Shiner Nursing and Rehabilitation Center

In the surveyor’s words

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

• No harm, potential for more than minimal, widespreadF727Dec 13, 2024

  Based on interview and record review, the facility failed to use the services of a registered nurse for at least 8 consecutive hours a day, 7 days a week for 42 days (5/11/24, 6/4/24, 6/5/24, 6/6/24, 6/7/24, 6/8/24, 6/10/24/, 6/12/24, 6/13/24, 6/14/24, 6/17/24, 6/18/24, 6/21/24. 6/22/24. 6/25/24, 6/27/24, 6/28/24, 6/29/24,7/1/24, 7/3/24, 7/5/24, 7/8/24, 7/9/24, 7/10/24, 7/11/24, 7/12/24, 7/13/24, 7/15/24, 7/16/24, 7/17/24, 7/18/24, 7/19/24, 7/20/24, 7/21/24, 7/22/24, 7/23,24, 7/24/24, 7/27/24, 7/28/24, 8/1/24, 8/2/24 and 8/12/24) of 184 days reviewed for nursing services. The facility had no RN coverage for 5/11/24, 6/4/24, 6/5/24, 6/6/24, 6/7/24, 6/8/24, 6/10/24/, 6/12/24, 6/13/24, 6/14/24, 6/17/24, 6/18/24, 6/21/24. 6/22/24. […]

• No harm, potential for more than minimal, widespreadF812Aug 31, 2022

  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 for 1 of 1 kitchen and 1 of 2 medication carts reviewed for sanitation, in that: 1. There was a 5-lb. bag of chopped lettuce in the reach-in cooler that was past its use-by date. 2. There was tub of pudding in medication cart drawer with date of 08/18/2022 , present with mold . These deficient practices could place residents who received meals and snacks from the kitchen at-risk for food borne illness. The findings were: 1. Observation on 08/28/2022 at 12:45 p.m. in the reach in cooler revealed there was a 5-lb. bag of factory-sealed chopped lettuce. The bag was unopened. […]

• No harm, potential for more than minimal, patternF686Aug 16, 2026

  Based on observation, interview and record review, the facility failed to ensure residents receive care, consistent with professional standards of practice, to prevent pressure ulcers and does not develop pressure ulcers unless the individual's clinical condition demonstrates that they were unavoidable and residents with pressure ulcers receive necessary treatment and services, consistent with professional stands of practice, to promote healing, prevent infection and prevent new ulcers from developing for 3 of 5 residents (Resident #2, Resident #3, and Resident #5) reviewed for pressure ulcers. 1. The facility failed to ensure Resident #2, who had a pressure wound, was wearing heel protector boots or had his heels floated while in bed on 08/14/2026 and 08/15/2026.2. […]

• No harm, potential for more than minimal, patternF842Aug 16, 2026

  Based on interview and record review, the facility failed to maintain clinical records in accordance with accepted professional standards and practices that were complete and accurately documented for 4 of 5 residents (Resident #2, Resident #3, Resident #4, and Resident #5) reviewed for accuracy of records: 1. The facility failed to document wound care on 08/12/2026, failed to document floating heels in bed on 08/07/2026 and 08/12/2026, failed to document medication administration on 08/08/2026 and failed to document a diagnosis for Resident #2. 2. The facility failed to document wound care on 07/11/2026, 07/25/2026, and 08/13/2026 for Resident #3. 3. The facility failed to update Resident #4's care plan to reflect she no longer required adaptive devices during meals. 4. […]

• No harm, potential for more than minimal, patternF801Mar 20, 2026

  Based on observation, interview, and record review, the facility failed to employ staff with the appropriate competencies and skill sets to carry out the functions of the food and nutrition service, taking into consideration resident assessments, individual plans of care, and the number, acuity and diagnoses of the facility's resident population in accordance with the facility assessment required for 1 of 1 facility reviewed for dietary requirements. The Dietary Manager did not have the appropriate certification, education, or qualifications to serve as the Director of Food and Nutrition Services, to include not following policy to substitute foods for 03/17/2026 lunch and not storing a container [whipped topping] appropriately on 03/17/2026. […]