Above average — CMS composite of the measures below.
The next survey window likely opens around May 2027
Estimate from public CMS data, current as of October 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Palma Real during CMS and state inspections, most recent first.
Failure to Provide Written Transfer/Discharge Notices: The facility failed to give written transfer or discharge notices to three residents or their RPs and instead relied on phone calls. One resident had CHF, AFib, and DM, and two residents had DM with severely impaired cognition on MDS. Family members stated they never received written notice, and the facility’s policy required written notice with the reason for transfer/discharge, appeal rights, and LTC Ombudsman information.
Food storage practices were not followed in the resident refrigerator, freezer, and dry storage areas. A box of frozen foods was left uncovered, items in the refrigerator were not sealed or dated, and several dry goods were expired or not rotated using FIFO. A personnel phone was also observed on a kitchen rack, and staff and the Dietician stated food items should be dated, covered, and rotated properly.
A resident with severely impaired cognition had a care plan that still listed both DNR and full code status even though the physician order and OOH DNR reflected DNR. Another resident with severely impaired cognition had a hospice care plan left in place after hospice was revoked and no hospice order remained. The DON and MDS nurse stated the hospice focus should have been removed and the code status care plan should have reflected the current status.
Medication Given Outside Ordered BP Parameters: A resident admitted with hypotension received midodrine despite BP readings that were not within the physician's ordered parameters. MAR review showed the medication was administered when systolic BP was above the threshold, and both an LVN and the DON stated it should have been held when the BP was not below the ordered limit.
Unlocked Medication Cart: An observation found the 100 Hall med cart unlocked and accessible, with the lock popped out and drawers open. An LVN stated she left the cart unlocked when she stepped away, and the ADON said nurses had recently been in-serviced on locking med carts. The facility policy required drugs and biologicals to be stored in locked compartments with access limited to authorized personnel.
The facility failed to maintain an infection prevention and control program when staff did not perform proper hand hygiene during meal tray passing and wound care. An MR was observed sanitizing her hands for only a few seconds between trays, and the DON was observed rubbing ABHS for only 3 to 8 seconds at a time while providing wound care to a resident with DM, severe cognitive impairment, and a Stage 3 coccyx pressure ulcer. Both staff members stated proper hand hygiene should take longer, and the facility policy and CDC guidance indicated hand sanitizer should be rubbed over all surfaces until hands feel dry, about 20 seconds.
A CNA did not perform adequate hand hygiene before assisting a resident with a transfer, lathering hands for only 6 seconds instead of the required duration. The resident had multiple medical conditions and required significant assistance. Facility leadership and policy both confirmed the expectation for at least 15–20 seconds of handwashing to prevent cross contamination.
Failure to Provide Written Transfer/Discharge Notices
Penalty
Summary
The facility failed to provide written notice before transfer or discharge to the resident or the resident’s representative in a language and manner they could understand for 3 of 5 residents reviewed for transfer and discharge: Resident #25, Resident #53, and Resident #51. The report states that the facility relied on telephone notification for these events and did not complete written transfer or discharge notices for the residents or their representatives. Resident #51 was an [AGE]-year-old male admitted on 03/10/2026 with diagnoses including paroxysmal arterial fibrillation, diastolic congestive heart failure, and diabetes. His discharge MDS assessment dated 03/20/2026 showed no BIMS score. Progress notes dated 03/20/2026 documented that family was present, requested the resident be sent to the hospital due to a change in condition, the physician gave orders to send him to the ER, transportation was called, and the RP was aware. The resident’s RP stated she was not present at the time of discharge to the hospital and never received written notice, and said the only notification received was by telephone. Resident #25 was a female with diagnoses including Type 2 DM and a quarterly MDS dated 06/04/2026 showing a BIMS score of 01, indicating severely impaired cognition. Her hospital transfer form dated 05/22/2026 documented reasons for transfer/discharge and that report was called to the hospital, and that her RP was notified by telephone. Resident #53 was a female with diagnoses including DM and a quarterly MDS dated 04/12/2026 showing a BIMS score of 02, indicating severely impaired cognition. Her hospital transfer form documented reasons for transfer/discharge and telephone notification of the RP. Family for both Resident #25 and Resident #53 stated they never received written notification of the transfers or discharges and only received telephone calls. The facility’s transfer and discharge policy required written notice with the reason, effective date, location, appeal rights, state appeal information, appeal form information, assistance information, and LTC Ombudsman contact information, and stated that notice must generally be provided at least 30 days prior to transfer or discharge or as soon as practicable in certain exceptions.
Food Storage and Dating Deficiencies
Penalty
Summary
The facility failed to store food in accordance with professional standards in the resident refrigerator, resident freezer, and walk-in pantry. During observation of the kitchen, a box of pancakes, waffles, and beef patties in the walk-in freezer were not covered or sealed and were exposed to air. In the refrigerator, a pie was not dated with an expiration date, and a box of lemons, lettuce, cucumbers, and onions were not in a sealed container or covered and were exposed to air. In the dry storage area, staff were not using the first in, first out method of storage. Containers of honey thickener expired on 04/08/26, fruit juice expired in 04/2026, thickened dairy beverage expired on 06/01/26, and a box of tea bags with an expiration date of 05/11/2025 was stored for use with a written date of 04/11/26 on the box. Observation of storage racks also revealed a personnel phone, a pack of flour tortillas with no open date, and a loaf of bread with no open date that had been opened and used that morning. During interviews, the Dietary Aide staff stated expired items should be thrown away, food in dry storage should be rotated using first in, first out, and items in the refrigerator and freezer should be covered and sealed to prevent contamination. Staff also stated personal items should not be in the kitchen. The Dietician stated expired food items could make a resident sick, that all products should have an open date, expiration date, and received date written on each item, and that some items in dry storage had been overlooked during inventory. The facility policy stated food must be stored safely, all food items must be dated with the received date unless labeled by the vendor, containers must be tightly covered, stock must be rotated, and frozen foods should be covered, labeled, and dated.
Care plans not updated for code status and hospice changes
Penalty
Summary
The facility failed to develop and implement comprehensive care plans that reflected the residents’ current needs for 2 residents reviewed. Resident #25 had a quarterly MDS showing severely impaired cognition with a BIMS score of 01, and the physician order summary listed DNR. Her record also contained an Out of Hospital DNR signed into place on 05/02/2025. However, the care plan initiated 04/21/2026 still included a focus for DNR and also a separate focus for full code status initiated 05/28/2026, with interventions to inform staff of code status and monitor for decrease in change of condition. The facility did not remove the full code status from the care plan after Resident #25 became DNR. Resident #53 had a quarterly MDS showing severely impaired cognition with a BIMS score of 02. Her hospice revocation statement showed hospice was revoked because she was seeking aggressive treatments and labs, and the physician order summary showed no hospice order. Even so, the care plan initiated 04/27/2026 still stated that Resident #53 required hospice and had elected hospice to evaluate and treat her, with interventions related to feeding assistance and monitoring for decreased appetite, weight loss, skin breakdown, nausea, and vomiting, and reporting to hospice. The DON stated the hospice orders had been rescinded and the resident was no longer on hospice, and the MDS nurse stated the hospice focus should have been removed from the care plan when hospice was rescinded.
Medication Given Outside Ordered Blood Pressure Parameters
Penalty
Summary
The facility failed to ensure that a resident was free from significant medication errors when midodrine was administered outside of the physician-ordered blood pressure parameters. Resident #54 was admitted with hypotension and had intact cognition with a BIMS score of 15. Her care plan identified hypotension and noted that midodrine had been initiated, with an intervention to give medications as ordered and monitor for side effects and effectiveness. The medication order summary showed midodrine 5 mg three times daily to be given only if systolic blood pressure was less than 90, and a later order also stated not to take it within 4 hours of bedtime. Record review of the MAR showed midodrine was given when the resident's blood pressure did not meet the ordered parameters, including at 103/61, 96/59, 106/68, and 132/66. During interviews, an LVN stated the medication should have been held when the systolic blood pressure was not below 90 and acknowledged that giving midodrine outside parameters could cause hypertension. The DON also stated the medication should not have been administered when systolic blood pressure was less than 90 and confirmed that giving it outside parameters could lead to hypertension. Another LVN stated she did not believe she administered the medication on one occasion and said it appeared to have been documented incorrectly, but the MAR reflected administration.
Unlocked Medication Cart
Penalty
Summary
The facility failed to ensure drugs and biologicals were labeled and stored appropriately for 1 of 4 medication carts reviewed, specifically the 100 Hall Medication Cart. On 06/07/2026 at 11:29 AM, an observation of the 100 Hall Medication Cart parked in the 100 Hall revealed that it was unlocked and able to be accessed. The lock was popped out, and the unlocked drawers could be accessed. In an interview on 06/08/2026 at 4:28 PM, LVN-E stated she worked on the 100 hall and was the one who left the medication cart unlocked while she stepped away from it. She stated she was supposed to lock the medication cart anytime she walked away from it because residents could access medications that did not belong to them. In an interview on 06/09/2026 at 11:03 AM, the ADON stated the nurses had recently been in-serviced about locking their medication carts. Record review of the facility's Medication Storage policy, implemented 12/01/2025, stated that all drugs and biologicals would be stored in locked compartments and that only authorized personnel would have access to the keys.
Infection Control Hand Hygiene Failures During Dining Room Assistance and Wound Care
Penalty
Summary
The facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections. During a dining room observation, MR was seen assisting with passing meal trays and performing hand hygiene with ABHS only briefly, rubbing her hands for approximately 2 to 4 seconds at a time after applying the sanitizer and passing only a couple of trays between sanitizing episodes. In interview, MR stated she typically sanitized after passing 2 to 3 trays and would rub her hands for 10 to 15 seconds until dry, and she acknowledged that 2 to 3 seconds was not long enough for hand hygiene and could have caused cross-contamination and residents to become sick. The facility also failed to ensure the DON performed proper hand hygiene during wound care for a resident with Type 2 DM and a Stage 3 pressure ulcer to the coccyx. The resident’s record showed severe cognitive impairment with a BIMS score of 01 and a pressure ulcer present on admission. During wound care observation, the DON was seen using ABHS multiple times but rubbing her hands together for only 3 to 8 seconds each time before attempting to don gloves, and she repeatedly had difficulty getting gloves on because they stuck to her hands. The DON stated she believed she was rubbing her hands until dry for about 10 to 15 seconds and that the gloves were sticking because they were too small. The facility policy and CDC guidance both stated hand sanitizer should be rubbed over all surfaces until hands feel dry, taking about 20 seconds.
Failure to Ensure Proper Hand Hygiene Prior to Resident Transfer
Penalty
Summary
A certified nursing assistant (CNA) failed to perform proper hand hygiene prior to assisting a resident with a transfer from bed to wheelchair. During observation, the CNA was seen lathering her hands for only approximately 6 seconds, which is less than the facility's policy requirement of at least 15 seconds and the generally accepted standard of 20 seconds. The CNA later stated in an interview that she believed she had washed her hands for 20 seconds or more and acknowledged that handwashing should be performed for 20 seconds to prevent cross contamination. The last hands-on in-service training for handwashing was conducted in September 2025, and the CNA had participated without reported issues at that time. The resident involved was an elderly female with a history of arteriovenous malformation of cerebral vessels, cerebral infarction, hypertension, and COPD. She had moderate cognitive impairment and required substantial to maximal assistance for transfers. Both the Director of Nursing (DON) and the Assistant Director of Nursing (ADON), who also served as the Infection Preventionist, confirmed in interviews that staff are expected to scrub their hands for at least 20 seconds to prevent cross contamination and reduce infection risk. The facility's hand hygiene policy, last reviewed in August 2019, specifies that hands should be rubbed together vigorously for at least 15 seconds, covering all surfaces.
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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 Mathis
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Avir At River Ridge | 18.7 mi | ★★★★★ | 15 | 1 |
| Windsor Calallen | 19.6 mi | ★★★★★ | 11 | 0 |
| Hacienda Oaks At Beeville | 21.8 mi | ★★★★★ | 4 | 0 |
| Avir At Beeville | 22.1 mi | ★★★★★ | 2 | 0 |
| Robstown Nursing And Rehabilitation Center | 22.4 mi | ★★★★★ | 7 | 0 |
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Trusted data, never guesswork. Every citation, penalty, rating and Plan of Correction on this page is sourced from public CMS records (latest release October 2026) and official state health department websites.