Not rated by CMS — ratings are suppressed for new or low-volume facilities.
Past the typical resurvey interval — a standard survey could occur at any time
Estimate from public CMS data, current as of June 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Hays Nursing And Rehabilitation Center during CMS and state inspections, most recent first.
The facility failed to maintain an effective infection prevention and control program, leading to cross-contamination among residents. A resident with severe cognitive impairment was observed sleeping in another resident's bed without consistent linen changes, and another resident ate from a contaminated meal tray. Additionally, a shared baby doll was not sanitized between uses. Staff interviews revealed a lack of specific training and intervention, highlighting gaps in infection control practices.
A facility failed to include a resident's behavior of sleeping in other residents' beds in her care plan, despite multiple observations and documentation by staff. The resident, with severe cognitive impairment and several diagnoses, was not provided with a comprehensive person-centered care plan as required. Interviews revealed a lack of communication and awareness among staff regarding the behavior, leading to uncertainty about responsibility for addressing it.
The facility failed to protect two residents in the Memory Care Unit from engaging in sexual activities when neither had the capacity to consent. Both residents had significant cognitive impairments, and the incident was not reported to the HHSC as required. Family members and a PPA expressed concerns about the residents' inability to consent and the potential trauma caused by the incident.
The facility failed to implement their abuse prevention policies, resulting in two residents with cognitive impairments engaging in sexual activities without the capacity to consent. The incident was not reported to the appropriate agencies, and the staff initially believed the interaction was consensual. This led to an Immediate Jeopardy situation, highlighting the need for proper assessment of consent capacity and adherence to reporting protocols.
The facility failed to report an incident where two cognitively impaired residents were found engaging in sexual activities. Despite the facility's policy requiring such incidents to be reported within 24 hours, the DON and ADM decided not to report it, believing it was consensual and caused no harm.
Infection Control Deficiencies in Resident Interactions and Shared Items
Penalty
Summary
The facility failed to maintain an effective infection prevention and control program, resulting in several instances of cross-contamination among residents. Resident #1, who has severe cognitive impairment and is incontinent, was observed sleeping in the bed of Resident #2 on multiple occasions. Despite staff awareness of this behavior, the linens were not consistently changed after Resident #1 used them, potentially exposing Resident #2 to bodily fluids and food particles. Staff interviews revealed a lack of consistent intervention and monitoring of Resident #1's behavior, which was not adequately addressed in her care plan. Additionally, Resident #1 was observed eating from Resident #3's meal tray, and Resident #3 subsequently consumed the remaining food, leading to potential cross-contamination. Staff failed to prevent this interaction, and the contaminated food was not replaced. This incident highlights a lapse in supervision and infection control practices during meal times, particularly in the secure unit where residents with severe cognitive impairments are housed. Furthermore, a shared baby doll used by multiple residents, including Resident #4 and Resident #5, was not sanitized between uses. The doll, which was in close contact with residents' faces and hands, was not cleaned before being given to another resident, increasing the risk of infection transmission. Staff acknowledged the need for more dolls and the requirement to sanitize shared items but had not implemented these measures. The Director of Nursing, responsible for infection control, admitted to not providing specific training on these issues, indicating a gap in the facility's infection prevention education.
Failure to Address Resident's Behavior in Care Plan
Penalty
Summary
The facility failed to develop and implement a comprehensive person-centered care plan for a resident, which is a requirement under S483.10(c)(2) and S483.10(c)(3). The care plan did not address the resident's behavior of sleeping in other residents' beds, despite this behavior being observed and documented multiple times by staff. The resident, a female with severe cognitive impairment and several diagnoses including vascular dementia and major depressive disorder, was noted to have this behavior in nursing progress notes and during observations by surveyors. Interviews with facility staff revealed a lack of awareness and communication regarding the resident's behavior. The Assistant Business Office Manager (ABOM) believed the behavior was care planned, while the Director of Nursing (DON) acknowledged having seen the behavior but was unaware of its frequency. The DON also indicated that the issue had not been discussed in meetings or identified as a concern, leading to uncertainty about responsibility for addressing the behavior. The facility's policy requires the interdisciplinary team to develop a comprehensive care plan within seven days of completing the Minimum Data Set (MDS), but this was not adhered to in this case.
Failure to Protect Residents from Non-Consensual Sexual Activity
Penalty
Summary
The facility failed to protect two residents in the Memory Care Unit (MCU) from engaging in sexual activities when neither had the capacity to consent. Resident #1, an elderly female with diagnoses including unspecified dementia, cognitive communication deficit, Alzheimer's disease, and hallucinations, was found performing oral sex on Resident #2. Resident #2, an elderly male with diagnoses including cerebral infarction, vascular dementia, and other cognitive impairments, was also involved in the incident. Both residents were documented as having significant cognitive impairments, with Resident #1 unable to complete a cognitive interview and Resident #2 having a moderate cognitive impairment. The incident was reported by a CNA who found the residents in bed together. Both residents were upset when interrupted, and staff initially believed the interaction was consensual. However, interviews with the Director of Nursing (DON) and the Administrator (ADM) revealed that the incident was not reported to the Health and Human Services Commission (HHSC) because they believed it was consensual. Family members and a Power of Attorney (PPA) expressed concerns, stating that neither resident had the capacity to consent and that the incident was upsetting and potentially traumatic. The facility's policy on abuse and neglect clearly states that each resident has the right to be free from abuse, including non-consensual sexual contact. Despite this, the facility failed to assess the residents' capacity to consent properly and did not report the incident as required. The Immediate Jeopardy (IJ) was identified, and the facility was notified, but the failure to protect the residents from abuse placed them at significant risk.
Removal Plan
- The Medical Director was notified of the Immediate Jeopardy.
- Resident #1 was assessed by ADON with no adverse effects. Resident #2 was discharged from facility. All Full-time, Part-time, PRN and agency staff will be in-serviced prior to working the floor on how to handle residents engaging in a sexual encounters. In-service includes separating residents and informing ED or DON/ADON immediately and IDT meeting will be scheduled. New staff will also be in-serviced during the orientation process prior to resident interactions. All staff currently working the floor have already been in-serviced by RN interim DON.
- Staff will separate residents wanting to engage in sexual encounter until the IDT process is completed and staff have been informed of IDT decision by ED or DON and plan of care is updated. These individuals will be identified based on staff interviews and observations.
- Facility process for residents to have sexual encounter is for staff to inform ED or DON of residents' desire based on interviews or observed behaviors. It will then be brought to the IDT (to include, but not limited to MD, ED, DON, ADON, SW) for them to make a determination of consent and need for further interventions and care plan updates, which will be done as soon as possible but up to three days. Staff made aware on case by case basis based on IDT determination. Facility will determine if needs or choices are changed as identified during quarterly care plan reviews. Staff will be made aware based on care plan. If staff encounter a situation involving residents, they will separate the residents and inform the ED or DON/ADON.
- Train the trainer in-service was given by the Clinical Resource RN and was completed with interim DON and Executive Director related to resident's capacity to consent and the IDT process to determine consensual relationships of residents.
- Summary of IJ and corrective action to be reviewed by QAPI Committee weekly or until substantial compliance established and continue monthly to ensure ongoing compliance.
Failure to Implement Abuse Prevention Policies
Penalty
Summary
The facility failed to implement their written policies and procedures regarding prohibiting and preventing abuse for two residents in the Memory Care Unit (MCU). The deficiency involved the facility's failure to protect two residents from engaging in sexual activities when neither had the capacity to consent. This incident was not reported to the appropriate state or federal agencies as required by the facility's policy and applicable regulations. The Director of Nursing (DON) and Administrator (ADM) reviewed video footage and interviews and concluded that the interaction was consensual, despite the residents' cognitive impairments and inability to consent. This decision was made without proper assessment of the residents' capacity to consent to sexual activities, leading to a failure in protecting the residents from potential abuse and neglect. Resident #1, an elderly female with diagnoses including unspecified dementia, cognitive communication deficit, Alzheimer's disease, and hallucinations, was found performing oral sex on Resident #2, an elderly male with diagnoses including cerebral infarction, vascular dementia, and memory deficit. Both residents resided in the MCU and had documented cognitive impairments. The incident was reported by a Certified Nursing Assistant (CNA) who found the residents in bed together. The residents were upset when interrupted, and the staff initially believed the interaction was consensual. However, the residents' Power of Attorney (PPA) later stated that neither resident had the ability to consent, highlighting the potential for emotional trauma and the need for proper assessment of consent capacity. The facility's policy on Freedom from Abuse, Neglect, and Exploitation clearly states that each resident has the right to be free from abuse, including non-consensual sexual contact. The policy also mandates reporting allegations of abuse to the appropriate state or federal agencies within specified timeframes. The facility's failure to report the incident and properly assess the residents' capacity to consent resulted in an Immediate Jeopardy (IJ) situation, which was later removed after corrective actions were implemented. However, the facility remained at a level of actual no harm at a scope of isolated that is not immediate jeopardy, indicating the need for further evaluation of the effectiveness of the corrective systems.
Removal Plan
- The Medical Director was notified of the Immediate Jeopardy.
- Resident #1 was assessed by ADON with no adverse effects. Resident #2 was discharged from facility. All Full-time, Part-time, PRN and agency staff will be in-serviced prior to working the floor on Abuse and Neglect policy. New staff will also be in-serviced during orientation process prior to resident interactions. All Staff currently working the floor have already been in-serviced by RN interim DON.
- Facility process for residents to have sexual encounter is for staff to inform ED or DON of residents' desire based on interviews or observed behaviors. It will then be brought to the IDT (to include, but not limited to MD, ED, DON, ADON, SW) for them to make a determination of consent and need for further interventions and care plan updates, which will be done as soon as possible but up to three days. Staff made aware as needed on a case by case basis based on IDT determination. Facility will determine if needs or choices are changed as identified during quarterly care plan reviews. Staff will be made aware based on care plan. If staff encounter a situation involving residents, they will separate the residents and inform the ED or DON/ADON immediately and IDT meeting will be scheduled.
- Train the trainer in-service was given by the Clinical Resource RN and was completed with interim DON and Executive Director related to resident's capacity to consent and the IDT process to determine consensual relationships of residents.
- Summary of IJ and corrective action to be reviewed by QAPI Committee weekly or until substantial compliance established and continue monthly to ensure ongoing compliance.
Failure to Report Incident Involving Cognitively Impaired Residents
Penalty
Summary
The facility failed to report an incident involving two residents who were not cognitively able to give consent and were found engaging in sexual activities. Resident #1, an elderly female with diagnoses including unspecified dementia and Alzheimer's disease, and Resident #2, an elderly male with diagnoses including vascular dementia and memory deficits following a stroke, were discovered by a CNA in bed together performing oral sex. Both residents were upset when interrupted, and the incident was documented by an LVN. Despite the facility's policy requiring the reporting of such incidents, the Director of Nursing (DON) and the Administrator (ADM) decided not to report the incident to the State Agency, believing it was consensual and caused no harm. The facility's policy on abuse, neglect, and exploitation mandates that all allegations of abuse or neglect be reported to the appropriate state or federal agencies within 24 hours. However, the DON and ADM reviewed video footage and interviews and concluded that the incident was consensual, despite the residents' cognitive impairments. This decision was contrary to the facility's policy and state regulations, which define non-consensual sexual contact as abuse and require timely reporting of such incidents. The failure to report this incident could place residents at risk of not having required incidents reported as mandated.
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Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
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Nursing homes near San Marcos
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Cypress Healthcare And Rehabilitation Center | 0.6 mi | — | 2 | 0 |
| San Marcos Rehabilitation And Healthcare Center | 1.9 mi | — | 1 | 0 |
| Legend Oaks Healthcare And Rehabilitation - New Br | 11.6 mi | — | 3 | 0 |
| Legend Oaks Healthcare And Rehabilitation-kyle | 12 mi | — | 7 | 0 |
| Sundance Inn Health Center | 12.2 mi | — | 2 | 0 |
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Trusted data, never guesswork. Every citation, penalty, rating and Plan of Correction on this page is sourced from public CMS records (latest release August 2026) and official state health department websites.