Below average — CMS composite of the measures below.
The next survey window likely opens around September 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 San Marcos Rehabilitation And Healthcare Center during CMS and state inspections, most recent first.
The facility did not post required daily nurse staffing information, including staff numbers, hours worked, and resident census, for several days. The posted information was outdated and did not reflect the current census. Staff interviews revealed that the responsibility for posting was assigned to one individual who did not complete the task due to other duties, and there was no monitoring by supervisory staff.
A resident with type II diabetes did not receive three doses of insulin due to a delay in pharmacy delivery after admission to the facility. The nursing staff failed to communicate the urgency of the medication, resulting in elevated blood sugar levels. The facility's emergency kit did not contain the specific insulin required, and the Director of Nursing acknowledged that an alternative could have been administered.
A resident with diabetes did not receive three doses of insulin due to a delay in pharmacy delivery after admission. The resident's blood sugar levels were elevated, and staff failed to communicate the urgency to the pharmacy or notify the NP in a timely manner. The facility's emergency kit did not contain the specific insulin required.
A resident with diabetes was not administered prescribed insulin due to unavailability upon admission to an LTC facility. The nursing staff failed to notify the NP or pharmacy promptly, resulting in elevated blood sugar levels. The DON noted the facility's e-kit lacked the specific insulin, and the NP stated earlier notification could have prevented potential negative outcomes.
A medication aide left a notepad with residents' names and vital signs visible on a medication cart in a hallway, exposing confidential health information. Staff interviews confirmed this was a breach of confidentiality and against facility policy, as sensitive medical data was not properly secured.
Two residents shared a room with a persistent, strong urine odor caused by one resident's repeated urination in inappropriate places and refusal to use briefs or allow staff to empty his urinal. Despite regular housekeeping and staff awareness, there were no effective interventions or clear guidance from management to address the odor or the behavior, resulting in an environment that was neither clean nor comfortable for the residents.
The facility did not create or implement individualized, person-centered care plans for several residents, resulting in care plans that lacked specific goals and interventions for activities based on each resident's preferences. Instead, generic interventions were used, and staff interviews revealed a lack of understanding about how to personalize care plans, leaving residents at risk of not having their recreational and social needs met.
Three residents with diabetes and cognitive impairment, all dependent on staff for personal hygiene, were observed to have long, jagged, or dirty nails despite care plans requiring assistance. Staff interviews revealed inconsistent attention to nail care and lack of follow-through on podiatry referrals, resulting in unmet hygiene needs as documented in facility records.
Two residents with cognitive and mental health impairments were not provided with individualized activities based on their assessments and care plans. Both were observed spending extended periods in bed with little to no engagement, despite documented preferences for specific activities. Staff interviews revealed a lack of awareness and coordination in activity planning, and activity logs showed only passive or generic activities.
Surveyors identified multiple deficiencies in food safety and sanitation, including staff handling ready-to-eat foods without gloves, unsealed food containers in storage, unsanitary equipment, and incomplete temperature and sanitizer logs. These actions were inconsistent with posted policies and professional standards, as confirmed by staff and management interviews.
Multiple infection control lapses were observed, including a medication aide placing an unsanitized finger in a medication cup before administering medications to a resident, a urinary catheter bag being left on the floor for another resident, and improper wound care practices by an LVN who failed to maintain hand hygiene and contaminated wound care supplies. These actions did not meet infection prevention standards and were acknowledged by staff as potential sources of cross-contamination.
Two residents with significant medical and cognitive impairments were not assisted in a timely manner to obtain needed dental services, including denture repair and replacement. Despite repeated documentation of broken or missing dentures and requests for dental care, the facility did not coordinate or document prompt dental appointments or follow-up, leaving both residents without necessary dental support for extended periods.
A resident sustained a significant laceration to his left leg during a transfer due to an exposed metal pipe on the bed frame, which lacked a protective cap. The incident occurred despite the facility's policy on maintaining safety and regular inspection of mechanical equipment. The resident, with a history of diabetes and fragile skin, experienced substantial bleeding and pain, requiring hospital evaluation and treatment.
Failure to Post Daily Nurse Staffing Information
Penalty
Summary
The facility failed to post required daily nurse staffing information, including the facility name, current date, total number and actual hours worked by RNs, LPNs, and CNAs per shift, and the resident census. This deficiency was observed for a period from 12/19/2025 to 12/29/2025. On 12/29/2025, the posted staffing information was outdated, displaying a date of 12/18/2025 and an incorrect census of 92 residents, while the actual census was 104. Several residents were observed near the posting, and one resident expressed that knowing the staffing numbers would be beneficial. Interviews with facility staff revealed that the VNDV was responsible for posting the staffing information daily but failed to do so due to being busy with other duties, especially during the holidays. The DON stated her role was limited to directing the VNDV to post the information and admitted she had not monitored compliance. The ADM indicated that the responsibility had always been assigned to the VNDV and was unaware of any issues until recently. The facility's policy required daily posting of staffing numbers in a public area, but this was not followed during the cited period.
Failure to Administer Insulin Due to Pharmacy Delay
Penalty
Summary
The facility failed to provide necessary pharmaceutical services to a resident, resulting in the non-administration of three doses of insulin. The resident, a male with a history of type II diabetes, stroke, coronary artery disease, and cholecystitis, was admitted to the facility with an order for insulin to be administered twice daily. However, due to a delay in delivery from the pharmacy, the resident did not receive his insulin doses on two occasions, which was documented by the nursing staff. The resident's blood sugar levels were recorded as elevated during this period, with readings reaching as high as 312 mg/dL. Interviews with the nursing staff and the Director of Nursing (DON) revealed a lack of communication and follow-up regarding the insulin order. The admitting nurse, who was new to the facility, assumed the pharmacy would deliver the insulin promptly and did not notify the pharmacy or the on-call nurse practitioner (NP) about the urgency of the medication. The DON acknowledged that the facility had an emergency kit with insulin, but not the specific type required for the resident, and stated that an alternative could have been administered. The facility's medication administration policy requires any irregularity in medication administration to be reported to a doctor, which was not adhered to in this case.
Failure to Administer Insulin Due to Pharmacy Delay
Penalty
Summary
The facility failed to ensure that a resident was free from significant medication errors, specifically regarding the administration of insulin. A male resident with a history of type II diabetes, stroke, coronary artery disease, and cholecystitis was admitted to the facility. Upon review, it was found that the resident did not receive three doses of insulin as prescribed due to a delay in delivery from the pharmacy. The resident's blood sugar levels were monitored and showed elevated readings, with the highest being 312 mg/dL. The resident expressed concern about his elevated sugar levels, which were not typical for him. The deficiency was further highlighted by the lack of communication and action from the facility staff. The admitting nurse, who was new to the facility, did not notify the pharmacy of the urgent need for insulin, assuming it would be delivered promptly. The LVN noticed the absence of insulin and contacted the pharmacy, but this was not done in a timely manner. The resident's NP was not informed of the situation until two days after admission, missing the opportunity to provide an alternative insulin order. The facility's DON acknowledged that the situation was not handled appropriately, as the specific insulin was not available in their emergency kit, and the on-call NP should have been contacted.
Failure to Notify and Administer Insulin
Penalty
Summary
The facility failed to immediately notify a resident's representative and nurse practitioner (NP) when there was a significant change in the resident's physical status due to the unavailability of prescribed insulin. The resident, a male with a history of type II diabetes, stroke, coronary artery disease, and cholecystitis, was admitted to the facility without his prescribed insulin being available. Despite having orders for insulin administration, the medication was not given on multiple occasions due to it not being available, as documented by the nursing staff. The resident's blood sugar levels were recorded as elevated, reaching as high as 312 mg/dL, which was concerning to the resident. Interviews with the nursing staff revealed a lack of communication and action regarding the unavailability of insulin. The admitting nurse, who was new to the facility, did not notify the pharmacy or the NP about the missing medication, assuming it would be delivered automatically. The Licensed Vocational Nurse (LVN) later contacted the pharmacy but was unsure why the issue was not addressed sooner. The Director of Nursing (DON) stated that the facility's emergency kit did not contain the specific insulin required and expected the nurse to contact the on-call NP. The NP confirmed she was not informed until days later and expressed that earlier notification could have led to alternative solutions to prevent potential negative outcomes like hyperglycemia.
Failure to Protect Resident Health Information Privacy
Penalty
Summary
The facility failed to maintain the confidentiality of personal and medical records for three residents diagnosed with hypertension. During an observation, a medication aide left a notepad containing the names and vital signs of these residents openly visible on top of a medication cart in a hallway. This notepad included sensitive information such as blood pressure and pulse readings, which were not secured or covered, making them accessible to unauthorized individuals. Interviews with facility staff, including the medication aide, assistant directors of nursing, the resident nurse coordinator, and the administrator, confirmed that this action was a breach of confidentiality and contrary to facility policy and HIPAA requirements. The facility's own Access and Confidentiality Agreement specified that such information must be protected and not left exposed. The incident was directly observed and corroborated by staff statements, establishing a clear failure to safeguard residents' protected health information.
Failure to Maintain a Safe, Clean, and Homelike Environment Due to Persistent Urine Odor
Penalty
Summary
The facility failed to provide a safe, clean, comfortable, and homelike environment for two residents sharing a room, as the room consistently possessed a strong, foul urine odor. One resident, who had intact cognition and a history of metabolic encephalopathy, dementia, and mobility issues, was observed to resist using a urinal and would urinate in inappropriate places, such as on the floor of his room. His care plan noted these behaviors and included general interventions such as monitoring and praising improvements, but did not specify effective strategies to prevent the behavior or address the resulting odor. Multiple observations over several days confirmed the persistent urine odor in the room, with staff and the other resident in the room acknowledging the unpleasant smell. The other resident, who also had intact cognition and multiple chronic health conditions, reported that the odor was awful and that the room was filthy. Staff interviews revealed that the urinal was often left full, the resident refused to wear briefs, and there was no clear guidance or specific interventions from management to address the odor or the urination behavior. Housekeeping cleaned the room regularly, but the odor quickly returned. Staff, including medication aides, CNAs, and nurses, expressed a lack of awareness of any effective interventions or care planning strategies to manage the situation. The administration acknowledged the issue and noted that the affected resident was offered a room change, which he declined. The facility's policy emphasized providing a homelike environment, but the ongoing odor and lack of effective intervention resulted in a diminished quality of life for the residents involved.
Failure to Develop and Implement Person-Centered Activity Care Plans
Penalty
Summary
The facility failed to develop and implement comprehensive, person-centered care plans for five out of eight residents reviewed for care plans. Specifically, the care plans did not include individualized goals and interventions for activities that matched each resident's preferences and interests, as identified in their assessments. Instead, the care plans contained generic statements and interventions, such as inviting residents to scheduled activities and providing activity calendars, without addressing the specific activities that residents enjoyed or found meaningful. For example, one resident with severe cognitive impairment and multiple diagnoses, including Alzheimer's disease and depression, was assessed as enjoying music, being around animals, group activities, and spending time outdoors. However, her care plan did not include interventions tailored to these preferences. Another resident with moderately impaired cognition expressed a preference for being around pets, keeping up with the news, and going outside, but his care plan also lacked specific interventions related to these interests. Similar deficiencies were noted for other residents, including those with intact cognition who identified reading, outdoor activities, and religious services as important, yet their care plans did not reflect these preferences. Interviews with staff revealed a lack of understanding and training regarding the creation of personalized care plans. The activities director admitted to using drop-down menus rather than entering specific information about residents' preferences, and was unaware that care plans could be individualized in this way. The MDS nurses also acknowledged gaps in their knowledge and practice, noting that care plans should include specific activities that residents enjoy. As a result, residents were at risk of not having their recreational and social needs met, as their care plans did not provide clear, measurable, and individualized actions to support their well-being.
Failure to Provide Required Nail Care for Dependent Residents
Penalty
Summary
The facility failed to provide necessary assistance with activities of daily living (ADLs), specifically nail care, for three residents who were unable to perform these tasks independently. Observations and interviews revealed that these residents had long, jagged, or dirty fingernails and toenails, despite care plans and MDS documentation indicating they required total assistance with personal hygiene. One resident reported almost scratching her eye due to jagged nails, and another expressed a desire to have her toenails trimmed. Staff interviews confirmed that nail care was not consistently provided, and that there was a lack of attention to nail hygiene during daily rounds. The residents involved had significant medical histories, including Type 2 Diabetes Mellitus and varying levels of cognitive impairment, which increased their dependence on staff for personal care. Documentation showed that these residents were dependent on staff for all personal hygiene tasks, and care plans specified the need for total assistance. Despite this, observations on multiple occasions found that their nails were not properly trimmed or cleaned, and in some cases, there was visible debris under the nails. Interviews with nursing staff, social workers, and administration indicated a lack of consistent communication and follow-through regarding referrals to podiatry and routine nail care responsibilities. Staff acknowledged the risks associated with untrimmed and unclean nails, such as potential for infection and injury, but also admitted that nail care was not always prioritized or checked during rounds. Facility policy required staff to provide assistance with personal hygiene, but this was not consistently implemented for the residents reviewed.
Failure to Provide Individualized Activities for Residents
Penalty
Summary
The facility failed to provide an ongoing program of activities tailored to the comprehensive assessment, care plan, and preferences of each resident, specifically for two residents reviewed for activities. Both residents were not provided with activities over a three-day period, as evidenced by observations, interviews, and record reviews. The lack of individualized activity programming was noted despite documented preferences and care plan directives for engagement and socialization. One resident, a male with multiple diagnoses including depression, dementia, and moderate cognitive impairment, was observed repeatedly lying in bed in the dark with no engagement in activities such as music or television. His care plan indicated a history of disinterest in activities but included interventions to encourage participation and social interaction. However, there was no evidence of care planning for his specific activity preferences, and activity logs only reflected passive activities like watching TV or observing surroundings, with no active engagement or individualized interventions. Another resident, a female with severe cognitive impairment and multiple mental health diagnoses, was also observed lying in bed with minimal engagement, primarily watching television. Her care plan called for staff support in activities and cognitive stimulation, but there was no documentation of care planning for her specific interests, such as reading, music, or religious activities. Staff interviews revealed a lack of awareness and coordination regarding individualized activity planning, and the activity director acknowledged insufficient familiarity with residents' preferences and a lack of guidance on interdisciplinary collaboration.
Failure to Follow Food Safety and Sanitation Standards in Dietary Services
Penalty
Summary
Surveyors observed multiple failures in the facility's dietary services related to food safety and sanitation. The cook was seen handling ready-to-eat foods, such as tortillas for breakfast tacos and chicken leg quarters, without wearing gloves during meal preparation and tray service. Additionally, the cook did not use gloves when preparing pureed and ground food items or when taking meal temperatures. These actions were in direct contradiction to posted signage and facility policy, which required glove use when handling food. Further inspection of the kitchen and storage areas revealed improper food storage practices. A container of sugar and a 50 lb. bag of rice in the dry storage room were both left unsealed, exposing them to possible pest contamination. The juice dispenser nozzle was found to have a pinkish-orange slimy buildup, and the lower-level stainless steel shelving where plate dome covers were stored had visible food debris and buildup. These conditions indicated a lack of adherence to professional standards for cleanliness and food safety. Record reviews showed that required logs for food temperatures, dish machine sanitizer, and the 3-compartment sanitizing sink were not completed or up to date. Interviews with dietary staff and management confirmed inconsistent practices regarding glove use and hand hygiene, as well as expectations for labeling, dating, and sealing food items. The facility's own policies, based on the Texas Food Establishment Rules, were not being consistently followed, as evidenced by the observed and documented deficiencies.
Infection Control Lapses in Medication Administration, Catheter Care, and Wound Care
Penalty
Summary
The facility failed to maintain an effective infection prevention and control program, as evidenced by multiple observed lapses in infection control practices involving three residents. In one instance, a medication aide was observed placing her unsanitized finger inside a medication cup before administering medications to a resident with diabetes and visual impairment. The aide later acknowledged that this action constituted cross-contamination and could cause infection. Another deficiency was observed with a male resident who had a urinary catheter due to sepsis and benign prostatic hyperplasia. On two separate occasions, his urinary catheter bag was seen resting on the floor, both while he was in his wheelchair and in bed. Facility staff, including a registered nurse consultant and an LVN, confirmed that catheter bags should be hooked to the side of the bed or wheelchair and not left on the floor, as this practice increases the risk of infection. A third incident involved improper wound care for a female resident with severe intellectual disabilities and a Stage 2 pressure ulcer. During wound care, an LVN touched clean gauze with unsanitized hands, failed to perform hand hygiene after removing soiled gloves, and used potentially contaminated supplies on the resident's wound. The LVN acknowledged that these actions could transfer bacteria to the wound. Facility leadership confirmed that these practices did not meet infection control expectations and could result in contamination of supplies and increased infection risk.
Failure to Provide Timely Dental Services for Residents with Denture Needs
Penalty
Summary
The facility failed to assist two residents in obtaining necessary routine dental services, resulting in unmet dental needs. One resident, a female with multiple complex medical conditions including hemiplegia, diabetes, dysphagia, and dementia, had a broken lower denture documented as early as January 2023. Despite this, there was no evidence that the facility took timely steps to repair or replace her denture, and she reported difficulty eating and not having seen a dentist. Her care plan indicated a need for assistance with activities of daily living, including oral hygiene, but no follow-up dental care was arranged. Another resident, a male with severe cognitive impairment, malnutrition, and no natural teeth, repeatedly reported that his dentures had been left in another country and expressed a desire for new dentures. Dental hygienist reports over several months documented his requests and the need for new dentures, with emails sent to inform the dentist. However, there was a lack of timely coordination for dental impressions and appointments, and the resident continued to be without dentures, impacting his ability to eat. The social worker acknowledged delays in obtaining family consent and arranging transportation, and also failed to document key communications regarding dental care in the resident's medical record. The facility's own dental services policy required prompt referral and action within three business days for lost or damaged dentures, as well as documentation of any delays and interim measures to support residents' eating and communication. In both cases, the facility did not follow these procedures, resulting in prolonged periods where the residents' dental needs were not met. Observations and interviews confirmed that both residents continued to experience difficulties related to their dental status, and the facility was unable to provide adequate explanations for the lack of timely intervention.
Failure to Maintain Safe Environment Resulting in Resident Injury
Penalty
Summary
The facility failed to ensure that the resident environment remained as free of accident hazards as possible, resulting in a laceration to a resident's left leg during a transfer. The resident, a [AGE] year-old male with a history of type II diabetes, an amputation, and fragile skin conditions, was being transferred from his wheelchair to his bed by physical therapy staff. During the transfer, the resident's leg came into contact with an exposed metal pipe on the bed frame, which lacked a protective cap, causing a significant laceration. The resident, who was on anticoagulant and antiplatelet medications, experienced substantial bleeding and pain following the incident, necessitating a hospital visit for evaluation and treatment of the wound. Interviews with staff revealed that the missing cap on the bed frame's metal pipe was identified as the cause of the injury. The physical therapy assistant who conducted the transfer noted the absence of the cap and the sharpness of the exposed metal compared to a capped pipe. The Director of Nursing (DON) and Licensed Vocational Nurse (LVN) acknowledged the resident's fragile skin condition and the potential for injury even with the cap in place, but confirmed that the missing cap contributed to the severity of the laceration. The maintenance staff confirmed that it was their responsibility to ensure all bed frame caps were in place and that a facility-wide inspection was conducted following the incident, finding no other missing caps. The facility's Mechanical Equipment Policy, which emphasizes safety and regular inspection of potentially dangerous mechanical equipment, was not adequately followed in this instance. The failure to maintain the bed frame in a safe condition directly led to the resident's injury. The incident highlights a lapse in the facility's adherence to its own safety protocols, resulting in harm to the resident during a routine transfer procedure.
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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 San Marcos
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Hays Nursing And Rehabilitation Center | 1.9 mi | ★★★★★ | 10 | 0 |
| Cypress Healthcare And Rehabilitation Center | 2.4 mi | ★★★★★ | 2 | 0 |
| Legend Oaks Healthcare And Rehabilitation-kyle | 10.1 mi | ★★★★★ | 9 | 0 |
| Deer Creek Nursing And Rehabilitation | 11.8 mi | ★★★★★ | 4 | 0 |
| Legend Oaks Healthcare And Rehabilitation - New Br | 13.2 mi | ★★★★★ | 11 | 0 |
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