Below 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 Hico Nursing And Rehabilitation during CMS and state inspections, most recent first.
A resident with recent dental extractions and a care plan requiring a mechanically soft, low concentrated sweets diet was served a regular diet, including a whole sandwich he could not eat. Staff interviews and record reviews revealed inconsistent communication and documentation regarding the resident's dietary needs, resulting in the kitchen not receiving updated instructions and the resident not receiving food in the required texture.
A resident with severe cognitive impairment and multiple psychiatric diagnoses exhibited unsolicited sexual behavior towards another resident. Although the incident was observed and the resident's doctor and family were notified, the mental health primary care provider was not informed. This oversight could delay necessary interventions and affect care quality.
A facility failed to include a resident's fall history and risks in the baseline care plan within 48 hours of admission, despite the resident being a high fall risk with a history of falls. The resident, admitted for respite care with multiple diagnoses including cognitive impairment, experienced several falls shortly after admission. The omission was acknowledged by the DON, who had the necessary information but did not update the baseline care plan accordingly.
A facility failed to update a resident's care plan to include newly identified sexual behaviors after an incident involving unsolicited advances towards another resident. The resident, with severe cognitive impairment and psychiatric conditions, had a care plan that did not address these behaviors. Staff interviews revealed that the psychiatric provider was not informed of the incident, which was considered a change in the resident's condition.
The facility failed to maintain RN coverage for 8 hours a day, 7 days a week, during a specific weekend in FY Quarter 3 2024. This deficiency was due to a lack of available RNs to hire or through agency services, as confirmed by the DON and ADM. The absence of RN coverage placed residents at risk of missed nursing assessments and care.
The facility's kitchen failed to meet food safety standards, with unlabeled and undated food items, an unclean ice machine, and expired or moldy food not being discarded. Improper storage practices were observed, including cracked storage bins and frost build-up in freezers. Staff interviews revealed awareness of proper procedures, but these were not consistently followed, leading to multiple deficiencies.
Two residents in an LTC facility were found in inadequate conditions due to failures in ADL care. A cognitively intact resident with dementia was left with soiled sheets and a brief, while a cognitively impaired resident with hemiplegia was found with food on her blouse and her call light out of reach. Staff acknowledged these conditions were inappropriate and did not align with facility policies on maintaining hygiene and dignity.
A resident with cognitive and physical impairments was left alone in her room with food on her blouse and her call light out of reach, compromising her dignity. Staff interviews revealed that the resident should have had a clothing protector and not been left in soiled clothing, as per facility policy on resident rights.
A resident with cognitive and mobility impairments was found in distress with her call light out of reach, contrary to facility policy. Staff interviews confirmed the expectation for call lights to be accessible, highlighting a lapse in ensuring resident needs were met.
A facility failed to maintain an effective infection control program when a CNA did not wash or sanitize hands after removing gloves and before applying a clean brief to a resident. The resident, who was severely cognitively impaired and dependent on staff for personal care, was at risk of infection due to this lapse. Despite training on hand hygiene, the CNA admitted to not following proper procedures, highlighting a deficiency in infection prevention practices.
The facility failed to ensure residents were free from neglect, leading to uncontrolled pain and unidentified injuries for two residents. One resident with terminal brain cancer experienced severe pain after a fall, and another resident was left without his prescribed hydrocodone for three days, causing significant pain and inability to sleep. The facility's failure to provide necessary pain management and timely medical interventions placed all residents at risk.
The facility failed to implement policies and procedures to prevent abuse, neglect, and exploitation, resulting in uncontrolled pain and unidentified injuries for two residents. One resident's pain was not managed after a fall, and another resident's prescribed pain medication was unavailable for three days, causing significant discomfort.
The facility failed to provide adequate pain management for two residents, resulting in unmanaged pain and discomfort. One resident with terminal brain cancer missed several doses of tramadol after a fall, and another resident was without hydrocodone for three days, leading to severe pain and sleep loss.
A resident fell and sustained a bump to her head and pain in her hip and leg. The facility failed to notify the family member promptly due to internet issues, leading to a delay in informing the family and potentially delaying treatment decisions.
A resident experienced a fall resulting in a possible fracture, but the facility failed to report the incident to the State Agency within the required two-hour timeframe. The delay was due to the DON's unfamiliarity with the new reporting protocol after transitioning from the Administrator role.
The facility failed to provide accurate pharmaceutical services and timely medication administration, as evidenced by missing signatures on narcotic count sheets, discrepancies between narcotic logs and MARs, and late medication administration by RN A and a former employee. This affected two residents with significant medical conditions.
Failure to Provide Mechanically Soft Diet as Ordered
Penalty
Summary
Resident #2, a male with type 2 diabetes mellitus and recent dental extractions resulting in the removal of seven teeth, was admitted to the facility and had a care plan specifying a mechanically soft, low concentrated sweets diet. Despite this, observations revealed that the resident was served a whole sandwich, which he was unable to eat, and there was no meal ticket present on his tray. Interviews with staff indicated confusion and lack of communication regarding the resident's dietary needs, with some staff being verbally informed of the required diet while others were unaware of any changes. Record reviews showed that the kitchen had documentation indicating a regular diet for the resident, not the mechanically soft diet as specified in the care plan. Further investigation revealed that the process for updating dietary information involved multiple steps, including updating the care plan, sending information to the kitchen, and providing meal slips. However, the dietary manager's absence and unclear communication led to the kitchen not receiving the updated meal information. The facility's policy required special care needs to be communicated through various mechanisms, but in this case, the failure to provide the correct food texture resulted in the resident not receiving food in a form he could eat, as required by his care plan.
Failure to Notify Mental Health Provider of Behavioral Change
Penalty
Summary
The facility failed to consult with a resident's mental health primary care provider (MHNP) following a significant change in the resident's behavior. The resident, a male with severe cognitive impairment and multiple diagnoses including unspecified psychosis and autism, exhibited unsolicited sexual advances towards another resident. This incident was observed by RN A, who intervened and notified the resident's doctor and family but failed to inform the MHNP. The resident's care plan, which was revised prior to the incident, did not include interventions for sexual behaviors, although it did address potential verbal and physical aggression. The MHNP, who was responsible for managing the resident's psychiatric care, was not informed of the new behavior, which she considered a significant change in condition. The MHNP expressed that she relies on the facility to report such changes, as the resident is unable to communicate effectively due to his condition. Interviews with facility staff, including the DON and ADM, revealed that it was their expectation that primary care providers be notified of any significant changes in a resident's condition. The facility's policy on notification of changes also mandates informing the resident's physician and family in such circumstances. The failure to notify the MHNP of the resident's new behavior could potentially delay necessary medical interventions and affect the quality of care provided to the resident.
Failure to Include Fall Risks in Baseline Care Plan
Penalty
Summary
The facility failed to develop and implement a baseline care plan for a resident within 48 hours of admission, as required. The baseline care plan did not include the resident's fall history or fall risks, despite the resident having a history of falls and being identified as a high fall risk. This omission was acknowledged by the Director of Nursing (DON), who completed the baseline care plan but failed to include the necessary information regarding the resident's fall risks. The resident, an elderly female admitted for respite care, had multiple diagnoses including senile degeneration of the brain, anxiety disorder, restlessness, agitation, and hypertension. The resident's admission documents and hospice records indicated a history of falls, which was communicated to the facility by the hospice nurse. Despite this, the baseline care plan marked the resident as having no history of falls, and the comment section was left blank, failing to address the resident's fall risks and necessary interventions. The resident experienced several falls shortly after admission, which were documented in the comprehensive care plan. The hospice nurse confirmed that fall preventive measures were in place during her visits, such as the bed being in the lowest position and a fall mat at the bedside. However, the initial failure to include fall risks in the baseline care plan could have resulted in inadequate care and treatment for the resident.
Failure to Update Care Plan for Resident's Sexual Behaviors
Penalty
Summary
The facility failed to develop and implement a comprehensive person-centered care plan for a resident, which included addressing newly identified sexual behaviors. This deficiency was identified after an incident where the resident made unsolicited sexual advances towards another resident. The care plan did not document these behaviors or include relevant interventions, despite the resident's history of severe cognitive impairment and psychiatric conditions. The resident, a male with diagnoses including adrenocortical insufficiency, unspecified psychosis, generalized anxiety disorder, onychogryphosis, and autistic disorder, was admitted to the facility with a PASRR positive status related to an intellectual disability. The resident's care plan, last revised in December, noted potential for verbal and physical aggression but did not address sexual behaviors. An incident report from January detailed an event where the resident was observed with his hands under another resident's shirt, which was not subsequently documented in the care plan. Interviews with facility staff, including a registered nurse and the primary care psychiatric services provider, revealed that the psychiatric provider was not informed of the incident, which was considered a change in the resident's condition. The Director of Nursing and the Administrator both expressed expectations that care plans should be updated with any significant changes in a resident's condition to ensure continuity of care and prevent potential negative outcomes for other residents.
Failure to Maintain Required RN Coverage
Penalty
Summary
The facility failed to ensure the presence of a registered nurse (RN) for at least 8 consecutive hours a day, 7 days a week, during the third fiscal quarter of 2024. Specifically, there was no RN coverage on two days, June 8 and June 9, 2024. This lack of RN coverage was confirmed through a review of daily staffing records, which showed zero hours worked by an RN on those dates. The absence of an RN placed residents at risk of missed nursing assessments, interventions, care, and treatment. Interviews with the Director of Nursing (DON) and the Administrator (ADM) revealed that the facility was aware of the requirement for daily RN coverage. The DON acknowledged the absence of RN coverage on the specified weekend, citing a lack of available RNs to hire or through agency services. The DON also mentioned working extra hours herself to cover the RN position when possible. The ADM confirmed the facility's obligation to maintain RN coverage and noted that the absence of such coverage could compromise the quality of resident care. There was no policy in place regarding RN coverage, and the facility relied on federal guidance for staffing requirements.
Food Safety and Storage Deficiencies in Facility Kitchen
Penalty
Summary
The facility failed to adhere to professional standards for food service safety in its kitchen, leading to multiple deficiencies. Observations revealed that food items, including leafy green vegetables and shredded cheddar cheese, were not labeled or dated to indicate their use-by or discard dates. Additionally, the ice machine was found to have slime, mold, or soil residues on its internal components, indicating a lack of proper cleaning and sanitization. Expired and mold-contaminated food products, such as hoagie buns and caramel-flavored dessert topping, were not discarded as required. Further inspection of the kitchen's storage areas showed improper storage practices. Large plastic storage bins were not labeled or dated, and some had cracked or broken lids, compromising the integrity of the stored food. The kitchen's vegetable freezer had significant frost build-up and ice crystals, which could affect the quality and taste of the food. Additionally, emergency water supplies were improperly stored directly on the floor, and the potato freezer contained unlabeled bags of food. Interviews with staff, including the Dietary Manager (DM) and Dietary Worker (DW), confirmed awareness of the need for proper food storage and sanitation practices. However, the DM admitted to being unaware of the specific issues observed during the inspection. The facility's policies on food safety and date marking were not consistently followed, as evidenced by the presence of expired and improperly stored food items. The ADM emphasized the importance of inspecting food upon receipt and maintaining clean appliances, but these expectations were not met, as shown by the deficiencies found during the survey.
Deficiencies in ADL Care and Hygiene Maintenance
Penalty
Summary
The facility failed to provide adequate care and assistance for activities of daily living (ADLs) for two residents, leading to deficiencies in maintaining their hygiene and dignity. Resident #14, a cognitively intact male with dementia and mobility issues, was observed with a brown smear on his bedsheet and a soiled brief in the trashcan, indicating inadequate personal hygiene care. Despite staff making rounds every two hours, the resident was left in this condition, and his lunch was served without addressing the hygiene issue, which was acknowledged by the charge nurse and the Director of Nursing (DON) as inappropriate. Resident #35, a cognitively impaired female with hemiplegia and communication difficulties, was found sitting in her wheelchair with food covering her blouse and her call light out of reach. The resident was left in her room with the door closed, and staff were unsure who was responsible for her condition. The DON stated that residents who feed themselves should have clothing protectors to prevent soiling, and it was inappropriate for the resident to be left with a soiled blouse, impacting her dignity. The facility's policy on ADLs emphasizes maintaining residents' abilities and providing necessary services for personal hygiene, grooming, and nutrition. However, the observations and interviews revealed that the facility did not adhere to these standards, resulting in residents being left in soiled conditions, which could lead to health decline and impaired dignity. The administration acknowledged the responsibility of CNAs and nurses to monitor and address these needs, but the deficiencies indicate a failure in executing these duties effectively.
Resident Dignity Compromised Due to Inadequate Care
Penalty
Summary
The facility failed to ensure that a resident was treated with respect and dignity, as evidenced by an incident involving a resident who was left alone in her room with the door shut, with food covering the front of her blouse. The resident, who had a history of hemiplegia and hemiparesis following a cerebral infarction, aphasia, anxiety, and conversion disorder with seizures, was observed sitting in her wheelchair with her call light out of reach and crying. The resident's care plan indicated she required supervision or assistance with eating and personal hygiene, yet she was found in a state that did not align with these needs. Interviews with facility staff, including a CNA and the DON, revealed that the resident should not have been left in her room with the door closed and in soiled clothing. The DON acknowledged that residents who feed themselves should have a clothing protector to prevent soiling, and that it was inappropriate to leave a resident in soiled clothing as it could impair dignity. The ADM also stated that residents should not be left in such conditions and emphasized the responsibility of CNAs and nurses to monitor and address these needs. The facility's policy on resident rights confirmed the expectation for residents to be treated with respect and dignity.
Failure to Ensure Call Light Accessibility for Resident
Penalty
Summary
The facility failed to ensure that a resident's call light was placed within reach, which is a necessary accommodation for residents with specific needs. The resident in question, a female with a history of hemiplegia and hemiparesis following a cerebral infarction, aphasia, anxiety, and conversion disorder with seizures, was found in her room with the call light clipped to her pillow, out of her reach. This resident, who was cognitively impaired and required assistance with mobility and personal care, was observed sitting in her wheelchair with food on her blouse and crying, indicating distress and unmet needs. Interviews with facility staff, including a CNA and the DON, confirmed that the call light should have been within the resident's reach at all times. The CNA was unsure who left the resident in this state, and the DON emphasized the importance of notifying her if the call light clip was broken. The ADM reiterated that all staff were responsible for ensuring call lights were accessible to residents, as per facility policy. The failure to place the call light within reach could have resulted in the resident being unable to call for help, potentially leading to falls or other unmet needs.
Inadequate Hand Hygiene During Incontinent Care
Penalty
Summary
The facility failed to establish and maintain an effective infection prevention and control program, as evidenced by the actions of CNA C during the provision of incontinent care for a resident. During the care, CNA C did not wash or sanitize his hands after removing gloves and before applying a clean brief to the resident, which is a critical step in preventing cross-contamination and the spread of infection. This lapse in hand hygiene occurred despite the facility's established policies and training on infection control and hand hygiene. The resident involved was an elderly female with multiple diagnoses, including dysphagia, anxiety, pneumonia, and atherosclerotic heart disease. She was severely cognitively impaired, requiring substantial assistance with personal hygiene and was fully dependent on staff for toileting and showering. The resident was frequently incontinent of bladder and always incontinent of bowel, necessitating regular and thorough incontinent care to prevent skin breakdown and infection. Interviews with CNA C, the Administrator, and the Director of Nursing confirmed that staff were trained and in-serviced on proper hand hygiene practices, including washing hands when transitioning from dirty to clean surfaces. Despite this training, CNA C admitted to not following the correct procedure, citing confusion from differing instructions by state surveyors. The facility's policies clearly outlined the importance of hand hygiene in preventing infection, yet the failure to adhere to these protocols during resident care posed a risk of infection transmission.
Neglect and Inadequate Pain Management
Penalty
Summary
The facility failed to ensure that residents were free from neglect, leading to uncontrolled pain and unidentified injuries for two residents. One resident, who had terminal brain cancer, experienced a fall and subsequent pain in her arm and hip. The facility did not provide her prescribed tramadol, failed to complete and document neuro checks after the fall, and delayed performing x-rays. The resident was left in constant pain, which was only partially managed after being transferred to a new facility. The hospice nurse and the new facility's administrator confirmed the resident's severe pain and inadequate care at the original facility. Another resident, who was cognitively intact and had a history of acute post-procedural pain and spinal stenosis, was left without his prescribed hydrocodone for three days. This led to significant pain, especially at night, causing an inability to sleep. The resident reported that his pain reached a level of 9 at night and averaged at a 6 during the day without his medication. The facility staff confirmed that the medication had run out and was not reordered in a timely manner. The facility's failure to provide necessary pain management and timely medical interventions placed all residents at risk of not having their needs met. The deficiencies were identified during observations, interviews, and record reviews, revealing a pattern of neglect and inadequate care. The facility's policies on medication administration and pain management were not followed, leading to significant harm and distress for the affected residents.
Failure to Implement Policies and Procedures for Pain Management and Resident Care
Penalty
Summary
The facility failed to develop and implement written policies and procedures to prevent abuse, neglect, and exploitation of residents, as well as the misappropriation of resident property. Specifically, the facility did not address Resident #1's pain in her arm and hip after a fall, failed to complete and document neuro checks after the fall, and delayed performing x-rays. Additionally, Resident #2's pain was not managed properly due to the unavailability of his prescribed hydrocodone for three days, leading to significant pain and inability to sleep. These failures resulted in uncontrolled pain and unidentified injuries for the residents involved. Resident #1, a [AGE] year-old female with diagnoses including syncope, glaucoma, and abnormal brain scan, experienced a fall that resulted in pain and a possible fracture. Despite orders for x-rays and pain medication, the facility did not administer the prescribed tramadol in a timely manner, and neuro checks were not documented. The resident's pain was not adequately managed, and she was observed to be in severe pain when moved or repositioned at a new facility. The facility's records showed multiple instances where the medication was unavailable, and neuro checks were not performed as required. Resident #2, a [AGE] year-old male with diagnoses including acute post-procedural pain, spinal stenosis, gout, and repeated falls, also experienced inadequate pain management. His prescribed hydrocodone was unavailable for three days, causing his pain to escalate to a level 9 at night and preventing him from sleeping. The facility's records indicated that the medication had run out, and the resident reported significant pain during this period. The facility's failure to ensure the availability of pain medication and timely administration led to unnecessary suffering for Resident #2.
Failure to Provide Adequate Pain Management
Penalty
Summary
The facility failed to ensure that pain management was provided to residents who required such services, consistent with professional standards of practice, the comprehensive person-centered care plan, and the residents' goals and preferences. Specifically, the facility did not have the prescribed tramadol available for a resident who suffered a fall and reported constant pain in her left arm and had a visible hematoma on her forehead. The resident's pain medication was not administered as scheduled, leading to unmanaged pain and discomfort. Additionally, the facility did not have the prescribed hydrocodone available for another resident for three days, resulting in severe pain, especially at night, and sleep loss. The resident's pain levels were documented as high as 9 during this period, indicating significant suffering due to the unavailability of the medication. The first resident, an elderly female with terminal brain cancer, experienced a fall and reported pain in her left arm and a hematoma on her forehead. Despite having orders for tramadol to manage her pain, the medication was not available in the facility, and the resident missed several doses. The resident's pain levels were documented multiple times, showing that she was in significant pain. Observations at a new facility revealed that the resident was in excruciating pain when repositioned, indicating that her pain was not adequately managed at the original facility. The second resident, an elderly male with diagnoses including acute post-procedural pain and spinal stenosis, was without his prescribed hydrocodone for three days. The resident reported severe pain, especially at night, which prevented him from sleeping. The facility's records and interviews with staff confirmed that the medication was not available, and the resident's pain levels were documented as high during this period. The facility's failure to ensure the availability of pain medication led to significant unmanaged pain for the resident.
Failure to Notify Family Member of Resident's Fall
Penalty
Summary
The facility failed to immediately notify the resident's representative when there was a significant change in the resident's physical status. Specifically, the facility did not inform the family member (FM) of a resident who experienced a fall, resulting in a bump to her head and pain in her hip and leg. The incident occurred early in the morning, and the responsible party was not notified until later in the day when the FM visited the resident and learned about the fall from a hospice nurse. The lack of notification was attributed to the internet being down, preventing the nurse from accessing the resident's face sheet to find contact information. Despite attempts to notify the FM through hospice, the FM was not informed in a timely manner. The resident involved was a female with a history of syncope, glaucoma, and an abnormal brain scan. She had been admitted to the facility recently and had no prior falls. The incident report and interviews revealed that the resident fell while self-transferring to the bathroom, resulting in a hematoma on her forehead and pain in her left arm. The facility's policy required prompt notification of family members in such cases, but this protocol was not followed, leading to a delay in informing the FM and potentially delaying treatment decisions.
Failure to Timely Report Resident Fall and Injury
Penalty
Summary
The facility failed to report an alleged violation involving abuse, neglect, or mistreatment within the required two-hour timeframe. Specifically, Resident #1 experienced a fall on 01/14/24 at 5:57 am, which resulted in a possible fracture to her left femur as indicated by x-ray results. The incident was not reported to the State Agency until 01/17/24 at 8:06 pm, well beyond the mandated two-hour window. The delay in reporting was attributed to the Director of Nursing (DON), who had recently transitioned from also serving as the Administrator and was not accustomed to the new reporting protocol. Resident #1, a [AGE] year-old female with diagnoses including syncope, glaucoma, and an abnormal brain scan, was admitted to the facility on [DATE]. Following the fall, the resident complained of significant pain, and subsequent imaging confirmed a possible fracture. Despite the severity of the injury, there was no progress note related to the fall in Resident #1's January 2024 records. The facility's Incident and Accidents policy, last revised on 01/01/23, mandates immediate reporting of such incidents, which was not adhered to in this case.
Failure to Provide Accurate Pharmaceutical Services and Timely Medication Administration
Penalty
Summary
The facility failed to provide pharmaceutical services to meet the needs of each resident, specifically in the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals. The facility did not maintain a system of medication records that enabled periodic accurate reconciliation and accounting for all controlled medications. This was evident in the missing signatures on narcotic count sheets for multiple dates in two medication locations, and discrepancies between the narcotic logs and the Medication Administration Records (MAR) for Resident #1's tramadol administration. The Director of Nursing (DON) admitted to not reconciling the narcotic count sheets against the MAR and not verifying the correct number of pills or timing of the pills based on the order. The facility also failed to ensure the safe and timely administration of medications. RN A and a former employee were noted to have administered medications outside the prescribed times, as evidenced by the Medication Admin Audit Report for both Resident #1 and Resident #2. The report highlighted multiple instances where medications were administered late, which was corroborated by confidential interviews with staff and residents. The DON had changed the medication administration times to accommodate RN A, who had difficulty administering medications within the required times, but this adjustment did not resolve the issue. Resident #1, a female with diagnoses including syncope, glaucoma, and an abnormal brain scan, had multiple instances where her tramadol was pulled but not documented as administered in the MAR. Resident #2, a male with diagnoses including acute post-procedural pain and spinal stenosis, also experienced late administration of his medications. The facility's policies on medication administration and controlled substance accountability were not followed, leading to these deficiencies. The DON acknowledged the issues but had not implemented the necessary corrective actions to address them.
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What surveyors actually found near you
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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 Hico
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Stephenville Nursing And Rehabilitation | 19.2 mi | ★★★★★ | 6 | 0 |
| Lone Star Rehabilitation & Wellness Center | 19.5 mi | ★★★★★ | 9 | 0 |
| Focused Care At Hamilton | 19.8 mi | ★★★★★ | 0 | 0 |
| Pecan Creek Healthcare Center | 20.1 mi | ★★★★★ | 0 | 0 |
| Avir At Stephenville | 20.1 mi | ★★★★★ | 7 | 0 |
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