Below average — CMS composite of the measures below.
A standard survey is most likely before around August 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 Paradigm At Bay City during CMS and state inspections, most recent first.
Two residents' medical records were not maintained according to professional standards when one resident's hospital records were uploaded to another resident's chart, resulting in missing and misfiled documentation. Staff interviews confirmed that multiple personnel could upload documents and acknowledged the privacy issue created by this error.
The facility failed to ensure the confidentiality of resident records, as a nurse left personal information of two residents unattended and visible on computer screens. This included a resident's face sheet and another's MAR, both left unlocked at the nurse's station, posing a risk of unauthorized access to sensitive information.
Two residents with cognitive impairments and health issues were observed smoking unsupervised and keeping cigarettes in their rooms, contrary to the facility's policy requiring staff to maintain smoking materials and supervise smoking. This lack of supervision and control posed safety risks, as staff interviews revealed a lack of awareness and enforcement of the smoking policy.
The facility failed to ensure proper incontinent care for a resident, leading to a risk of urinary tract infections. An observation revealed that a CNA did not thoroughly clean the resident's urinary meatus, despite being trained and checked for competency. The resident, who was cognitively intact but dependent on staff for personal care, had a care plan indicating the need for prompt changing and protective skin barrier application.
The facility failed to provide adequate pharmaceutical services for a resident with a G-tube. Expired medications were found in the carts of two LVNs, and one LVN used improper procedures for G-tube medication administration. The resident had a recent G-tube replacement due to a weak tube.
The facility failed to secure medications properly when an LVN left eye drops unsupervised on top of a medication cart. The LVN acknowledged the risk and the facility's policy requires all medications to be locked inside the carts.
The facility failed to ensure the dumpster lids and doors were secured, which could place residents at risk of infection from improperly disposed garbage. An observation revealed that the facility's dumpster area had a commercial-sized dumpster with the top lid completely open. The Dietary Manager stated that it was the dietary department's responsibility to keep the dumpster doors closed, but noted that housekeeping might have left it open after disposing of the night's trash in the morning. The Administrator and DON confirmed that the dumpster should be completely closed to avoid trash spillage and infection control issues.
A facility failed to maintain accurate clinical records for a resident with diabetes, as an LVN did not document insulin administration on multiple occasions despite elevated blood glucose levels. This lack of documentation could lead to inappropriate medication administration and a decline in the resident's health status.
The facility failed to maintain an infection prevention and control program when two CNAs did not perform proper hand hygiene during incontinence care for a resident with multiple health conditions. This included not changing gloves or sanitizing hands after touching soiled areas and before handling clean items, placing the resident at risk for infections.
Failure to Maintain Accurate and Resident-Specific Medical Records
Penalty
Summary
The facility failed to maintain accurate and resident-specific medical records in accordance with accepted professional standards for two residents. Specifically, one resident's hospital records were incorrectly uploaded and attached to another resident's medical chart, while the correct resident's chart did not contain her own hospitalization records. This error was identified during a review of the medical charts, where it was found that the hospital records for one resident were present in the chart of another, and missing from the appropriate chart. Interviews with facility staff, including the DON, MDS Nurse, and RSC, confirmed that multiple staff members have the ability to upload documents to resident charts. Staff acknowledged that uploading documents to the wrong chart is a privacy issue and that there are procedures in place to notify administration and correct such errors. The facility's policy requires that medical records be maintained in a manner that protects electronic protected health information from unauthorized use or access, but this standard was not met in this instance.
Confidentiality Breach of Resident Records
Penalty
Summary
The facility failed to maintain the confidentiality of personal and medical records for two residents. RN A left Resident #3's personal information unattended and visible on a computer screen in the resident data portal. During an interview, RN A was distracted by a resident's call light and left the computer screen unlocked, displaying Resident #3's face sheet. This incident was observed twice, indicating a lapse in securing sensitive information. Additionally, Resident #4's Medication Administration Record (MAR) was left unlocked and unattended on a laptop at the nurse's station. The laptop was not properly secured, allowing unauthorized access to the resident's medical information. The Director of Nursing (DON) acknowledged that leaving resident information exposed constitutes a HIPAA violation, highlighting the risk of unauthorized access to personal information for 55 residents stored in the data portal.
Inadequate Supervision and Control of Smoking Materials
Penalty
Summary
The facility failed to ensure adequate supervision and control of smoking materials for two residents, leading to potential safety hazards. Resident #1, a 67-year-old man with COPD and cognitive impairment, was observed smoking unsupervised and keeping cigarettes in his room, contrary to the facility's policy that smoking materials should be maintained by staff. His care plan indicated he was a supervised smoker, yet he reported that he usually smoked alone and was not prevented from keeping cigarettes in his possession. This lack of supervision and control over smoking materials posed a risk of injury. Similarly, Resident #2, a 57-year-old man with multiple health issues including COPD and cognitive impairment, was seen taking a cigarette from his room and smoking unsupervised. His care plan also required supervision while smoking, and he was to be informed of the facility's smoking policy. Despite these measures, he was able to access cigarettes independently. Interviews with staff revealed a lack of awareness and enforcement of the smoking policy, as residents were not supposed to have cigarettes in their rooms or smoke unsupervised. The Director of Nursing was unaware of the residents' access to cigarettes and acknowledged the safety concerns associated with this practice.
Inadequate Incontinent Care Leading to Risk of UTIs
Penalty
Summary
The facility failed to ensure that a resident who was incontinent of bladder received appropriate treatment and services to prevent urinary tract infections. Specifically, the facility did not ensure that CNAs properly cleaned the resident during incontinent care. During an observation, it was noted that a CNA did not spread the resident's labia to thoroughly clean the area and the urinary meatus, which is necessary to prevent infections. The CNA admitted to not performing the task correctly because she was nervous, despite having been trained and checked for competency in peri care. The resident involved was an elderly female with a history of pneumonia, congestive heart failure, and dysphagia. She was cognitively intact but dependent on staff for toileting hygiene and other personal care needs. The resident's care plan indicated that she was at risk for skin breakdown due to bowel and bladder incontinence and required prompt changing and application of a protective skin barrier. Despite these instructions, the facility did not provide a policy on perineal care when requested, and the CNA's failure to follow proper procedures was confirmed by the Director of Nursing.
Expired Medications and Improper G-Tube Medication Administration
Penalty
Summary
The facility failed to provide adequate pharmaceutical services for a resident with a gastrostomy tube (G-tube). During an observation, it was noted that LVN A's cart contained expired medications, including an insulin Glargine injection pen and glucose control solutions. Additionally, LVN B's cart contained expired Enoxaparin syringes. These expired medications were not removed from the carts as required by the facility's policy. LVN A admitted to using a plunger to administer water and medications through the G-tube, which is against proper procedures, and acknowledged the risks associated with using expired medications and control solutions. The resident involved was a male with a history of a displaced fracture of the right humerus, aphasia, and aphonia. The resident had a recent change in condition due to a weak G-tube, which required replacement. The facility's policy on medication storage and expiration was not followed, as expired medications were found in the medication carts and were not discarded promptly. The ADON confirmed the presence of expired medications in LVN B's cart and acknowledged that they should have been removed immediately.
Failure to Secure Medications Properly
Penalty
Summary
The facility failed to ensure drugs and biologicals were secured properly for one of five medication carts reviewed. Specifically, LVN A left an optic medication (eye drops) on top of the medication cart unsupervised. This was observed on 3/27/24 at 10:42 a.m. During an interview at 10:45 a.m., LVN A acknowledged that all medications should be locked inside the carts and recognized the risk of leaving eye drops out, as another resident could pick it up and use it or drink it. The facility's policy and procedure titled 'Storage of Medications' states that medication carts should be locked when not attended by authorized personnel.
Improper Disposal of Garbage and Refuse
Penalty
Summary
The facility failed to ensure the dumpster lids and doors were secured, which could place residents at risk of infection from improperly disposed garbage. An observation revealed that the facility's dumpster area had a commercial-sized dumpster with the top lid completely open. The Dietary Manager stated that it was the dietary department's responsibility to keep the dumpster doors closed to prevent insects and trash from entering the facility, but noted that housekeeping might have left it open after disposing of the night's trash in the morning. The Administrator and the Director of Nursing (DON) confirmed that the dumpster should be completely closed to avoid trash spillage and infection control issues. A review of the facility's waste disposal policy indicated that waste containers and dumpsters should be covered and closed at all times to prevent disease transmission and pest infestation.
Failure to Document Insulin Administration
Penalty
Summary
The facility failed to ensure clinical records were maintained in accordance with accepted professional standards and practices for one resident reviewed. Specifically, LVN B did not document the administration of insulin on the eMAR for multiple dates in March 2024, despite the resident having elevated blood glucose levels that required intervention. The resident, a male with type 2 diabetes mellitus, hypertension, and a history of cerebral infarction, had several instances of high blood sugar readings without corresponding documentation of insulin administration or physician contact as required by the sliding scale orders. This lack of documentation could lead to inappropriate and inadequate medication administration and a decline in the resident's health status. During interviews, the DON and Regional Nurse were unaware of the elevated blood glucose levels and stated that the expectation was to contact the MD immediately if levels were outside the sliding scale parameters. LVN B admitted to administering insulin and contacting the doctor but failed to document these actions in the eMAR and nurse's notes. The failure to document interventions meant that other nurses were not aware of the resident's condition and necessary follow-up actions. The Nurse Practitioner confirmed that LVN B had contacted her regarding the resident's high blood sugar and received new orders for insulin administration, which were also not documented properly.
Infection Control Deficiency During Incontinence Care
Penalty
Summary
The facility failed to establish and maintain an infection prevention and control program, as evidenced by the actions of two CNAs during the provision of incontinence care to a resident. The resident, an elderly female with diagnoses including pneumonia, congestive heart failure, and dysphagia, was observed to be dependent on staff for toileting hygiene and other personal care needs. During the care, the CNAs did not perform proper hand hygiene, which included not changing gloves or sanitizing hands after touching soiled areas and before handling clean items, such as the resident's brief and clothing. This failure was observed by a surveyor and confirmed through interviews with the involved CNAs and the Director of Nursing (DON). The DON acknowledged that the CNAs' actions were not in compliance with the facility's infection control policies and placed the resident at risk for infections. The facility's hand hygiene policy and infection control program were reviewed, revealing that proper hand hygiene is a critical component for preventing the spread of infection. The CNAs' failure to follow these protocols during incontinence care was a clear deficiency in the facility's infection prevention and control program.
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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 Bay City
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Avir At Bay City | 0.7 mi | ★★★★★ | 13 | 0 |
| Matagorda Nursing & Rehabilitation Center | 2.2 mi | ★★★★★ | 1 | 1 |
| Paradigm At Sweeny | 17.4 mi | ★★★★★ | 2 | 0 |
| Wharton Nursing And Rehabilitation Center | 23.9 mi | ★★★★★ | 8 | 4 |
| Paradigm At The Prairies | 24 mi | ★★★★★ | 15 | 2 |
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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 July 2026) and official state health department websites.