Palo Duro Nursing Home

In the surveyor’s words

From the most serious findings on record at Palo Duro Nursing Home, in the surveyor’s own words.

• No harm, potential for more than minimal, widespreadF812Jul 30, 2024

  Based on observation, interview and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety in one of one kitchen observed for food storage, preparation, and distribution. A. The DM did not perform hand hygiene appropriately when preparing pureed foods. This failure could place residents who ate food served by the kitchen at risk of food-borne illness from cross-contamination. Findings included: During an observation and interview on 7/28/24 at 10:55 am, the DM was observed preparing the pureed foods. The DM changed her gloves then touched various kitchen surfaces including the prep table and the blender. The DM went to the stove and used a ladle to put gravy into the blender. […]

• No harm, potential for more than minimal, widespreadF812Jun 1, 2023

  Based on observation, interview, and record review the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety in 1 of 1 kitchen and 1 of 1 kitchen storage room reviewed for kitchen sanitation. 1. The facility failed to ensure stored foods were properly labeled and dated. 2. The facility failed to ensure foods were sealed properly. 3. The facility failed to properly sanitize thermometer to check food temperatures. 4. The facility failed to ensure proper thawing procedures. 5. The facility failed to ensure proper infection control measures. 6. The facility failed to check expiration dates on foods. 7. The facility failed to properly cover/seal foods. […]

• No harm, potential for more than minimal, patternF679Aug 20, 2025

  Based on interview, observations and record review the facility failed to provide, based on the preferences of each resident, an ongoing program to support residents in their choice of activities, both facility-sponsored group and individual activities and independent activities, designed to meet the interests of and support the physical, mental, and psychosocial well-being of each resident, encouraging both independence and interaction in the community for 12 residents reviewed for activities.A. The facility failed to follow the activity calendar for August. B. The facility activity calendar for August failed to incorporate physical activities and interaction in the community into its activity programs. […]

• No harm, potential for more than minimal, patternF727Aug 20, 2025

  Based on interview and record review, the facility failed to use the services of a Registered Nurse (RN) for at least eight consecutive hours a day, seven days a week for the months of April 2025, May 2025, June 2025, July 2025 and August 2025 .for weekend RN coverage. A. The facility failed to ensure they had RN coverage 8 hours a day, 7 days a week for the following days: April 202504/13/25, 04/19/25, 04/20/25 May 202505/03/25, 05/10/25, 05/11/25, 05/17/25, 05/18/25, 05/24/25, 05/25/25 June 202506/1/25, 06/7/25, 06/08/25, 06/14/25, 06/15/25, 06/22/25 July,2025 07/05/25, 07/6/24, 07/12/25,07/13/25, 07/19/25, 07/20/25, 07/26/25, 07/27/25 August,202508/02/25, 08/03/24, 08/09/25, 8/10/25, 08/16/25 and 08/17/25 This failure could place residents at risk for inconsistency in care and services. […]

• No harm, potential for more than minimal, patternF940Jul 15, 2025

  Based on interviews, and record reviews the facility failed to develop, implement, and maintain an effective training program for all new and existing staff, consistent with their expected roles. The facility failed to ensure Abuse, Neglect and Exploitation Training, Fall Prevention, Restraint Reduction, HIV and Bloodborne Pathogens, Emergency Procedures, and Dementia Training were completed upon hire for 2 of 5 employees (Marketing/Admissions Coordinator and CNA A) reviewed for required trainings. Based on interviews, and record reviews the facility failed to develop, implement, and maintain an effective training program for all new and existing staff, consistent with their expected roles. […]