Below 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 Trucare Living Centers - Selma during CMS and state inspections, most recent first.
The facility failed to ensure that a physician consistently documented required visit notes, including review of the total program of care, for four residents under one physician’s care. Over extended periods, the EHR contained only sporadic or no physician progress notes for these residents, despite the physician reporting that he visited them every other month and was in the building weekly. During the same time, multiple visits by an NP and a PA were documented. In interviews, the DON confirmed the physician’s regular presence but could not explain the missing notes, and the physician acknowledged that his notes were not in the records and stated he must not have entered them. The Administrator reported there was no policy addressing clinical record accuracy or ensuring that physicians documented a note after each visit.
Food storage and labeling practices were not followed in the kitchen and nourishment refrigerator. A crate of milk boxes was observed on the floor in the refrigerator, and multiple items in the nourishment refrigerator/freezer lacked resident names, and one opened cottage cheese container had no seal, lid, or open date. The DM, DON, DDM, and Administrator gave differing statements about responsibility for the nourishment refrigerator, and the facility policy required food items to be stored above the floor and below the sprinkler unit.
A resident with dementia, depression, and a history of delusions and medication refusal became verbally and physically aggressive, including grabbing a CNA and attempting to strike the Psych NP, and was sent to the hospital for evaluation. After the transfer, the facility told the family it did not want the resident back because of safety concerns, but the record did not document the reason for refusing readmission. The SW stated no 30-day notice or discharge summary was completed, and the required discharge planning review, comprehensive discharge instruction form, and final discharge summary were not done.
A resident was transferred to the hospital for behavioral symptoms, but the facility did not send the required discharge notice to the State LTC Ombudsman. The resident’s record showed no evidence of Ombudsman notification, and the Ombudsman confirmed she never received notice, while the Administrator stated she did not consider it a 30-day discharge.
The facility failed to ensure MDS assessments accurately reflected resident medication use for two residents. One resident with diabetes had insulin orders for Humalog and Lantus, and the MAR showed both were given daily during the look-back period, but the MDS recorded fewer insulin injection days. Another resident with dementia, depression, anxiety, and chronic pain was receiving Effexor XR, but the MDS did not include antidepressant use in the high-risk drug class section. The MDS Coordinator and DON stated the MDS should be accurate and reflect the care residents receive.
Inaccurate PASARR Screening for Mental Illness: A resident with a documented dx of bipolar disorder was screened as having no mental illness on both the hospital and facility PASARR Level 1 forms. The MDS Case Manager confirmed the error, stated they were responsible for reviewing PASARR documents on admission, and noted there was no policy for PASARR assessments.
Scissors were found in a resident’s room on separate observations despite the resident having dementia, moderate cognitive impairment, and needing substantial to maximal assistance with ADLs. A CNA stated the scissors were a potential accident hazard and could injure the resident or wandering residents, while the DON and Administrator said there had been an ongoing issue with the resident’s family taking scissors from the activity room and using them in the room.
Unlabeled Pills Left in Medication Cart: The facility failed to ensure medications in the 300/400 hall med aide cart were stored in properly labeled containers. During observation, a clear dosing cup with loose pills was found in a cart drawer. The MA stated such pills should not be left in the cart and should be disposed of if not given immediately, and the DON stated medications should not be left in dosing cups because they could be confused and given to the wrong resident. The facility policy required all medications to be properly labeled.
A CNA provided incontinent/peri care to a resident with dementia, reduced mobility, and frequent bowel/bladder incontinence, but did not wash hands with soap and water after stool contact and instead sanitized hands between glove changes. The CNA also placed a clean brief on the resident’s bed while continuing care, then used that brief on the resident. The DON stated stool exposure required soap-and-water handwashing and that the brief should have been discarded because it was cross contamination.
A resident with severe cognitive impairment was allegedly slapped in the face by a family member during a transfer, as witnessed by a CNA. The incident was reported internally to nursing leadership and the Administrator, but was not reported to the State Survey Agency or law enforcement as required. The facility's incident log did not document the event, and the internal investigation was not completed at the time of survey. Staff interviews confirmed knowledge of the event and the regulatory requirement to report abuse allegations.
A resident with a Foley catheter was observed without a privacy cover, compromising their dignity and privacy. Despite facility protocols requiring privacy covers, staff interviews revealed confusion over responsibility for ensuring covers were in place. The resident's care plan and MAR indicated the need for privacy covers, but this was not adhered to, highlighting a lapse in maintaining resident dignity.
A resident with multiple health issues experienced a change in condition, including diarrhea and fever, but the facility failed to notify the family member promptly. The resident's condition worsened, leading to a hospital transfer. Despite staff training on notification protocols, the responsible party was not informed in a timely manner.
A facility failed to specify the frequency for changing the formula bottle or tubing for a resident receiving enteral nutrition, leading to potential risks of expired formula and clogged tubing. The resident, with a history of pneumonia and dysphagia, had orders lacking clarity on when to change the feeding components, which should have been done every 24 hours. Observations and interviews confirmed the oversight, highlighting a lapse in protocol adherence.
A facility failed to maintain accurate medical records for a resident, resulting in confusion over fluid restriction orders. The resident's care plan and MAR contained inconsistent and duplicate entries, leading to staff uncertainty about the correct fluid restriction. Interviews revealed a lack of awareness and understanding among staff, including CNAs, LVNs, and dietary personnel. The resident's physician and NP were unaware of the restriction, and the facility lacked a policy for fluid restrictions, contributing to the deficiency.
The facility failed to maintain proper infection control practices, as a CNA did not follow correct perineal care procedures, risking contamination of a surgical wound, and an LVN neglected to wear a gown while administering g-tube medication, despite EBP requirements. Both staff members had received training but did not adhere to protocols during these incidents.
The facility failed to properly label and store medications, as an expired medication was found in the medication room, and medications for two discharged residents were not disposed of correctly. The DON confirmed that expired and discharged residents' medications should be removed and stored in a locked disposal box. The medication aide responsible for the medication room admitted to missing the expired medication and was unsure how the discharged residents' medications ended up there.
A resident with moderate cognitive impairment was discharged from a facility without the required written notification to their representatives and the State Long-Term Care Ombudsman. The family was verbally informed of the discharge due to wandering behaviors and felt they had no choice but to agree. The facility's Administrator did not provide written notice, believing it unnecessary since the family agreed, and the facility lacked a policy for such notifications.
Two residents' care plans were not updated to reflect their current needs and conditions. One resident's care plan lacked documentation for bedrails, CPAP use, and OSA diagnosis, despite these being in use. Another resident's care plan still included hospice services and diuretic therapy, which were discontinued. Staff interviews confirmed these oversights, highlighting a failure to adhere to the facility's policy for revising care plans as needed.
A resident with multiple diagnoses, including OSA, did not have necessary orders for bedrails and a CPAP machine, despite using both devices. The facility failed to obtain these orders, leading to potential risks due to inaccurate records. Staff interviews revealed confusion and lack of responsibility in ensuring proper equipment orders, which could negatively impact the resident's care.
The facility failed to provide appropriate CPAP treatment for two residents. One resident with OSA was not assessed for CPAP use, and no orders were obtained, leading to the resident using a CPAP device without staff assistance. Another resident with Pulmonary Fibrosis had an order for CPAP treatment, but the device was missing pieces and not included in the care plan, preventing its use. The facility's policy did not address the need for physician orders for treatments/devices, contributing to these deficiencies.
A facility failed to obtain medication orders for diuretics for a resident with Congestive Heart Failure, despite the resident providing a hospital discharge report listing Lasix. The LVN did not add the diuretic to the resident's orders as the FNP did not check it off, and the DON was unaware of the discrepancy. The facility's policy did not address orders for treatments/devices, contributing to the oversight.
The facility failed to maintain complete and accurate medical records for a resident, particularly regarding incontinent care documentation. Despite the resident being generally clean and groomed, multiple days in March 2024 lacked proper documentation, leading to concerns about the accuracy of care records.
Failure to Ensure Physician Visit Documentation in Clinical Records
Penalty
Summary
The facility failed to ensure that a physician reviewed residents’ total programs of care and documented visit notes, including progress notes and orders, at each required visit for four of five sampled residents under the care of one physician. For one resident with hypertension encephalopathy, stroke, anxiety disorder, and other conditions, the electronic record showed only two visit notes from the primary physician over an approximately ten‑month period, despite the physician reporting that he saw the resident every other month. During that same timeframe, multiple visit notes were documented by NPs and a PA, but there were no additional physician notes between early June 2025 and late April 2026. For a second resident with pneumonia, dysphagia, anemia, atrial fibrillation, hypertension, diabetes, and severely impaired cognition, record review from mid‑January to late April 2026 revealed no physician visit notes from the primary physician, although numerous visit notes were entered by a PA. A third resident with lymphedema, hypertension, hyperlipidemia, COPD, cellulitis, and moderately impaired cognition had no physician visit notes from admission through late April 2026, while NPs and a PA documented several visits during that period. A fourth resident with anxiety disorder, hyperlipidemia, bipolar disorder, neuromuscular bladder dysfunction, and fibromyalgia likewise had no physician visit notes from admission through late April 2026, despite multiple NP and PA visit notes. In interviews, the DON stated that the physician was in the facility weekly to see his residents and could not explain the absence of physician progress notes for the affected residents. The physician confirmed he was in the facility weekly, that he alternated visits with his NP and PA, and that he believed he had seen all four residents numerous times, including in February 2026, but acknowledged that his notes were not present in the electronic records and stated he “must not have put a note” in the records. The Administrator reported that she checked the electronic records after physician visits but noted that providers often delayed entering notes and also stated there was no facility policy on accuracy of clinical records or ensuring that physicians wrote a note after each visit. The report states that this deficient practice could place residents at risk for physician‑identified concerns, inadequate monitoring of medical conditions, and miscommunication with other health care providers.
Food Storage and Labeling Deficiencies in Kitchen and Nourishment Refrigerator
Penalty
Summary
The facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety for 1 of 1 kitchen areas reviewed. During observation on 02/10/2026, a crate of individual milk boxes was found on the floor under shelving in the kitchen refrigerator. During interview, the DM stated items in the refrigerator should be 8 inches from the floor and 16 inches from the ceiling, and stated the risk of leaving items on the floor could include mold, a dirty floor, or critters getting into the items. The DM also stated items are labeled with a date so staff know when they were opened and when they are getting ready to expire. On 02/12/2026, observation of the nourishment refrigerator/freezer revealed one cottage cheese container with no seal and no lid, with no open date or resident name; one sealed cottage cheese with no resident name; three homestyle chicken noodle soups with no resident names; one chicken soup with no resident name; and one frozen cheese enchiladas meal with no resident name. The DON stated items in the nourishment refrigerator/freezer should have the resident's names on them and, if opened, the date when the item was opened. The DON stated the risk could be someone else taking the item and that items without dates would be thrown away. The DDM stated there was no specific policy regarding the nourishment refrigerator/freezer, and the Administrator stated the dietary department was responsible for the nourishment refrigerator. The facility policy, Food Storage: Cold Foods, revised 2/2023, stated all food items will be stored 6 inches above the floor and 18 inches below the sprinkler unit.
Failure to Document and Complete Safe Discharge After Hospital Transfer
Penalty
Summary
The facility failed to permit a resident to return after hospitalization and failed to document sufficient preparation and orientation for a safe and orderly transfer or discharge. Resident #18 was admitted with diagnoses including diabetes, depression, and hypercholesterolemia, and the care plan reflected dementia, risk for cognitive decline, and behaviors such as accusing others of stealing, refusing medications, and needing frequent interactions to ensure needs were met. The resident’s psychiatric evaluation noted major depressive disorder management, psychotherapy recommendations, and a history of declining medications. On 1/19/26, the resident exhibited escalating behavioral symptoms. Progress notes documented that she was going in and out of rooms, raising her voice, threatening staff, accusing a CNA of stealing her phone, and grabbing the CNA’s scrub top, causing the CNA to fall. The Psych NP documented that the resident was agitated, yelling, verbally hostile, accused the NP of stealing her watch, and attempted to strike the NP. The NP noted the resident did not respond to de-escalation attempts and had baseline delusional thinking, including beliefs that medications were poison, with routine refusal of medications and testing. The resident was sent to the hospital for further medical evaluation. After the transfer, the facility did not document the reason for not accepting the resident back. The resident’s family member stated the facility contacted her while the resident was still in the hospital and said the facility did not want to take her back because of safety concerns, though she might be allowed to return temporarily if alternate placement could not be found. The SW stated the IDT met without the family member, discussed the resident attacking a CNA and nearly striking the Psych NP, and contacted the family about referral to other facilities. The SW also stated no 30-day notice was given and no discharge summary was done, and acknowledged that the discharge planning review, comprehensive discharge instruction form, and final discharge summary were not completed. The DON and Administrator stated the resident was not allowed back because of safety concerns and described the situation as an emergency, but the record did not include documentation of the reason for refusing readmission.
Failure to Notify State LTC Ombudsman of Resident Discharge
Penalty
Summary
The facility failed to send a copy of Resident #18’s discharge notice to the representative of the State LTC Ombudsman before the resident was discharged. Resident #18 was a female resident admitted to the facility with diagnoses including diabetes, depression, and hypercholesterolemia, and her most recent quarterly MDS reflected that she was cognitively intact for daily decision-making skills. Her care plan included discharge planning expectations and interventions related to medication management and involving family or friend support in discharge planning if discharge was optional. Record review showed Resident #18 was transferred to the hospital on 1/19/26 for behavioral symptoms such as agitation and psychosis, and the medical record contained no evidence of a discharge notice to the State Ombudsman. During interviews, the resident’s family member stated the facility did not want to take the resident back because of safety concerns and that there was no care plan meeting or discussion about discharge. The State LTC Ombudsman stated she did not receive notification regarding Resident #18’s discharge and could not locate any discharge notice for the resident, although she had located notices for other residents from the same facility. The Administrator stated she did not notify the Ombudsman because she did not consider it a 30-day discharge and said she would have notified the Ombudsman for a 30-day discharge.
Inaccurate MDS Documentation for Insulin and Antidepressant Use
Penalty
Summary
The facility failed to ensure resident assessments accurately reflected resident status for 2 residents reviewed for MDS accuracy. For one resident with diagnoses including depression, cerebral infarction, type 2 diabetes mellitus, hyperlipidemia, and hypertension, the quarterly MDS documented insulin use incorrectly. The resident’s record showed orders for Humalog sliding scale insulin and Lantus 5 units at bedtime, and the January MAR documented both insulins were administered on all 7 days in the look-back period, yet the MDS recorded only 5 days of insulin injections in Section N0350. For another resident with diagnoses including dementia, depression, anxiety, hypertension, and chronic pain, the quarterly MDS did not include antidepressant use in Section N0415 High-Risk Drug Classes: Use and Indication. The resident’s order summary showed Effexor XR 150 mg daily, and the November MAR documented the medication was administered during the 7-day look-back period. The resident’s care plan also identified antidepressant medication use and included interventions related to administration and monitoring of side effects and effectiveness. During interview, the MDS Coordinator stated she gathers information for the MDS, sends it to corporate for review and corrections if needed, and then gives it to the DON for signature before transmission. She stated the assessment should be accurate and that she was responsible for ensuring accuracy before transmission. The DON stated the MDS should be accurate to provide the best care for residents and that staff are expected to obtain the most accurate data for the MDS and care plan.
Inaccurate PASARR Screening for Mental Illness
Penalty
Summary
PASARR screening for mental disorders or intellectual disabilities was not accurately completed for one resident. Resident #39 was admitted with a primary diagnosis of spinal stenosis, lumbar region with neurogenic claudication, and the record also showed a diagnosis of bipolar disorder with an onset date of 02/05/2025. The resident’s MDS showed a BIMS score of 15 out of 15, indicating intact cognition for daily decisions. However, the PASARR Level 1 screening completed at the hospital on 02/05/2025 and the PASARR Level 1 screening completed at the nursing facility both marked section C0100, Mental Illness, as “no.” During interview, the MDS Case Manager stated they were responsible for reviewing PASARR documents when a resident is admitted and for checking the clinical record for accuracy for the PASARR assessment. The MDS Case Manager confirmed that Resident #39 was marked as having no mental illness on the PASARR despite having bipolar disorder. The MDS Case Manager also stated the importance of an accurate PASARR was that residents could receive the specialized services or counseling they require, and stated they did not have a policy for PASARR assessments.
Scissors Left in Resident Room
Penalty
Summary
The facility failed to ensure Resident #5’s room remained free of an accident hazard when a pair of blue-handle scissors was found in the room on two separate observations. Resident #5 was a [AGE]-year-old male admitted and re-admitted to the facility with diagnoses including reduced mobility, dementia, anxiety disorder, restless leg syndrome, hemiplegia, and hemiparesis affecting the right dominant side. His most recent quarterly MDS reflected moderate cognitive impairment for daily decision-making and a need for substantial to maximal assistance with ADLs, and his care plan identified an ADL self-care performance deficit related to impaired balance. During observation, the scissors were seen on top of a chest of drawers at the foot of the bed and later on top of a dresser next to the television. A CNA observed the scissors and stated they probably should not have been there because they were a potential accident hazard and could injure the resident or other wandering residents who might enter the room. The CNA also stated such items should be reported to the charge nurse or administrative staff. Resident #5 stated he did not know the scissors were in his room and denied ever seeing or using them. The DON and Administrator stated there had been an ongoing issue with the resident’s family taking scissors from the activity room and using them in the resident’s room, and that the resident would need to be assessed for safety and care planned before having access to scissors.
Unlabeled Pills Left in Medication Cart
Penalty
Summary
The facility failed to ensure drugs and biologicals used in the facility were labeled in accordance with currently accepted professional principles for 1 of 2 medication carts assessed, specifically the 300/400 hall medication aide cart. During an observation of that cart, a clear dosing cup containing loose pills was found sitting in a drawer of the medication cart. The medications in the cup were not in a properly labeled container while stored in the cart. During an interview at the time of the observation, the MA stated that dosing cups with pills should not be left in the cart and that pills in the cup should have been disposed of if they were not going to be administered immediately. The MA also stated that leaving pills in dosing cups for later administration could confuse the person giving the medications and result in the pills being given to the wrong resident. The DON later stated that pills that are not dispensed should not be left in the cart, that staff should dispose of medications that could not be administered, and that medications should not have been placed in a dosing cup if a resident was not present or had not been checked first to ensure readiness to take them. Record review of the facility policy titled Labeling of Medication Containers stated that all medications maintained in the facility shall be properly labeled in accordance with current state and federal regulations.
Hand Hygiene and Cross-Contamination During Peri Care
Penalty
Summary
The facility failed to maintain an infection prevention and control program for Resident #5, a male with reduced mobility, dementia, anxiety disorder, restless leg syndrome, and right-sided hemiplegia/hemiparesis who was moderately cognitively impaired and frequently incontinent of bladder and bowel. During incontinent/peri care, CNA E cleaned copious stool from the resident, removed the soiled brief, and then removed her gloves without washing her hands with soap and water before sanitizing and putting on a new pair of gloves. CNA E then placed a clean brief on the resident's bed while continuing peri care, later using that brief on the resident after further cleaning. The resident’s care plan directed staff to check for incontinence, wash, rinse, and dry the perineum, and provide peri care after each incontinent episode. The DON stated staff were expected to wash hands with soap and water when stool was present because of the chance of contact with stool, and stated the clean brief should have been discarded once it was placed on the bed and peri care continued because it was considered cross contamination. The facility’s hand hygiene policy stated hand hygiene is the primary means to prevent the spread of infections and that gloves do not replace hand washing/hand hygiene.
Failure to Timely Report Alleged Physical Abuse by Family Member
Penalty
Summary
The facility failed to ensure that an allegation of physical abuse involving a resident and her responsible party (RP) was reported to the State Survey Agency within the required timeframe. On 3/29/25, a certified nursing assistant (CNA) witnessed the RP slap the resident in the face during a transfer while the resident was agitated and combative. The CNA immediately reported the incident to a licensed vocational nurse (LVN), who then notified the Director of Nursing (DON) and the Administrator. Despite this, the incident was not documented in the facility's incident log for March 2025, nor was it reported to the State Survey Agency (HHSC) or law enforcement as required by regulation. The resident involved was an 81-year-old female with severe cognitive impairment (BIMS score of zero), dementia, and a history of incontinence and limited mobility, requiring maximum assistance for transfers and care. Skin assessments and vital signs following the incident showed no physical injuries or abnormalities, and the resident did not express pain or psychosocial harm during subsequent interviews. However, the resident was unable to clearly recall or respond to questions about the incident due to her cognitive status. Multiple staff interviews confirmed knowledge of the abuse allegation and awareness of mandatory reporting requirements. The social worker, LVN, DON, and Administrator all acknowledged that the incident was reportable to the State Survey Agency and potentially to law enforcement. Despite this, the facility did not report the allegation within the required two-hour window, and the internal investigation remained incomplete as of the survey date. The facility's own policy also required immediate reporting of such incidents, which was not followed in this case.
Failure to Ensure Privacy for Resident with Foley Catheter
Penalty
Summary
The facility failed to uphold the dignity and privacy of a resident by not ensuring that a privacy cover was placed over the resident's Foley catheter bag. The resident, a male with a history of pneumonia, acute respiratory failure with hypoxia, and reflux uropathy, was observed with his catheter bag exposed and visible to anyone passing by his open door. This observation was made despite the care plan and medication administration record (MAR) indicating that a privacy cover should be verified as in place every shift. Interviews with facility staff, including a CNA, an LVN, and the DON, revealed a lack of clarity and responsibility regarding the placement of privacy covers. The CNA stated that she did not have access to the covers and believed it was the nurses' responsibility, while the LVN acknowledged the importance of the covers but did not ensure they were used. The DON confirmed that all staff were responsible for ensuring privacy covers were in place, but was unsure about the training provided to staff on this matter. The facility's document on Resident's Rights emphasized the importance of privacy and dignity, which was not upheld in this instance.
Failure to Notify Family of Resident's Condition Change
Penalty
Summary
The facility failed to notify the resident's representative when a resident experienced a change in physical condition. The resident, a female with multiple diagnoses including kidney failure, dementia, and diabetes, was admitted to the facility in June 2023. On a particular day, the resident exhibited symptoms such as diarrhea, a slight fever, and increased lethargy. Despite these changes, the responsible party was not informed in a timely manner. The resident's condition was noted by LVN H, who recorded the symptoms and notified the Nurse Practitioner (NP) around noon. However, the resident's family member was not informed of the change in condition until they arrived at the facility later in the afternoon. By that time, the resident's condition had deteriorated significantly, prompting the family member to insist on transferring the resident to the hospital for further evaluation. Interviews with facility staff, including LVN H and the Director of Nursing (DON), revealed that there was a lapse in communication regarding the resident's condition. Although the staff had received training on the importance of notifying the responsible party during a change in condition, this protocol was not followed in this instance. The failure to notify the family member promptly could have delayed necessary medical interventions for the resident.
Failure to Specify Enteral Feeding Change Frequency
Penalty
Summary
The facility failed to provide adequate care and services to prevent complications for a resident receiving enteral nutrition. The resident, a male with a history of pneumonia, acute respiratory failure with hypoxia, and reflux uropathy, required tube feeding due to dysphagia. However, the enteral feeding order for this resident did not specify the frequency for changing the formula bottle or tubing, which is crucial to prevent complications such as expired formula and clogged tubing. Observations revealed that the resident's feeding pump was running at a rate of 20ml/hr with a Jevity 1.2 formula bottle that was not changed as per the facility's policy. Interviews with the LVN and the facility dietician confirmed that the orders lacked clarity on when to change the tubing and formula, which should have been done every 24 hours. The dietician noted that the original order was not clarified upon the resident's admission from the hospital, leading to the potential risk of the resident receiving expired nutritional formula. The Director of Nursing (DON) stated that tube feeding orders from the hospital are entered by the admitting nurse and reviewed for accuracy in clinical meetings. The facility policy mandates changing the tube feeding tubing every 24 hours, and staff are required to sign off on this in the MAR. The failure to adhere to these protocols could result in the resident becoming sick or contracting an infection, as the formula could expire if not changed timely.
Inaccurate Fluid Restriction Orders Lead to Deficiency
Penalty
Summary
The facility failed to maintain complete and accurate medical records for a resident, leading to confusion and inconsistency regarding the resident's fluid restriction orders. The resident, who had a history of kidney failure, dementia, edema, and other health conditions, was documented to be on a fluid restriction in the care plan and MAR. However, there were discrepancies in the fluid restriction orders, with duplicate entries and varying amounts noted, leading to uncertainty among staff about the correct fluid restriction. Interviews with various staff members, including CNAs, LVNs, the dietician, and the dietary manager, revealed a lack of awareness and understanding of the resident's fluid restriction. Some staff members were unaware of any fluid restriction, while others recalled different amounts, such as 1200cc or 1500cc, but could not confirm the exact order. The dietician and dietary manager expressed confusion over the 300cc order, which they found unusual and did not align with standard practices. The resident's physician and NP were also unaware of the fluid restriction, and the physician noted that the 300cc order was likely incorrect. The deficiency was further compounded by the lack of communication and coordination between nursing and dietary staff. The dietary manager relied on communication forms from nursing to update diet orders, but inconsistencies in these forms led to incorrect fluid amounts being provided to the resident. The DON acknowledged the oversight and noted that the fluid restriction order should have been discontinued long ago. The facility lacked a policy for fluid restrictions, contributing to the ongoing confusion and failure to provide accurate care for the resident.
Infection Control Lapses in Resident Care
Penalty
Summary
The facility failed to maintain an effective infection prevention and control program, as evidenced by two specific incidents involving residents. In the first incident, a Certified Nursing Assistant (CNA) did not follow proper infection control practices while providing perineal care to a resident. The CNA wiped from back to front, which is against the recommended front-to-back direction, potentially contaminating a surgical wound dressing on the resident's scrotum. Additionally, the CNA did not change gloves or wash hands after cleaning the buttocks area before placing a clean brief and repositioning the resident. This resident had a history of surgical aftercare and was dependent on staff for toileting hygiene, with a care plan focused on preventing infections due to incontinence and catheter use. In the second incident, a Licensed Vocational Nurse (LVN) failed to adhere to Enhanced Barrier Precautions (EBP) while administering medication via a gastrostomy tube to another resident. The LVN did not wear a gown, although gloves were used, despite the presence of an EBP sign and PPE supplies readily available. This resident had severe cognitive impairment and required enteral feeding due to dysphagia and cerebrovascular insufficiency. The care plan for this resident included the use of proper PPE during high-contact care activities to prevent the transfer of multidrug-resistant organisms (MDROs). Both staff members involved in these incidents had received training and passed competency reviews in their respective areas of infection control. However, their failure to adhere to established protocols during these specific instances could lead to cross-contamination and the spread of infections among residents. The Director of Nursing (DON) confirmed the expected procedures and expressed surprise at the lapses, given the staff's training and previous performance.
Medication Storage and Labeling Deficiencies
Penalty
Summary
The facility failed to ensure that all drugs and biologicals were labeled and stored according to professional standards in the medication room. During an observation, an over-the-counter medication, Feosol, was found with an expiration date of 06/2024, indicating it was not removed from the medication room after its expiration. This oversight was acknowledged by the Director of Nursing (DON), who stated that expired medications should be removed from stock to prevent the risk of being ineffective. Additionally, medications belonging to two discharged residents were found in the medication room, not properly disposed of as per facility policy. The medications included Diclofenac Topical 1% cream, Probiotic Culturelle, Lidocaine 4% ointment, Simvastatin, and Midodrin. The DON confirmed that medications for discharged residents should be stored in a locked disposal box for proper disposal by the pharmacist. The medication aide responsible for maintaining the medication room admitted to missing the expired Feosol and was unsure how the discharged residents' medications ended up in the medication room, suggesting that other staff might have placed them there without her knowledge.
Failure to Provide Written Discharge Notification
Penalty
Summary
The facility failed to provide timely written notification to a resident's representative and the State Long-Term Care Ombudsman before discharging the resident. The resident, an elderly male with moderate cognitive impairment, unspecified dementia, major depressive disorder, and unspecified pulmonary fibrosis, was discharged without the required written notice. The facility's records indicated that the resident was expected to remain in the facility on a long-term basis, as discussed with the resident and family. Family members, who were the resident's representatives, reported that they were informed verbally by the facility's social worker and Administrator about the discharge due to the resident's wandering behaviors. They felt compelled to agree to the discharge without receiving any written notice. The facility's social worker and Administrator confirmed that no written notice was provided, with the Administrator stating that she did not believe it was necessary since the family had agreed to the discharge. The facility lacked a policy requiring written notification for discharge decisions.
Failure to Update Care Plans for Residents
Penalty
Summary
The facility failed to ensure that the comprehensive care plans for two residents were updated to reflect their current needs and conditions. For the first resident, the care plan was not revised to include the use of bedrails, a CPAP machine, or the diagnosis of obstructive sleep apnea (OSA). Despite the resident's intact cognition and the presence of a CPAP machine in the room, the care plan did not reflect these critical elements. Interviews with the resident and staff revealed that the resident used the CPAP every night and had signed a consent for bedrails, yet these were not documented in the care plan. The second resident's care plan was not updated to reflect the discontinuation of hospice services and diuretic medications. The resident had revoked hospice services to seek aggressive treatment and was not receiving diuretics upon readmission to the facility. However, the care plan still included hospice services and diuretic therapy, which were no longer applicable. Interviews with staff indicated that the care plan should have been updated following the resident's change in condition and medication orders. The Director of Nursing (DON) and other staff acknowledged the discrepancies in the care plans and the importance of maintaining accurate documentation for continuity of care. The facility's policy required care plans to be revised as changes in the resident's condition dictated, yet this was not adhered to in these cases. The failure to update the care plans could potentially place residents at risk of their current needs not being met.
Failure to Obtain Necessary Device Orders for Resident
Penalty
Summary
The facility failed to ensure that a resident received treatment and care in accordance with professional standards of practice, the comprehensive care plan, and the resident's choices. Specifically, the facility did not obtain necessary device orders for a resident on two occasions, which could lead to improper care due to inaccurate records. The resident, who was admitted with multiple diagnoses including obstructive sleep apnea (OSA), did not have orders for the use of bedrails or a CPAP machine, despite using both devices. The resident had signed a consent for the use of bedrails to assist with mobility, and the use of these rails was observed. However, there was no corresponding physician order for the bedrails, which is necessary to ensure they are used appropriately as an assistive device rather than a restraint. Additionally, the resident brought a CPAP machine from home and used it nightly, but the facility did not have an order for its use. The lack of orders meant that staff were not assisting the resident with the CPAP, and there was no verification of the device's settings or appropriateness for the resident's condition. Interviews with facility staff revealed a lack of clarity and responsibility regarding obtaining and verifying orders for the resident's devices. The admitting nurse was responsible for ensuring the resident had the proper equipment orders, but this was not completed. The Director of Nursing (DON) and other staff members acknowledged the oversight but did not take steps to rectify the situation. The absence of orders for the bedrails and CPAP could potentially lead to negative outcomes for the resident, as the devices were used without proper authorization or verification of their necessity and safety.
Failure to Provide Appropriate CPAP Treatment
Penalty
Summary
The facility failed to provide appropriate respiratory care for two residents who required CPAP treatment. Resident #1, diagnosed with Obstructive Sleep Apnea (OSA), was not assessed for the use of a CPAP upon admission, and no orders were obtained for its use. Despite having a CPAP device brought from home, it was not included in the resident's care plan, and the nursing staff refused to assist with its application due to the lack of a physician's order. Interviews with the resident and staff revealed that the CPAP was used nightly by the resident, but the Director of Nursing (DON) was unaware of its presence in the resident's room. Resident #2, who had a diagnosis of Pulmonary Fibrosis and other chronic conditions, had an order for CPAP treatment at bedtime or while sleeping. However, the CPAP was not included in the resident's care plan, and the device was reportedly missing pieces, preventing its use. The DON confirmed that the CPAP was put away due to missing parts and that the resident had never used it, despite having an order for its application. The facility's policy on physician orders for treatments and devices did not address the need for such orders, contributing to the oversight. These deficiencies in respiratory care for both residents highlight a failure to adhere to professional standards of practice and the residents' comprehensive person-centered care plans. The lack of proper assessment, documentation, and adherence to physician orders for CPAP treatment placed the residents at risk of not receiving the full therapeutic benefits of their prescribed respiratory care.
Failure to Obtain Medication Orders for Diuretics
Penalty
Summary
The facility failed to provide pharmacological services to meet the needs of a resident, identified as Resident #4, by not obtaining medication orders for diuretics, specifically Lasix or Bumex, which were necessary for the resident's condition. Resident #4 had been admitted with several diagnoses, including Congestive Heart Failure, and was supposed to receive diuretics as per the hospital discharge reconciliation report. However, the facility's records showed that the resident was not receiving any diuretics. During an interview, the resident confirmed that she had provided the facility with a copy of her hospital medication list, which included Lasix, but she did not receive it at the facility. The deficiency was further highlighted during interviews with facility staff. An LVN acknowledged seeing the diuretic on the hospital medication list but stated that the FNP did not check it off to be added to the resident's orders. The LVN admitted to not reviewing the FNP's progress note, which mentioned continuing Bumex. The DON was unaware of why the FNP included Bumex in her note if it was not on the medication reconciliation. The Administrator emphasized the importance of having accurate orders for medications and treatments, stating that the nurse management team was responsible for ensuring this accuracy. The facility's policy on physician medication orders did not address orders for treatments or devices, which may have contributed to the oversight.
Failure to Maintain Accurate Medical Records
Penalty
Summary
The facility failed to maintain complete and accurate medical records for a resident, specifically regarding the documentation of incontinent care. The resident, who had diagnoses including dementia, stroke, and major depressive disorder, was found to have multiple days in March 2024 where incontinent care was not documented by CNA A. This lack of documentation was observed across various shifts, leading to concerns that the resident's care was not properly recorded, which could result in assumptions that the resident did not receive necessary care and potentially develop skin issues and infections. Interviews with the resident and staff revealed that the resident was generally clean and groomed, and there were no immediate signs of neglect such as skin tears or bruises. However, the resident did report delays in staff responding to call lights for incontinent care. CNA B admitted to providing care but failing to document it due to not having a POC log-in and was subsequently terminated for unrelated attendance issues. LVN A and the Corporate RN acknowledged the missing documentation and emphasized the importance of accurate record-keeping to avoid false allegations of neglect. The Medical Director and other CNAs confirmed that the resident sometimes refused care or soiled briefs intentionally, but there was no evidence that the resident was left in a soiled state. Despite this, the lack of documentation persisted, highlighting a systemic issue in ensuring that all care activities were properly recorded. The facility had conducted in-service training on POC documentation, but the deficiency in maintaining accurate records remained evident.
What surveyors are citing around you — mapped
All 10 risk areas, ranked with evidence
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 1,052 citations issued within 25 miles in the last 12 months — including the 21 immediate-jeopardy cases — 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
Every risk area becomes concrete audit steps drawn from real citations at facilities like yours — run them this week, before your window opens.
Illustrative
Risk indicators are statistical estimates from public CMS data — not predictions, findings, or compliance advice.
Nursing homes near Selma
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Advanced Rehabilitation & Healthcare Of Live Oak | 2.6 mi | ★★★★★ | 3 | 0 |
| Avir At Schertz | 2.9 mi | ★★★★★ | 41 | 2 |
| Avir At Converse | 4 mi | ★★★★★ | 13 | 0 |
| Silver Tree Nursing And Rehabilitation Center | 4.4 mi | ★★★★★ | 25 | 1 |
| San Antonio Wellness & Rehabilitation | 4.6 mi | ★★★★★ | 4 | 0 |
Every risk area ranked, a do-first checklist, and your local survey patterns
Built specifically for Trucare Living Centers - Selma.
100% money-back within 48 hours.
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.