Frank M. Tejeda Texas State Veterans Home

In the surveyor’s words

From the most serious findings on record at Frank M. Tejeda Texas State Veterans Home, in the surveyor’s own words.

• No harm, potential for more than minimal, widespreadF803Aug 6, 2021

  Based on observation, interview, and record review, the facility failed to ensure that the menus were followed for 1 of 1 observed meal (breakfast meal) reviewed for menus in that: Scrambled eggs were served instead of cheese omelet and no syrup was available for the waffles served, as per the menu during the breakfast meal on 08/05/2021. This deficient practice could place residents who were served meals from the kitchen at risk for dissatisfaction, poor intake, and/or weight loss. The findings were: Record review of the facility's, Week-at-a-Glance, menu revealed a cheese omelet was to be served with breakfast on 08/05/2021. Further review revealed syrup was to be served with the breakfast meal. The menu revealed no indication of a substitute. Observation on 08/05/2021 at 7:38 a.m. […]

• No harm, potential for more than minimal, widespreadF842Feb 12, 2021

  Based on interview and record review, the facility failed to maintain clinical records in accordance with accepted professional standards and practices that are complete and accurately documented for 3 of 5 residents (Resident #1, #3, and #5) reviewed for accuracy of medical records, in that: 1. The facility did not document administration of Resident #1's [MEDICATION NAME] Solution on 1/12/21, 1/14/21, 1/17/21, and 2/7/21, and [MEDICATION NAME] Solution in Resident #1's MAR. 2. The facility did not document administration of Resident #3's aspirin, calcium supplement, [MEDICATION NAME], [MEDICATION NAME] powder, Tamsulosin HCl, and Eliquis on 1/29/21 in Resident #3's MAR. 3. […]

• No harm, potential for more than minimal, patternF607Aug 26, 2026

  Based on interview and record review, the facility failed to develop and implement its written policies and procedures to prohibit and prevent abuse, neglect, and exploitation of residents and misappropriation of resident property, for 4 (Resident #1, Resident #3, Resident #4, and Resident #5) of 8 residents reviewed for abuse and neglect, in that: The facility failed to develop and implement policies and procedures determining when to report crimes to local law enforcement. This failure could place residents at a greater risk of abuse and neglect. The findings included: Record review of Resident #1's face sheet dated 08/26/26 revealed a [AGE] year-old male with an initial admission date of 09/02/20 and a current admission date of 07/05/26. […]

• No harm, potential for more than minimal, patternF609Aug 26, 2026

  Based on interview and record review, the facility must ensure all alleged violations involving abuse, neglect, exploitation or mistreatment are reported immediately, but not later than 2 hours after allegation is made for 5 of 8 residents (Resident #1, Resident #2, Resident #3, Resident #4 and Resident #5) reviewed for abuse and misappropriation. The facility failed to report alleged abuse of Resident #5 by Resident #4 to law enforcement within 2 hours on 05/18/26.The facility failed to report alleged abuse of Resident #1 by Resident #3 to law enforcement and HHSC within 2 hours on 08/18/26.The facility failed to report alleged misappropriation of property of Resident #2's rings to HHSC within 24 hours of learning about the allegation on 08/10/26. […]

• No harm, potential for more than minimal, patternF689Mar 6, 2026

  Based on observations, interviews, and record reviews, the facility failed to ensure the resident environment remained as free of accident hazards as was possible, and each resident received adequate supervision and assistance devices to prevent accidents for 2 of 38 residents (Resident #157, Resident #110) and 1 of 8 halls (300 hall) reviewed, in that: 1. The facility failed to ensure no hazardous products were left accessible to residents of 300 hall. 2. The facility failed to store a package of cigarettes found on Resident # 157's bed.3. The facility failed to secure a cigarette lighter found on Resident #110's bedside table. These deficient practices could place residents at-risk of avoidable accidents, decline in physical condition, and injury. The findings were:1. […]