Duncanville Healthcare and Rehabilitation Center

In the surveyor’s words

From the most serious findings on record at Duncanville Healthcare and Rehabilitation Center, in the surveyor’s own words.

• Immediate jeopardy, patternF600May 19, 2023

  Based on interview, and record review, the facility failed to ensure the resident was free from abuse for 1 (Residents #1) of 3 residents reviewed for abuse. 1. The facility failed to protect Resident #1 from continued abuse. Resident #1 was verbally abused twice by MA B. MA B told Resident #1 you need to shut up, CNA A witnessed the incident did not act, and MA B worked another 7 days and verbally abused Resident #1 again. An Immediate Jeopardy was identified on 05/18/23. The IJ Template was provided to the facility on [DATE] at 6:48 p.m. […]

• Immediate jeopardy, patternF609May 19, 2023

  Based on interview and record review the facility failed to ensure all alleged violations involving abuse, neglect, exploitation or mistreatment, which included injuries of unknown source and misappropriation of resident property, were reported immediately, but not later than 2 hours after the allegation was made, if the events caused the allegation involved abuse or resulted in serious bodily injury, or not later than 24 hours to the administrator or the facility and to other officials, which included the State Survey Agency, in accordance with State law through established procedures for one of 1 resident (Resident #1) reviewed for reporting incident allegations. 1. […]

• Immediate jeopardy, patternF684Jun 27, 2022

  Based on observation, interview, and record review, the facility failed to ensure residents received treatment and care in accordance with professional standards of practice for 1 (Resident #1) of 4 residents reviewed for quality of care. The facility failed to ensure Resident #1's admission orders [MEDICAL RECORD OR PHYSICIAN ORDER] . On 06/20/22, Resident #1 admitted to the ICU after he was noted with a change in condition. The resident admitted with a blood glucose greater than 1200 milligrams per deciliter and was treated for [MEDICAL RECORD OR PHYSICIAN ORDER] . It was determined a past non-compliance Immediate Jeopardy existed from 06/04/22 to 06/20/22. […]

• Immediate jeopardy, isolatedF678May 20, 2025

  Based on observation, interview, and record review, the facility failed to ensure personnel provided basic life support, which included CPR, to a resident requiring such emergency care prior to the arrival of emergency medical personnel and subject to related physician orders and the resident's advance directives for 1 of 7 residents (Resident #1) reviewed for cardio-pulmonary resuscitation. RN E failed initiate CPR when FM C told him Resident #1 was unresponsive on [DATE]. A Past Non-Compliance Immediate Jeopardy (PNC IJ) was identified and presented to the Administrator and DON on [DATE] at 4:04 PM at exit. The noncompliance began on [DATE] and ended on [DATE]. […]

• Immediate jeopardy, isolatedF580Jan 12, 2024

  Based on interview and record review the facility failed to consult with the resident's physician and notify the resident's representative when there was a significant change in the resident's physical, mental, or psychosocial status for 1 of 5 residents (Resident #1) reviewed for notification of changes. The facility failed to notify and consult with the Resident #1's physician and notify the resident's representative when Resident #1 was coughing up blood on [DATE] and her blood sugar level dropped to 52 mg/dl on [DATE]. Resident #1 was hospitalized on [DATE] and expired on [DATE]. An Immediate Jeopardy (IJ) was identified on [DATE] at 2:25 PM. […]