Average — CMS composite of the measures below.
The next survey window likely opens around November 2026
Estimate from public CMS data, current as of August 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at La Vida Serena Nursing And Rehabilitation during CMS and state inspections, most recent first.
Resident Council grievances were not fully investigated, documented, or communicated back to the group. Concerns raised by the council included meals, hydration, rounding, call lights, showers, room temperatures, and dining room requests, but the grievance forms and meeting minutes did not show findings, resolutions, or documented responses from AD, DON, Nursing, Dietary, or Admin. Interviews confirmed the group was not told the outcomes and facility leaders could not explain why the grievance process was not completed as required by policy.
QAPI Program and Grievance Tracking Failures: The facility failed to maintain a comprehensive QAPI program that used resident, family, and staff input to identify and prioritize quality issues. Resident Council minutes documented repeated concerns about direct care, nutrition, showers, call lights, staffing, and environment, but there was no documentation of facility responses or grievance outcomes. The AD, DON, and ADM described a grievance process involving assignment to department heads and communication back to residents, yet multiple grievance forms showed no investigation, findings, or resolution documented for the Resident Council group.
Unsafe and Poorly Maintained Environmental Conditions: Surveyors observed multiple environmental deficiencies in resident rooms, a hydration room, and a laundry room, including a dirty/rusty bathroom vent, a nonworking bathroom light, a broken window shade, peeling paint and water spots on a ceiling, a dirty/rusty laundry vent, peeling ceiling paint, a dislodged wall panel, a wall area with a black-dotted film resembling mold, and dirty/stained floor tiles. The Maintenance Director stated he was aware of the areas needing repair, and the facility policy required routine preventative maintenance.
Failure to Develop Comprehensive Care Plans for Dialysis and PICC Line Needs: Two residents had identified medical needs that were not fully reflected in their care plans. One resident with ESRD had orders for dialysis 3 times weekly and access checks, but the care plan lacked focus areas, goals, and interventions. Another resident with a UTI had a PICC line for IV antibiotics, yet the care plan did not include focuses, goals, or interventions for the UTI, PICC line, or antibiotic use. The RN MDS nurse stated she overlooked adding the care plans due to human error, and the DON and Administrator acknowledged the missing care plan elements.
A resident with a history of falls, syncope, difficulty walking, moderate cognitive impairment, poor vision, and wheelchair use had a care plan that included an anti-slip mat on the wheelchair seat. Surveyors observed the mat missing from the wheelchair seat on multiple occasions, and the resident stated it had been missing since the wheelchair was washed and that she had been asking staff for it because it helped keep her from slipping out of the wheelchair. CNAs and an LVN stated they were aware of the resident’s fall risk, but some were unaware the mat was required or that it was missing.
Incorrect Scanning of Resident Medical Records: Medical records were not maintained accurately when a 13-page hospital discharge document for one resident was found in another resident’s chart. The Medical Records staff member stated she was responsible for scanning documents and had made mistakes placing records into the wrong resident files, and the DON and Administrator acknowledged the scanning errors.
A resident with severe cognitive impairment and multiple diagnoses did not have her care plan and Kardex updated in a timely manner to reflect the need for extensive assistance with two staff for transfers via mechanical lift, despite assessment findings. The MDS nurse acknowledged the delay, and the DON confirmed the update should have occurred immediately after the assessment, in accordance with facility policy.
A resident with severe cognitive impairment and a care plan requiring two-person mechanical lift transfers was instead moved by a CNA using a single-person pivot transfer, resulting in a laceration that required stitches and hospital care. The CNA did not follow the MDS assessment or care plan, leading to the injury.
A resident with severe cognitive impairment sustained a laceration to the left lower calf during a transfer, requiring hospital treatment. Although the incident was witnessed and reported internally, it was not reported to the State Survey Agency as required by policy and state law.
A resident with serious health conditions, including end-stage renal disease, elected hospice services, but the facility's Quarterly MDS assessment inaccurately documented the resident as not receiving hospice care. The MDS nurse and DON confirmed the error, acknowledging that the MDS should have been completed as a Significant Change MDS to reflect the hospice election.
A resident with an enteral access device did not receive medications according to professional standards. The LVN administered crushed medications directly into the syringe without dissolving them in water, contrary to the facility's policy and best practices. Interviews revealed a lack of adherence to proper procedures, risking the effectiveness of the medications and the patency of the feeding tube.
Two residents experienced falls resulting in major injuries that were not accurately coded in their MDS assessments. One resident had a fracture of the right pubis, and another had a comminuted fracture of the right clavicle. The MDS Nurse admitted to the coding errors, which could affect financial reimbursement and state communication, though care plans were updated with the injuries.
The facility failed to post daily nurse staffing information from 07/05/2024 to 07/11/2024. A document dated 07/04/2024 was found posted, indicating a lapse in updates. The ADMIN confirmed the oversight, initially stating the document was to be posted every morning, but later clarified the night shift charge nurse was responsible. The new charge nurse placed the document in the ADON's box, who was on vacation, leading to the failure. The DON acknowledged potential communication impacts, and the ADMIN noted the facility lacked a specific policy, relying on federal and state regulations.
Resident Council Grievances Not Investigated or Communicated
Penalty
Summary
The facility failed to consider the views of the Resident Council group and failed to act promptly on grievances and recommendations raised during Resident Council meetings from June 2025 through November 2025. Review of Resident Advisory Council minutes from June 2025 through December 2025 showed no documentation of the facility’s responses to multiple grievances brought forward by the group. The grievances documented in the record included concerns about meals, hydration and water pass, daytime rounding, night shift rounding, call lights not being answered appropriately, CNA staff complaining and talking about being tired, pulling doubles, and cussing in the hallway. Additional concerns included dining room requests such as leaving one napkin dispenser on the countertop, larger menu font for easier reading, posting alternative menus, call lights being within reach, showers occurring only once a week at times, residents requesting specific shower times, no hot water on the 500/600 hall, colder rooms on the 100 hall in the evenings, and staff checking on residents more often during the morning. The grievance forms reflected that concerns were reported to AD, Nursing, Dietary, Admin, or DON, but several forms did not show assignment to a department or person. The record showed no investigation, no results, and no resolution reported back to the Resident Council group for these grievances. During interviews, the Resident Council group stated they did not receive information on the outcome of the grievances and wanted that to change. The AD, DON, and ADM each described a grievance process in which concerns were to be assigned, investigated, resolved, and communicated back to the resident or group, but they also stated they were unsure why the Resident Council grievances did not contain findings, corrective actions, or documented communication of the outcome. The facility policies reviewed stated residents have the right to voice grievances and that the facility must make prompt efforts to resolve them, with written grievance decisions including findings, conclusions, and corrective action.
QAPI Program and Grievance Tracking Failures
Penalty
Summary
The facility failed to implement and maintain a comprehensive QAPI program and plan that addressed the full range of services provided. The report states the facility did not use performance indicator data, resident and staff input, or other information to identify and prioritize problems and opportunities, and did not identify and prioritize quality deficiencies through Resident and Family Council minutes, the grievance review process, or daily QA meetings. The QAPI Committee was not aware of the issues concerning the resident and family group response and resident records identified during the survey week, and therefore did not undergo good faith attempts to correct quality deficiencies. Resident Advisory Council minutes from multiple meetings documented concerns about direct care, nutrition services, maintenance, activities, medication administration, showers, water pass/hydration, call lights, staffing, room temperature, and dining room requests. The minutes reflected the concerns raised by residents, but there was no documentation of the facility’s responses to the grievances. In interviews, the Resident Council group stated the AD submitted group grievances during monthly meetings to management staff, but they did not receive information on the outcome and wanted that to change. The AD stated she recorded the group grievances, entered them on a grievance report, and gave them to department heads to address and return once resolved. The DON stated grievances were expected to be investigated, resolved, and communicated back to the complainant, and that unresolved grievances or lack of communication would upset residents and make them feel unheard. The ADM stated the grievance process was the same for individual and group grievances and that group grievance resolution details would be provided at the next Resident Council meeting, but she was unsure why the grievance reports and minutes did not contain findings, conclusions, or corrective actions. Review of multiple grievance report forms showed the concerns were assigned to departments such as Dietary, Nursing, or DON, but the forms did not document investigations, results, or resolution reported back to the Resident Council group.
Unsafe and Poorly Maintained Environmental Conditions
Penalty
Summary
The facility failed to provide a safe, functional, sanitary, and comfortable environment in 3 of 13 resident rooms reviewed for environmental concerns, as well as in 1 hydration room and 1 laundry room. Observations with the Administrator and Maintenance Director identified a dirty and rusty bathroom ceiling vent in room 205, an overhead bathroom light that did not turn on in room 206, and a broken window shade next to bed B in room 213. In the hydration room, there was a ceiling area with peeling paint and water embarkation spots. In the laundry room, surveyors observed a circular ceiling vent measuring approximately 2x3 ft with dirt and rust, a ceiling area measuring approximately 1x1 ft with peeling paint, a corner wall panel about 1.5 ft long that was dislodged from the side wall, a corner wall area behind the washing machine measuring approximately 1.5x1.5 ft with a black-dotted film resembling mold, and 12 floor tiles measuring 1x1 ft that were dirty and stained. During interview, the Maintenance Director stated staff notify him of pending work order needs and that he had been aware of the observed areas needing repair. The Administrator stated the completed repairs would create a safer environment for residents and staff. Record review showed the facility policy titled Preventative Maintenance in the Environment of Care Policy and Procedure Manual dated 2003 stated preventative maintenance will be completed routinely and according to protocol by the Maintenance Supervisor or qualified designee.
Failure to Develop Comprehensive Care Plans for Dialysis and PICC Line Needs
Penalty
Summary
The facility failed to develop and implement comprehensive person-centered care plans with measurable objectives and timeframes for 2 residents whose assessments identified ongoing medical needs. For one resident admitted with end stage renal disease, the record showed orders for dialysis three times weekly and nursing assessment of the dialysis access for bruit and thrill every shift, but the care plan only repeated the dialysis and access-monitoring orders and did not include focus areas, goals, or interventions. For another resident admitted with hemiparesis and a urinary tract infection, the record showed a PICC line in the right upper arm for intravenous antibiotics and orders to maintain the line, flush it before and after medication, and avoid blood pressure or venipuncture in the right arm, but the care plan did not include focus areas, goals, or interventions for the UTI, PICC line, or antibiotic use. Record review showed the resident with ESRD was admitted with a diagnosis of end stage renal disease, had a BIMS score of 13, and received dialysis treatments. The physician ordered dialysis on Tuesdays, Thursdays, and Saturdays, nursing assessment of the dialysis device for a positive bruit and thrill every shift, and permission to withhold medications prior to dialysis appointments. The care plan dated 12/10/2025 reflected the dialysis schedule and access assessment, but further review found no focus care areas, goals, or interventions. Record review for the second resident showed admission with diagnoses including hemiparesis and UTI, a BIMS score of 15, and need for antibiotics via a PICC intravenous access. Nursing documentation stated the resident returned from the hospital with a PICC line in the right upper arm. Physician orders included IV levofloxacin for UTI, dressing changes to the double-lumen PICC line, flushing the line with normal saline before and after medication, and no blood pressure or venipuncture to the right arm. The care plan dated 12/10/2025 had no focus, goals, or interventions for the UTI, PICC line, or antibiotic use. During interviews, the RN MDS nurse stated she had overlooked adding these nursing care plans due to human error, and the DON and Administrator stated residents with dialysis and IV antibiotic needs should have care plans developed and implemented.
Missing Wheelchair Anti-Slip Mat for a Resident at Fall Risk
Penalty
Summary
The facility failed to ensure that Resident #9’s environment remained free of accident hazards and that the resident received adequate supervision and assistance devices to prevent accidents when the anti-slip mat prescribed for the resident’s wheelchair seat was missing for days. Resident #9 was admitted with diagnoses including a history of falling, syncope and collapse, and difficulty walking, and her annual assessment showed moderate cognitive impairment, poor vision, use of a wheelchair, and a need for safety assistance and supervision related to fall risk and a history of falling. Her care plan identified a potential for falls related to a history of falls and included an anti-slip mat as an intervention. Record review showed Resident #9 had previously fallen out of her wheelchair and stated she slipped and fell out of the wheelchair while wearing socks. During observations, Resident #9 was seen seated in her wheelchair and later in bed with the wheelchair at bedside, and on both occasions the wheelchair seat had no anti-slip mat. Resident #9 stated the mat had been missing since her wheelchair was washed and that she had been asking staff for it because it helped prevent her from slipping out of the wheelchair. CNAs stated they were aware she was a fall risk but did not know she needed the mat, and one LVN stated she was aware of the fall risk but did not know the mat was missing until the resident reported it. The DON and Administrator stated the nurses and CNAs were responsible for ensuring residents received care according to their care plans and reporting discrepancies in care.
Incorrect Scanning of Resident Medical Records
Penalty
Summary
The facility failed to maintain medical records completely, accurately documented, readily accessible, and systematically organized for 2 of 8 residents reviewed for accurate medical records. Resident #9’s record showed an admission date of 3/21/2025 with diagnoses including a history of falling, syncope and collapse, and difficulty walking, and the annual MDS described the resident as a female admitted for LTC with safety assistance and supervision related to fall risk and history of falling, with a BIMS score of 12 indicating moderate cognitive impairment, adequate hearing, poor vision, use of glasses, and use of a wheelchair. Resident #76’s record showed an admission date of 10/3/2025 and discharge date of 10/20/2025 with diagnoses including COPD and anxiety disorder, and the discharge MDS indicated the resident was admitted for rehabilitation care and discharged home with home healthcare after 17 days. A review of Resident #9’s scanned medical records found a 13-page hospital discharge document for Resident #76 dated 10/3/2025 stored in Resident #9’s record. During interview, the Medical Records staff member stated she was responsible for scanning documents into resident records and had made mistakes scanning records into the wrong residents’ medical records. The DON and Administrator stated they were the supervisors for the Medical Records staff member and acknowledged she had made mistakes in scanning medical records.
Failure to Timely Update Care Plan and Kardex After Assessment
Penalty
Summary
The facility failed to review and revise the care plan for a resident after a comprehensive assessment, as required. Specifically, the Kardex for a female resident with severe cognitive impairment, anxiety disorder, communication deficit, and dementia was not updated in a timely manner to reflect her need for extensive assistance with two staff members for transfers via mechanical lift. The quarterly MDS assessment indicated this level of assistance was necessary, but the Kardex continued to list her as requiring assistance from only one staff member during transfers. Interviews with facility staff revealed that the MDS nurse did not update the Kardex until several weeks after the assessment, acknowledging that this oversight could prevent staff from being aware of the resident's correct transfer status. The DON confirmed that the update should have occurred immediately after the assessment and that failure to do so could negatively affect residents. Facility policy requires care plans to be reviewed and revised after each assessment, but this was not followed in this instance.
Failure to Use Required Mechanical Lift Results in Resident Injury
Penalty
Summary
A deficiency occurred when a resident with severe cognitive impairment and multiple diagnoses, including dementia and a communication deficit, was transferred by a CNA using a single-person standing pivot transfer instead of the required two-person mechanical lift. The resident's care plan and MDS assessment both specified that transfers should be performed with two staff members using a mechanical lift. During the improper transfer, the resident's left leg rubbed against the bed frame, resulting in a laceration that required 13 stitches and hospital treatment. The CNA involved was unaware of the transfer requirements indicated in the MDS assessment and did not follow the established care plan. Interviews and record reviews confirmed that the CNA had previously used the mechanical lift but failed to do so during this incident. The facility's policy required the use of a mechanical lift for safe transfers, and the DON acknowledged that not following the MDS assessment could result in resident injury. The incident was documented in progress notes, and the resident was able to communicate pain following the transfer, prompting emergency medical attention.
Failure to Report Alleged Neglect Following Resident Injury
Penalty
Summary
The facility failed to ensure that an allegation of neglect was reported to the State Survey Agency as required by both state law and facility policy. A female resident with severe cognitive impairment, anxiety disorder, communication deficit, and dementia sustained a laceration to her left lower calf during a transfer from wheelchair to bed, which required 13 stitches. The incident was witnessed by a CNA, who reported it to the on-duty LVN, and the resident was subsequently sent to the hospital for evaluation and treatment. Documentation confirmed the injury and subsequent care, but there was no record of a self-reported incident regarding neglect for this resident in the Texas Unified Licensure Information Portal (TULIP). Interviews revealed that the DON was informed of the injury and notified the Administrator, but neither the DON nor the Administrator reported the incident to the State Survey Agency. The Administrator stated he did not report the injury because it was witnessed, but later acknowledged, after reviewing neglect guidelines, that the incident should have been reported. Facility policy requires reporting all allegations of abuse, neglect, exploitation, mistreatment, and injuries of unknown source to the appropriate authorities, which was not followed in this case.
Inaccurate Hospice Status Documentation in Resident Assessment
Penalty
Summary
The facility failed to ensure an accurate assessment for a resident, specifically in the documentation of hospice care status. The resident, who was of advanced age and had multiple serious health conditions including osteomyelitis, Type II diabetes with unspecified complications, and end-stage renal disease, had elected hospice services effective May 14, 2024. However, the Quarterly Minimum Data Set (MDS) assessment inaccurately documented that the resident was not receiving hospice care. This discrepancy was identified during a review of the resident's records and confirmed through interviews with the MDS nurse and the Director of Nursing (DON). The MDS nurse acknowledged that the MDS should have been completed as a Significant Change MDS to reflect the resident's hospice election. The nurse admitted to using the Resident Assessment Instrument (RAI) as a reference for the MDS but failed to accurately code the resident's hospice status. The DON confirmed the expectation that the MDS nurse should follow the RAI reference and ensure accurate coding, with the DON responsible for reviewing the accuracy. The Long-Term Care Facility Resident Assessment Instrument 3.0 User's Manual specifies that a Significant Change in Status Assessment (SCSA) is required when a terminally ill resident enrolls in a hospice program, which was not adhered to in this case.
Improper Medication Administration via Enteral Access Device
Penalty
Summary
The facility failed to ensure that medications were administered according to professional standards and practices for a resident with an enteral access device. The resident, a male with moderately impaired cognition, was admitted with a primary diagnosis of cerebral infarction and other conditions such as seizure disorder and malnutrition. The resident's care plan included specific instructions for medication administration via the enteral access device, which were not followed by the staff. During an observation, an LVN prepared and administered medications to the resident by crushing tablets and adding them directly to the syringe without dissolving them in water, contrary to the prescribed method. The LVN added each crushed medication to the remaining liquid in the syringe, followed by a water flush, resulting in visible powder residue and frothy particulate in the syringe. This method of administration was inconsistent with the facility's policy and professional guidelines, which require medications to be dissolved in water and flushed between each administration to ensure proper delivery and prevent complications. Interviews with the LVN, DON, and R.Ph. revealed a lack of understanding and adherence to the correct procedure for administering medications via an enteral access device. The R.Ph. and MD acknowledged that while there was no immediate risk of adverse reactions from the method used, the best practice involves dissolving medications in water before administration. The facility's policy and external guidelines emphasize the importance of proper medication preparation to maintain the patency of the feeding tube and ensure the therapeutic effectiveness of the medications.
Inaccurate MDS Assessments for Two Residents
Penalty
Summary
The facility failed to ensure accurate assessments for two residents, leading to deficiencies in their care documentation. Resident #1, who had a history of cerebral infarction, dementia, and heart failure, experienced an unwitnessed fall resulting in a fracture of the right pubis. Despite this incident, the resident's Quarterly MDS did not reflect the fall or the major injury, which was a nondisplaced fracture of the right inferior pubic ramus. The MDS Nurse acknowledged that the fall should have been coded as a major injury under the J section of the MDS Assessment. Similarly, Resident #2, who had diagnoses including systolic heart failure and mild cognitive impairment, was found to have a bruise and a comminuted fracture of the right clavicle after a fall. However, the Quarterly MDS for this resident did not accurately reflect the fall with a major injury. The MDS Nurse admitted to inaccurately coding the resident's fall, noting that the resident had two or more falls but not that there was a major injury. The care plan did include the injury, but the MDS assessment was not updated accordingly. Interviews with the MDS Nurse, DON, and ADMIN revealed a consensus that the inaccurate MDS coding would not have impacted the direct care provided to the residents, as long as the care plans were updated. However, it was acknowledged that the coding errors could affect financial reimbursement and communication with the state regarding the level of assistance required by the residents. The facility's policy emphasizes the importance of accurate MDS assessments to reflect the resident's status, as required by federal regulations.
Failure to Post Daily Nurse Staffing Information
Penalty
Summary
The facility failed to post daily nurse staffing information, including the facility name, current date, total number and actual hours worked by registered nurses, licensed practical or licensed vocational nurses, certified nurse aides directly responsible for resident care per shift, and the resident census. This deficiency was observed from 07/05/2024 to 07/11/2024. On 07/11/2024, a document labeled with the facility's name and dated 07/04/2024 was found posted, indicating that the required daily updates had not been made. The ADMIN confirmed the oversight and initially stated that the staffing document was supposed to be posted every morning around 10:00 a.m., but later clarified that the night shift charge nurse was responsible for this task. The night shift charge nurse, who was new, had been placing the document in the ADON's box, who was on vacation, leading to the failure in posting. The DON acknowledged that this lapse in posting could impact communication with residents who are cognitively aware and visiting families or guests seeking this information. The ADMIN expressed uncertainty about the impact of not posting the daily census and nurse staffing information and noted that the facility lacked a specific policy, relying instead on federal and state regulations.
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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 Del Rio
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Val Verde Nursing And Rehabilitation Center | 3.3 mi | ★★★★★ | 4 | 0 |
| Del Rio Nursing And Rehabilitation Center | 3.5 mi | ★★★★★ | 16 | 0 |
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