Average — CMS composite of the measures below.
A standard survey is most likely before around September 2026
Estimate from public CMS data, current as of August 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Val Verde Nursing And Rehabilitation Center during CMS and state inspections, most recent first.
A cognitively intact female resident with multiple neurologic and psychiatric diagnoses reported to the ADMIN and DON, in the presence of her family member, that a male resident had been sexually inappropriate with her on several occasions, including touching her breasts and genital area and kissing her. The facility documented the allegation, interviewed both residents and nearby residents, and noted conflicting accounts, with the female resident later telling staff and therapists that the encounters were consensual and that she had lied to her family member. Despite its own policy requiring that all alleged abuse be reported to the state agency and other authorities within 2 hours, the ADMIN, acting as abuse coordinator, decided not to submit a self-report to the State Agency because the internal investigation concluded the allegation was not true, resulting in a failure to immediately report an alleged abuse incident as required.
Surveyors found that required daily nurse staffing and census information was not updated for several consecutive days, with an outdated staffing sheet remaining posted in the lobby/dining area. The DON reported she had previously handled the postings but believed the ADON had assumed responsibility, while the ADON stated she was unfamiliar with the full process and thought the DON was still posting the form, particularly on weekends. The ADMIN explained that the DON prepared postings and weekend supervisors were supposed to move pre-prepared sheets, and later the ADON discovered that more recent staffing sheets had been placed behind the outdated one instead of being flipped to the front. No written facility policy on daily staffing posting could be located, and leadership stated that procedures were to follow state and federal requirements.
Two residents with cognitive impairment and mobility issues experienced unwitnessed falls resulting in injuries, but the DON and administrator did not report these incidents as required by ANE protocols and state law. Despite staff training and facility policies mandating immediate reporting of injuries of unknown source, the incidents were not documented or reported to the state agency within the required timeframe.
Two residents with cognitive impairment and significant medical conditions experienced unwitnessed falls resulting in injuries. The facility did not complete or document thorough investigations or submit required incident reports to the state agency, despite policies mandating immediate reporting and investigation of such events. Staff interviews confirmed that documentation and reporting procedures were not consistently followed.
Five loose medication pills were found inside a medication cart drawer, confirmed by an LVN who suggested they may have dropped during a medication pass. The DON stated that medication carts should not contain loose medications and that the responsible nurse is accountable for the cart's contents. Facility policy requires prescription medications to be properly labeled, but the loose pills did not meet these standards.
The facility employed a Food Service Director who did not have the required certification, education, or experience in dietary management, as confirmed by interviews and record review. The director had no prior dietary management experience and was not certified at the time of the survey, only recently enrolling in a certification course. Facility leadership acknowledged the lack of required qualifications, and review of job descriptions and federal regulations confirmed the deficiency.
Surveyors found that the facility did not maintain proper kitchen sanitation, with a dirty ceiling vent, an open attic trap door near food storage freezers, and peeling paint above the dish machine conveyor belt. Staff interviews confirmed these issues had been identified but not fully addressed, in violation of facility policy and federal food code.
A medication aide left a computer screen displaying a resident's medication list unlocked and unattended for several minutes, resulting in a failure to maintain privacy and confidentiality of medical records. The resident had multiple chronic conditions and moderate cognitive impairment. The aide was unaware of the requirement to lock the computer screen, contrary to facility policy.
A resident with dementia, cognitive communication deficit, and COPD, who had a terminal prognosis and was on hospice, was inaccurately coded on the MDS assessment as not receiving hospice services. The MDS Coordinator confirmed this was an oversight, despite documentation in the care plan and clinical record showing active hospice enrollment.
A resident's clinical record and face sheet did not include all current diagnoses, specifically omitting Hypertension and Hypothyroidism, even though there were active medication orders for these conditions. The DON confirmed that the face sheet, used by outside providers, should accurately reflect the resident's health status, but it was incomplete at the time of review.
A review found that 23 resident rooms did not meet the required 80 square feet per resident, with measurements showing only 72 to 77.5 square feet per resident in rooms with two beds. The facility had a previous waiver for room size, which had expired, and no changes had been made to the affected rooms since then. The Administrator planned to request a continuation of the waiver, and the Life Safety Code Manager had no concerns based on a recent survey.
The facility failed to update care plans for two residents, one with new pressure injuries and another with significant weight loss, leading to deficiencies in wound care and weight management. The care plans were not revised to include necessary interventions, despite clear policies requiring updates for significant changes in condition.
A resident with significant weight loss and a stage 4 pressure ulcer did not receive the ordered fortified foods at all meals. Despite dietary orders being input into the system, meal tickets did not reflect the need for fortified foods, and there was no verification process to ensure accuracy.
The facility failed to ensure a medication cart was locked and attended, leaving it unsecured in a common area with medications and scissors accessible. The responsible LVN admitted to forgetting to lock the cart during an emergency, despite being trained to do so. The DON confirmed the policy requiring carts to be locked when not in use.
Failure to Immediately Report Resident-on-Resident Sexual Abuse Allegation to State Agency
Penalty
Summary
The deficiency involves the facility’s failure to immediately report an allegation of abuse to the State Agency (HHSC) as required by regulation and facility policy. A cognitively intact female resident with spastic hemiplegic cerebral palsy, generalized anxiety disorder, and spina bifida with hydrocephalus reported to facility staff, in the presence of her family member, that a male resident had been sexually inappropriate with her on multiple occasions. The family member brought the resident to the Administrator (who is the abuse coordinator) and the DON, and the resident described that the male resident had touched her breasts and genital area over clothing, kissed her, and engaged in repeated intimate contact over several days. The resident also stated there were times she did not verbally consent and times she told him no. This information was documented on a grievance form and in a typed interview on the same day. The Administrator and DON interviewed both residents and initiated an internal investigation. The female resident’s account included that she had invited the male resident into her room, discussed sexual content on television, and allowed or encouraged intimate touching, while also reporting that he had made a move on her that she did not like and that she cried and did not ask for it. The male resident denied any sexual contact, stating he only waved to her, had given her a necklace and some food, and did not enter her room for sexual purposes. The facility also interviewed nearby residents, who denied witnessing inappropriate behavior, and placed the male resident on a behavior monitoring log. Despite the conflicting accounts and the initial allegation of sexual abuse, the Administrator later stated that the facility did not submit a self-report to HHSC because their investigation concluded that what the female resident was claiming was not true. Throughout this period, the resident’s cognitive status was documented as intact, with BIMS scores of 13–15 and orientation in all spheres, and she was considered capable of making her own decisions. She had a documented history of behavioral issues, including crying out, yelling at family and staff, and seeking attention from multiple male figures, as well as a care plan problem related to ineffective coping and sexualized or attention-seeking behaviors. Therapy and counseling notes showed that she later told her therapist and the occupational therapist that the relationship with the male resident was consensual, that she liked the contact, and that she had lied to her family member because she did not want them to know. However, the facility’s own abuse policy defined an “alleged violation” as any reported situation that could indicate abuse and required reporting all alleged violations to the Administrator, state agency, APS, and other required agencies immediately but not later than 2 hours when abuse was involved. The Administrator, as abuse coordinator, acknowledged that no state report was made, and the DON was unsure if a state report had been completed, establishing that the facility failed to ensure the allegation was reported to HHSC within the required 2-hour timeframe. The deficiency is further supported by the facility’s written policies on Abuse, Neglect and Exploitation and on Incidents and Accidents, which require that alleged abuse be treated as an incident requiring an incident report and prompt external reporting. The Administrator stated that the alleged incident was initially treated as abuse but that, during the two hours they had to report, the resident changed her story and said she had lied, and on that basis the facility chose not to submit a report to the state. Despite this, the policy did not condition reporting on the outcome of the internal investigation or the perceived credibility of the allegation. Surveyor interviews and record review confirmed that no immediate report to HHSC was made for this allegation involving possible sexual abuse between residents, resulting in noncompliance with the requirement to report all alleged violations of abuse immediately, but not later than 2 hours, to the State Agency.
Failure to Maintain Current Daily Nurse Staffing and Census Posting
Penalty
Summary
The deficiency involves the facility’s failure to post required daily nurse staffing and census information for four consecutive days. On observation on 02/03/2026 at 10:14 a.m. and 4:15 p.m., the only staffing document posted in the front lobby/front dining space was dated 01/30/2026, even though the review period covered 01/31/2026 through 02/03/2026. This document, labeled as the facility’s direct care daily staffing 8-hour form, contained the census and the number and hours worked by RNs, LVNs, medication aides, and CNAs for all three shifts, but it was not current for the days under review. The report states that from 01/31/2026 to 02/03/2026, the facility failed to post the required current nurse staffing and census information, which surveyors identified as a failure to comply with posting requirements. In interviews, the DON stated she had previously been responsible for posting the daily census and nurse staffing information but that the ADON had taken over that responsibility in February 2026. The DON indicated the posting was expected to be in the dining room and noted that staff also had a sign-in sheet and a staff schedule in the employee breakroom, and she did not believe the lack of current posting impacted residents or guests because they could ask staff directly. The ADON reported she was not very familiar with the daily posting process, believed the DON was still posting the form, and was unsure about weekend procedures or whether a facility policy existed. The Administrator stated the DON was responsible for preparing postings and that weekend nurse supervisors were to move pre-prepared sheets, and acknowledged that lack of daily posting could affect residents and guests who wanted to know who was working. Later on 02/03/2026, the ADON reported she had just created and posted the current day’s information and found prior days’ postings behind the 01/30/2026 sheet, indicating staff had not flipped the sheets. The Administrator was unable to locate a facility policy on daily census and staffing posting and stated the facility’s procedure was to follow state and federal regulations.
Failure to Timely Report Injuries of Unknown Source Following Unwitnessed Falls
Penalty
Summary
The facility failed to ensure that all alleged violations involving abuse, neglect, exploitation, or mistreatment, including injuries of unknown source and misappropriation of resident property, were reported within the required timeframes to the administrator and appropriate authorities. Specifically, the Director of Nursing (DON) did not identify unwitnessed falls resulting in injuries for two residents as alleged violations of injury of unknown source. As a result, these incidents were not reported to the administrator or to the State Survey Agency within 24 hours as required by state law and facility policy. One resident, who had diagnoses including acute respiratory failure, dementia, muscle wasting, and sepsis, experienced an unwitnessed fall resulting in a laceration to the right eyebrow with swelling and bleeding, requiring transfer to the hospital. The resident had moderately impaired cognition and required substantial assistance with mobility. Despite the severity of the injury and the resident's inability to explain what happened, there was no incident report documented in the electronic medical record, nor was a report submitted to the state agency. Similarly, another resident with severe cognitive impairment and a history of repeated falls was found on the floor with a hematoma and laceration after an unwitnessed fall. This incident was also not reported to the state agency as required. Interviews with staff revealed that while they were knowledgeable about abuse, neglect, and exploitation (ANE) reporting protocols and had received recent training, the DON and administrator did not follow established procedures for reporting unwitnessed falls with injuries of unknown source. The DON stated that she did not submit ANE reports for these incidents because she believed the residents could explain their falls, despite one resident having severe cognitive impairment. The administrator also indicated uncertainty about whether the incidents met the threshold for reporting, and there was a lack of documentation and timely notification to authorities as required by facility policy and state regulations.
Failure to Investigate and Document Alleged Abuse or Neglect Following Unwitnessed Falls
Penalty
Summary
The facility failed to provide evidence that all allegations of abuse, neglect, or mistreatment were thoroughly investigated and documented for two residents who experienced unwitnessed falls with injuries. For one resident, who had diagnoses including acute respiratory failure, dementia, muscle wasting, and sepsis, there was no documented incident report or evidence of a thorough investigation following an unwitnessed fall that resulted in a laceration and swelling to the right eyebrow. The resident was found on the floor by staff, was confused, and unable to explain what happened. Despite the injury and the resident's cognitive impairment, there was no incident report submitted to the state agency, and no documentation of a post-fall interview or investigation was found in the medical record. Another resident, with diagnoses including heart failure, repeated falls, and severe cognitive impairment, also experienced an unwitnessed fall resulting in a hematoma and laceration to the face. The nursing staff documented the immediate care provided and notified the DON and physician, but again, there was no evidence of a facility incident report or state notification for this injury of unknown origin. The DON and ADM both stated that their protocol requires reporting and investigation of all unwitnessed falls with injury, but could not provide documentation or recall why these incidents were not reported as required. The DON also indicated that she does not keep documentation of post-fall interviews or chart them in the electronic medical record. Facility policies reviewed require immediate investigation and documentation of all alleged violations, including injuries of unknown source, and mandate reporting to the state agency within specified timeframes. Despite these policies, the facility did not follow its own procedures for reporting, investigating, and documenting the incidents involving the two residents. Staff interviews confirmed that required steps, such as completing incident reports and submitting state notifications, were not consistently performed, and there was a lack of thorough documentation regarding the investigation of these unwitnessed falls.
Loose Medication Pills Found in Medication Cart
Penalty
Summary
Surveyors observed that a medication cart on the 300 hall contained five loose medication pills inside one of its drawers. During interviews, an LVN confirmed the presence of the loose pills and stated they may have dropped during her medication pass or possibly by another nurse at an undetermined time. The DON acknowledged that medication carts should not contain loose medications and that the nurse responsible for the cart is accountable for its contents. Review of the facility's policy indicated that prescription medications must be properly labeled with specific information, but the loose pills were not labeled or stored according to these requirements.
Unqualified Food Service Director Lacks Required Certification
Penalty
Summary
The facility failed to employ a Food Service Director with the appropriate competencies, certifications, and skill sets required to manage the food and nutrition service. The Food Service Director, hired in March, did not possess certification as a dietary manager or food service manager, nor did she have an associate's or higher degree in food service management or hospitality. Her previous work experience was limited to medical records and central supply departments, with no prior dietary management experience. At the time of the survey, she had only recently enrolled in a national dietary certification course and had not yet obtained the necessary credentials. Interviews with facility leadership, including the Administrator and Human Resource Director, confirmed awareness of the regulatory requirement for the Food Service Director to be certified and acknowledged that the current director was not yet qualified. Review of the facility's job description and relevant federal food code regulations further substantiated that the position required specific education, training, and certification, which the current Food Service Director did not meet. This deficiency was identified during a review of the facility's compliance with dietary requirements.
Failure to Maintain Kitchen Sanitation and Food Safety Standards
Penalty
Summary
Surveyors observed that the facility failed to maintain proper sanitation and safety standards in the kitchen and food storage areas. Specifically, a large overhead ceiling vent in the main kitchen was found to be covered with dirt and dust particles, and an attic ceiling trap door above the outside kitchen patio area, where two food storage freezers were located, was not fully closed. Additionally, in the dish room above the dish machine conveyor belt, there was a section of ceiling with exposed and peeling paint, with the potential for paint particles to fall onto clean dishware. These conditions were directly observed during a walkthrough with the Food Service Director. Interviews with facility staff confirmed that the issues had been previously identified but not addressed in a timely manner. The Food Service Director acknowledged the potential for dirt, dust, and paint particles to contaminate food or clean dishware, and stated that work orders had been placed for some, but not all, of the deficiencies. The Maintenance Director confirmed receipt of a work order for the kitchen ceiling vent and noted that the dish room ceiling issue had been documented previously. Facility policy and federal food code require that non-food-contact surfaces be kept free of dust, dirt, and other contaminants, and that kitchen facilities be maintained in a clean and sanitary condition.
Failure to Secure Electronic Medical Records During Medication Administration
Penalty
Summary
A medication aide (MA) failed to maintain the privacy and confidentiality of a resident's personal and medical records by leaving a computer screen unlocked and unattended for four minutes. The computer displayed the resident's morning medication list, which was visible during this time. The MA stated she was unaware that locking the computer screen was necessary and believed that simply minimizing the screen was sufficient to protect the information. The resident involved was an elderly female with diagnoses including heart failure, kidney disease, and peripheral vascular disease, and had moderate cognitive impairment as indicated by a BIMS score of 11. The facility's policy required privacy to be maintained at all times for all resident information, but this was not followed during the medication administration process.
Inaccurate MDS Assessment Coding for Hospice Services
Penalty
Summary
The facility failed to accurately complete the Minimum Data Set (MDS) assessment for one resident. Record review showed that the resident was admitted with diagnoses including unspecified dementia, cognitive communication deficit, and chronic obstructive pulmonary disease, and had a terminal prognosis with an active hospice order. However, the resident's quarterly MDS assessment was incorrectly coded to indicate that the resident was not receiving hospice services, despite documentation in the care plan and clinical record confirming hospice enrollment. The MDS Coordinator confirmed during interview that this was an oversight, and the Director of Nursing stated that all MDS assessments are expected to be correctly coded according to the RAI manual.
Incomplete and Inaccurate Clinical Records for Resident Diagnoses
Penalty
Summary
The facility failed to maintain complete and accurate clinical records for one resident, as required by accepted professional standards. Specifically, the resident's face sheet and clinical record did not include all current diagnoses, omitting both Hypertension and Hypothyroidism, despite the presence of physician orders for medications to treat these conditions. The omission was confirmed during an interview with the Director of Nursing, who acknowledged that the face sheet, which is used by outside health providers, should accurately reflect the resident's health status. Record review showed that the resident was admitted with diagnoses of Heart Failure, Pneumonia, and Muscle Wasting and Atrophy, but the additional diagnoses of Hypertension and Hypothyroidism were not documented in the resident's list of diagnoses or on the face sheet. The resident's admission MDS assessment and comprehensive care plan were still in process and not yet due for completion, and therefore did not yet include all diagnoses. The facility's policy requires that each resident's medical record contain an accurate representation of the resident's experiences and enough information to provide a complete picture of the resident's progress.
Resident Rooms Below Required Square Footage
Penalty
Summary
The facility failed to provide the required minimum of 80 square feet per resident in 23 out of 37 resident rooms reviewed, specifically in rooms 7-8 and 20-40. Measurements of these rooms, which contained two beds each, were found to be between 144 and 155 square feet, resulting in only 72 to 77.5 square feet per resident, which is below the regulatory requirement. Record review indicated that a previous room size waiver had expired, and there had been no changes to the number or size of the affected rooms since the last waiver. Interviews with the Administrator confirmed the intent to request a continuation of the room size waiver, and the Life Safety Code Manager expressed no concerns regarding the waiver request based on a recent Life Safety Survey.
Failure to Update Care Plans for Wound Care and Weight Loss
Penalty
Summary
The facility failed to develop and implement a comprehensive person-centered care plan for two residents, leading to deficiencies in wound care management and weight loss management. For the first resident, a male with a history of pneumonia and pressure ulcers, the facility did not update the care plan to include wound care management after he developed new pressure injuries. Despite the resident's declining health and the absence of the Wound Care Nurse, the care plan was not revised to reflect the necessary interventions for wound care management, which was acknowledged by the Director of Nursing (DON) as a lapse in protocol. For the second resident, a female with a history of stage 4 pressure ulcers and type 2 diabetes, the facility failed to update the care plan to address significant weight loss. The resident experienced a 7.14% weight loss over a month, and although dietary interventions were recommended and initiated, these changes were not reflected in the care plan. The MDS Nurse, responsible for updating care plans, was unsure why the significant weight loss was not documented, indicating a gap in the care planning process. The facility's policies on pressure injury prevention and care plan revisions upon status change were not followed, leading to these deficiencies. The policies clearly state that care plans should be updated with new or modified interventions when there are significant changes in a resident's condition, such as the development of new pressure injuries or significant weight loss. The failure to adhere to these policies resulted in the residents not receiving the necessary care to address their medical conditions adequately.
Failure to Provide Therapeutic Diet as Ordered
Penalty
Summary
The facility failed to ensure that a resident with a nutritional problem was offered a therapeutic diet as ordered by the healthcare provider. Specifically, Resident #46, who had a significant weight loss and was diagnosed with a stage 4 pressure ulcer and type 2 diabetes, was not receiving the ordered fortified foods at all meals. Despite the dietary orders being input into the system, the resident's meal tickets did not reflect the need for fortified foods, which was confirmed through record reviews and observations. The Dietary Manager and the Director of Nursing (DON) were unaware of the discrepancy, and there was no verification process in place to ensure the accuracy of meal tickets. Resident #46 had a BIMS score indicating moderate cognitive impairment and had experienced a weight loss of over 7% in one month. The resident's care plan did not address the significant weight loss, and the dietary orders for fortified foods were not correctly reflected on the meal tickets. Interviews with the Dietary Manager and the DON revealed that the system automatically inputs dietary orders, but there was no verification process to ensure accuracy. The facility's policy on diet order accuracy was not effectively implemented, leading to the resident not receiving the therapeutic diet as prescribed.
Medication Cart Left Unlocked and Unattended
Penalty
Summary
The facility failed to ensure all drugs and biologicals were stored in locked compartments under proper temperature controls and permitted only authorized personnel to have access to the keys for one of four medication carts reviewed for medication storage. Specifically, the Nurses Medication Cart was left unlocked and unattended in the common area in front of the nurses' station. The cart contained scissors, prescription, and over-the-counter medications, and there were staff, residents, and visitors in the immediate vicinity. In an interview, the LVN responsible for the cart acknowledged that it should not have been left unlocked and unattended, explaining that she had been trained to keep it locked but had forgotten to do so in the rush to attend to a resident emergency. The DON confirmed that it was the facility's policy and expectation that medication carts are locked when not in active use, and that staff are trained on this policy upon hire, during annual competency testing, and through in-service trainings. The facility's policy explicitly states that medication carts must be locked at all times when not in use and should not be left unlocked or unattended in resident care areas.
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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 Del Rio
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Del Rio Nursing And Rehabilitation Center | 0.8 mi | ★★★★★ | 16 | 0 |
| La Vida Serena Nursing And Rehabilitation | 3.3 mi | ★★★★★ | 13 | 0 |
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