Based on interview and record review, the facility failed to implement an antibiotic stewardship program that included antibiotic use protocols. * The facility did not include the antibiotic time out protocol in their Antibiotic Stewardship policy in the Infection Control Tracking and Trending review. This failure could place residents with infections at risk for unnecessary antibiotic use and increased infections that are resistant to antibiotics. Findings included: Record review of an undated Antimicrobial Stewardship Policy indicated Facility Antimicrobial Stewardship Mission StatementOur facility embraces the importance of an infection prevention and control program that includes an antimicrobial stewardship program, providing antibiotic use protocols and monitoring to prevent… …
F881 citations in Texas
Antibiotic stewardship · Infection Control Deficiencies
Implement a program that monitors antibiotic use.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
Against expectation — 2025
Texas cites F881 less often than its own record predicts
0.15 times the national share — cited less often here than elsewhere.
Of every deficiency written in Texas in 2025, this is the portion that was F881.
Each state is measured against its own expected share, not against other states.
In the surveyor’s words
What Texas surveyors wrote
F881 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 interview and record review, the facility failed to implement an antibiotic stewardship program that included antibiotic use protocols and a system to monitor antibiotic use. The facility's infection prevention and control program did not implement a facility-wide system to monitor the use of antibiotics, develop and implement protocols to optimize the treatment of [REDACTED]. This failure could place residents receiving antibiotics at risk for unnecessary antibiotic use, inappropriate antibiotic use, and increased infections that are resistant to antibiotics. Findings included: During an interview on 08/14/19 at 1:34 p.m ., the ADON said she was responsible for the Infection Control Program, and they did not track antibiotic usage. …
The short window
Recent years
| Year | Share of Texas citations | vs expected |
|---|---|---|
| 2023 | 0.18% | 0.40× |
| 2024 | 0.11% | 0.24× |
| 2025 | 0.07% | 0.15× |
Shares of citations, not counts: earlier years hold fewer inspections.
What else Texas surveyors cite →
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