Citations in Texas
Statistics, citations and compliance trends for long-term care facilities in Texas.
Statistics for Texas (Last 12 Months)
Financial Impact (Last 12 Months)
Latest citations in Texas
A resident with CKD stage 5 and ESRD had an MDS that did not indicate dialysis in Section O, even though the resident had active orders for dialysis, a care plan for dialysis-related needs, and staff confirmed he was receiving dialysis at an outside clinic on a regular schedule. The MDS nurse stated dialysis should have been triggered on the assessment and described the omission as an oversight/data entry error.
Insulin Pen Not Primed Before Administration: An LVN administered Lantus to a resident with diabetes without priming the insulin pen first. The resident had orders for Lantus 30 units BID, and the LVN stated he was not familiar with priming the pen. The DON stated the pen should be primed before use to ensure the resident receives the appropriate dose.
A resident with dysphagia and a hx of stroke was ordered a slow-flow adaptive drinking cup with fluids, and the care plan and meal ticket also identified the need for the device. During a meal observation, a CNA served cranberry juice in a regular cup instead, and the resident drank from it and immediately coughed. The CNA, an LVN, the SLP, and the DON all acknowledged the resident should have received the ordered adaptive cup.
Missing Hospice Election and Certification Documents: The facility failed to coordinate hospice care planning and ensure a resident’s hospice binder contained the election/cancellation/update form and the physician’s certificate of terminal illness. A resident with schizophrenia, metastatic breast cancer, and severe cognitive impairment was receiving hospice services, and the DON stated the hospice company was responsible for the binder after the missing forms were identified and faxed.
An LVN failed to follow hand hygiene and insulin pen preparation practices during a medication pass for a resident with diabetes. After washing his hands, he turned off the faucet with his bare hand, then administered insulin without cleaning the insulin pen’s rubber seal with alcohol first. The DON stated both actions were a break in infection control, and the facility policy required proper hand hygiene and noted that gloves do not replace hand hygiene.
Food service safety standards were not followed in the kitchen. Two 5-lb containers of cottage cheese and two 5-lb containers of sour cream were found in the refrigerator without labels showing when they were received, opened, or when they should be discarded. In addition, personal items were on food prep counters during meal prep, including 2 cell phones, a charger and wires, a personal vape, and a drink tumbler. The FSM stated opened foods should be labeled and used within 7 days, and that the items on the counters could contribute to an unsanitary food prep area.
MDS Did Not Reflect Resident’s Dialysis Treatments
Penalty
Summary
The facility failed to ensure Resident #17’s MDS assessment accurately reflected that the resident was receiving dialysis treatments. Resident #17 was a [AGE]-year-old male admitted with diagnoses including diabetes, hyperlipidemia, peripheral vascular disease, and chronic kidney disease stage 5. The most recent MDS assessment reflected kidney disease and moderate cognitive impairment for daily decision-making, but Section O did not indicate that the resident required dialysis. Record review showed the resident had active orders for dialysis-related care, including checking the left upper arm shunt every shift for signs and symptoms of infection or bleeding and receiving dialysis at a clinic on Monday, Wednesday, and Friday. The comprehensive care plan also identified that the resident required dialysis treatments related to end stage renal disease. During interviews, staff stated the resident had been receiving dialysis before admission and continued while in the facility. The MDS nurse reviewed the assessment and stated dialysis should have been triggered on the MDS and that it was an oversight and data entry error.
Insulin Pen Not Primed Before Administration
Penalty
Summary
The facility failed to provide pharmaceutical services to meet the needs of each resident when LVN B administered Lantus insulin to Resident #97 without priming the insulin pen first. Resident #97 was a cognitively intact male with diagnoses that included diabetes, peripheral vascular disease, acquired absence of left toes, and acquired absence of the right leg below the knee. His orders included Lantus 100 unit/mL insulin, 30 units subcutaneously twice daily, and his care plan identified diabetes with interventions for administering medications as ordered. During observation, LVN B obtained the insulin pen from the medication cart, inserted a needle into the rubber seal without cleaning it first, did not prime the pen, dialed the dose to 30 units, and injected the resident. When interviewed, LVN B stated he was not familiar with priming an insulin pen and did not fully know the technology behind priming it, despite having skills training within the year that included insulin use. The DON stated that an insulin pen should be primed before administration and checked for air bubbles because priming ensures the resident receives the appropriate dose. The Lantus package insert also stated to perform the safety test before each injection to ensure an accurate dose.
Failure to Provide Ordered Adaptive Drinking Cup
Penalty
Summary
The facility failed to provide Resident #24 with the physician-ordered slow-flow adaptive drinking cup during the noon meal. Resident #24 had diagnoses including dysphagia and a history of stroke. The physician order dated 06/11/2024 required a slow-flow adaptive drinking cup with fluids, and the care plan dated 11/11/2025 identified the adaptive drinking cup as needed to promote safe swallowing and reduce the risk of aspiration. The meal ticket also indicated that Resident #24 required a slow-flow adaptive drinking cup with meals. During observation of meal service on 07/13/2026 at 12:15 pm, CNA D served cranberry juice in a regular drinking cup instead of the ordered adaptive cup. Resident #24 independently lifted the regular cup, drank the juice, and immediately coughed after swallowing. CNA D stated the resident should have been provided a slow-flow adaptive drinking cup and acknowledged the incorrect cup was served. LVN C stated she was responsible for making sure residents had what was ordered by the doctor and said the resident should have had a sippy cup. The SLP stated Resident #24 required thin liquids with small sips when drinking, and the DON stated staff are educated regarding adaptive equipment needs and that the slow-flow adaptive drinking cup is intended to regulate fluid intake and promote safer swallowing.
Missing Hospice Election and Certification Documents
Penalty
Summary
The facility failed to collaborate with hospice representatives and coordinate the hospice care planning process for a resident receiving hospice services, and failed to ensure that the resident’s hospice documents were present in the hospice binder. Resident #23 was a [AGE]-year-old female admitted to the facility on 04/01/26 with diagnoses including schizophrenia, malignant neoplasm of the right breast, secondary malignant neoplasm of axilla and upper limb lymph nodes, and mild intellectual disabilities. Her Significant Change MDS showed a BIMS score of 5, indicating severe cognitive impairment, and her comprehensive care plan showed hospice services were initiated on 06/15/26. The Physician Order Summary dated 07/16/26 showed she was admitted to [Hospice Company] for malignant neoplasm of the right breast with an order date of 06/12/26. Record review of the hospice binder for Resident #23 on 07/15/26 at 3:00 PM showed there were no forms under the tab for Form 3071 and Form 3074. During initial rounds on 07/13/26 at 10:45 AM, Resident #23 was observed visiting with a hospice employee in her room, and during interview on 07/15/26 at 10:55 AM she confirmed she had a visitor from hospice and stated she was pleased with services from the facility and hospice and received help when needed. During interview on 07/15/26 at 3:30 PM, the DON stated she would have to ask the hospice company why Forms 3071 and 3074 were not in the hospice binder because they are responsible for the binder; the DON then called the hospice company and they faxed the forms to her. The facility’s hospice policy stated that when a resident participates in hospice, a coordinated plan of care between the facility and hospice agency is developed and the resident’s care plan should be revised and updated with changes.
Infection Control Lapses During Insulin Administration
Penalty
Summary
Provide and implement an infection prevention and control program was deficient when an LVN failed to follow hand hygiene and insulin administration practices during a medication pass for a resident with diabetes. Resident #97 was cognitively intact, had diagnoses including diabetes, peripheral vascular disease, acquired absence of left toes, and acquired absence of the right leg below the knee, and was ordered Lantus insulin 30 units subcutaneously twice daily. During observation, the LVN washed his hands in the resident’s bathroom and turned off the faucet with his bare hand instead of using a paper towel, then returned to the medication cart and administered insulin without cleaning the rubber seal of the insulin pen with alcohol first. During interview, the LVN stated that after washing hands the faucet should be turned off with a paper towel because the handle could be contaminated and germs could be reintroduced, and he acknowledged he did not realize he had turned it off with his bare hand. He also stated he was not sure the rubber seal on the new insulin pen had to be cleaned with alcohol before use, despite having skills training within the year. The DON stated the nurse should have wiped the rubber seal with alcohol before inserting the needle and should have used a paper towel to turn off the faucet because it was cross contamination and a break in infection control. The facility’s hand hygiene policy stated all staff must perform proper hand hygiene procedures and that gloves do not replace hand hygiene.
Food Storage and Kitchen Sanitation Deficiencies
Penalty
Summary
The facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety in 1 of 1 kitchen reviewed. During an observation and interview, the refrigerator contained 2 five-pound containers of cottage cheese and 2 five-pound containers of sour cream that were not labeled with the date received, the date opened, or the discard date. The Food Service Manager stated the food should have been labeled with the date received and opened, and that opened food should be discarded after 7 days. The FSM also stated the unlabeled foods available for meal service could potentially contribute to food borne illnesses. During a separate observation and interview, the kitchen food preparation counters had personal items in use while staff were preparing for the noon meal service. These items included 2 personal cell phones, one being used to play music and one being charged with a wire and charger plugged into an electrical outlet, a personal electronic vape, and a personal drink tumbler. The Food Service Manager stated the expectation was that those items not be stored in the kitchen and stated the personal items kept on the food preparation counters could potentially contribute to an unsanitary food preparation area. A record review of the facility's Food Safety policy stated opened food shall be labeled, dated, and stored properly and perishable opened foods shall be used within 7 days or less.
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Compliance trends in Texas
Data through Jun 2026Comparisons below measure the most recent period Jul 2025 – Jun 2026 against the prior period Jul 2024 – Jun 2025 (two equal 12-month windows). The most recent 1 months are excluded because CMS is still publishing them.
Top tags by month · last 24 months
dashed = still reportingMonthly citation counts for the 5 most-cited tags. The dashed tail is the 1-month reporting lag.
Frequency movers
Biggest change in how often each tag is cited, as a rate per 100 inspections (so it isn't skewed by survey volume): Jul 2025 – Jun 2026 vs the prior period Jul 2024 – Jun 2025. Only tags with at least 20 citations in both periods are shown.
Severity movers
Tags whose average scope/severity shifted the most: Jul 2025 – Jun 2026 vs the prior period Jul 2024 – Jun 2025. The number is the average severity on the A–L scale (A=0…L=11); the letter is the band it falls in. A rise means the same tag is being cited at a more serious level — note the average can move enough to rank here while staying within the same letter. Same 20-citation minimum applies.
Care domain movers
Citations grouped into CFR care domains — F-tags by their §483 regulatory section (CMS State Operations Manual, Appendix PP) — measured as a rate per 100 inspections: Jul 2025 – Jun 2026 vs the prior period Jul 2024 – Jun 2025. Share is the domain's portion of citations this period; avg severity is the mean scope/severity letter and immediate jeopardy the percentage cited at J–L, both over the current period. Domains with at least 20 citations in both periods are shown; the sparkline tracks the last 12 months (left = oldest).
Immediate jeopardies · this period
Citations at the most serious scope/severity — J–L, immediate jeopardy, residents placed at risk of serious harm or death — over Jul 2025 – Jun 2026 vs the prior period Jul 2024 – Jun 2025. "Surveys with an IJ" counts distinct health inspections that had at least one.
Survey activity · by month
faded/dashed = still reportingCitations each month split into complaint-driven (unscheduled, triggered by grievances) vs standard surveys — bars, left axis — with the number of inspections as a line on the right axis. Rising inspections signal more scrutiny; a rising complaint share means more off-cycle surveys. The most recent 1 months are still being reported.
Deficiency-free survey rate
Share of health surveys that found zero deficiencies — the odds of a clean survey. Jul 2025 – Jun 2026 vs the prior period Jul 2024 – Jun 2025; the most recent 1 months are still being reported (dashed).
Penalties · by month
faded = still reportingTotal civil money penalty dollars imposed on the state's facilities each month — how hard the state is enforcing. The most recent 1 months are still being reported, and penalties often lag citations by several months.
Emerging tags
Tags that weren't established last period but surged — an early warning, distinct from movers (which track already-common tags). Criteria: fewer than 20 citations in the prior period, but at least 10 this period and 2.5× their prior volume. The sparkline shows monthly counts over the last 12 months (left = oldest).
Trusted data from CMS and state health departments
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