Above average — CMS composite of the measures below.
The next survey window likely opens 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 Truman W Smith Children's Care Center during CMS and state inspections, most recent first.
Two residents with gastrostomy tubes did not receive enteral nutrition as ordered when nursing staff relied on inaccurate pre‑printed feeding bag labels instead of verifying physician orders and the MAR. One resident with chronic respiratory failure and developmental disabilities was ordered Pediasure Peptide at 150 ml/hr for a total of 240 ml twice daily, but the pump was repeatedly set to 240 ml/hr with a higher total volume based on the label. Another resident with spastic quadriplegic cerebral palsy, protein‑calorie malnutrition, and ventilator dependence was ordered Compleat Pediatric Reduced Calorie at 68 ml/hr for 18 hours, but the pump and label reflected 68 ml/hr for 17 hours and an incorrect total volume, and the calculated total volume on the order itself was also wrong. Multiple nurses and leadership acknowledged that the pump settings and volumes did not match the MD orders and that staff were responsible for ensuring enteral feedings followed the prescribed rate, duration, and volume as required by facility policy.
A respiratory therapist failed to communicate with a nonverbal, fully dependent resident while providing urgent tracheal suctioning, despite the resident's care plan requiring staff to converse and provide reassurance during care. The incident occurred during an emergency response to an oxygen desaturation event, and interviews confirmed that staff are expected to maintain communication with residents to support dignity, even when residents cannot respond.
A resident with a gastrostomy tube was observed receiving tube feeding while lying flat, despite medical orders and care plan requirements for head-of-bed elevation. Nursing staff had documented compliance, but no wedges or elevation were in place, and clinical staff were unaware of the omission until it was identified. This failure to maintain proper positioning did not align with facility policy or CDC guidelines for aspiration prevention.
Surveyors found that air filters in the laundry room were dirty with a thick dark gray substance, despite staff statements that filters were changed weekly. There was confusion among staff and management about the process and responsibility for changing the filters, resulting in a failure to maintain a clean and sanitary environment as required by facility policy.
A facility failed to maintain effective infection control, as a CNA did not change gloves or sanitize hands during incontinent care, and an RN neglected hand hygiene during medication administration for multiple residents. These lapses occurred despite the facility's policies emphasizing the importance of proper glove use and handwashing to prevent infections.
The facility failed to store and handle food according to professional standards, with expired items found in the kitchen and personal items improperly stored. Staff interviews revealed lapses in following procedures for checking expired foods, posing a risk of foodborne illness to residents.
A facility failed to maintain a sanitary and homelike environment for a resident by not removing a green sputum-filled suction canister that was over three-quarters full. The canister, belonging to a previous resident, remained in the room for several days despite staff acknowledging it should have been removed. This oversight was contrary to the facility's policy and raised concerns about bacteria growth and the unpleasant appearance of the canister.
Failure to Follow Enteral Feeding Orders for Two Tube-Fed Residents
Penalty
Summary
The deficiency involves the facility’s failure to follow physician orders for enteral nutrition for two residents with gastrostomy tubes, resulting in incorrect feeding rates, durations, and total volumes. For the first resident, an adult male with chronic respiratory failure, a gastrostomy tube, developmental disorder of speech and language, and congenital hydrocephalus, the physician’s order specified Pediasure Peptide at 150 ml/hr for a total volume of 240 ml twice daily. The Enteral TAR reflected these same orders. However, a nurse reported that she relied on a pre‑printed label on the feeding bag, which indicated a rate of 240 ml/hr with a total volume of 360 ml, and she set the pump accordingly. On the day of observation, the pump was found set at 240 ml/hr with 240 ml already administered, and the nurse stated she had used the same settings the previous day and that the school staff did not change pump settings. The nurse caring for the first resident acknowledged that she did not verify the pump settings against the physician’s orders and instead followed the pre‑printed label, which did not come from the pharmacy. She stated that she had administered the resident’s enteral feedings at 240 ml/hr with a total volume of 360 ml at both scheduled times on the prior day and that the school would have administered the morning feeding at the same incorrect rate and volume because she had pre‑set the pump. Another nurse stated that she checked the MAR against pre‑printed labels because the MAR was always accurate and the labels were not, and she confirmed that administering a feeding at 240 ml/hr instead of the ordered 150 ml/hr could cause abdominal discomfort and vomiting. Facility leadership, including the ADON and DON, confirmed that the resident’s feeding rate had been set too high and that staff should have followed the enteral orders rather than the pre‑printed label. For the second resident, an adult female with spastic quadriplegic cerebral palsy, gastrostomy, protein‑calorie malnutrition, feeding difficulties, ventilator dependence, dysphagia, and no speech, the physician’s order specified Compleat Pediatric Reduced Calorie at 68 ml/hr by gastrostomy tube for 18 hours with a total volume of 1174 ml. The Enteral TAR documented administration at 68 ml/hr for 18 hours with a total volume of 1174 ml daily. During observation, the resident’s feeding pump was infusing at 68 ml/hr for 17 hours, and the pre‑printed label on the feeding bag read 68 ml/hr for 17 hours with a total volume of 1156 ml. A nurse stated that this resident was not assigned to her that day and, after checking, reported that the order was for 68 ml/hr for 18 hours and that the total volume on the order itself had also been calculated incorrectly and should have been 1224 ml. She explained that with the pump set for 17 hours instead of 18, the resident would not receive the full ordered amount of feeding. The nurse who set up the second resident’s feeding stated that night shift prepared feeding bags with pre‑printed labels and that she set the pump according to the label. She acknowledged that feeding orders sometimes changed and that staff were supposed to look at the MAR and Kardex and receive updates in report when changes occurred. She stated that the nurse was responsible for ensuring that what was administered matched the physician’s orders and that if the resident did not receive the prescribed amount of feeding, she could lose weight. The ADON for the resident’s unit reported that the resident had returned from a doctor’s visit with a new order to increase feedings to 18 hours and that the nurse who received the order did not enter the total volume correctly. The DON confirmed that the label for this resident had not been updated when the new order was entered and that, if the total volume and duration were incorrect, the resident would not receive the correct amount of feeding. The facility’s Enteral Nutrition policy required that nurses confirm that enteral nutrition orders were complete, including volume and rate of administration, and that staff caring for residents with feeding tubes be trained to recognize and report complications such as nausea, vomiting, diarrhea, abdominal cramping, inadequate nutrition, and aspiration.
Failure to Communicate with Nonverbal Resident During Care
Penalty
Summary
A deficiency was identified when a respiratory therapist (RT) failed to treat a resident with respect and dignity by not communicating with him while providing care. The resident involved was a male with multiple complex medical conditions, including obstructive hydrocephalus, neuromuscular scoliosis, chronic respiratory failure with hypoxia, anoxic brain injury, spastic quadriplegic cerebral palsy, and obstructive sleep apnea. He was nonverbal, rarely understood by others, had severely impaired memory and decision-making skills, and was totally dependent on staff for activities of daily living. His care plan specifically required staff to converse with him during care and to provide means of communication and reassurance to decrease anxiety. During an observed incident, the resident's oxygen and heart rate monitor began alarming while a respiratory therapist was present in the room with his roommate. Another RT (RT C) was called in to assist. RT C entered the room, quickly donned personal protective equipment, and proceeded to lift the resident, adjust his position, and perform tracheal suctioning without speaking to or explaining the care to the resident at any point. After completing the procedure and replacing the pulse oximeter, RT C left the room, still having not communicated with the resident during the entire episode. Interviews with RT C, the DON, and the Administrator confirmed that staff are expected to knock, introduce themselves, and explain care to residents, even in emergency situations. RT C acknowledged that she did not think about talking to the resident during the urgent situation. The DON and Administrator both stated that staff are regularly in-serviced on the importance of maintaining resident dignity through communication, but also noted that it can be challenging when residents are unable to respond. The facility's policy required residents to be treated in a manner that supports their dignity, but did not specifically address communication during care.
Failure to Elevate Head of Bed During Enteral Feeding
Penalty
Summary
A deficiency was identified when a resident with a gastrostomy tube was observed lying flat on a mattress on the floor while receiving tube feeding, without any wedges or elevation to the head of the bed. The resident had medical orders requiring the head of the bed to be elevated to 30 degrees every shift, and the care plan specified elevation to 45 degrees during and for thirty minutes after tube feeding. Despite these documented requirements, the resident was found receiving tube feeding at 100 milliliters per hour from a kangaroo pump while lying flat, with no evidence of head-of-bed elevation. Record reviews showed that nursing staff had been signing off on the medication administration record (MAR) indicating the head of the bed was elevated as ordered, including on the day of the observation. Interviews with nursing staff and the DON confirmed that the standard practice was to elevate the head of the bed for residents receiving tube feedings, and that wedges should be used for residents whose mattresses are on the floor. However, the staff were unaware that the resident did not have wedges in place at the time of the observation, and the DON was not aware of the omission until it was brought to her attention. The facility's enteral nutrition policy referenced the need for head-of-bed elevation to reduce aspiration risk, and CDC guidelines recommend elevating the head of the bed to 30-45 degrees for patients at high risk for aspiration, such as those with enteral tubes. Despite these standards and the resident's care plan, the required positioning was not maintained, resulting in a failure to provide appropriate care and services to prevent complications associated with enteral feeding.
Failure to Maintain Clean Air Filters in Laundry Room
Penalty
Summary
The facility failed to maintain a safe, functional, sanitary, and comfortable environment in the laundry room, as evidenced by dirty air filters on both the clean and dirty sides of the room. Observations revealed that the air filters had a thick dark gray substance on them. Interviews with laundry aides and the maintenance man indicated that air filters were supposed to be changed weekly, but the filters were visibly dirty at the time of inspection. The maintenance man stated he was responsible for changing the filters and would do so more frequently if notified by staff that the filters were clogged. However, there was inconsistency among staff and management regarding the process and frequency of changing the air filters, with some staff unsure of who was responsible or how often the task was performed. The Director of Nursing (DON) and the Administrator both acknowledged that the air filters appeared to need changing and were not aware of the specific process or schedule for filter replacement in the laundry room. The facility's Homelike Environment Policy required a clean, sanitary, and orderly environment, but the presence of dirty air filters with accumulated lint and dust indicated non-compliance with this policy. No specific residents were identified as being directly affected at the time of the deficiency.
Infection Control Lapses in Hand Hygiene and Glove Use
Penalty
Summary
The facility failed to maintain an effective infection prevention and control program, as evidenced by improper hand hygiene and glove use during resident care. Specifically, a CNA did not change gloves or sanitize hands after performing incontinent care on a resident, leading to potential cross-contamination. The CNA admitted to forgetting to change gloves due to nervousness, and this oversight was not noticed by the assisting CNA. The staff coordinator confirmed that the CNAs were trained to change gloves and sanitize hands between dirty and clean procedures, but this protocol was not followed during the observed care. Additionally, an RN failed to perform hand hygiene before and after administering medications to three different residents. The RN acknowledged that hand hygiene is typically a habit but admitted to forgetting due to nervousness. This lapse in protocol was observed during medication preparation and administration, including G-Tube feeding and eye drop administration. Other nursing staff and the DON confirmed that hand hygiene is a critical infection control measure and should be performed before and after medication administration to prevent cross-contamination. The residents involved in these observations had complex medical conditions, including cerebral palsy, chronic respiratory failure, and dependence on G-Tube feeding. These conditions make them particularly vulnerable to infections, highlighting the importance of strict adherence to infection control protocols. The facility's policies on perineal care and hand hygiene emphasize the need for proper glove use and handwashing to prevent the spread of infections, but these were not adhered to during the observed incidents.
Food Safety and Storage Deficiencies in Kitchen
Penalty
Summary
The facility failed to adhere to professional standards for food service safety, as evidenced by improper storage and handling of food items in the kitchen. During an observation, a 32-ounce bag of frozen hashbrowns was found opened and improperly wrapped in a plastic shopping bag without a label or date, indicating a lapse in food safety protocols. Additionally, a gallon container of distilled white vinegar was found in the dry pantry with an expiration date that had passed, further highlighting the facility's failure to monitor and manage food expiration dates effectively. Interviews with staff revealed a lack of adherence to the facility's established procedures for checking expired foods. The Dietary Aide admitted to missing the expired vinegar due to being busy, and the Dietary Manager (DM) acknowledged her responsibility to ensure that staff performed their duties, including checking for expired foods. The Administrator confirmed that all foods should be used or disposed of by their use-by dates to prevent foodborne illnesses. The facility's policies clearly stated that expired foods must be removed and personal items should not be stored in food preparation areas, yet these guidelines were not followed, posing a risk of foodborne illness to residents.
Failure to Maintain Sanitary Environment Due to Unremoved Suction Canister
Penalty
Summary
The facility failed to provide a safe, functional, sanitary, and comfortable environment for Resident #48, as evidenced by the presence of a green sputum-filled suction canister that was over three-quarters full and had not been removed in a timely manner. The canister, which belonged to a previous resident who had been discharged to the hospital, remained in the room for several days, despite the facility's policy requiring such canisters to be changed out when they are three-quarters full or at least once a month. This oversight was observed over multiple days, with the canister still present in the room of Resident #48, who was on droplet precautions due to mycoplasma pneumonia. Interviews with various staff members, including LVNs, RNs, and the respiratory therapist, revealed a lack of clarity and responsibility regarding the removal of the suction canister. Staff members acknowledged that the canister should have been removed when the previous resident was admitted to the hospital, and they expressed concerns about the potential for bacteria growth and the unpleasant appearance of the canister. Despite these acknowledgments, the canister remained in the room, indicating a failure in the facility's procedures for maintaining a homelike environment. The Director of Nursing and the Administrator also recognized the issue, noting that the presence of the canister was not conducive to a homelike environment and could be distressing for residents and their visitors. The facility's policy on maintaining a homelike environment and the procedure for changing out supplies were not adhered to, leading to this deficiency. The failure to remove the canister not only compromised the sanitary conditions of the room but also potentially exposed Resident #48 to health risks associated with the presence of the sputum-filled canister.
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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 Gladewater
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Legend Oaks Healthcare And Rehabilitation Center - | 1 mi | ★★★★★ | 14 | 0 |
| Pine Tree Lodge Nursing Center | 9.1 mi | ★★★★★ | 19 | 2 |
| Buckner Westminster Place | 12.5 mi | ★★★★★ | 0 | 0 |
| Heritage At Longview Healthcare Center | 12.9 mi | ★★★★★ | 1 | 0 |
| The Oaks At Longview | 12.9 mi | ★★★★★ | 8 | 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.