Starr County Nursing and Transitional Care

In the surveyor’s words

From the most serious findings on record at Starr County Nursing and Transitional Care, in the surveyor’s own words.

• No harm, potential for more than minimal, patternF760Dec 8, 2025

  Based on interview and record review, the facility failed to ensure residents were free from any significant medication errors for one of five residents (Resident #2) reviewed for medication errors. The facility failed to administer Resident #2's clonidine (blood pressure medication) when Resident #2's blood pressure was within parameters 12 days in the months of September and October 2025. This failure could place residents at risk for complications such as increased blood pressure, exacerbation of symptoms, and potential hospitalization. The findings include:Record review of Resident #2's face sheet, dated 10/14/25, reflected a [AGE] year-old male with an admission date of 05/15/24. […]

• No harm, potential for more than minimal, patternF842Jul 21, 2023

  Based on observation, interview, and record review, the facility failed to maintain clinical records on each resident that were complete and accurate, for one Resident (R#114), of four residents reviewed for clinical records, in that; The facility did not document physician orders that indicated to document the level of pain every shift with a scale of 0-10. This failure could place residents at risk for not receiving proper care and treatments. The findings were: Record review of Resident #114's Order Summary report dated 07/21/2023 indicated Resident #141 was a [AGE] year-old male who was admitted to facility on 07/11/2023 with diagnoses that included: Hypertension, Major Depressive Disorder, Alzheimer's Disease, Dementia, and Pain. […]

• No harm, potential for more than minimal, isolatedF686Jan 13, 2026

  Based on observations, interviews, and record review, the facility failed to ensure residents who entered the facility without pressure ulcers did not develop pressure ulcers and residents having pressure ulcers received care and treatment consistent with professional standards of practice to promote healing and further development of skin breakdown or pressure ulcers for 1 (Resident #1) of 3 residents reviewed for pressure ulcers. -The facility failed to ensure Resident #1 was repositioned to promote healing. This failure placed residents at risk of developing new pressure injuries/ulcers, worsening of existing pressure injuries/ulcers, infection, experiencing pain, decreased quality of life, and death. […]

• No harm, potential for more than minimal, isolatedF695Jan 13, 2026

  Based on observation, interview, and record review, the facility failed to ensure that a resident who needs respiratory care was provided such care consistent with professional standards of practice for 1 of 4 (Resident #30) residents reviewed for oxygen in that:Resident #30's oxygen tubing was not connected to the concentrator. This failure could place residents who receive oxygen at risk of developing respiratory complications and a decreased quality of care. The findings included:Record Review of Resident #30's face sheet dated 1/12/2026 indicated he was a [AGE] year old male initially admitted on [DATE] and readmitted [DATE] with the diagnoses of Cerebral Infarction (condition that occurs when blood flow is disrupted causing brain tissue to die), Severe vascular dementia (brain damage… […]

• No harm, potential for more than minimal, isolatedF761Jan 13, 2026

  Based on observation, interview, and record review, the facility failed to ensure all drugs and biologicals were secured and stored in accordance with currently accepted professional principles and standards for 1 of 2 medication storage rooms (200 Hall Medication Storage Room) reviewed for medication storage. The facility failed to ensure the 200 Hall Discontinued Medication cabinet was locked and secured. This failure could place the residents at risk of gaining access to unlocked medications that were not prescribed to them and place the facility at risk of drug diversion. Findings included: In an observation in the 200 hall medication room on 01/12/2026 at 4:02 p.m., a cabinet that had a sign posted that read Discontinue Medications and Medications on Hold was not locked and secured. […]