Below 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 Songbird Lodge during CMS and state inspections, most recent first.
Dietary staff failed to ensure that 1 of 3 staff reviewed, a dishwasher, had a food handler's certificate. Record review showed no evidence of the certificate, and interviews confirmed the DM was responsible for monitoring kitchen staff training while the ADMN and Dietician stated all kitchen staff were expected to have the certification.
A dietary aide with an active respiratory infection was observed in the kitchen preparing tortillas with cheese while wearing a mask below his nose. He stated he had a doctor’s note saying he should not work, but the DM told him he had to stay. The DM said she thought the mask made it okay for him to work, while the ADMN and Dietician stated sick kitchen staff should not have been in the building and that the DM was responsible for monitoring kitchen staff.
A facility failed to include key interventions in resident care plans. One resident with CKD on dialysis had a physician-ordered fluid restriction, but the care plan did not address it even though the resident said he drank what he wanted. Two residents with severe cognitive impairment and fall risk had fall mats in use and one had a recent fall event, but neither care plan included the fall mat intervention.
Uncertified SNAs were allowed to work beyond the 4-month limit and provide direct care. Record review showed three SNAs lacked current CNA certification or had no CNA certification, while facility job descriptions stated the SNA role was limited to 120 days and required testing and certification. The RCN and ADMN stated SNAs were expected to be enrolled in classes and certified within the required timeframe, but monitoring and follow-up were not completed.
Menu Substitutions Not Followed or Communicated: The facility did not serve the posted lunch menu items to residents on B hall, with trays observed containing mashed potatoes and a different protein instead of the listed mashed sweet potatoes and roasted pork loin, and the posted dessert was also not served. Staff said the substitutions occurred because some food items were unusable or not received, and the DM stated residents were notified by the kitchen whiteboard, though she did not know how room-bound residents were informed and did not notify the dietician. Residents reported they were unhappy and said no one told them about the menu changes.
QAPI failed to carry out the corrective actions for a cited issue involving SNA certification tracking. The deficiency involved multiple SNAs and centered on the facility's failure to ensure an SNA was certified within the required time. Interviews showed the ADMN, DON, and HR did not consistently follow through with the monitoring and tracking process, and the RDO stated the prior DON had not followed policy and protocols.
Inaccurate MDS Included Pneumonia Diagnosis: A resident’s annual MDS incorrectly indicated pneumonia in the 7-day look-back period even though there were no current antibiotic orders for pneumonia. The resident’s care plan had no pneumonia focus, goal, or intervention, and staff stated the entry should not have been checked if the resident did not have a current diagnosis. Staff identified the error as human error and stated the MDS should have been accurate.
An RN left Medication Cart #1 unattended and unlocked, with the cart keys hanging from the narcotic box. The cart contained multiple residents’ meds, and the narcotic box held controlled substances behind only one lock even though the RN stated they should have been behind two locks. The RDO and RCN stated the cart should have been locked when not in use and the keys should not have been left on the cart.
A resident receiving hospice services had no hospice election form, CTI, OOHDNR, hospice medication info, or hospice physician orders in the chart, and the care plan had no hospice interventions. Staff interviews showed confusion about where hospice paperwork should be kept, the resident was still listed as full code, and the DON did not know who was responsible for hospice communication or documentation.
Survey Binder Missing Recent Investigation Results: The facility failed to keep the survey binder updated with the most recent survey and investigation findings for resident and family review. The binder near the entrance contained only the last standard survey and did not include recent investigation results, while the ADMN and RDO stated they were unsure the investigation findings were required and that no policy existed for the binder.
Surveyors observed that two residents had medications, including pill cups and respiratory treatments, left unattended at their bedsides without completed self-administration assessments or care plan documentation. Staff interviews confirmed that medications were sometimes left unsupervised, contrary to facility policy requiring observation during administration and secure storage. The DON acknowledged these lapses and the absence of required assessments.
A student nurse aide worked full-time without certification beyond the allowed period, risking inappropriate care for residents. The aide failed the skills test and did not retake it due to cost, as the facility only covered the first attempt. The DON was unaware of the certification time limit and had recently taken over monitoring responsibilities. No adverse effects were reported, but the potential risk was acknowledged.
The facility failed to conduct an annual performance review and provide 12 hours of in-service education for a nurse aide over two years. Interviews and record reviews revealed that the aide had not received a performance evaluation or completed the required training since her hire. The DON confirmed the lack of documentation and acknowledged the responsibility of department heads to ensure compliance. The aide was unaware of the mandatory training requirements, indicating a systemic issue in monitoring and enforcing compliance.
The facility failed to provide safe respiratory care for two residents with COPD, as their nasal cannulas and nebulizers were not stored properly, risking infection. Observations showed one resident's nasal cannula on the floor and another's nebulizer uncovered. Interviews with the administrator and DON confirmed the expectation to store equipment in plastic bags, aligning with facility policy.
The facility failed to secure medication carts on Hall A and Hall E, leaving them unlocked and unattended, which could allow unauthorized access to medications. Staff interviews revealed an understanding of the policy requiring carts to be locked when not in use, but this was not followed, posing a risk of drug diversion.
Dietary Staff Lacked Required Food Handler Certification
Penalty
Summary
The facility failed to employ sufficient dietary staff with the appropriate competencies and skill sets to carry out food and nutrition services for 1 of 3 dietary staff reviewed, DS G. Record review on 12.10.2025 showed no evidence that DS G had a food handler's certificate, and the facility also failed to provide a policy regarding dietary staff requirements for food handler certification before the exit conference on 12.11.2025. During interview, the DM stated that one of the dishwashers did not have a food handler's certificate and said he only washed dishes and did not handle food for residents. She stated she was not sure why he had not gotten the certificate and that she was responsible for monitoring staff training in the kitchen. The ADMN stated that all dietary staff should have a food handler's certificate and that the DM should be monitoring completion of the course. The Dietician also stated that all kitchen staff were expected to have a food handler's certificate and that staff without one should be monitored by the DM.
Kitchen staff worked while infected
Penalty
Summary
The facility failed to prepare, distribute, and serve food in accordance with professional standards for food service safety when a dietary aide with an active respiratory infection was observed working in the kitchen. During an observation, the dietary aide was wearing a mask below his nose and only covering his mouth while wearing gloves and preparing tortillas with cheese. In an interview, he stated he had a doctor’s note telling him not to work because of a respiratory infection, and that he had given the note to the DM, who told him he had to work and could not leave. Record review showed a return-to-work/school note from a local medical center stating the dietary aide was seen and could return to work on 12/15/2025. The DM stated she thought it was acceptable for the dietary aide to work because he was wearing a mask, and she acknowledged that if a kitchen staff member was sick and served food to residents, it could cause residents to get sick. The ADMN stated that once informed the dietary aide was working in the kitchen with an infection, she asked him to leave the facility. The Dietician stated kitchen staff who come to work sick should have been told to leave and should not have been in the building, and that the DM should have been monitoring kitchen staff daily. The facility policy titled, Guidelines For Work Restrictions For Persons With Infectious Diseases, stated that Group A streptococcal disease required relief from direct resident contact until 24 hours after adequate treatment is started.
Incomplete Care Plans for Fluid Restriction and Fall Mat Interventions
Penalty
Summary
The facility failed to develop and implement comprehensive, person-centered care plans for 3 residents by omitting ordered interventions that were in use or required. Resident #2 was admitted with chronic kidney disease and dependence on renal dialysis, had a BIMS score of 07, and was on a therapeutic diet with dialysis treatments while in the facility. A physician order dated 12/2/2025 required a fluid restriction of no greater than 32 oz per day related to renal dialysis, but the care plan only addressed potential fluid deficit and hemodialysis and did not include the fluid restriction. During interview, Resident #2 stated he was supposed to be on a fluid restriction but drank what he wanted. Resident #7 was admitted with diagnoses including unsteadiness on feet and muscle weakness, had a BIMS score of 03, required supervision or touching assistance with bed-to-chair transfers, and had a history of two or more falls with no injuries. Her physician order dated 6/18/2025 directed that a fall mat be placed at bedside for injury prevention related to falls. Although the mat was observed in her room and an incident note documented she was found lying on the floor beside the bed, the care plan only identified her as at risk for falls and refusing shoes; it did not include the fall mat as an intervention. The care plan goal was listed as not sustaining serious injury, with a target date of 9/08/2025. Resident #64 was admitted with diagnoses including epilepsy and failure to thrive, had a BIMS score of 02, and required substantial assistance with transfers from bed to chair. A fall mat was observed beside her bed, and staff confirmed it was being used, but her care plan did not include the fall mat as an intervention. Her care plan identified her as at risk for falls with a goal of not sustaining serious injury through the review date and a target date of 1/07/2026. Staff interviews reflected that fall mats should have been included in the care plan if they were being utilized, and the facility policy stated the comprehensive care plan should describe the services to be furnished and the interventions to be implemented.
Uncertified SNAs Provided Direct Care Beyond Allowed Timeframe
Penalty
Summary
The facility failed to ensure that student nurse aides who had worked more than 4 months were trained and competent, and that student nurse aides who had worked less than 4 months were enrolled in appropriate training. Record review showed that SNA M had a hire date of 4/18/2023 and was working full time as of 12/11/2025, but an employability status check dated 12/11/2025 listed a CNA certification expiration date of 5/22/15. SNA N had a hire date of 4/18/2023 and was also working full time, but the employability status check dated 12/11/2025 showed no CNA certification. SNA O had a hire date of 3/26/2025 and was working full time, and the employability status check dated 12/11/2025 showed no CNA certification. The facility records reviewed for these three SNAs included job descriptions stating that the position was limited to 120 days and that the individual was required to test and obtain certification. The records also stated that the SNAs were to only perform patient care areas they had been trained for. During interview, the RCN stated that when NAs were hired, they were expected to be enrolled in classes within 30 days and certifiable at 60 days, and that the facility had no policy on NAs other than NATCEP requirements. The ADMN stated that three SNAs were changed to Hospitality Aides because they had worked for four months or more, but also stated that they had been performing direct care with residents after the 4-month time frame. The ADMN stated the DON had been responsible for monitoring the nurse aides and that the failure occurred because the previous DON did not follow up and complete the task.
Menu Substitutions Not Followed or Communicated
Penalty
Summary
The facility failed to follow the posted lunch menu for residents receiving meals from the kitchen on B hall. The weekly menu posted in the dining area listed roasted pork loin, gravy, mashed sweet potatoes, parmesan brussel sprouts, honey roll, and pecan pie, but the white board outside the kitchen showed roasted pork loin, gravy, mashed sweet potatoes, parmesan brussel sprouts, honey roll, and vanilla pudding. During lunch service, kitchen staff were observed plating the last three resident trays with mashed potatoes and Italian sausage instead of the planned mashed sweet potatoes and roasted pork loin, and the last three trays passed on B hall also contained mashed potatoes rather than mashed sweet potatoes and a different protein product rather than roasted pork loin. Staff interviews showed the substitutions occurred because some sweet potatoes were bad, the kitchen ran out of sweet potatoes, and the pecan pie was not served because it was not received on the shipment truck. The dietary manager stated residents were notified of substitutions by writing on the whiteboard outside the kitchen, but also stated she did not know how residents who did not leave their rooms were notified of the dessert change and did not know if residents had been notified of the potato and protein substitutions. She also stated she did not notify the dietician of the potato and protein substitution. In a confidential group meeting, 8 of 8 residents stated they were unhappy that items served were not the items posted and that no one informed them of the menu changes.
QAPI Committee Failed to Follow Through on SNA Certification Monitoring
Penalty
Summary
The facility's QAPI committee failed to implement the corrective actions outlined in the Plan of Correction for deficient practice F728 related to the hiring and use of a nurse aide. The cited issue involved 3 of 4 SNAs reviewed, including SNA J, SNA M, and SNA N, and centered on the facility's failure to ensure SNA A (identified in the report as SNA M) was certified within the required time. The deficiency was identified during an abbreviated survey that began on 03/13/2025 and was documented in a CMS 2567 dated 03/14/2025. The facility's submitted Plan of Correction stated that the Area Director of Operations in-serviced the Administrator and HR on auditing and tracking SNA certification compliance, and that a monthly monitoring and tracking system had been implemented for the SNA certification process. During an interview on 12/11/2025, the ADMN stated she had followed up during QAPI meetings but had not completed the follow-up she was supposed to do with the DON, and that the DON and HR were supposed to handle tracking afterward but did not follow through. The ADMN also stated there was a continued monitoring log for SNAs and NAs for 90 days, but she had not monitored the tracking as expected. The RDO stated her expectations were to inspect and monitor staff where needed, and said the ultimate failure occurred because the previous DON had not followed through with the policy and protocols.
Inaccurate MDS Included Pneumonia Diagnosis
Penalty
Summary
The facility failed to ensure the comprehensive assessment accurately reflected Resident #32’s status. The Annual MDS dated 11.27.2025 indicated in Section I that the resident had pneumonia during the past seven days of the look-back period, even though record review showed no current physician orders for antibiotic therapy for pneumonia as of 12.01.2025. The resident’s electronic face sheet dated 12.09.2025 listed diagnoses including pneumonia, unspecified organism, history of falling, unspecified dementia, hypertension, iron deficiency anemia, and presence of a cardiac pacemaker. Record review of the resident’s care plan dated 09.11.2025 showed no evidence of a focus, goal, or intervention for pneumonia. During interviews, the Regional Reimbursement Nurse, Regional Nurse, and LVN MDS Coordinator each stated that if the resident did not have a current diagnosis of pneumonia within the last seven days, it should not have been checked on the MDS. They stated the error was due to human error and that the MDS should have been accurate; the Regional Reimbursement Nurse also stated she was responsible for monitoring MDS accuracy, and the Regional Nurse stated the DON was responsible for signing the MDS and ensuring accuracy.
Unlocked Medication Cart with Unsecured Controlled Substances
Penalty
Summary
Medication Cart #1 was observed unattended and unlocked, with the cart keys inserted and hanging from the narcotic box. During the observation, RN E stated the cart was his responsibility and that the medication carts were supposed to be locked whenever they were not in use, but he had left the cart unsecured while helping a resident who had fallen and was being assisted back to her room. RN E also stated that residents could have easily opened the cart and had access to the medications and scissors left in the open cart. The cart contained medications for 15 residents, including Crestor, Melatonin, Mirtazapine, Eliquis, Metoclopramide, Lyrica, Calcium/Magnesium/Zinc, Atorvastatin, Trazodone, Baclofen, Carvedilol, Famotidine, Keflex, Seroquel, Senna-S, Buspirone, Sertraline, Metoprolol, Potassium chloride, Ticagrelor, Carisoprodol, Amitriptyline, Metformin, Gabapentin, Omeprazole, and Donepezil. In the narcotic box, behind one lock, were tramadol, morphine, lorazepam gel syringes, hydrocodone, alprazolam, and diazepam gel. RN E stated the narcotic medications should have been behind two locks. The RDO and RCN both stated the medication cart should have been locked when not in use and that the keys should not have been left unattended on the cart.
Hospice documentation and care coordination were not maintained for a resident receiving hospice services
Penalty
Summary
The facility failed to collaborate with hospice representatives and coordinate the hospice care planning process for a resident receiving hospice services, and it failed to maintain required hospice forms and documentation. The record for the resident reflected diagnoses including failure to thrive and protein calorie malnutrition, and the quarterly MDS showed a BIMS score of 02 indicating severe cognitive impairment. A significant change MDS had been initiated but not completed, and the resident’s care plan contained no focus or interventions for hospice services. The resident’s physician orders dated 11/25/2025 reflected that she may admit to hospice for protein calorie malnutrition. However, the medical record reviewed on 12/08/2025 contained no hospice election form, physician certification of terminal illness, hospice medication information, OOHDNR form, or hospice physician orders. During observation, the resident was lying in bed, smiling when spoken to, and stated she had no concerns with her care. Interviews showed conflicting and incomplete communication about the resident’s hospice status and paperwork. The resident’s RP stated the resident had been on hospice for several weeks and that an OOHDNR form had been signed during hospice admission. The LVN stated hospice documents should have been in the EMR or a hospice binder, but no binder was found and the resident was listed as full code in the profile. The hospice RN stated the facility should have hospice documents and that the OOHDNR, CTI, and hospice election agreement would be sent to the facility. The DON stated she was still learning which documents were needed, did not know who was responsible for communicating with hospice companies, and did not know where communication documentation would be kept.
Survey Binder Missing Recent Investigation Results
Penalty
Summary
The facility failed to post in a place readily accessible to residents, family members, and legal representatives the results of the most recent surveys and investigations of the facility, including any plans of correction, without identifying information about complainants or residents. During observation, the survey results binder located in a bin on the right wall near the entrance contained the last standard recertification survey dated 9/06/2024, but it did not include the investigation results from 3/14/2025, 5/29/2025, or 10/02/2025. A sign directed the public to the binder, but the binder did not reflect the more recent investigation findings. During interviews, the ADMN stated she was responsible for updating the binder and initially believed she had placed the investigation findings in it, but later stated she was unsure whether the investigation findings were required to be included. She stated the facility had been investigated on 3/14/2025 with citations written, and on 5/29/2025 and 10/2/2025 with no citations written. The ADMN and the RDO both stated they did not know that investigation results needed to be included in the survey binder, and they stated the facility did not have a policy on the required posting for the survey binder.
Medications Left Unattended at Bedside Without Proper Assessment or Security
Penalty
Summary
Surveyors found that the facility failed to store all drugs and biologicals in locked compartments, as required, for two residents. Medications, including pill cups with multiple medications and respiratory treatments such as inhalers and nebulizer solutions, were observed left unattended at the bedside of both residents. Neither resident had a completed assessment for self-administration of medication, and their care plans did not address self-administration or the use of lock boxes for medication storage. One resident, with severe cognitive impairment and multiple diagnoses including metabolic encephalopathy and depression, was found with a pill cup of medications and respiratory treatments at her bedside. She reported that medication aides routinely left her medications for her to take without supervision and that she did not know what the medications were. The other resident, who was cognitively intact but had diagnoses including dementia and anxiety, was also found with an open pill cup containing several medications left on her bedside table. She stated that staff had left medications at her bedside multiple times without ensuring they were taken. Interviews with staff, including the DON and medication aides, confirmed that medications were sometimes left at residents' bedsides without supervision, and that there was no documentation of self-administration assessments for these residents. Facility policy required that medications be administered as prescribed and that staff observe residents taking their medications, but these procedures were not followed. The DON acknowledged that medications should not be left at bedside unless a self-administration assessment was completed and appropriate storage, such as a lock box, was provided.
Failure to Ensure Timely Certification of Student Nurse Aide
Penalty
Summary
The facility failed to ensure that a student nurse aide (SNA A) was certified within the required time frame, as she had been working full-time since April 2023 without completing a training and competency evaluation program. SNA A had a CNA certification expiration date of May 2015 and had not passed the skills test required for certification. Despite working continuously at the facility, SNA A had not registered to retake the test due to the cost, as the facility only covered the first attempt. This oversight placed residents at risk of receiving inappropriate care from an individual whose skill level was not verified. The Director of Nursing (DON) was unaware of the time limit for certification and had recently assumed responsibility for monitoring CNA certifications. The previous Assistant Director of Nursing (ADON) was responsible for this task but was no longer employed at the facility. The DON acknowledged that SNA A was working without certification and that no negative effects had occurred to residents, although there was a potential risk of residents not receiving appropriate care. The facility's job description for a student nurse aide clearly stated the requirement to obtain certification within 120 days, which was not met in this case.
Failure to Conduct Annual Performance Review and In-Service Education
Penalty
Summary
The facility failed to conduct an annual performance review and provide 12 hours of in-service education for a specific nurse aide (SNA A) over the years 2024 and 2025. This deficiency was identified through interviews and record reviews, which revealed that SNA A had not received a performance evaluation or completed the required in-service education since her hire date in April 2023. The Director of Nursing (DON) confirmed the lack of documentation for these requirements and acknowledged the responsibility of department heads to ensure compliance with training and certification requirements. Interviews with the Administrator and SNA A highlighted a lack of awareness and enforcement of the mandatory training requirements. The Administrator expected employees to complete monthly scheduled training via a computer-based program, while SNA A was unaware of the state or federal requirements for in-service education. The DON could only provide documentation of a single new employee orientation in-service training from April 2023, indicating a systemic issue in monitoring and ensuring compliance with training requirements. This failure could potentially impact the quality of care provided to residents.
Failure to Provide Safe Respiratory Care
Penalty
Summary
The facility failed to provide safe and appropriate respiratory care for two residents, as observed during a survey. Resident #38, a female with severe cognitive impairment and chronic obstructive pulmonary disease (COPD), was found with her nasal cannula uncovered and the nasal prongs lying on the floor. Her care plan did not specify when the oxygen tubing needed to be changed, despite physician orders indicating a weekly change. Similarly, Resident #61, a male with moderate cognitive impairment and COPD, had his nebulizer uncovered on the nightstand. His care plan also lacked specific instructions for changing the oxygen tubing, although physician orders allowed for changes as needed. Interviews with the facility's administrator and Director of Nursing (DON) revealed that the expectation was for nebulizer mouthpieces and oxygen nasal cannulas to be stored in plastic bags when not in use to prevent cross-contamination and potential illness. The facility's policy on respiratory therapy infection prevention, revised in 2011, also required storing the circuit in a plastic bag between uses and discarding the administration setup every seven days. The failure to adhere to these standards placed residents at risk for infections and communicable diseases.
Medication Cart Security Lapse
Penalty
Summary
The facility failed to ensure that drugs and biologicals were secured and stored according to accepted professional principles, as observed in two of the five medication carts on Hall A and Hall E. On Hall E, the medication cart was found unlocked and unattended while the nurse was in a resident's room, out of the line of sight of the cart. The cart contained over-the-counter medications, prescription medications, insulin, breathing treatment medication, and a narcotic drawer that was locked with one lock. Similarly, on Hall A, the medication cart was observed unlocked and unattended with a resident nearby. LVN B admitted to not being aware of anyone being close to the cart and acknowledged the risk of residents accessing medications not prescribed to them. Interviews with staff, including LVN A and the Director of Nursing (DON), revealed an understanding that medication carts should be locked when not in use or under direct supervision. LVN A admitted to leaving the cart unattended and unlocked, recognizing the potential for drug diversion. The DON and the Administrator (ADM) both emphasized the expectation for medication carts to be locked to prevent unauthorized access. A review of the facility's policy confirmed that medication carts should be locked when not in use or under direct supervision, highlighting a deviation from established procedures.
What surveyors are citing around you — mapped
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Repeat citations, what's rising near you, and quality measures — ranked so department heads know exactly where to look first.
Illustrative
What surveyors actually found near you
We read the 26 citations issued within 25 miles in the last 12 months — and tell you exactly what happened, in plain English, matched to your record.
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.
Illustrative
A prioritized, do-first checklist
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Illustrative
Risk indicators are statistical estimates from public CMS data — not predictions, findings, or compliance advice.
Nursing homes near Brownwood
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Pecan Bayou Nursing And Rehabilitation | 0.3 mi | ★★★★★ | 6 | 0 |
| Brownwood Nursing And Rehabilitation | 0.4 mi | ★★★★★ | 11 | 0 |
| Oak Ridge Manor | 0.4 mi | ★★★★★ | 5 | 0 |
| Cross Country Healthcare Center | 1.7 mi | ★★★★★ | 1 | 0 |
| Care Nursing & Rehabilitation | 6.4 mi | ★★★★★ | 3 | 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.