Above average — CMS composite of the measures below.
A standard survey is most likely before around October 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 Towers Nursing Home during CMS and state inspections, most recent first.
A resident with severe cognitive impairment, muscle wasting, anemia, and muscle weakness had a care plan and physician orders for daily wound care to a Stage 2 pressure ulcer on the buttocks, including cleansing and application of zinc oxide. Review of the Treatment Administration Record showed that the ordered wound care was not provided on two separate days, despite the care plan interventions and facility policy requiring systematic pressure injury prevention and management. Skin assessments documented the ongoing presence of the Stage 2 ulcer without undermining or tunneling, and interviews with clinical leadership confirmed the missed treatments, even though they reported no documented deterioration of the wound.
A resident with an indwelling suprapubic catheter had a care plan and facility policy requiring the catheter drainage bag to be kept below bladder level, off the floor, and with tubing free of kinks, along with monitoring for UTI signs and symptoms. On multiple observations, surveyors found the catheter tubing kinked and the drainage bag lying on the floor partially under the bed, despite staff interviews confirming that catheters should be hung on the bed below the bladder and never placed on the floor, and acknowledging that such positioning and kinking could lead to UTI or other infection.
A resident with severe dementia, dysphagia, and severe protein-calorie malnutrition received IV fluids for dehydration per physician orders, and this IV therapy was captured on the MDS as parenteral/IV fluids. However, the comprehensive care plan dated around the time of these orders was not updated to include the IV fluids, despite facility policy requiring that all MDS-triggered care areas be considered in the plan of care. The DON acknowledged that IV use is a significant change that should appear in the care plan, and the MDS Coordinator confirmed the omission and that the care plan should have been updated.
A resident who was unable to perform activities of daily living did not receive the necessary care and assistance from staff, resulting in unmet personal care needs.
The facility did not have an infection prevention and control program in place, as observed by surveyors, resulting in a deficiency related to the lack of systematic infection control measures.
A resident with type I diabetes and end-stage renal disease was not administered insulin and had her blood sugar levels unchecked over several days, leading to hospitalization for diabetic ketoacidosis (DKA). The facility's nursing staff failed to adhere to the prescribed medication regimen, resulting in the resident's condition worsening. The administration took corrective action by terminating the involved staff members.
A resident with cerebral infarction, Parkinson's, and morbid obesity, requiring two-person assistance for bed mobility, fell and sustained facial lacerations when a CNA attempted peri-care alone. Despite the resident's dependency on assistance, the CNA proceeded without help, leading to the resident rolling off the bed. The incident was reported by another CNA, and the resident was assessed and sent to the hospital for evaluation.
The facility's kitchen was found to have several sanitation deficiencies, including undated and improperly stored food items, such as a rotten banana and moldy strawberries. Food products were stored on the floor in the walk-in refrigerator and freezer, and some items were past their use-by dates. Interviews with staff confirmed that these practices violated the facility's policies and could lead to contamination and foodborne illnesses.
The facility failed to implement an effective antibiotic stewardship program, leading to inappropriate antibiotic use in two residents. One resident received cephalexin for UTI prophylaxis without an end date, against pharmacist recommendations. Another resident was given Rocephin before lab results confirmed an infection, which later showed no infection. The DON acknowledged ongoing issues with physicians not following stewardship policies, despite previous efforts to address these practices.
A facility failed to correct a PASARR evaluation for a resident with bipolar disorder, leading to an inaccurate assessment upon admission. The resident, diagnosed with myocardial infarction, dementia, and bipolar disorder, required assistance with all ADLs and had an indwelling catheter. Interviews with staff revealed that the incorrect PASARR was acknowledged but not promptly corrected, and the facility's policy was not followed.
A resident with multiple health conditions, including diabetes and dementia, was not provided with adequate nail care, resulting in a brown substance under her nails. Despite requiring extensive assistance with personal hygiene, there was no documentation of nail care being provided, and her care plan did not address her habit of digging into her brief. Staff interviews revealed inconsistencies in nail care responsibilities and a lack of in-service training on nail care.
A resident with intact cognitive function was found with a PIV that was not properly labeled, contrary to facility policy. The care plan did not address IV therapy, and observations showed the IV tubing was discarded while the PIV remained in place without proper labeling. Interviews with staff confirmed that standard practices for IV care were not followed, posing a risk of infection.
The facility failed to provide proper respiratory care for two residents, resulting in deficiencies in oxygen equipment management. Both residents, with chronic respiratory failure and dementia, did not have their oxygen tubing and nebulizer equipment changed as required. Observations showed outdated tubing, dirty concentrator filters, and improper equipment dating. Interviews with staff confirmed non-compliance with facility protocols, potentially risking respiratory infections.
Missed Ordered Treatments for Stage 2 Pressure Ulcer
Penalty
Summary
The deficiency involves the facility’s failure to provide pressure ulcer treatment as ordered for a resident with an existing Stage 2 pressure ulcer on the buttocks. The resident was admitted and readmitted multiple times and had diagnoses including muscle wasting and atrophy at multiple sites, iron deficiency anemia, and muscle weakness. An admission MDS dated 02/25/2026 documented severely impaired cognition with a BIMS score of 99 and impaired short- and long-term memory, and that the resident was admitted with a Stage 2 pressure ulcer. The comprehensive care plan revised on 03/03/2026 identified an alteration in skin integrity related to the Stage 2 pressure ulcer on the buttocks, with interventions including applying treatment as ordered, weekly and PRN assessment and documentation of the ulcer, monitoring for signs and symptoms of infection, notifying the physician of skin integrity impairments, and turning and repositioning as needed. Physician orders dated 03/18/2026 directed wound care to the buttocks consisting of cleansing with wound cleanser, patting dry, and applying zinc oxide to the wound bed, leaving it open to air once daily until resolved. The Treatment Administration Record (TAR) for March 2026 showed this wound care was to be provided every day shift. However, the TAR documented that the resident did not receive the ordered wound care on 03/18/2026 and 03/25/2026. Skin assessment nurse notes dated 03/17/2026 and 03/24/2026 consistently described a Stage 2 pressure ulcer with partial-thickness skin loss and exposed dermis on the buttocks, present on admission, with no undermining or tunneling. Interviews with the nurse practitioner, DON, nurse consultant, and administrator confirmed that the ordered treatments on the two identified dates were missed. The nurse practitioner stated that the resident’s overall health, cognition, and physical condition had improved and that there was no negative outcome or deterioration of the skin concerns from the missed treatments. The DON acknowledged that the treatments on 03/18/2026 and 03/24/2026 were not provided and stated she did not know why they were missed. The nurse consultant and administrator both confirmed that the wound did not deteriorate according to the medical record, but each acknowledged that there is a possibility that wounds may worsen if treatments are not provided as ordered. The facility’s policy on Pressure Injury Prevention and Management, dated 08/15/2022, stated the facility is committed to prevention of avoidable pressure injuries and promotion of healing of existing pressure injuries through a systematic approach to assessment and treatment, which was not followed when the ordered wound care was not administered on the documented dates.
Improper Management of Indwelling Catheter Drainage Bag and Tubing
Penalty
Summary
Surveyors identified a deficiency in the facility’s provision of catheter care for a resident with an indwelling suprapubic catheter. The resident was admitted with diagnoses including need for assistance with personal care, unspecified dementia, and a displaced intertrochanteric fracture of the left femur. The baseline care plan documented that the resident had a 16 French Foley catheter with a 10 ml balloon and specified interventions such as positioning the catheter bag and tubing below the level of the bladder and away from the room entrance, checking tubing for kinks each shift, monitoring intake and output, and monitoring for pain, discomfort, and signs and symptoms of UTI. The care plan also noted behavior problems related to hitting staff secondary to pain, but at the time the care plan was printed there was no care plan addressing the resident throwing items such as the catheter. On two separate observations the surveyor noted that the resident’s catheter drainage system was not maintained according to the care plan and facility policy. During the first observation, the resident was sitting up in bed with the bed in low position and a fall mat beside the bed; the indwelling catheter bag had kinks in the tubing and the drainage bag was lying on the floor halfway underneath the bed. A subsequent observation the same morning found the resident lying in bed with the bed still in low position, and the catheter remained kinked with the drainage bag in a covered bag lying on the floor partially under the bed. These observations showed that staff had not ensured the catheter tubing was free of kinks and that the drainage bag was not placed on the floor, contrary to the documented interventions and facility policy. Multiple staff interviews confirmed that the observed catheter positioning and tubing condition were inconsistent with expected practice and the facility’s own policy. The MDS coordinator LVN, LVNs, and CNAs interviewed all stated that catheter drainage bags should be hung on the side of the bed below the level of the bladder, that tubing should be straight and free of kinks, and that catheter bags should never be lying flat on the floor. They acknowledged that if the catheter bag was on the floor or the tubing kinked, urine might not flow properly and the resident could develop a UTI or other infection such as sepsis. The facility’s undated policy on indwelling urinary catheters explicitly directed staff to keep catheter and drainage tubing free from kinks, keep the drainage bag below the level of the bladder, and not place the drainage bag on the floor to reduce the risk of contamination and catheter-associated UTI. Despite this, the resident’s catheter bag and tubing were observed kinked and resting on the floor on more than one occasion.
Failure to Update Care Plan for IV Fluids After Assessment
Penalty
Summary
The deficiency involves the facility’s failure to ensure a comprehensive care plan was reviewed and revised by the interdisciplinary team after assessments for one resident. The resident was an elderly female admitted with diagnoses including severe dementia due to an underlying physiological condition, dysphagia in the pharyngeal stage, and severe protein-calorie malnutrition. Record review showed that the resident’s comprehensive care plan, dated 12/25/2025 and 01/12/2026, did not include or reflect the initiation of IV fluids. Physician orders dated 01/12/2026 documented an order for Lactated Ringers IV solution, and the MDS assessments, including one dated 01/13/2026, indicated that parenteral/IV fluids (K0520A) were provided during the look-back period. Interviews and policy review further supported the deficiency. The DON stated that an IV is a significant change and should be included in the care plan, but she was unable to state how soon it should be added. The MDS Coordinator confirmed that the IV fluids for dehydration were not included in the resident’s care plan and stated that the care plan should have been updated immediately, noting that the MDS did indicate the use of IV fluids. Review of the facility’s comprehensive care plan policy, implemented 10/24/2022, documented that the comprehensive care plan will be developed within 7 days after completion of the comprehensive MDS assessment and that all care assessment areas triggered by the MDS will be considered in developing the plan of care. Despite this policy, the resident’s care plan was not updated to reflect the IV fluids for dehydration.
Failure to Assist Residents with Activities of Daily Living
Penalty
Summary
A deficiency was identified when care and assistance were not provided to residents who were unable to perform activities of daily living (ADLs) independently. The report notes that residents requiring help with ADLs did not receive the necessary support from staff, resulting in unmet care needs for those individuals. This failure to provide assistance directly affected residents who were dependent on staff for their daily personal care and routine activities.
Failure to Implement Infection Prevention and Control Program
Penalty
Summary
The facility failed to provide and implement an infection prevention and control program. This deficiency was identified during the survey process, as the facility did not have an established or operational program to prevent and control infections among residents and staff. The absence of such a program was observed and documented by surveyors, indicating a lack of systematic measures to address infection risks within the facility. No specific residents or staff members were mentioned in the report, and there were no details provided regarding individual medical histories or conditions at the time of the deficiency.
Failure to Administer Insulin and Monitor Blood Sugar
Penalty
Summary
The facility failed to ensure that a resident was free from significant medication errors, specifically in the administration of insulin and monitoring of blood glucose levels. The resident, a female with a history of end-stage renal disease, type I diabetes, and previous episodes of diabetic ketoacidosis (DKA), was not administered her prescribed Insulin Glargine on several occasions and her blood sugar levels were not checked as required. This lapse in care occurred over a period from late July to early August, during which the resident's blood sugar levels were not monitored, and insulin was not administered according to the physician's orders. On August 2nd, the resident exhibited signs of high blood sugar, including changes in mental status and refusal to attend dialysis. The nursing staff, upon being alerted by the resident's family member, discovered that the resident's blood sugar was extremely high, and the glucometer was unable to read it. Despite receiving insulin as per the sliding scale and additional interventions, the resident's condition did not improve, leading to her being sent to the hospital where she was diagnosed with DKA. Interviews with the nursing staff revealed that there was a lack of adherence to the prescribed medication regimen, which was critical for managing the resident's diabetes. The deficiency was attributed to the failure of the nursing staff to perform timely blood sugar checks and administer insulin as ordered. The facility's administration acknowledged the oversight and took action by terminating the Director of Nursing and the involved Licensed Vocational Nurse. The incident highlighted the importance of consistent monitoring and medication administration for residents with chronic conditions like diabetes to prevent severe complications such as DKA.
Failure to Provide Adequate Assistance During Peri-Care
Penalty
Summary
The facility failed to ensure that a resident's environment was free from accident hazards, resulting in an incident where a resident rolled out of bed during peri-care and sustained facial lacerations. The resident, who was diagnosed with cerebral infarction, Parkinson's disease, and morbid obesity, required total assistance from two staff members for bed mobility and peri-care. Despite this requirement, a CNA attempted to provide peri-care alone, leading to the resident rolling off the bed and injuring herself. The resident's medical records indicated that she was dependent on assistance for bed mobility, as noted in her MDS Admission Assessment and Comprehensive Care Plan. The incident occurred when the CNA asked the resident to help with peri-care, and the resident attempted to assist by turning to her side. However, due to her lack of core strength and the CNA's solo attempt to provide care, the resident's momentum caused her to fall off the bed. Interviews with staff revealed that the CNA was aware of the resident's need for two-person assistance but proceeded alone. The incident was witnessed by another CNA, who reported the fall to the RN on duty. The RN assessed the resident and facilitated her transfer to the hospital for evaluation. The facility's policy required two-person assistance for residents unable to perform activities of daily living independently, which was not adhered to in this case.
Sanitation Deficiencies in Kitchen Storage and Food Handling
Penalty
Summary
The facility failed to maintain sanitary conditions in its kitchen, as observed during a survey. Several issues were identified, including a box of bananas in the dry storage area that was not dated and contained a rotten banana. Additionally, food products and boxes were improperly stored on the floor in the walk-in refrigerator and freezer, which is against the facility's policy. An open bag of biscuit dough in the freezer was exposed to air, and several food items in the refrigerator were past their use-by dates, including a container of strawberries with visible mold. Interviews with the Food Service Supervisor (FSS) and Dietary Aide (DA) revealed that the facility's policy requires all food items to be dated when received and when opened, with a use-by date of no more than three to four days. The FSS and DA acknowledged that failure to date and properly store food could lead to contamination and foodborne illnesses. The FSS also noted that food should not be stored on the floor to prevent contamination, and that exposed food in the freezer could suffer from freezer burn, affecting taste and nutritional value. The facility's Food Storage Policy, as well as the Food and Drug Administration Food Code, were reviewed and found to require proper labeling, dating, and storage of food items to ensure safety and quality. The policy mandates that refrigerated foods be stored off the floor and used within 72 hours, while frozen foods should be in moisture-proof containers. The Administrator confirmed these expectations, emphasizing the importance of following guidelines to prevent bacteria and contamination.
Failure in Antibiotic Stewardship Program
Penalty
Summary
The facility failed to establish an effective infection prevention and control program, specifically lacking an antibiotic stewardship program with protocols and a system to monitor antibiotic use. This deficiency was identified in two residents. The first resident, a female with multiple diagnoses including chronic heart failure and moderate cognitive impairment, was placed on cephalexin for UTI prophylaxis without an end date, despite recommendations from a consultant pharmacist to amend the order. The pharmacist noted that prophylactic use of antimicrobials was contraindicated, yet the resident continued to receive the antibiotic daily for several months. The second resident, a female with severe cognitive impairment and a history of UTIs, was administered Rocephin before the results of a urinalysis and UTI panel were available, which later showed no infection. The DON acknowledged that antibiotics should not have been given prior to lab results and expressed ongoing issues with physicians not adhering to the facility's antibiotic stewardship policies. The facility's policy requires that antibiotics be prescribed with specific indications, doses, and durations, and that narrow-spectrum antibiotics be used when appropriate. Interviews with the DON revealed that the facility had previously addressed the issue of inappropriate antibiotic use with providers, emphasizing the risk of antibiotic resistance. The facility's Medical Director had also recommended adherence to evidence-based practices and the use of resources like UpToDate to maintain current guidelines. Despite these efforts, the facility's failure to implement and monitor an effective antibiotic stewardship program led to the identified deficiencies.
Failure to Correct PASARR Evaluation for Resident with Bipolar Disorder
Penalty
Summary
The facility failed to complete a preadmission screening and resident review (PASARR) for a resident with a mental disorder, specifically bipolar disorder. Upon admission, the resident was incorrectly evaluated, and the PASARR form was not corrected in a timely manner. The resident, who was admitted with diagnoses including myocardial infarction, dementia, and bipolar disorder, had an entry Minimum Data Set (MDS) that lacked a cognitive assessment and showed a score of 00 on the Brief Interview for Mental Status (BIMS). The resident required assistance with all activities of daily living (ADLs) and was assessed with an indwelling catheter and frequent incontinence. Interviews with facility staff, including the MDS nurse, LVNs, the Director of Nursing (DON), and the administrator, revealed that the incorrect PASARR evaluation was acknowledged but not promptly corrected. The MDS nurse admitted responsibility for ensuring the accuracy of PASARR forms and noted that the form had not been signed by the physician within two weeks of the resident's admission. The administrator confirmed that the facility's policy was not followed, and the PASARR should have been resubmitted for correction, particularly regarding the diagnosis of bipolar disorder, which needed clarification. Despite daily monitoring, the resident had not exhibited manic or depressive behaviors since admission.
Failure to Provide Adequate Nail Care for Resident
Penalty
Summary
The facility failed to provide necessary services for a resident who was unable to perform activities of daily living, specifically in maintaining good grooming and personal hygiene. Resident 29, a female with multiple diagnoses including type 2 diabetes with diabetic neuropathy, dementia, and other conditions, was observed with a brown substance under her fingernails on multiple occasions. Despite being identified as requiring extensive assistance with personal hygiene due to impaired cognition and other physical limitations, there was no documentation of nail care being provided, and her care plan did not address her habit of digging into her brief. Interviews with staff, including an LVN, CNA, DON, and ADM, revealed inconsistencies in the understanding and execution of nail care responsibilities. While the care plan and task list indicated that nail care was to be provided by CNAs, there was no specific order for nail care in the resident's records. Staff interviews indicated that nail care was generally performed on Sundays, and there was a lack of in-service training on nail care for 2023 and 2024. The facility's policy stated that residents unable to perform ADLs should receive necessary services to maintain grooming and hygiene, yet this was not adhered to in the case of Resident 29.
Failure to Properly Administer and Label IV Fluids
Penalty
Summary
The facility failed to administer parenteral fluids in accordance with professional standards of practice and physician orders for a resident. The resident, a female with intact cognitive function, was observed with a peripheral intravenous catheter (PIV) in her right wrist, which was not properly labeled with the date, initials, or IV gauge. The comprehensive care plan did not address IV therapy, despite the resident being at risk for infection and fluid volume deficit. Observations revealed that the IV tubing was disconnected and discarded, and the PIV remained in place without proper labeling for several days. Interviews with facility staff, including an LVN and the Director of Nursing (DON), confirmed that the standard practice for IV care was not followed. The LVN admitted uncertainty about the labeling of the IV dressing, acknowledging the risk of infection due to improper labeling. The DON expressed her expectation for IV sites to be dated, initialed, and checked every shift, with orders in place if the site needed to remain. The facility's policy, dated July 2016, required all IVs to be labeled with specific information, which was not adhered to in this case.
Deficiencies in Respiratory Care Management
Penalty
Summary
The facility failed to provide appropriate respiratory care for two residents, leading to deficiencies in the management of their oxygen equipment. Resident #65, a female with chronic respiratory failure and dementia, did not have her oxygen tubing and nebulizer equipment changed every seven days as required. Observations revealed that her oxygen tubing was past the seventh day, and the air filter on her concentrator was dirty. Additionally, her nebulizer mask was not bagged properly and was dated incorrectly, indicating it had not been changed as per the facility's protocol. Similarly, Resident #81, who also suffers from chronic respiratory failure and dementia, experienced similar issues with her respiratory care. Her oxygen tubing was not dated, and the air filter on her concentrator was found to be dirty. Despite a nurse's visit, the tubing and nasal cannula were not replaced, and the equipment was not maintained according to the facility's standards. The lack of proper dating and maintenance of the equipment could potentially lead to respiratory infections, as noted by the staff. Interviews with the LVN and DON confirmed that the facility's procedures for changing and maintaining respiratory equipment were not followed. The LVN acknowledged that the equipment should be changed every seven days and dated, and the DON emphasized the importance of adhering to these protocols to prevent respiratory issues. The facility's policy on oxygen safety did not address specific procedures for respiratory equipment maintenance, contributing to the oversight in care for these residents.
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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 Smithville
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Windsor Nursing And Rehabilitation Center Of Bastr | 13.7 mi | ★★★★★ | 1 | 0 |
| Bastrop Lost Pines Nursing And Rehabilitation Cent | 13.9 mi | ★★★★★ | 10 | 1 |
| Silver Pines Nursing And Rehabilitation Center | 14 mi | ★★★★★ | 0 | 0 |
| Care Inn Of La Grange | 16.6 mi | ★★★★★ | 12 | 0 |
| Monument Rehabilitation And Nursing Center | 17.5 mi | ★★★★★ | 8 | 0 |
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