Above average — CMS composite of the measures below.
The next survey window likely opens around November 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 Querencia At Barton Creek during CMS and state inspections, most recent first.
Hand hygiene and shared equipment sanitation were not followed during a medication pass for multiple residents. An MA did not clean a BP cuff or machine before or after use and did not perform hand hygiene after preparing meds and before administering them to residents with diagnoses including HTN, CHF, CKD, COPD, and diabetes. The DON and IPCP stated staff were expected to perform hand hygiene before preparing meds, before administering meds, and to disinfect the BP cuff between uses.
A medication cart on the south hall was left only partially locked while unattended, and an MA later opened it without using keys. In a separate event, an MA administered Miralax mixed in water to a cognitively intact resident but left part of the dose at the bedside after the resident drank only part of it. Interviews with the IPCP, DON, and other staff confirmed carts must be fully locked when unattended and residents should swallow all meds before staff leave unless self-administration is approved.
Two residents with cognitive and mobility impairments were not provided adequate supervision or required assistance devices during transfers, as staff failed to use gait belts and did not follow updated care plans or therapy recommendations. This resulted in one resident sustaining a hip fracture after a fall and another being transferred without proper safety measures, despite staff training and facility policies mandating these precautions.
A resident with advanced dementia and mobility issues experienced a fall while being assisted without a gait belt and contrary to the care plan's requirement for a two-person assist. Following the fall, staff failed to conduct thorough post-fall assessments, did not consistently document or address the resident's pain, and delayed notifying the NP. As a result, the resident's hip fracture went untreated for 48 hours before hospital transfer and diagnosis.
A resident with severe cognitive impairment and mobility issues experienced a fall and was later evaluated by therapy, which recommended a two-person assist for transfers. The care plan was not updated to reflect this change, and staff were not informed or educated on the new requirement. As a result, the resident was assisted by one CNA without a gait belt, fell again, and suffered a hip fracture that required surgery. The deficiency involved failures in care plan updates, communication, and staff education following significant changes in the resident's condition.
The facility failed to ensure proper use of facial hair restraints in one of its kitchens, as a cook was observed handling food without a beard restraint properly worn. Despite being on a disciplinary plan for a similar issue, the cook adjusted the restraint only after noticing a state surveyor. The Culinary Director and Dietician confirmed the importance of such restraints to prevent food contamination, as per facility policy and FDA guidelines.
A resident with anxiety was prescribed Alprazolam without a stop date, contrary to the facility's policy limiting PRN psychotropic medication orders to 14 days. The oversight occurred during the resident's transfer from assisted living to skilled nursing, and staff interviews revealed a lack of adherence to the policy, raising concerns about potential risks associated with prolonged medication use.
Hand Hygiene and Blood Pressure Equipment Not Sanitized During Medication Pass
Penalty
Summary
The facility failed to establish and maintain an infection prevention and control program during medication administration observations involving four residents. During the observed medication pass, MA A did not perform hand hygiene after preparing medications and before administering them to Resident #11, Resident #13, Resident #19, and Resident #36. MA A also handled shared blood pressure equipment without sanitizing it before or after use while assessing these residents' blood pressures. Resident #11 was cognitively intact and had diagnoses including chronic systolic heart failure, atherosclerotic heart disease, type 2 diabetes mellitus with hyperglycemia, and constipation. During the observation, MA A removed a wrist blood pressure cuff from the medication cart, entered the room without hand hygiene, applied the cuff, returned it to the cart without sanitizing it, prepared medications without hand hygiene, and then returned to the room to administer the medications before washing her hands in the resident's bathroom. Resident #19 was cognitively intact and had diagnoses including essential hypertension, acute kidney failure, and benign prostatic hyperplasia with lower urinary tract symptoms. MA A used a wrist blood pressure cuff from the cart without sanitizing it, assessed the resident's blood pressure, then later retrieved a wheeled blood pressure machine and applied a new cuff to the resident's left upper arm without sanitizing it. She returned the equipment to the cart without sanitizing it or performing hand hygiene, prepared medications, returned to the room without hand hygiene, and administered the medications before washing her hands in the bathroom. Resident #36 was cognitively intact and had diagnoses including heart failure, chronic kidney disease stage 3, and benign prostatic hyperplasia. MA A brought the blood pressure machine to the room without sanitizing it or her hands, assessed the resident's blood pressure, then returned to the cart, put on gloves, administered nasal spray, removed the gloves, sanitized her hands, prepared oral medications, and returned to the room without hand hygiene to administer them. Resident #13 had severe cognitive impairment and diagnoses including COPD, hypertensive heart disease with heart failure, and atherosclerotic heart disease. MA A brought the blood pressure machine to the room without sanitizing it or her hands, assessed blood pressure, sanitized her hands, returned to the cart, prepared medications without sanitizing the blood pressure machine, used gloves to open capsules and crushed tablets, mixed the medications in pudding, returned to the resident without hand hygiene, and administered the medications with a spoon before washing her hands in the bathroom.
Unsecured medication cart and medication left at bedside
Penalty
Summary
Drugs and biologicals were not stored in locked compartments as required when a medication cart on the south side hall was left unsecured while unattended by MA A. During observation, MA A was seen using the medication cart, appearing to press the lock only partway in rather than fully securing it with a key, then walking away from the cart and entering a resident room. She later returned to the cart and again opened it without using her keys after only partially engaging the lock. The report also documents that Resident #11, a cognitively intact male with diagnoses including chronic systolic heart failure, atherosclerotic heart disease, type 2 diabetes mellitus with hyperglycemia, and constipation, did not consume all of his medication before MA A left the room. MA A prepared Miralax by mixing 17 grams in 8 ounces of water and administered it along with the resident's other medications. The resident drank approximately 5 ounces, and MA A told him she would leave the rest for him to finish. MA A then left the room to wash her hands, leaving approximately 3 ounces of the medication mixture on the resident's over-bed table. Interviews confirmed that MA A understood the cart should be fully locked when unattended and that medication should not be left at the bedside unless specifically ordered. The IPCP, MA B, LVN C, the DON, and the ADM all stated that medication carts must be locked when not in use and that residents should swallow all medications before staff leave the bedside unless self-administration has been approved. The facility policy titled Administering Medications required the medication cart to be kept closed and locked when out of sight, and the Medication Labeling and Storage policy required compartments containing medications and biologicals to be locked when not in use.
Failure to Use Gait Belts and Follow Transfer Protocols Results in Resident Falls and Injury
Penalty
Summary
The facility failed to ensure that residents received adequate supervision and assistance devices to prevent avoidable accidents, specifically for two residents reviewed for quality of care. One resident, an elderly female with severe cognitive impairment, osteoporosis, muscle weakness, and a history of falls, was not transferred according to her therapy evaluation, which required a two-person assist and the use of a gait belt. Instead, a CNA assisted her alone and without a gait belt, resulting in a fall that led to a hip fracture. The care plan was not updated after a previous fall, and the therapy recommendation for a two-person transfer was not incorporated into the care plan or communicated effectively to staff. Additionally, post-fall assessments and documentation were incomplete, and pain and mobility changes were not promptly recognized or reported, delaying the identification of the fracture. Another resident, also with cognitive impairment and mobility issues, was assisted by a CMA during a transfer without the use of a gait belt, contrary to facility policy and training. This resident had a history of falls and was care planned for extensive assist with one-person physical assist, but the required safety device was not used during the observed transfer. Interviews with staff revealed that while they had received training on the use of gait belts and fall procedures, there was inconsistency in following these protocols, and some staff were not familiar with the specific care needs of the residents involved. Facility policies required comprehensive, person-centered care plans, regular updates following changes in condition, and the use of gait belts for transfers and ambulation assistance. However, the care plans were not consistently updated to reflect therapy recommendations, and staff did not always review or follow the electronic care plans prior to providing care. The lack of adherence to established procedures and failure to use required safety equipment directly contributed to the residents' falls and injuries. The deficiency was identified as Immediate Jeopardy due to the risk of serious harm and injury to residents.
Failure to Provide Timely Post-Fall Assessment and Care
Penalty
Summary
A deficiency occurred when a resident with advanced dementia, osteoporosis, and a history of falls experienced a fall and did not receive timely or adequate post-fall assessment and care according to professional standards and the resident's care plan. The resident, who was non-verbal and required substantial assistance with transfers, fell while being assisted to the restroom without a gait belt. The care plan and recent physical therapy evaluation indicated a need for a two-person assist for transfers, but this was not communicated to or followed by staff, resulting in a one-person assist at the time of the fall. Following the fall, the initial assessment by nursing staff did not identify pain or significant injury, and only a minor skin abrasion was documented. However, over the next 48 hours, multiple staff members observed the resident displaying non-verbal signs of pain, such as facial grimacing and difficulty with transfers. Despite these observations, there was a lack of consistent and thorough post-fall assessments, including range of motion (ROM) and pain assessments, as required by facility policy. Documentation of pain assessments and the effectiveness of PRN Tylenol administration was also missing. Communication with the nurse practitioner (NP) was delayed, and the NP was not notified of the resident's pain symptoms until nearly two days after the fall. The resident remained in pain and with an untreated hip fracture for up to 48 hours before being sent to the emergency room, where a left femoral neck fracture was diagnosed. Interviews with staff revealed gaps in communication, incomplete documentation, and a lack of adherence to post-fall protocols. The care plan was not updated to reflect the increased assistance required for transfers, and staff were not consistently aware of or following the resident's current care needs. These failures resulted in a delay in identifying and treating a significant injury.
Failure to Update Care Plan After Significant Change and Fall
Penalty
Summary
The facility failed to develop and implement a comprehensive, person-centered care plan for a resident following significant changes in her condition, specifically after a fall and a subsequent physical therapy evaluation. The resident, an elderly female with severe cognitive impairment, osteoporosis, Alzheimer's disease, unsteadiness, muscle weakness, and a history of falls, experienced a fall on 07/20/2025. Despite a physical therapy evaluation on 07/30/2025 recommending a two-person assist for transfers, the care plan was not updated to reflect this change. The care plan continued to indicate a one-person assist, and staff were not educated on the new requirement. On 08/03/2025, the resident fell again while being assisted to the restroom by a CNA who did not use a gait belt and was unaware of the need for a two-person assist. The resident was unable to bear weight after the fall, exhibited changes in behavior and eating, and was later diagnosed with a hip fracture, requiring surgery. Multiple staff interviews revealed a lack of communication and documentation regarding the resident's change in transfer status and post-fall assessments. The care plan and MDS were not updated in a timely manner, and staff were not consistently informed of the resident's needs, leading to improper care and delayed recognition of injury. Facility policies required care plans to be updated with measurable objectives and timetables following significant changes in a resident's condition. However, the interdisciplinary team did not revise the care plan after the therapy evaluation or the fall, and there was a breakdown in communication between therapy, nursing, and direct care staff. The failure to update the care plan and educate staff on the resident's new transfer needs resulted in the resident not receiving care in accordance with her current condition, as required by facility policy and professional standards.
Improper Use of Facial Hair Restraints in Kitchen
Penalty
Summary
The facility failed to adhere to professional standards for food service safety in one of its two kitchens, specifically regarding the use of facial hair restraints by staff. During an observation, a cook was seen handling food without properly wearing a beard restraint, which was instead positioned around his neck. Upon noticing the state surveyor, the cook adjusted the restraint to cover his facial hair. Interviews with the cook and the Culinary Director confirmed that staff were required to wear beard guards to prevent hair from contaminating food, a policy that was not followed in this instance. The Culinary Director acknowledged that the cook was already on a disciplinary action plan for a similar issue in August, and a final disciplinary notice was issued following this incident. The facility's policy mandates the use of hair and facial hair restraints when handling or preparing food, aligning with the U.S. FDA Food Code requirements. The Dietician also emphasized the importance of using hair restraints to prevent contamination. The failure to comply with these standards could potentially place residents at risk for foodborne illness.
Failure to Limit PRN Psychotropic Medication Orders
Penalty
Summary
The facility failed to ensure that PRN orders for psychotropic drugs were limited to 14 days unless the attending physician or prescribing practitioner documented their rationale for extending the order in the resident's medical record. This deficiency was identified for a resident who was prescribed Alprazolam, an anti-anxiety medication, without a stop date. The resident, a female with a diagnosis of anxiety, hypertension, and hyperlipidemia, was moderately cognitively impaired and had been receiving Alprazolam as needed for anxiety. The medication order, which started on 8/12/24, did not include a stop date, and the medication was administered on 8/21/24. Interviews with facility staff revealed a lack of adherence to the policy that PRN orders for psychotropic medications should be limited to 14 days. An LVN expressed uncertainty about why the order was written for an indefinite period and raised concerns about the risk of falls due to prolonged use. The DON acknowledged that the oversight might have occurred during the resident's transfer from assisted living to skilled nursing, where different regulations apply. The facility's policy, updated in July 2022, clearly states that PRN orders for psychotropic medication are limited to 14 days, highlighting a lapse in compliance with this policy.
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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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How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Park Manor Bee Cave | 4.7 mi | ★★★★★ | 8 | 0 |
| Brush Country Nursing And Rehabilitation | 4.7 mi | ★★★★★ | 23 | 1 |
| Longhorn Village | 4.9 mi | ★★★★★ | 0 | 0 |
| Brookdale Westlake Hills | 5 mi | ★★★★★ | 9 | 0 |
| Barton Valley Rehabilitation And Healthcare Center | 5.2 mi | ★★★★★ | 18 | 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 July 2026) and official state health department websites.