Based on interviews and record review the facility failed to ensure a resident with pressure ulcers receives necessary treatment and services, consistent with professional standards of practice, to promote healing, prevent infection and prevent new ulcers from developing for 1 (CR#1) of 7 residents reviewed. The facility failed to initiate wound preventative measures on [DATE] when CR#1 readmitted to the facility leading to infection and hospitalization. The facility failed to assess and recognize a change in condition and initiate wound preventative measures of [DATE] when the facility became aware that CR#1 had redness on her sacrum area during weekly skin observation leading to infection and hospitalization. An Immediate Jeopardy (IJ) was identified on [DATE]. …
F686 citations in Texas
Pressure ulcers · Quality of Life and Care Deficiencies
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
Against expectation — 2025
Texas cites F686 less often than its own record predicts
0.63 times the national share — cited less often here than elsewhere.
Of every deficiency written in Texas in 2025, this is the portion that was F686.
Each state is measured against its own expected share, not against other states.
In the surveyor’s words
What Texas surveyors wrote
F686 findings written in Texas, one from each severity band recorded here, most serious first.
Severity is as the surveyor wrote it. Some findings had already been corrected before the survey.
Based on interviews and record reviews, the facility failed to ensure a resident received care, consistent with professional standards of practice, to prevent pressure ulcers and did not develop pressure ulcers unless the individual's clinical condition demonstrated that they were unavoidable for 1 of 3 residents (Resident #1) reviewed for pressure ulcers.The facility failed to ensure preventative measures were in place to prevent Resident #1 from developing a DTI to his right hip, right foot, and right heel within 2 days of his admission to the facility.This failure placed residents at risk of the development and/or deterioration of pressure ulcers. …
Based on observation, interview and record review, the facility failed to ensure residents with a pressure ulcer received necessary treatment and services, consistent with professional standards of practice, to promote healing for 1 of 3 residents (Resident #5) reviewed for pressure ulcers. The facility failed to ensure LVN A followed physician orders for Resident #5's wound care to his left heel. This failure could place residents at risk of delayed wound healing, worsening wounds resulting in undue pain and discomfort, and deterioration on residents' general condition.Findings include: Record review of the admission record for Resident #5, dated 09/16/26, revealed a [AGE] year-old male who was admitted to the facility on [DATE] with the following diagnoses: Alzheimer's disease (a… …
The short window
Recent years
| Year | Share of Texas citations | vs expected |
|---|---|---|
| 2023 | 1.04% | 0.51× |
| 2024 | 1.12% | 0.54× |
| 2025 | 1.24% | 0.63× |
Shares of citations, not counts: earlier years hold fewer inspections.
What else Texas surveyors cite →
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