Above average — CMS composite of the measures below.
Past the typical resurvey interval — a standard survey could occur at any time
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 Life Care Center Of Plano during CMS and state inspections, most recent first.
A resident with dementia and total dependence for ADLs had a care plan that addressed general self-care deficits, bed mobility, and some activity interests but omitted specific, well-known comfort preferences. Posters placed in the room by the resident’s family clearly directed staff to always elevate the head of the bed, keep the TV on channels 54 or 55 at volume 30, and maintain the room temperature at 71–72 degrees, yet these preferences were not documented in the care plan. CNAs and LVNs reported relying on room signs and verbal shift reports rather than the written care plan, and several staff acknowledged they did not review care plans. MDS staff, the DON, and the Administrator confirmed that such preferences should have been included per the facility’s person-centered care planning policy, but they were not, resulting in an incomplete and non-individualized care plan.
Surveyors found that the facility’s activities program was being directed by an Activity Director who lacked the required certification or qualifying credentials. The Activity Director had been hired and functioning in the role for several months without meeting federal criteria for an activities professional or therapeutic recreation specialist, and she could not describe the risks to residents from her lack of qualification. The Administrator confirmed he had only recently learned she was not certified and acknowledged that this could affect her ability to recognize and address resident isolation, contrary to facility policy and regulatory requirements for a qualified individual to direct the activities program.
A resident with cognitive impairment and no prior history of elopement left the facility unsupervised by following a visitor out the front door, which was unlocked by the receptionist who did not recognize him as a resident. The resident was missing for over an hour before being found at a nearby apartment complex, with staff unaware of his absence until notified by external parties. Staff did not verify the resident's location, and elopement risk assessments and monitoring procedures were not effectively implemented, resulting in a deficiency for inadequate supervision and accident prevention.
The facility failed to ensure proper food storage, labeling, and sealing in both the walk-in refrigerator and freezer, and did not maintain temperature monitoring or logs for two chest freezers. During meal preparation, dietary staff did not use required hair or facial hair restraints and failed to follow proper hand hygiene protocols, including not washing hands between glove changes while handling food.
Three residents did not have their care needs and preferences accurately reflected in their care plans, including the use of psychotropic medication, specific ADL assistance, and a preference for being assisted by a family member. Staff interviews and observations confirmed these needs and preferences were known but not documented, resulting in incomplete person-centered care planning.
Two residents who were dependent on staff for ADL care did not receive adequate assistance with grooming and nail care. One resident with diabetes and other chronic conditions was observed with long, dirty fingernails on multiple days, while another resident with multiple diagnoses had long fingernails and facial hair that had not been addressed. Staff interviews revealed confusion about responsibility for nail care and a lack of attention to residents' grooming needs, despite facility policy requiring assistance with these tasks.
Staff failed to consistently perform hand hygiene and use EPA-approved disinfectants during incontinence care, blood glucose monitoring, and wound care for several residents with complex medical needs, resulting in lapses in infection prevention and control protocols.
Staff failed to keep a foley catheter drainage bag below the bladder during a mechanical lift transfer for a resident with severe cognitive impairment and multiple medical conditions. The drainage bag was observed above the bladder, contrary to physician orders and facility policy, and staff interviews revealed uncertainty about proper procedures during transfers.
Two residents did not receive respiratory care in accordance with professional standards: one received tracheostomy care from an LVN who failed to perform required hand hygiene and maintain sterile technique, while another received continuous oxygen therapy without a physician order specifying the amount to be administered. These failures were confirmed by staff interviews and review of facility policies.
A resident did not receive a timely dose of levothyroxine because staff failed to re-order the medication as required. When the medication was unavailable, an LVN borrowed it from another resident's supply instead of using the E-Kit, contrary to facility policy. Staff interviews confirmed that nurses are responsible for re-ordering medications when supplies run low and that the E-Kit should be used for missing doses.
A LVN left a medication cup with a pill on top of an unlocked medication cart and left the cart unattended while assisting a resident and administering medications to another. The LVN acknowledged the error, and the DON confirmed that staff are trained to keep medication carts locked and medications secured, as required by facility policy.
A CNA in an LTC facility failed to demonstrate competency in repositioning a resident according to the care plan, resulting in the resident grimacing in pain. The CNA grabbed the resident's neck to reposition him, contrary to the facility's policy, which prohibits pulling from the head of the bed. The resident, who had multiple cognitive and mental health diagnoses, required assistance with ADLs due to an ADL self-care performance deficit.
The facility failed to maintain proper kitchen sanitation, with observations revealing thick black buildup on the grease trap and food residue and grease on the stove. Interviews indicated inconsistent cleaning practices among kitchen staff, and the Food Services Director acknowledged outdated and unchecked cleaning schedules.
The facility failed to ensure that a resident's fall mat was placed on both sides of the bed as noted in the care plan. The resident, with a history of falls and severe cognitive impairment, was found without fall mats, which were rolled up in the corner of the room. Staff interviews confirmed that the mats should have been placed back immediately to prevent potential injury.
Failure to Incorporate Resident Comfort Preferences Into Comprehensive Care Plan
Penalty
Summary
Surveyors identified a deficiency in the facility’s failure to ensure a comprehensive, person-centered care plan that described all services needed to attain or maintain a resident’s highest practicable well-being. The resident involved was an elderly male with vascular dementia, muscle weakness, peripheral vascular disease, gastroparesis, generalized anxiety disorder, and dysphagia, who was totally dependent on staff for all self-care needs and was rarely understood, so cognition was not assessed on the MDS. His comprehensive care plan, with multiple revisions, addressed ADL self-care deficits, bed mobility, repositioning, nail care, meal provision, and some activity preferences such as watching television, family visits, and ice cream snacks. The care plan also included an intervention to turn off lights and television at bedtime. Despite these documented elements, the care plan did not include several specific and consistently expressed preferences related to the resident’s comfort and routine. The resident’s room contained multiple posters created by his relative that clearly stated his preferences: his head should always be elevated, his television should be on channel 54 or 55 with the volume at 30, and the room temperature should be maintained at 71–72 degrees with heat when cold outside and cool when hot outside. These posters were observed by surveyors, and staff interviews confirmed that these preferences were known and used in daily care. However, review of the resident’s care plan showed no entries reflecting his preferred TV channels and volume, preferred room temperature settings, or the need for his head to always be raised. Interviews with CNAs, LVNs, MDS staff, the DON, and the Administrator revealed that staff relied on in-room posters, verbal reports, and family input rather than the written care plan to learn and follow the resident’s preferences. One CNA who worked with the resident daily described his need to have the TV on at all times (muted when asleep) and his head elevated at all times except during care, noting he would vomit if his head was not up, but she stated she had no access to the care plan. Another CNA and an agency LVN reported learning about preferences from room signs and shift report, and both stated they did not look at care plans. The MDS Nurse Coordinators acknowledged seeing the posters and agreed the preferences should have been added to the care plan immediately once staff were aware of them, but one coordinator admitted she had seen the posters and had not paid attention to what they stated, and no one had told her to add them. The DON and Administrator both stated that all resident or representative preferences should be listed in the care plan and that if preferences were not listed, the care plan was incomplete. The facility’s own policy on Person Centered Care Planning required a person-centered comprehensive care plan to meet resident preferences and goals, yet the resident’s specific preferences for TV settings, room temperature, and head elevation were not incorporated into his written care plan.
Unqualified Staff Directing the Activities Program
Penalty
Summary
The facility failed to ensure its activities program was directed by a qualified professional as required by regulation and facility policy. Record review showed the Activity Director was hired on 08/24/2024 and began performing activity duties on 10/18/2025. During an interview, the Activity Director reported she did not yet have her activity certification and stated that a previous administrator had agreed to pay for the certification, but it had not been obtained. When asked about the risk to residents from her lack of certification, she stated she did not have an answer. In a separate interview, the Administrator acknowledged he had just learned that the Activity Director was not certified. He stated that the risk to residents was that the Activity Director might not be able to identify if residents were isolating themselves or secluded and how to address that. Review of the facility’s “Therapeutic Activities Program” policy, dated 09/26/2025, showed it required that the activities program be directed by a qualified activities director responsible for directing the development, implementation, supervision, and ongoing evaluation of the activities program. Federal regulatory criteria cited in the report specify that the activities program must be directed by a qualified therapeutic recreation specialist or activities professional meeting defined licensure, certification, experience, or training requirements, which the current Activity Director did not meet at the time of the survey.
Resident Elopement Due to Inadequate Supervision and Failure to Identify Exit-Seeking Behavior
Penalty
Summary
A deficiency occurred when a resident with a history of metabolic encephalopathy, chronic kidney disease, and intermittent memory problems was able to leave the facility without staff awareness. The resident was admitted as oriented to person, place, and time, and initial elopement risk assessments did not identify him as at risk for elopement. However, the resident exited the facility by following a visitor out the front door, which was unlocked by the receptionist, who did not recognize him as a resident at the time. The resident was missing for approximately 1.5 hours before being located at a nearby apartment complex, after crossing a parking lot and service road. During the time the resident was missing, staff did not notice his absence. An LPN assumed the resident was in therapy and did not verify his location. The facility's elopement book and risk lists were not effectively used to identify or monitor the resident, and the receptionist was not aware of the resident's status. The incident was only discovered when the apartment complex staff contacted the facility, prompting the Maintenance Director to retrieve the resident. Law enforcement was also involved after being called to the apartment complex, where the resident was found confused and unable to explain how he had arrived there. The facility's policies required regular elopement risk assessments and quarterly elopement drills, but the resident's risk status was not updated until after the incident. Staff interviews revealed that while elopement drills and in-services had been conducted, there was a lack of immediate recognition and response to the resident's absence. The failure to provide adequate supervision and to ensure the area was free from accident hazards resulted in the resident's unsupervised departure and subsequent exposure to potential harm.
Food Storage, Preparation, and Staff Hygiene Deficiencies in Dietary Services
Penalty
Summary
The facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety. In the walk-in refrigerator, bell peppers were found with wrinkling skin, softness, and white spots, indicating spoilage, and chicken noodle soup was not fully covered with plastic wrap. In the walk-in freezer, several food items including garlic bread, hash browns, and beef steak patties were found in torn or unsealed packaging, and packages of shrimp and brussels sprouts were not dated when received. The Dietary Manager confirmed that items should be dated, labeled, and sealed, and acknowledged that some items were not handled according to policy. Two chest freezers in the kitchen were found to be in use without thermometers, and there were no temperature logs maintained for these freezers. The chest freezers also had ice accumulation on the sides. The Dietary Manager was unable to locate thermometers for the freezers and admitted that temperature logs were not being kept. The Maintenance Director was unaware that the chest freezers were still in use and confirmed that they should have thermometers to ensure proper temperature maintenance. During lunch meal preparation and service, the Dietary Manager was observed plating food without a facial hair restraint for his mustache and failed to wash his hands between glove changes, despite handling food and touching the inner parts of plates. Another dietary staff member was observed with hair not fully covered by her hat while preparing food. Both staff members acknowledged awareness of the requirements for hair and facial hair restraints and proper hand hygiene, but did not comply with these standards during the observed meal service.
Failure to Develop and Implement Comprehensive, Person-Centered Care Plans
Penalty
Summary
The facility failed to develop and implement comprehensive, person-centered care plans for three residents, resulting in deficiencies related to the documentation and communication of their care needs and preferences. For one resident with severe cognitive impairment and multiple diagnoses, the care plan did not reflect the use of psychotropic medication (Depakote) or the resident's dependence on staff for activities of daily living (ADLs), despite physician orders and staff interviews confirming these needs. The Director of Nursing and MDS Coordinator acknowledged that these aspects should have been included in the care plan to ensure staff awareness and appropriate interventions. Another resident, who was cognitively intact and required substantial assistance with ADLs, had a care plan that failed to specify the type of assistance needed or her preference for bed baths. Interviews with the resident and staff confirmed that bed baths were provided according to her preference, but this was not documented in the care plan. The care plan only included a general intervention to assist with ADLs as needed, lacking the specificity required for person-centered care. A third resident, who had quadriplegia and moderately impaired cognition, preferred to be fed and assisted with ADLs by a family member who was also a resident. Although staff and the residents themselves confirmed this preference, the care plan did not address it. The MDS Coordinator, Activity Director, and other staff agreed that this preference should have been documented to ensure all staff were aware and could honor it. The facility's policy required individualized, person-centered care plans based on resident assessments, but this was not consistently implemented for these residents.
Failure to Provide Adequate Assistance with Grooming and Nail Care
Penalty
Summary
The facility failed to provide necessary assistance with activities of daily living (ADLs), specifically in maintaining good grooming and personal hygiene for two residents who were unable to perform these tasks independently. One resident, a female with a history of heart disease, type 2 diabetes, and hypertension, required substantial to maximal assistance with personal hygiene. Observations on two consecutive days revealed that her fingernails were approximately 0.5 inch in length with a dark brown substance underneath, indicating they had not been cleaned or trimmed. The resident reported she could not recall the last time her fingernails were trimmed and stated that no one had asked her about nail care. Staff interviews revealed confusion regarding responsibility for nail care, with CNAs believing nurses or the podiatrist were responsible, and nurses indicating that podiatrist visits were infrequent and that CNAs should clean the nails as needed. Another resident, a woman with diagnoses including enterocolitis due to clostridium difficile, morbid obesity, and muscle weakness, was observed to have facial hair about an inch long on her chin and fingernails that were 0.5-0.7 cm in length with a dark substance underneath. This resident was dependent on staff for showering, bathing, and toileting hygiene, and expressed a desire to have her facial hair removed and fingernails cut, stating that no one had asked her about these grooming needs. Staff interviews confirmed that the resident's grooming needs had not been noticed or addressed, and acknowledged that long and dirty nails could pose a risk of infection and negatively affect the resident's self-esteem. Review of the facility's policy on activities of daily living indicated that residents should receive assistance as needed to complete ADLs, including ensuring fingernails are clean and trimmed to avoid injury and infection. Despite this policy, the facility did not ensure that dependent residents received adequate assistance with nail care and grooming, as evidenced by the observations and staff interviews.
Failure to Adhere to Infection Control and Hand Hygiene Protocols
Penalty
Summary
The facility failed to maintain an effective infection prevention and control program, as evidenced by multiple staff not adhering to proper hand hygiene and equipment disinfection protocols during resident care. In one instance, a CNA provided incontinence care to a male resident with a history of infection and diabetes without performing hand hygiene before donning gloves, and again failed to sanitize hands when changing gloves between dirty and clean tasks. The CNA only performed hand hygiene after completing all care and handling trash, contrary to facility policy and infection control standards. During blood glucose monitoring for two residents with diabetes, LVNs did not follow required disinfection and hand hygiene procedures. One LVN used an alcohol prep pad instead of an EPA-approved germicide to clean the glucometer before and after use, citing a lack of appropriate supplies on the cart. Another LVN failed to perform hand hygiene after removing gloves and before handling an insulin pen, only sanitizing hands after preparing the medication. Both staff acknowledged awareness of the correct procedures and the risks associated with non-compliance. Additionally, during wound and incontinence care for a female resident with a sacral pressure ulcer, the Treatment Nurse did not perform hand hygiene after removing gloves and before re-gloving to continue wound care. This lapse occurred after cleaning a bowel movement and before re-treating the wound. The Treatment Nurse later confirmed that hand hygiene should have been performed at that point. Facility policy reviews confirmed that hand hygiene is required before and after resident contact, after glove removal, and after contact with blood or body fluids.
Failure to Maintain Foley Catheter Drainage Bag Below Bladder During Transfer
Penalty
Summary
Staff failed to maintain proper positioning of a foley catheter drainage bag for a resident who was incontinent of bladder and required total assistance with activities of daily living. During a mechanical lift transfer, the catheter drainage bag was observed being placed above the resident's bladder, first by being hooked onto the lift sling and then placed on the resident's lap, before finally being attached to the wheelchair. This was contrary to physician orders and facility policy, both of which required the drainage bag to be kept below the level of the bladder at all times to maintain unobstructed urine flow and prevent complications. The resident involved was a severely cognitively impaired female with multiple diagnoses, including diabetes, traumatic brain injury, respiratory failure, and neurogenic bladder, and had an indwelling catheter in place. Interviews with the staff involved revealed uncertainty and lack of clear instruction regarding the correct handling of the drainage bag during mechanical lift transfers, despite documentation indicating they had been deemed competent in catheter care. The facility's policy and physician orders were not followed during the observed transfer.
Failure to Provide Safe and Appropriate Respiratory Care
Penalty
Summary
The facility failed to provide safe and appropriate respiratory care for two residents requiring such care, as evidenced by direct observation, interviews, and record review. For one resident with a tracheostomy, an LVN did not perform hand hygiene at multiple required points during the tracheostomy care procedure. The LVN donned gloves and a gown without first sanitizing her hands, removed the old stoma dressing and inner cannula, and then proceeded to open and handle sterile supplies without hand hygiene. During the process, the LVN contaminated the sterile field by touching a non-sterile saline bottle and failed to maintain sterile technique throughout the procedure. The LVN acknowledged awareness of the correct sterile procedure and hand hygiene requirements but stated she was nervous and forgot to sanitize her hands. The facility's policy and staff interviews confirmed that tracheostomy care should be performed using sterile technique with hand hygiene before and after glove changes. Another resident was observed receiving continuous oxygen therapy via nasal cannula, but there was no physician order specifying the need for oxygen or the number of liters to be administered. The resident's care plan and physician order summary did not reflect any order for oxygen therapy, despite the resident stating she had been receiving oxygen since admission. Staff interviews confirmed that a physician order should have been in place prior to administering oxygen, and the absence of such an order was acknowledged as a failure to follow protocol. Both deficiencies were confirmed through interviews with nursing staff and the DON, who stated that proper procedures were not followed. The facility's policies on tracheostomy care and oxygen administration both require adherence to professional standards, including sterile technique and physician orders for respiratory treatments. The observed failures placed residents at risk for respiratory infections and incorrect oxygen administration.
Failure to Timely Re-Order and Securely Administer Medication
Penalty
Summary
Facility staff failed to provide pharmaceutical services that ensured the accurate acquiring, receiving, dispensing, and administering of medications for a resident. Specifically, staff did not re-order levothyroxine 50 mcg in a timely manner, resulting in a missed dose for a male resident with diagnoses including malnutrition and seizure disorder. The medication administration record indicated a missed dose, and there was no documentation in the progress notes to explain the omission. During medication administration, the nurse was unable to locate the medication and did not retrieve it from the E-Kit as required. Instead, the nurse borrowed levothyroxine from another resident's supply and administered it, which was confirmed during a subsequent interview. The nurse admitted to not following the proper procedure due to being in a hurry and not knowing why the medication had not been re-ordered. Other staff interviews confirmed that nurses are responsible for re-ordering medications when a 7-day supply remains and that the E-Kit is available for such situations. The facility's policy requires timely re-ordering and use of electronic systems to track medication needs.
Failure to Secure Medications and Lock Medication Cart
Penalty
Summary
A deficiency was identified when a Licensed Vocational Nurse (LVN) failed to properly secure medications on a medication cart in Hall E. During a medication pass, a medication cup containing a tan pill was left on top of the unlocked medication cart while the LVN assisted a resident in the bathroom. The LVN then left the cart unlocked and unattended again while administering medications to another resident in a different room. The LVN admitted to being distracted and acknowledged that the pill was an extra dose that should have been destroyed, and that medications should not be left unsecured or on top of the cart. The Director of Nursing (DON) confirmed that leaving the medication cart unlocked could allow unauthorized access to medications, and stated that staff are trained to keep carts locked and medications secured at all times. Facility policy requires all medications and biologicals to be securely stored in locked cabinets or carts, inaccessible to residents and visitors. The observed actions were not in compliance with this policy.
Inappropriate Repositioning Technique by CNA
Penalty
Summary
The facility failed to ensure that a Certified Nurse Aide (CNA) demonstrated competency in providing care according to the comprehensive care plan for a resident. The deficiency involved CNA A grabbing the resident's neck to reposition him in bed, which resulted in the resident grimacing in pain. This action was not in accordance with the facility's transfer and repositioning policy, which prohibits pulling from the head of the bed and manual patient repositioning. The resident involved was a male with multiple diagnoses, including cognitive impairment, dementia, psychotic disturbance, mood disturbance, anxiety, and other mental health conditions. The resident required assistance with activities of daily living (ADLs) due to an ADL self-care performance deficit related to activity intolerance and dementia. The care plan specified that the resident was totally dependent on 1-2 staff for repositioning and turning in bed every 2-4 hours or as necessary. The incident occurred when CNA A attempted to reposition the resident by grabbing his neck, which was captured on video. The resident's family had previously complained about the resident leaning to one side in bed, prompting CNA A to attempt repositioning. However, the method used was inappropriate and not aligned with the facility's policy, leading to the resident's discomfort and grimacing.
Failure to Maintain Kitchen Sanitation
Penalty
Summary
The facility failed to ensure proper sanitation in the kitchen, specifically regarding the grease trap and stove. Observations revealed a thick black buildup on the grease trap and food residue and grease buildup on the sides of the stove. Interviews with kitchen staff indicated that the cleaning responsibilities were not consistently followed, with some staff members not cleaning the grease trap or stove if they did not use certain equipment during their shift. The Food Services Director acknowledged that the cleaning schedule was outdated and not routinely checked for thoroughness, leading to the observed unsanitary conditions. Further observations confirmed that the grease trap and stove remained unclean despite the Food Services Director's efforts to address the issue. Interviews with multiple cooks revealed a lack of clarity and consistency in cleaning responsibilities, with some cooks not cleaning areas they did not use. The Food Services Director admitted that the grease trap required significant effort to clean and that it was his responsibility to ensure proper sanitation. The facility's cleaning policy and the US Public Health Service Food Code were not adhered to, resulting in the accumulation of grease and food residue on kitchen equipment.
Failure to Ensure Fall Mats in Place for Resident at Risk of Falls
Penalty
Summary
The facility failed to ensure that Resident #1's fall mat was placed on both sides of his bed as noted in his care plan. Resident #1, a [AGE] year-old male with a history of traumatic hemorrhage of the cerebrum, protein-calorie malnutrition, muscle weakness, history of falling, and vascular dementia, was observed lying in bed without fall mats on either side. The fall mats were found rolled up and propped in the corner of the room. Nurse Aide A admitted to rolling up the mats with the intention of transferring the resident to a wheelchair but left to find assistance without putting the mats back down. LVN B and the DON confirmed that the mats should have been placed back immediately to prevent potential injury from falls. Interviews with the staff revealed that it was the responsibility of both the nurse aides and nurses to ensure that fall mats were used for residents at risk of falls. The DON emphasized that staff should plan ahead and ensure mats are in place if they need to leave the room. The facility's policy on fall management, reviewed in December 2023, indicated that patient safety should be promoted by proactively identifying, care planning, and monitoring fall indicators. The failure to follow these protocols put Resident #1 at increased risk for accidents and injury.
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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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Illustrative
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Nursing homes near Plano
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Landmark Of Plano Rehabilitation And Nursing Cente | 0.4 mi | ★★★★★ | 19 | 0 |
| The Healthcare Resort Of Plano | 1.3 mi | ★★★★★ | 1 | 0 |
| Carrara | 1.4 mi | ★★★★★ | 6 | 0 |
| The Hillcrest Of North Dallas | 1.8 mi | ★★★★★ | 1 | 0 |
| Continuing Care At Highland Springs | 2 mi | ★★★★★ | 6 | 2 |
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