she checked it once a month, and reported she had last checked it two weeks earlier. She also stated she had received training on checking carts for expired medications, labeling medications, storage of medications, and dating insulin after opening, but could not recall when the training occurred. During interview, the DON stated all nurses were responsible for checking carts and refrigerators for expired medications and that the ADON was responsible for monitoring and ensuring nurses labeled and discarded expired medications, though she did not specify how often. The ADON stated her expectation was that nurses check their carts for medication labeling and expired medications every week and said she last checked the carts and refrigerators at the end of August. Facility policy dated 01/20/21 stated medication carts are routinely inspected for discontinued, outdated, defective, or deteriorated medications with worn, illegible, or missing labels, and that these medications are removed and destroyed in accordance with facility policy.
Undated Open Insulin Vial in Medication Refrigerator
Penalty
Summary
Drugs and biologicals used in the facility were not labeled in accordance with accepted professional principles when one vial of Lantus insulin 100 unit/ml in the medication room refrigerator for Halls 100, 200, and 300 was observed opened, partially used, and not labeled with the open date. The observation was made with LVN A, who stated she knew insulin pens and vials were supposed to be dated once opened and that nurses were responsible for dating and labeling insulin when opened. She also stated that failure to label and date insulin could result in staff not noticing when it had expired and continuing to administer expired medication. The DON stated nursing staff were expected to date insulin pens once opened and that all nurses were responsible for checking carts and refrigerators to ensure insulin was dated and labeled. ADON B stated she was responsible for checking refrigerators to ensure insulins were dated and labeled, but she missed the opened, undated vial that had been returned to the refrigerator. Record review showed the facility had training on 08/16/25 that included dating insulin once opened, and the facility's Medication Storage policy dated 01/20/21 stated certain medications such as multiple-dose injectable vials require an expiration date shorter than the manufacturer's expiration date once opened and that medication carts are routinely inspected for missing labels.
Failure to Use Gait Belt During Transfer Results in Resident Fall and Fractures
Penalty
Summary
A deficiency occurred when a certified nursing assistant (CNA) failed to use a gait belt while transferring a resident from the toilet to a wheelchair. The resident, who had a history of stroke with right-sided hemiplegia, generalized muscle weakness, and was on anticoagulant therapy, required substantial to maximal assistance with transfers as documented in her care plan and MDS assessment. The care plan specifically instructed staff to use a gait belt for all transfers due to the resident's fall risk and right-sided weakness. On the day of the incident, the CNA assisted the resident off the toilet without applying a gait belt, despite the resident's request for help and her care plan requirements. During the transfer, the resident lost balance and fell, resulting in significant injuries including a 10th rib fracture, a right tibia spiral fracture, and proximal and distal right fibula fractures. The resident reported severe pain and was subsequently transported to the hospital for evaluation and treatment. Interviews with the resident, her responsible party, and multiple staff members confirmed that the gait belt was not used during the transfer, and that the resident did not refuse its use. Staff interviews also indicated that the use of gait belts for transfers was standard practice and that gait belts were readily available in resident rooms. Further review of facility records, including the resident's care plan, fall risk assessment, and staff training materials, confirmed that the expectation was for gait belts to be used for all transfers requiring staff assistance. The CNA involved acknowledged forgetting to use the gait belt and recognized the risk of falls associated with not following this protocol. Other staff consistently reported that gait belts were mandatory for transfers and that failure to use them could result in resident injury.
Failure to Change PICC Line Dressing as Ordered
Penalty
Summary
A deficiency occurred when the facility failed to ensure that parenteral fluids were administered in accordance with professional standards of practice and physician orders for a resident with a PICC line. The resident, an elderly female with a history of left leg amputation, pressure ulcers, and infection following a procedure, had physician orders specifying that the transparent dressing on her PICC line should be changed every seven days, with measurements of the upper arm circumference and exterior catheter length at each dressing change. The medication administration record indicated that the dressing change was documented as completed on the appropriate date. However, during an observation and interview, it was found that the PICC line dressing was dated ten days prior, indicating that the dressing had not been changed as ordered. Nursing staff interviews revealed that the responsible nurse had not checked the date on the dressing and had only assessed the IV site for redness and swelling. The nurse acknowledged that the dressing should have been changed and that failure to do so could increase the risk of infection. The DON confirmed that the electronic medical record had prompted the task, but it appeared to have been marked as completed without the actual dressing change being performed. The facility's policy required transparent dressings to be changed every seven days and as needed, with documentation of the procedure and any signs or symptoms of complications. The care plan for the resident did not reflect the presence of a PICC line, and the required monitoring and documentation were not consistently performed. This lapse in following physician orders and facility policy resulted in a deficiency related to the safe and appropriate administration of IV fluids.
Failure to Follow Enhanced Barrier Precautions During Wound Care
Penalty
Summary
The facility failed to maintain an effective infection prevention and control program for a resident with multiple wounds and a history of infection. During wound care for a female resident with an above-the-knee amputation, pressure ulcers, and a wound vac, a certified nursing assistant (CNA) assisted a licensed vocational nurse (LVN) without wearing a gown, despite Enhanced Barrier Precautions (EBP) signage and policy requiring both gloves and gowns for high-contact activities such as wound care. The CNA only wore gloves while helping to reposition the resident and did not don a gown as required. The LVN, who was performing the wound care, wore the appropriate personal protective equipment (PPE) but did not remind the CNA to wear a gown, believing that only the person conducting the actual wound care needed to do so. The CNA later acknowledged forgetting to wear the gown, despite having received in-service training on EBP and infection prevention. The director of nursing (DON) and the facility administrator both confirmed that all staff are expected to follow EBP protocols, including wearing gowns and gloves during high-contact care activities. Review of the resident's care plan and physician orders indicated the presence of multiple wounds and a high risk for infection, with interventions specified for wound care and infection monitoring. However, the care plan did not specifically address EBP for the resident's wounds or wound vac. Facility policy and posted signage clearly outlined the requirement for gowns and gloves during high-contact activities, but this protocol was not followed during the observed incident.
Improper Transfer Technique Leads to Resident Injury
Penalty
Summary
The facility failed to ensure adequate supervision and use of assistance devices during a transfer, resulting in a skin tear for a resident. The resident, a female with severe cognitive impairment and a history of falls, required total assistance with activities of daily living, including transfers. On the day of the incident, CNA A attempted to transfer the resident from her bed to a shower chair without using a gait-belt, which was against the facility's policy. This improper transfer technique led to a skin tear on the resident's right arm. The resident's care plan indicated she needed extensive assistance for transfers, yet CNA A proceeded with the transfer without the necessary equipment. The resident's family reported that the resident had refused a shower, but CNA A continued with the transfer, which was captured on video. The video showed CNA A lifting the resident by her arms and neck, which was not in accordance with safe transfer practices. The resident complained of leg pain after the transfer, prompting an x-ray that showed no fractures. The facility's investigation confirmed the incident, and CNA A was suspended and later terminated. The Director of Nursing acknowledged that the transfer was conducted improperly and against policy. The facility's policy required the use of a gait-belt to ensure resident safety during transfers, which was not adhered to in this case.
Improper Body Mechanics During Incontinence Care
Penalty
Summary
The facility failed to ensure that residents received treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the residents' choices. Specifically, the Wound Care Nurse did not use proper body mechanics while providing incontinence care to a resident. During the care, the nurse lifted the resident's right leg straight in the air, which was captured on video. The resident did not appear to express pain during the procedure, but later was diagnosed with a right hip fracture at the hospital. The resident, an elderly female with intact cognition, had multiple diagnoses including cerebral infarction, chronic pain syndrome, and muscle weakness. Her care plan required gentle peri-care after each incontinence episode. The resident's family reported that she had complained of right hip pain for over a week before being admitted to the hospital, where she was diagnosed with a sub-capital right femoral neck fracture. The attending surgeon noted that the fracture appeared subacute to chronic, suggesting it was not a recent injury. Interviews with facility staff, including the Wound Care Nurse, DON, and Administrator, revealed that the resident was vocal about her care preferences and did not complain of pain during the leg lift. The staff believed the fracture occurred during transport to the hospital, as there were no reports of incidents or increased pain prior to the hospital visit. The facility's incontinence care policy recommended repositioning residents on their side rather than lifting their legs, which was not followed in this instance.
Infection Control Deficiency Due to Improper Incontinence Care
Penalty
Summary
The facility failed to establish and maintain an effective infection prevention and control program, as evidenced by improper incontinence care provided to a resident. Caregiver A was observed wiping the resident's perineal area from back to front, contrary to the recommended front-to-back technique, which is essential to prevent infections. Additionally, Caregiver A did not change her gloves after wiping the resident's perineal area before applying cream to another area of the resident's body, increasing the risk of cross-contamination. The resident involved was an elderly female with multiple health conditions, including cerebral infarction, irritant contact dermatitis, and recurrent cellulitis, among others. Despite the facility's policy and training on proper perineal care and infection control, Caregiver A admitted to the difficulty in performing the task correctly due to the resident's lack of flexibility. Both the Director of Nursing and the Administrator acknowledged the importance of proper technique and glove changes to prevent infections, yet the facility's practices did not align with these standards.
Deficiencies in Grooming and Incontinence Care
Penalty
Summary
The facility failed to provide adequate grooming and personal hygiene care for two female residents, resulting in unshaved facial hair. One resident, a female with severe cognitive impairment, was observed with long white facial hair on her chin. Despite her care plan indicating the need for assistance with personal hygiene, she remained unshaved over multiple days. The resident expressed her dislike for having facial hair, but did not recall when she last received a shave. Another female resident, who was cognitively intact and required partial assistance with personal hygiene, was also observed with facial hair. She expressed embarrassment over the facial hair, yet remained unshaved. The CNA responsible for their care admitted to being in a hurry and not noticing the facial hair due to a busy workload. The facility also failed to provide timely incontinence care for a male resident, who was dependent on staff for toileting and had a history of medical conditions including a stroke and diabetes. The resident was found with soiled bedding, indicating he had been incontinent multiple times throughout the day without receiving care. The CNA who discovered the situation noted that the resident was a heavy wetter and required frequent changes. However, the previous shift's CNA did not change the resident in a timely manner, citing a busy schedule and lack of towels as reasons for the delay. The CNA did not report the issue to the nurse or the oncoming aide, resulting in the resident remaining in soiled conditions for an extended period. Interviews with facility staff, including the DON and LVN, revealed that there was an expectation for CNAs to notify nurses if they needed assistance with providing care. The facility's policies on resident showers and incontinence care did not adequately address the specific needs for shaving female residents or the timeliness of incontinence care. The lack of adherence to these care standards placed the residents at risk for skin breakdown, infection, and emotional distress.
Lack of Physician's Order for Oxygen Therapy
Penalty
Summary
The facility failed to ensure that a resident requiring respiratory care had a physician's order for oxygen treatment, which is a deficiency in providing care consistent with professional standards. The resident, an elderly female with multiple diagnoses including end-stage renal disease, non-Alzheimer's dementia, and respiratory failure, was observed to be on continuous oxygen via nasal cannula at 2 liters per minute. Despite the resident's reliance on oxygen therapy, there was no documented physician's order in her clinical record. Interviews with facility staff revealed a lack of awareness and oversight regarding the resident's oxygen therapy. An LVN acknowledged that the resident had been on continuous oxygen for approximately two months due to low oxygen saturation levels but was unaware that a physician's order was missing. The Director of Nursing (DON) was also unaware of the continuous oxygen use, mistakenly believing it was administered only as needed. The facility's policy on oxygen administration requires verification of a physician's order, which was not adhered to in this case.
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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 Keller
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| The Harrison At Heritage | 2 mi | ★★★★★ | 11 | 0 |
| Legend Oaks Healthcare And Rehabilitation - Fort W | 2.6 mi | ★★★★★ | 11 | 1 |
| Green Valley Healthcare And Rehabilitation Center | 2.9 mi | ★★★★★ | 4 | 1 |
| North Pointe Nursing And Rehabilitation | 3.4 mi | ★★★★★ | 1 | 1 |
| Discovery Village At Southlake | 3.7 mi | ★★★★★ | 2 | 0 |
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