Average — CMS composite of the measures below.
The next survey window likely opens around January 2027
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 Royse City Medical Lodge during CMS and state inspections, most recent first.
Unlabeled Refrigerated Food Items: Surveyors observed a block of cheese and a pack of lunch meat in the walk-in refrigerator without dates or labels. The Consultant Dietitian, Dietary Manager, and a cook all stated that kitchen staff were responsible for dating and labeling food items, and the facility policy required refrigerated foods to be dated, labeled, and tightly sealed.
Advance directive documentation was not handled correctly for two residents. One resident with dementia, diabetes, and heart disease signed a DNR, but the physician DNR order was entered later after an audit. Another resident with dementia, stroke-related deficits, and seizures signed a DNR, but the care plan still listed FULL CODE and the DNR order was not transcribed into PCC for an extended period. Staff interviews showed the SW, ADON, MDS nurse, and medical records process did not ensure the resident wishes were reflected promptly in the chart.
A resident’s Quarterly MDS was inaccurately coded because opioid use was not checked in Section N even though the MAR showed Norco was administered during the 7-day look-back period. The MDS Nurse Coordinator acknowledged the omission and stated she overlooked the opioid medication when completing the assessment; the DON identified the MDS Nurse Coordinator as responsible for accurate MDS completion.
Missing Physician Order for Trapeze Bar: A resident with bilateral AKA, CVA, CP, DM, PVD, hyperlipidemia, and generalized weakness used a trapeze bar for bed mobility and transfers, but the device was installed and included in the care plan without a written physician order. Staff interviews showed the resident requested the trapeze bar, therapy observed her using it, and the DON acknowledged the physician’s verbal approval was not documented in the chart.
A resident with multiple chronic conditions and moderate cognitive impairment was on enhanced barrier precautions for high-contact care. During a transfer from a shower chair to bed, an LVN and a hospice aide wore gloves but did not wear gowns, despite signage and an order requiring gown and glove use for transfers. Both staff later stated they did not notice the signage, and the DON confirmed transfers are a high-contact activity requiring PPE.
The facility failed to maintain proper nail care and hygiene for several residents, leading to unclean and untrimmed nails. This deficiency was observed in residents with varying levels of cognitive and physical impairments, who were dependent on staff for assistance with activities of daily living. Despite the facility's policy requiring regular nail care, staff inconsistencies and lack of training contributed to the oversight, posing a risk of infection and decreased quality of life.
The facility failed to properly store and label food items in their kitchen and storage areas, as observed in the walk-in refrigerator and freezer. Multiple food items, including foiled covered items, a container labeled 'chicken', fruit cups, and sandwiches, were found without proper labeling or use-by dates. The external trailer freezer also contained opened boxes of food items lacking proper labeling and secure closure. Interviews with staff revealed a lack of adherence to labeling protocols, posing a risk of food contamination and potential illness for residents.
A LTC facility failed to maintain an effective infection control program, with CNAs not performing hand hygiene or using appropriate PPE during care for three residents. One resident was frequently incontinent, another was on droplet precautions for COVID-19, and the third was on enhanced barrier precautions due to a pressure ulcer. Staff acknowledged lapses in protocol, recognizing the risk of infection spread.
A resident with moderate cognitive impairment was transferred without a gait belt, contrary to facility policy, resulting in the resident experiencing pain. The CNA involved acknowledged the requirement for gait belt use, which was confirmed by the DON, but the orientation checklist lacked specific gait belt training.
A resident with a urinary catheter was at risk for UTIs due to improper catheter care during a transfer. CNA C placed the catheter bag on the bed, causing urine to back up in the tubing. The resident's care plan required the catheter bag to be below the bladder, a protocol not followed during the incident.
A facility failed to provide appropriate respiratory care for a resident on hospice requiring oxygen therapy. The resident's room lacked 'Oxygen in Use' signage, which is essential for safety in a smoking facility. Staff interviews confirmed this oversight, acknowledging it as a deviation from policy and a potential risk to care quality.
A facility failed to ensure proper pharmaceutical services for a resident requiring G-tube medication administration. The resident, with severe cognitive impairment and dependent on tube feeding, had physician orders for water flushes between medications to prevent tube obstruction. RN B did not follow these orders, administering medications without the prescribed flushes, and admitted to not reviewing the orders beforehand. The DON confirmed the importance of following orders to prevent complications.
Unlabeled Refrigerated Food Items
Penalty
Summary
The facility failed to store food in accordance with professional standards in its only kitchen when surveyors observed the walk-in refrigerator on 2/10/2026 at 9:13 AM. One block of cheese wrapped in plastic and one pack of lunch meat were found without dates or labels. The observation showed that these refrigerated food items were not marked to identify when they were received or opened. During interviews, the Consultant Dietitian stated that all food items in the kitchen should be appropriately labeled and dated, and that if deli meat and cheese were removed from their original packaging, they should be labeled and dated with the received date. The Dietary Manager stated that cooks were typically responsible for labeling and dating food items when stored in the refrigerator and that all kitchen staff were expected to date and label food items. A cook with 6 years of experience stated that kitchen staff were responsible for dating and labeling food items and that open items were typically marked with a used-by date and unopened items with a received date. The facility policy titled Food Storage required refrigerated foods to be dated, labeled, and tightly sealed, and the FDA Food Code cited in the record required certain refrigerated ready-to-eat foods to be clearly marked when the original container is opened.
Advance Directive and DNR Orders Not Timely Documented
Penalty
Summary
The facility failed to obtain timely physician orders for DNR status after two residents signed advance directive forms, and one resident’s care plan did not reflect the correct code status. Resident #2 was a male with diagnoses including unspecified dementia, cognitive communication deficit, type 2 diabetes, atherosclerotic heart disease, and neurocognitive disorder. His record showed he signed an Out of Hospital Do Not Resuscitate Order, but the physician order for DNR was not entered until later. Staff interviews indicated the Social Worker completed the DNR paperwork with the resident or representative, then provided it to the ADONs to obtain the physician order and enter it into the medical record. During interviews, the MDS Nurse and DON stated the delay in entering Resident #2’s DNR order was an oversight and that the resident could have received CPR against his wishes if the order was not in the chart. ADON E stated the DNR paperwork should have been given to the ADONs the same day it was signed and that she did not know why there was a delay in obtaining the order. The DON stated she became aware of the missing order during an audit and it was corrected later. The facility policy stated the DON or designee would notify the attending physician of advance directives so appropriate orders could be documented in the resident’s medical record and plan of care. Resident #59 was a female with diagnoses including hypertension, cerebrovascular accident, hemiplegia or hemiparesis, non-Alzheimer’s dementia, and seizure disorder, with a BIMS score of 08/15 indicating moderate cognitive impairment. Her care plan stated she had elected FULL CODE status, but her advance directive record showed she signed a DNR form and it was scanned the same day, and the provider order later reflected DNR. The MDS Nurse stated the care plan had not been updated with the correct advance directive, and ADON E stated it was her responsibility to transcribe the DNR form order into PCC once signed. She also stated she did not know how the order was not placed in PCC for one month and a half.
Inaccurate MDS Coding for Opioid Use
Penalty
Summary
The facility failed to ensure Resident #61’s Quarterly MDS assessment accurately reflected her status related to prescribed opioid medication use. Resident #61 was an [AGE]-year-old female with diagnoses including chronic kidney disease, acute and chronic respiratory failure, and carcinoma of the anus. Her Quarterly MDS assessment dated 12/12/25 reflected no cognitive impairment and a BIMS score of 15, and Section N indicated antidepressant and antiplatelet medications were continued, but opioid medication was not checked. Record review showed a physician order for Norco Oral Tablet 7.5-325 mg every 4 hours as needed, and the December 2025 MAR reflected the medication was administered on 12/5, 12/9, and 12/11, which fell within the 7-day look-back period before the MDS was completed. During interview, the MDS Nurse Coordinator reviewed the assessment and stated opioid should have been checked because the resident received opioid medication during the look-back period, and that she had overlooked it when completing the assessment. The DON stated the MDS Nurse Coordinator was responsible for accurately completing MDS assessments.
Missing Physician Order for Trapeze Bar
Penalty
Summary
The facility failed to ensure adequate supervision and assistive devices were in place for one resident reviewed for assistive devices. Resident #7, a cognitively intact female with diagnoses including peripheral vascular disease, stroke, cerebral palsy, diabetes, hyperlipidemia, generalized muscle weakness, and bilateral above-knee amputation, had a trapeze bar installed above her bed to assist with mobility and transfers. Her MDS indicated she needed supervision or touching assistance for transfers, and her care plan included the trapeze bar as an intervention for positioning and reduced mobility. Record review and staff interviews showed the trapeze bar had been in place for about 5 to 6 months, but there was no physician order for the device in the medical record. Resident #7 stated the trapeze bar was placed at her request and that she used it to transfer between her bed and wheelchair. The DON confirmed the trapeze bar was installed by maintenance per the resident’s request and acknowledged that a written physician order should have been present. The DON also stated the physician was aware of and verbally approved the device, but this approval was not documented as an order. Interviews with the ADON, LVN, DOR, MDS nurse, and Maintenance Director showed staff understood that mobility devices generally required physician orders, but the order was not obtained or verified for this resident. The DOR stated therapy had observed the resident transferring safely with the trapeze bar, but also acknowledged the trapeze bar was not recommended by therapy. The facility did not have a specific policy for obtaining physician orders for mobility devices, and the DON stated staff were expected to follow nursing standards of practice requiring physician orders for resident care needs.
Failure to Use Required PPE During Enhanced Barrier Precautions
Penalty
Summary
The facility failed to maintain an infection control program designed to prevent the development and transmission of infection for one resident observed for infection control. Resident #4 had diagnoses including hypertension, type 2 diabetes, cerebrovascular accident, hemiplegia or hemiparesis, non-Alzheimer's dementia, and cognitive communication deficit, and had a BIMS score of 09/15 indicating moderate cognitive impairment. The resident's care plan directed staff assistance for all ADLs and use of a Hoyer lift for transfers. The resident also had a doctor order to implement and maintain enhanced barrier precautions during high-contact care activities. During observation, Resident #4 was seen in a shower chair with a mechanical lift sling under the resident and a mechanical lift next to the bed. CNA F exited the room with gloved hands, removed the gloves, discarded them, sanitized hands, and went to find help for the transfer. CNA F and LVN D then entered the room, washed their hands, put on clean gloves, and did not put on gowns. They attached the sling to the mechanical lift and transferred the resident from the shower chair to the bed. After the transfer, both staff turned the resident side to side and removed the sling. LVN D then removed gloves, washed hands, and exited the room, and CNA F removed gloves, took the mechanical lift outside the room, and sanitized hands. In interview, LVN D stated she did not put on a gown because she did not notice the signage at the room entrance, was not familiar with the resident, and it was her first day on the job. After reviewing the signage, she stated the resident was on enhanced barrier precautions and that transfer was a high-contact activity requiring gown and gloves. CNA F stated she was a hospice aide, did not know the resident was on enhanced barrier precautions, and did not notice the signage by the room entrance. The DON stated staff should gown and glove for high-contact activities including transfer and peri care, and that training on enhanced barrier precautions was done on hire, in monthly staff meetings, and as needed. The facility policy stated enhanced barrier precautions include gown and gloves during high-contact resident care activities, including bathing/showering in a shared/common shower room and transferring.
Deficiency in Resident Nail Care and Hygiene
Penalty
Summary
The facility failed to provide necessary services for residents who were unable to carry out activities of daily living, specifically in maintaining good grooming and personal hygiene. This deficiency was observed in five residents who were dependent on staff for assistance with activities of daily living. The residents' nails were found to be unclean and untrimmed, which could lead to a risk of infection and a decrease in quality of life. The facility's policy required nail care to be performed during bathing or as needed, but this was not consistently followed. Resident #39, a woman with severe cognitive impairment and hemiplegia, had nails that were overgrown and untrimmed. She could not recall the last time her nails were cut, indicating a lack of regular nail care. Similarly, Resident #36, a male with severe cognitive impairment and limited mobility, had nails with dark brown residue underneath, suggesting neglect in personal hygiene. The staff, including CNAs and nurses, were responsible for nail care, but there was a lack of training and awareness among CNAs regarding their responsibilities. Resident #76, a male with intact cognition but limited physical mobility, also had long and dirty nails. Despite being aware of the expectation to report nail care needs to the charge nurse, the staff failed to address this issue. Additionally, Resident #34 and Resident #55, both with substantial assistance needs, had untrimmed and dirty nails. There was no documentation of nail care refusal, and the staff interviews revealed inconsistencies in understanding and executing nail care responsibilities. The facility's policy emphasized the importance of nail care to prevent infections, but this was not adequately implemented, leading to the observed deficiencies.
Improper Food Storage and Labeling in Facility Kitchen
Penalty
Summary
The facility failed to adhere to professional standards for food service safety by not properly storing and labeling food items in their kitchen and storage areas. Observations in the facility's kitchen walk-in refrigerator revealed multiple food items, including foiled covered items, a container labeled 'chicken' with an open lid, fruit cups, and sandwiches, all without proper labeling or use-by dates. Additionally, the walk-in freezer contained an open box of cut carrots without a secure closure or date label. The facility's external trailer freezer also had several opened boxes of food items, such as chicken, burritos, dinner rolls, and lasagna rolls, all lacking proper labeling and secure closure. Interviews with the Dietary Manager and staff members highlighted a lack of adherence to labeling protocols. The Dietary Manager acknowledged that cooks were responsible for labeling items in the freezer and that all kitchen staff should label items in other storage areas. She emphasized the importance of sealing food items to prevent contamination and illness. Staff members confirmed the difficulty in labeling items in the trailer freezer due to poor lighting and cold smoke, which hindered proper labeling and closure of food items. The facility's Food Receiving and Storage Policy, revised in July 2014, mandates that all food stored in refrigerators and freezers be covered, labeled, and dated. The Food and Drug Administration Food Code also requires that food storage containers be identified with the common name of the food and marked with a date if held for more than 24 hours. The facility's failure to comply with these standards poses a risk of food contamination and potential illness for residents consuming meals from the facility's kitchen.
Infection Control Deficiencies in LTC Facility
Penalty
Summary
The facility failed to maintain an effective infection control program, as evidenced by several observed deficiencies involving three residents. For Resident #5, a CNA did not perform hand hygiene between glove changes during incontinence care, despite the resident being frequently incontinent of bladder and bowel. The CNA acknowledged the lapse in protocol, recognizing the risk of infection due to improper hand hygiene practices. In the case of Resident #69, who was on droplet precautions due to COVID-19, a CNA interacted with the resident without wearing a mask and failed to perform hand hygiene before entering another resident's room. The CNA admitted to not following the facility's expectations for PPE use and hand hygiene, understanding the potential risk of infection to the resident and others. For Resident #199, who was on enhanced barrier precautions due to a pressure ulcer, two CNAs provided incontinence care without wearing gowns, despite signage indicating the need for PPE. Both CNAs acknowledged their oversight, with one citing nervousness and the other misunderstanding the signage. The Director of Nursing confirmed the expectation for staff to perform hand hygiene and use appropriate PPE to prevent infection spread.
Failure to Use Gait Belt During Resident Transfer
Penalty
Summary
The facility failed to ensure adequate supervision and use of assistance devices during a resident transfer, which was observed with one resident. The resident, who had a moderately impaired cognition and required moderate one-person assistance for transfers, was transferred from her bed to a wheelchair without the use of a gait belt. Instead, the CNA lifted the resident by her armpits, causing the resident to express pain. This action was contrary to the facility's policy and the resident's care plan, which required the use of a gait belt for safe transfers. Interviews with the CNA and the Director of Nursing (DON) confirmed that the expectation was to use a gait belt during transfers to prevent injury. The CNA acknowledged the requirement and admitted to not using the gait belt, despite having been trained on its use. The facility's policy on safe lifting and movement of residents emphasized the use of appropriate techniques and devices, such as gait belts, to ensure the safety of both staff and residents. However, the CNA's orientation checklist did not specifically mention gait belt training, indicating a possible gap in the training process.
Inadequate Catheter Care Leads to Potential UTI Risk
Penalty
Summary
The facility failed to provide appropriate catheter care for a resident who was incontinent of bladder, leading to a potential risk for urinary tract infections. During an observation, CNA C was seen transferring a resident from bed to wheelchair without keeping the urinary catheter bag below the level of the bladder. This resulted in urine backing up in the tubing towards the resident's bladder. The resident's care plan specifically required the catheter bag to be positioned below the bladder to prevent such occurrences. The resident involved had a moderately impaired cognition with a BIMS score of 10 and required moderate assistance for transfers. The resident's medical history included conditions such as abnormal posture, unsteadiness on feet, retention of urine, and muscle weakness. Despite CNA C's skills verification indicating competence in catheter care, the failure to maintain the catheter bag below the bladder was acknowledged by both CNA C and the Director of Nursing, who confirmed that this oversight could increase the risk of urinary tract infections.
Failure to Provide Appropriate Respiratory Care
Penalty
Summary
The facility failed to provide appropriate respiratory care for a resident on hospice who required oxygen therapy. The resident, an elderly female with severe cognitive impairment and multiple diagnoses including dementia and hypertensive chronic kidney disease, was observed to be on oxygen therapy via nasal cannula. However, there was no signage indicating 'Oxygen in Use' on the resident's room door, which is necessary to ensure safety and alert staff in case of emergencies or evacuations. Interviews with facility staff, including a CNA, an LVN, and the DON, confirmed that the absence of the oxygen signage was a deviation from the facility's policy and professional standards of practice. The staff acknowledged that the signage is crucial in a smoking facility to prevent smoking or open flames near oxygen, and its absence could lead to decreased quality of care by not meeting the resident's care needs. The facility's policy on oxygen administration, revised in October 2010, also required 'No smoking/Oxygen in Use' signs as part of the necessary equipment and supplies for oxygen therapy.
Failure to Follow G-Tube Medication Administration Protocol
Penalty
Summary
The facility failed to provide adequate pharmaceutical services for a resident who required medication administration via a G-tube. The resident, a severely cognitively impaired female with multiple diagnoses including dysphagia and cerebral infarction, was dependent on tube feeding for more than half of her caloric intake. The physician's orders specified that the G-tube should be flushed with 15 to 30 ml of water between each medication to prevent tube obstruction and ensure proper hydration. However, during an observation, RN B did not follow these orders and failed to flush the G-tube between medications, administering them consecutively without the prescribed water flushes. RN B admitted to not reviewing the physician's orders prior to administering the medications and acknowledged the potential consequences of not flushing the G-tube as prescribed. The Director of Nursing confirmed that staff are required to follow physician orders and that failing to do so could lead to a clogged G-tube, necessitating hospital intervention, and could decrease the resident's hydration. Despite RN B's competency assessment indicating proficiency in G-tube medication administration, the failure to adhere to the prescribed procedure was observed.
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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 Royse City
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Greenville Health & Rehabilitation Center | 10.8 mi | ★★★★★ | 2 | 0 |
| Briarcliff Health Center Of Greenville | 11.2 mi | ★★★★★ | 15 | 1 |
| Greenville Gardens | 11.7 mi | ★★★★★ | 14 | 0 |
| Legend Healthcare And Rehabilitation - Greenville | 11.7 mi | ★★★★★ | 5 | 0 |
| Highland Meadows | 12.8 mi | ★★★★★ | 10 | 0 |
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