Below 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 Paradigm At The Creek during CMS and state inspections, most recent first.
Resident-to-resident abuse occurred when a resident with severe cognitive impairment and a history of aggression struck another resident in the head with a closed fist during a dining room altercation over coffee. Staff interviews and records showed the assaulted resident was crying and upset afterward, and the hospital evaluated the event as assault/trauma. The aggressive resident had diagnoses including dementia, schizophrenia, and schizoaffective disorder, with prior aggressive behaviors documented in the care plan.
Incomplete Abuse and Injury Investigations: The facility’s abuse/neglect investigations for multiple residents were documented without witness statements or interview summaries. The reports involved resident-to-resident altercations, alleged abuse, and injuries of unknown origin, including a resident with a fractured toe, a nonverbal resident with finger swelling and bruising, and several incidents where residents were reported to have hit, scratched, kicked, or thrown coffee at each other. The Administrator signed the reports as unfounded, but the investigation files did not contain the supporting staff interviews described in the state form instructions.
A resident with osteomyelitis, moderate cognitive impairment, and wheelchair dependence fell while self-transferring after his wheelchair slid from under him. Surveyor observation later found the wheelchair’s brake was loose and would not lock the tire, and the DON and DOR confirmed the chair had a broken brake that maintenance could not fix.
A deficiency was cited when a resident's care plan did not address all identified needs and failed to include measurable timetables and specific actions, as observed in the resident's records during the survey.
A resident with severe cognitive impairment and total dependence on staff for care sustained a finger fracture of unknown origin. Despite multiple staff providing care and assistance, the injury was not identified until a family member noticed swelling and brought it to staff attention. The facility was unable to determine how the injury occurred, indicating a failure to provide adequate supervision and ensure a safe environment.
A facility failed to prevent resident-to-resident abuse due to inadequate supervision and staffing. In one case, a resident with cognitive issues attacked his roommate, causing a severe head injury. In another, a resident with severe cognitive impairment wandered into another's room, leading to a physical altercation. Both incidents occurred on a secure unit that was understaffed, contrary to facility requirements.
The facility failed to provide sufficient nursing staff, leading to resident-to-resident altercations in the secured unit. One incident involved a resident with severe cognitive impairment who wandered into another resident's room, resulting in a physical confrontation. Another incident occurred during an overnight shift with only one CNA present for 19 residents, leading to a severe injury requiring hospitalization. These incidents highlight the facility's failure to ensure adequate staffing and supervision.
The facility failed to accurately assess two residents' wandering behaviors in their MDS, leading to potential risks. One resident's MDS did not reflect his wandering, despite incidents of inappropriate behavior and a physical altercation. Another resident's MDS inaccurately coded his wandering as not exhibited, although staff and family confirmed frequent wandering and related altercations. Interviews revealed unclear responsibilities and a lack of updates to the MDS following significant incidents.
A resident in a memory care unit with multiple health conditions was found unresponsive, and the facility failed to provide timely and appropriate CPR. A delay occurred due to a lack of urgency in communication, improper CPR initiation by a CNA, and issues accessing the crash cart and AED. The resident, who was full code, died shortly after being transported to the hospital.
The facility failed to update care plans for two residents, one requiring oxygen therapy and another with an indwelling catheter and slit penis, leading to deficiencies in their care. The MDS nurse and DON admitted to oversight and lack of updates, placing residents at risk for complications.
The facility failed to provide safe respiratory care for two residents. One resident's breathing mask was not dated or stored properly, and another resident's humidifier bottle was not disposed of in a timely manner. Staff interviews confirmed that these practices were not followed, and there was no policy on maintaining respiratory equipment.
The facility failed to ensure that a resident received proper wound care and infection control practices. The Wound Care Nurse did not clean the resident's wounds correctly and improperly stored the normal saline bottle, leading to potential cross-contamination. Additionally, the IV tubing was not dated as required for infection control.
The facility failed to ensure proper pressure ulcer care for a resident, leading to a deficiency in preventing infections and promoting healing. The Wound Care Nurse did not clean the wound correctly and took the normal saline bottle in and out of the resident's room, against infection control protocols. The resident had a severely impaired cognition and a stage III sacral pressure ulcer.
A facility failed to secure a resident's catheter as ordered by the physician, placing the resident at risk for traumatic removal and catheter-acquired infections. The resident, with multiple diagnoses including an indwelling catheter, was observed without a catheter securing device, and the catheter tubing was not stabilized. The charge nurse and DON acknowledged the issue, and the MDS Coordinator admitted to missing necessary updates to the care plan.
The facility was found to have improperly disposed of garbage, with a commercial-size dumpster behind the dietary department left three-quarters full and its door wide open. The Food Service Manager acknowledged that dumpster doors should be closed to prevent pests and insects from accessing the garbage. The facility's waste disposal policy requires dumpsters to be closed at all times.
Resident-to-Resident Physical Abuse
Penalty
Summary
The facility failed to ensure a resident was free from abuse when one resident physically assaulted another resident in the memory care unit. Resident #1 had diagnoses including dementia, schizophrenia, Parkinson's disease, and type II diabetes, and her annual MDS showed a BIMS of 7 with severe cognitive impairment. During the incident, Resident #1 was struck in the head with a closed fist after a conflict involving coffee, and she was observed crying and upset afterward. She later told nursing staff that the other resident had tried to get her coffee and hit her in the head. Resident #2 had diagnoses including dementia with psychotic disturbance, anxiety disorder, paranoid schizophrenia, and schizoaffective disorder, and his quarterly MDS showed a BIMS of 3 with severe cognitive impairment. His care plan identified a potential for physical aggression and documented prior aggressive behavior toward other residents. On the day of the incident, a progress note documented that he accused another resident of trying to steal his coffee and was redirected by nursing staff. The facility's investigation summary stated that Resident #2 and another resident were arguing, the Activity Assistant redirected the other resident away, and Resident #2 then turned to Resident #1, tried to grab her coffee, and grabbed her hair. Staff interviews described the altercation as occurring in the dining room of the memory care unit. One CNA stated Resident #2 was swinging at another resident, and then suddenly went over and hit Resident #1 with a closed fist to the side of her head. Staff also reported that Resident #1 was crying after the incident. The hospital record identified the event as an assault/trauma, and the facility policy prohibited abuse, neglect, exploitation, and mistreatment by anyone in the facility.
Incomplete Abuse and Injury Investigations
Penalty
Summary
The facility failed to have evidence that alleged violations were thoroughly investigated for 7 of 16 residents reviewed for freedom from abuse and neglect. The deficiencies involved allegations of abuse, resident-to-resident altercations, and injuries of unknown origin for Residents #1, #4, #5, #6, #7, #9, and #11. In each of the cited investigations, the Administrator signed HHSC Form 3613-A reports that concluded the allegations were unfounded, but the reports did not include witness statements or interview summaries from staff members as part of the investigation record. For Resident #4, a provider investigation report dated 3/6/26 documented an injury of unknown origin after swelling was found on a toe on 2/26/26. The investigation summary stated the resident had serious vascular issues, had several toes amputated, had no safety awareness, and would propel himself around the facility and bump into objects, walls, and people. The report concluded the injury appeared accidental and was marked unfounded, but the attached records did not include interview summaries or witness statements. For Resident #9, a provider investigation report dated 4/2/26 documented swelling and bruising to the left 4th finger on 3/25/26, with x-ray findings describing a small bony fragment in the volar middle phalangeal base. The summary stated the resident rolled around the facility without safety awareness and was nonverbal and unable to say whether he bumped into anything, but no witness statements or interview summaries were attached. For Resident #1, a provider investigation report dated 3/12/26 documented a resident-to-resident incident in which Resident #2 grabbed Resident #1’s hair and pulled it during an altercation in the secure unit dining room. The report listed witnesses but did not include interview summaries or witness statements. For Residents #5 and #6, a provider investigation report dated 3/29/26 documented a hallway altercation in which the residents argued, kicked each other, and Resident #6 threw coffee at Resident #5; the report again lacked witness statements or interview summaries. For Residents #7 and #8, a provider investigation report dated 4/2/26 documented an allegation that Resident #8 hit Resident #7 in the eye, but the attached records did not include witness statements or interview summaries. For Residents #10 and #11, a provider investigation report dated 4/28/26 documented a dining room altercation in which Resident #10 struck Resident #11 and caused a superficial skin tear, yet the report also lacked witness statements or interview summaries. The Administrator stated she spoke to staff, interviewed residents, and used chart documentation to determine what happened, but also stated she did not remember talking to other staff for some incidents and that there were no witness statements for the Resident #8 and #9 incident.
Inoperable Wheelchair Brake Led to Resident Fall
Penalty
Summary
The facility failed to ensure Resident #2’s environment remained free from accident hazards when his wheelchair brake was inoperable. Resident #2 was admitted with osteomyelitis, had a BIMS of 12 indicating moderate cognitive impairment, used a wheelchair for mobility, and required substantial to maximal assistance for chair-to-bed transfers. His care plan identified him as at risk for falls and injuries and included interventions such as encouraging him to ask for staff assistance and to lock his wheels before transfers. On 3/10/26, Resident #2 was found on the floor between his bed and wheelchair after he stated he was trying to get into bed by himself and the wheelchair slid from under him. The nurse documented no visible injuries or pain. During a later observation, the surveyor noted the wheelchair’s left brake was loose and did not lock the tire, and the wheelchair could be easily pushed back. The Director of Rehabilitation stated the wheelchair had a broken brake that maintenance tried but was unable to fix, and the DON acknowledged the brake was broken and that a new wheelchair had been ordered.
Incomplete Care Plan Lacking Measurable Actions
Penalty
Summary
A deficiency was identified due to the failure to develop and implement a complete care plan that addresses all of a resident's needs. The care plan lacked measurable timetables and specific actions, resulting in incomplete documentation and planning for the resident's care requirements. This omission was observed during the survey and was based on a review of the resident's records, which did not contain a comprehensive or measurable care plan as required.
Failure to Prevent and Identify Injury of Unknown Origin in Dependent Resident
Penalty
Summary
A deficiency occurred when the facility failed to provide adequate supervision to prevent an accident resulting in a physical injury of unknown origin to a resident who was totally dependent on staff for care. The resident, a male with a history of toxic encephalopathy, dementia with psychotic disturbance, CVA, and other complex medical conditions, was found by a family member to have a swollen and outwardly turned finger. The injury was later diagnosed as a mildly displaced fracture of the fourth proximal phalanx. The resident was non-verbal, had severely impaired cognition, and required total assistance for all activities of daily living, including transfers and mobility, and was always incontinent. He was also noted to have a history of behavioral symptoms and impaired communication, making it difficult for him to express needs or report incidents. On the morning of the incident, multiple staff members, including CNAs and a medication aide, provided care and assistance to the resident. All staff interviewed stated that they did not observe any swelling or injury to the resident's hand during their interactions, including during transfers from bed to wheelchair and while administering medications. The resident was described as compliant with care during these interactions. The injury was only discovered when a family member visited and noticed the swelling, prompting further assessment and eventual transport to the hospital, where the fracture was confirmed. Staff and facility leadership were unable to determine how or when the injury occurred, and no staff could provide an explanation for the cause of the fracture. The facility's failure to identify, prevent, or explain the cause of the resident's injury, despite the resident's total dependence on staff and inability to communicate effectively, constitutes a lack of adequate supervision and failure to ensure a safe environment free from accident hazards. The incident raised concerns of possible abuse or neglect due to the unexplained nature and type of injury, as well as the lack of timely recognition by staff. The facility's own policies prohibit abuse, neglect, and exploitation, and require prompt identification and investigation of injuries of unknown origin, but these measures were not effective in this case.
Resident-to-Resident Abuse Due to Inadequate Supervision
Penalty
Summary
The facility failed to protect residents from abuse, specifically in two incidents involving resident-to-resident altercations. In the first incident, a resident with cognitive issues and a history of inappropriate behaviors attacked his roommate, resulting in a severe head injury that required 32 staples. The altercation occurred after an argument, and the staff on duty, a CNA, was unable to prevent the incident due to being the only aide on the unit at the time. The facility's staffing records confirmed that only one CNA was present, despite the requirement for two CNAs on the secure unit. In the second incident, another resident with severe cognitive impairment and a history of wandering entered another resident's room, leading to a physical altercation. The resident who entered the room was known to wander and had previously been involved in similar incidents. The altercation resulted in a cut to the chin of the wandering resident. Staff interviews revealed that the unit was often short-staffed, which may have contributed to the inability to prevent the altercation. Both incidents highlight the facility's failure to provide adequate supervision and staffing to prevent resident-to-resident abuse. The facility's policies and procedures on abuse prevention were not effectively implemented, as evidenced by the lack of sufficient staff to monitor and manage residents with known behavioral issues. The facility's assessment indicated that the secure unit required two CNAs per shift, but this was not consistently maintained, leading to the incidents of abuse.
Inadequate Staffing Leads to Resident Altercations
Penalty
Summary
The facility failed to provide sufficient nursing staff with the appropriate competencies and skills to ensure resident safety and maintain the highest practicable physical, mental, and psychosocial well-being of each resident. This deficiency was identified through observations, interviews, and record reviews, particularly affecting two residents in the secured unit. The incidents involved resident-to-resident altercations due to inadequate supervision and staffing levels, which resulted in injuries to the residents involved. One incident involved a resident who wandered into another resident's room, leading to a physical altercation. The wandering resident, who had severe cognitive impairment and a history of wandering, was not adequately supervised, resulting in a confrontation with another resident who responded aggressively. This lack of supervision and insufficient staffing on the secured unit contributed to the altercation and subsequent injuries. Another incident occurred on the overnight shift when there was only one CNA present for 19 residents in the secured unit. This inadequate staffing level led to a resident-to-resident altercation, where one resident was severely injured and required hospitalization. The facility's failure to ensure adequate staffing and supervision on the secured unit directly contributed to these incidents, highlighting the need for improved staffing practices to prevent such occurrences.
Inaccurate MDS Assessments for Wandering Behaviors
Penalty
Summary
The facility failed to ensure the accuracy of the Minimum Data Set (MDS) assessments for two residents, which placed them at risk of not receiving appropriate care and services. Resident #2's MDS did not accurately reflect his wandering behavior, despite his care plan indicating episodes of inappropriate behavior and wandering throughout the facility. This discrepancy was evident as Resident #2 was involved in an altercation with his roommate, resulting in a head injury that required medical attention. Similarly, Resident #3's MDS inaccurately coded his wandering behavior as not exhibited, even though his care plan identified him as at risk for wandering due to his dementia and ambulatory status. Multiple staff members and a family member confirmed that Resident #3 frequently wandered into other residents' rooms, leading to altercations. Despite these behaviors being documented in care plans and observed by staff, the MDS did not reflect these issues, indicating a failure in the assessment process. Interviews with facility staff, including the MDS nurse and the Director of Nursing (DON), revealed a lack of clarity and responsibility in updating the MDS assessments. The MDS nurse indicated that the Social Services Director was responsible for certain sections of the MDS, and there was uncertainty about why updates had not been made following significant behavioral incidents. The DON and Administrator acknowledged the need for accurate assessments but did not provide a clear explanation for the discrepancies in the MDS records.
Delayed and Improper CPR Response in Memory Care Unit
Penalty
Summary
The facility failed to provide timely and appropriate basic life support, including CPR, to a resident in need of emergency care. The incident involved a resident with multiple health conditions, including COPD, vascular dementia, and diabetes, who was found unresponsive in the memory care unit. Despite the resident's full code status, there was a delay in initiating CPR and calling emergency services, which contributed to the resident's death shortly after being transported to the hospital. The report highlights several critical failures in the emergency response. A laundry aide did not immediately communicate the urgency of the situation, leading to a delay of at least three minutes before nursing staff arrived to assess the resident. When CPR was initiated by a CNA, it was done improperly while the resident was still in a wheelchair, and without first checking for a pulse. Additionally, the crash cart and AED were not immediately accessible, causing further delays in providing necessary emergency care. Interviews with staff revealed confusion and a lack of urgency in responding to the emergency. The crash cart was locked, and staff were initially unable to locate the key, further delaying the provision of oxygen and the use of the AED. The nursing staff's actions were inconsistent with the facility's protocols for handling unresponsive residents, and there was a lack of clear communication and coordination among staff during the incident.
Failure to Update Care Plans for Oxygen Therapy and Catheter Care
Penalty
Summary
The facility failed to develop and implement a comprehensive person-centered care plan for two residents, leading to deficiencies in their care. Resident #49, a male with severe cognitive impairment and multiple diagnoses, had a physician's order for oxygen therapy as needed, but this was not included in his care plan. The MDS nurse admitted to overlooking this aspect of the care plan, and the Director of Nursing (DON) confirmed that the regional MDS nurse was responsible for ensuring all care plans were complete. Despite the order, the resident's care plan did not reflect the need for oxygen therapy, and no oxygen was administered as per the March 2024 Medication Administration Record (MAR). This oversight placed the resident at risk for not receiving necessary oxygen therapy. Resident #63, a male with multiple diagnoses including bipolar disorder and diabetes, was readmitted to the facility with an indwelling Foley catheter and a slit penis. The care plan did not reflect these changes, and the resident was observed without a catheter securing device, causing irritation and potential trauma. The charge nurse and DON were unaware of the slit penis and the lack of a securing device until it was brought to their attention by the surveyor. The DON acknowledged that the care plan should have been updated to include the catheter and the slit penis to ensure proper care and prevent complications. Interviews with the MDS Coordinator and DON revealed that the facility had been without an MDS nurse for a couple of months, and the corporate nurse was handling the MDS and care plans. The MDS Coordinator admitted to missing the necessary updates to Resident #63's care plan, which could lead to missed care and potential urinary infections. The facility's care planning policy requires that each resident's care plan remains current and informs staff of the resident's needs, strengths, goals, and approaches, but this was not adhered to in these cases.
Failure to Provide Safe Respiratory Care
Penalty
Summary
The facility failed to provide safe and appropriate respiratory care for residents, specifically in the cases of two residents. Resident #32, a male with chronic obstructive pulmonary disease (COPD), heart failure, and Alzheimer's Disease, had a breathing mask that was not dated and was not stored inside a bag when not in use. This was observed during a survey, and it was confirmed by staff interviews that respiratory equipment should be dated and stored properly to prevent infections. The resident's care plan included the use of aerosol or bronchodilators as ordered, but the facility did not adhere to proper infection control practices for the respiratory equipment. Resident #49, a male with metabolic encephalopathy and cerebral infarction, had an oxygen machine with a humidifier bottle dated 03/05/24, which was not disposed of in a timely manner. The resident's care plan did not reflect the use of oxygen therapy via nasal cannula, despite a physician's order for oxygen at 2-3 LPM as needed. Staff interviews revealed that respiratory equipment, including humidifier bottles, should be changed weekly and dated for infection control. The Director of Nursing (DON) and the Infection Control Nurse confirmed that they were responsible for ensuring these practices were followed, but there was no policy on maintaining respiratory equipment in the facility.
Failure to Follow Proper Wound Care and Infection Control Practices
Penalty
Summary
The facility failed to ensure that Resident #57 received treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the resident's choices. Specifically, the facility did not date the IV tubing for Resident #57, which is necessary for infection control. Additionally, the Wound Care Nurse did not clean Resident #57's wounds correctly, using a technique that could potentially lead to infection. The nurse cleaned the wound beds with moistened normal saline gauze starting around the edges of the wound and moving over the wound bed with the same gauze, rather than starting at the center and moving outward in a circular motion as required by the facility's policy. The Wound Care Nurse also failed to store the normal saline bottle properly, taking it in and out of Resident #57's room during wound dressing changes, which could lead to cross-contamination. The nurse admitted to this practice during an interview, acknowledging that it was incorrect and could cause cross-contamination. The Director of Nursing (DON) and the Infection Control Nurse confirmed that the proper technique for cleaning wound beds involves starting from the center and moving outward in a circular motion to prevent infections. Resident #57, a [AGE] year old male with multiple diagnoses including cerebrovascular disease, local infection of the skin, depression, chronic atrial fibrillation, and atherosclerosis with ulceration, was observed to have several wounds on his left lower extremity. The resident's comprehensive care plan included interventions to follow standard precautions to prevent cross-contamination and infection. Despite this, the facility's failure to adhere to proper wound care techniques and infection control practices placed the resident at risk for infections and a decrease in quality of life.
Deficiency in Pressure Ulcer Care and Infection Control
Penalty
Summary
The facility failed to ensure proper pressure ulcer care for a resident, leading to a deficiency in preventing infections and promoting healing. The Wound Care Nurse did not clean the resident's sacral wound correctly, using the same saline gauze more than once and not following the proper technique of cleaning from the center outward in a circular motion. Additionally, the Wound Care Nurse took the normal saline bottle in and out of the resident's room, which is against infection control protocols and can lead to cross-contamination. The resident involved had a severely impaired cognition and a stage III sacral pressure ulcer that was almost healed at the time of the observation. The Wound Care Nurse had been working at the facility for less than a month and had previously worked at an Assisted Living Facility (ALF). Despite receiving competency training on wound care, the nurse did not adhere to the facility's policy for dressing changes. The Director of Nursing (DON) and the Infection Control Nurse confirmed that the proper technique for cleaning a wound bed was not followed, and the normal saline bottle should not have been taken in and out of the resident's room. The facility's policy for dressing changes emphasizes using aseptic techniques and cleaning the wound in a circular motion from the center outward to prevent infections.
Failure to Secure Catheter Leading to Risk of Infection and Trauma
Penalty
Summary
The facility failed to ensure a resident who was incontinent of bladder received appropriate treatment and services to prevent urinary tract infections. Specifically, the facility did not secure the resident's catheter as ordered by the physician, which placed the resident at risk for traumatic removal and catheter-acquired infections. The resident, a [AGE] years-old male with multiple diagnoses including an indwelling catheter and acute cystitis, was observed without a catheter securing device, and the catheter tubing was not stabilized to his leg. The resident reported irritation from the catheter tubing, and the CNA confirmed that the resident often did things for himself, including removing the catheter leg strap. The charge nurse and DON both acknowledged that the resident's catheter should have been secured to prevent trauma and infection. The charge nurse stated that she was responsible for monitoring the resident's catheter, but the resident did not like the leg strap, and this issue was reported to the DON. The DON admitted that the facility had no MDS nurse for a couple of months, and the corporate nurse was working on the MDS and care plan. The DON was unaware of the slit to the resident's penis and expected residents with indwelling catheters to have physician orders and care plans in place. The MDS Coordinator confirmed that the resident did not have a care plan for his indwelling catheter and admitted to missing the necessary updates. This oversight could lead to missed care and potential urinary infections. The facility's policy on indwelling catheters did not address securing the catheter, and the CDC guidelines referenced in the policy emphasized the importance of properly securing indwelling catheters to prevent movement and urethral traction.
Improper Garbage Disposal in Facility Dumpster
Penalty
Summary
The facility failed to properly dispose of garbage and refuse, as observed in the dumpster area located behind the dietary department. The commercial-size dumpster was found to be three-quarters full of garbage with its door wide open. This observation was made during a survey on March 26, 2024, at 8:30 am. In an interview conducted shortly after the observation, the Food Service Manager confirmed that the dumpster doors should always be closed to prevent vermin, pests, and insects from accessing the garbage and potentially entering the facility. The facility's Nutrition Services Policies and Procedures on waste disposal, dated June 2019, specify that waste containers should be covered and dumpsters should be closed at all times to prevent the transmission of disease and deter pests.
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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 Wharton
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Wharton Nursing And Rehabilitation Center | 2 mi | ★★★★★ | 8 | 4 |
| Paradigm At The Prairies | 12.8 mi | ★★★★★ | 15 | 2 |
| Spjst Rest Home No 2 | 17.4 mi | ★★★★★ | 9 | 0 |
| S.p.j.s.t. Rest Home 3 | 18.7 mi | ★★★★★ | 8 | 0 |
| Arbor Hills Rehabilitation And Healthcare Center | 22.8 mi | ★★★★★ | 4 | 0 |
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