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 Hearthstone Nursing And Rehabilitation during CMS and state inspections, most recent first.
A resident with severe cognitive impairment and multiple comorbidities exhibited ongoing physical and verbal aggressive behaviors documented in MDS assessments and nursing progress notes, including hitting staff, throwing items, and pushing another resident. Despite these documented behaviors, the comprehensive care plan did not include aggression as a problem area or outline related goals and interventions. The DON, ADON, and ADM acknowledged that the care plan should have been updated in accordance with the facility’s care planning policy, which requires the IDT to revise care plans as resident conditions and behaviors change.
A resident with a newly diagnosed Major Depressive Disorder was not referred for a Level II PASARR evaluation after a significant change in condition. Despite facility policy and staff acknowledgment that a new diagnosis should trigger a PASARR review, the required referral was not completed, and the resident was not listed among PASARR-positive individuals.
A resident with a diagnosis of Major Depressive Disorder and a positive Level II PASARR screening did not receive a timely referral for specialized services, as required. Despite recommendations and approvals for therapies, the facility failed to notify the appropriate authorities and initiate PASARR services within the mandated timeframe, as confirmed by staff interviews and record review.
A facility failed to include hospice services in a resident's care plan, despite documentation of hospice admission in the resident's records. The MDS nurse, responsible for care plans, was unaware of this omission, which could delay necessary care. The resident, an elderly female with multiple health issues and severe cognitive impairment, was not care planned for hospice services, contrary to facility policy.
The facility failed to maintain proper infection control practices during medication administration, as observed with two residents. The MA did not perform hand hygiene or sanitize the blood pressure cuff between residents, increasing the risk of infection. Both residents had significant medical conditions, making them vulnerable to infections. Interviews confirmed the facility's policies on hand hygiene and equipment sanitation, which were not followed during the incidents.
A resident with severe cognitive impairment and a history of bipolar disorder was slapped on the head by a CNA during a wheelchair transfer in the facility's lobby. The incident was witnessed by the receptionist and a van driver from another facility. The resident was assessed with no apparent injury, and the CNA was removed from duty and terminated. Local law enforcement found probable cause for assault, resulting in a warrant for the CNA's arrest.
A facility failed to document follow-up observations for a resident with severe cognitive impairment and a tracheostomy stoma, who experienced uncontrolled coughing and respiratory distress. Despite interventions ordered by the NP, the resident's condition did not improve significantly, and he was sent to the ER. The nurse did not document changes in the resident's condition, and the facility's policy lacked guidance on nursing documentation.
A resident with severe cognitive impairment was observed spitting out her morning medication, which was not confirmed by the administering LVN. The LVN was unaware of the resident's history of pocketing/spitting out medication and did not ensure consumption, contrary to facility policy.
Failure to Update Care Plan for Ongoing Aggressive Behaviors
Penalty
Summary
The deficiency involves the facility’s failure to review and revise a resident’s person-centered comprehensive care plan to reflect current aggressive behaviors. The resident, a 75-year-old female admitted with diagnoses including severe unspecified dementia without behavioral disturbance, type 2 diabetes mellitus, delusional disorder, depression, and hypertension, had an MDS assessment showing a BIMS score of 2, indicating severe cognitive impairment. The same MDS documented physical behavioral symptoms directed toward others, verbal behavioral symptoms, and other behavioral symptoms occurring multiple days during the look-back period. Despite these documented behaviors, the comprehensive care plan dated 10/31/2025 did not include an aggressive behavior problem area, related goals, or interventions. Nursing progress notes documented multiple episodes of escalating aggressive behavior over several weeks. On 9/17/2025, staff documented the resident throwing items off the counter, hitting staff, cussing at staff, throwing offered water on the floor, and being on 1:1 observation. On 9/24/2025, notes indicated physically aggressive behavior toward staff and that the resident pushed another resident down when touched, with reports of increased aggressive behaviors during the day. On 10/3/2025, documentation showed the resident was physically aggressive toward nursing staff when they attempted to redirect her. These entries demonstrated ongoing and increasing aggressive behaviors that were recorded in the nursing notes but not incorporated into the resident’s care plan. Interviews with facility leadership confirmed that the care plan was not updated to reflect the resident’s aggressive behaviors despite policy requirements. The DON stated she was familiar with the Care Planning policy, acknowledged that the MDS coordinator was responsible for completing care plans with input from the IDT, and agreed that the resident’s aggressive behaviors should have been documented in the care plan but did not know why this had not occurred. The ADON reported recent training on the Care Plans policy and stated that the resident’s care plan needed to be updated as soon as behaviors were reported by staff. The ADM also confirmed prior training on care planning, stated that the resident’s physical aggression should be documented in the care plan as soon as it was noticed or as soon as possible, and noted that while the behaviors were documented in nursing progress notes, they were not reflected in the care plan. Review of the facility’s Care Planning policy showed that care plans must incorporate identified problem areas, risk factors, measurable goals, and be revised as residents’ conditions change, which did not occur in this case.
Failure to Refer Resident for Level II PASARR After New Mental Health Diagnosis
Penalty
Summary
The facility failed to refer a resident for a Level II PASARR (Preadmission Screening and Resident Review) following a new diagnosis of Major Depressive Disorder. Record review showed that the resident was admitted with no prior diagnosis of mental disorder, intellectual disability, or related condition, as indicated by a negative Level I PASARR screening. However, subsequent documentation, including the resident's face sheet, MDS record, and care plan, confirmed a diagnosis of Major Depressive Disorder. Despite this significant change in condition, there was no evidence that the resident was referred for a Level II PASARR evaluation, nor was the resident listed among PASARR-positive residents. Interviews with facility staff, including the MDS Coordinator, DON, and Administrator, confirmed that the facility's policy requires a new PASARR screening upon a significant change in condition or new diagnosis of mental illness, intellectual disability, or related condition. Staff acknowledged that failure to conduct an accurate PASARR screening could result in residents not receiving appropriate services. The MDS Coordinator was identified as responsible for PASARR screenings, but the required referral for Level II PASARR was not completed for the resident after the new diagnosis.
Failure to Timely Refer Resident for PASARR Specialized Services
Penalty
Summary
The facility failed to notify the appropriate state mental health or intellectual disability authority promptly after a significant change in the condition of a resident with a mental illness, as required for PASARR (Preadmission Screening and Resident Review) processes. Record review showed that a male resident with a diagnosis of Major Depressive Disorder had a positive Level II PASARR screening and was recommended for specialized services, including physical, occupational, and speech therapy. Despite these recommendations and approvals for services, the facility did not ensure that the resident was referred to PASARR services within the required timeframe. The care plan did not indicate whether the resident received PASARR services, and documentation revealed the resident had been PASARR positive for several years. Interviews with facility staff, including the MDS Coordinator, DON, and Administrator, confirmed that the referral for PASARR services was not sent within the required 20-day period following the IDT meeting. Staff acknowledged that this delay or omission could result in the resident not receiving necessary specialized services. Facility policy required notification to the Local Intellectual and Developmental Disability Authority (LIDDA) within two days of admission for positive PASARR screenings, but this process was not followed for the resident in question.
Failure to Include Hospice Services in Resident's Care Plan
Penalty
Summary
The facility failed to develop and implement a comprehensive person-centered care plan for a resident who was receiving hospice services. Despite the resident's admission to hospice being documented in the physician's orders and the Admission MDS assessment, the care plan did not reflect this critical aspect of the resident's care. The MDS nurse, who was responsible for completing care plans, acknowledged awareness of the resident's hospice status but was unaware that the care plan did not include hospice services. This oversight could potentially lead to a delay in care or interventions for the resident. The resident in question was an elderly female with multiple diagnoses, including diabetes, hyperlipidemia, dementia, and hypertension, and was severely cognitively impaired with a BIMS score of 07. The Director of Nursing (DON) confirmed that the MDS nurse was responsible for care planning hospice services and that the omission of hospice services from the care plan was not in line with the facility's policy. The facility's policy mandates that care plans include measurable objectives and timeframes to meet the resident's needs, and the failure to include hospice services in the care plan was a deviation from this policy.
Inadequate Infection Control Practices During Medication Administration
Penalty
Summary
The facility failed to establish and maintain an effective infection prevention and control program, as evidenced by the improper hand hygiene and equipment sanitation practices observed during medication administration for two residents. The medication aide (MA) did not perform hand hygiene or sanitize the blood pressure cuff between residents, which is a critical step in preventing the transmission of communicable diseases and infections. This oversight was observed during the administration of medications to two residents, both of whom had significant medical conditions that increased their vulnerability to infections. Resident #17, a female with severe cognitive impairment and multiple diagnoses including encephalopathy, acute respiratory failure, diabetes, pneumonia, anxiety, and major depressive disorder, was one of the residents affected. Her care plan included a focus on resolving an acute infection without complications. The MA used an unsanitized blood pressure cuff on Resident #17 and failed to perform hand hygiene before and after administering medications. Similarly, Resident #44, who had moderate cognitive impairment and a history of dementia, depression, high blood pressure, and urinary tract infections, was also at risk. Her care plan highlighted the risk of infection, particularly COVID-19. The MA repeated the same unsanitary practices with Resident #44, using the same blood pressure cuff without cleaning it and neglecting hand hygiene. Interviews with the MA, DON, RN, and ADM confirmed the facility's policies on hand hygiene and equipment sanitation, emphasizing their importance in infection control, yet these were not adhered to during the observed incidents.
Resident Abuse Incident Involving CNA
Penalty
Summary
The facility failed to protect a resident from abuse, as evidenced by an incident involving a Certified Nursing Assistant (CNA) who slapped a resident on the head in the presence of witnesses. The incident occurred in the facility's front lobby while the resident was being transferred to another wheelchair. The resident, who has severe cognitive impairment and a history of bipolar disorder, was reportedly making a kicking movement when the CNA responded by slapping him. This action was witnessed by the facility's receptionist and a van driver from another facility. The resident involved in the incident is an elderly male with a history of cerebral infarction, hemiplegia, hemiparesis, acute respiratory failure, and bipolar disorder. His care plan indicated a severe cognitive impairment with a BIMS score of 0, and he had not exhibited any physical or verbal behaviors prior to the incident. The resident's care plan also noted a self-care deficit and potential for physical aggression due to his bipolar disorder, with specific interventions outlined for staff to manage his behavior. Following the incident, the resident was assessed by a nurse, who found no apparent injury on his head. The facility's administrator, who serves as the abuse and neglect coordinator, was notified, and an investigation was initiated. The CNA involved was removed from duty and subsequently terminated. The incident was reported to local law enforcement, who found probable cause for assault, leading to a warrant for the CNA's arrest.
Failure to Document Follow-Up Observations for Resident with Respiratory Distress
Penalty
Summary
The facility failed to ensure accurate documentation of medical records for a resident with severe cognitive impairment and a tracheostomy stoma. The resident was experiencing uncontrolled coughing and respiratory distress, which was reported by his roommate. LVN C assessed the resident and noted foam-like secretions from the trach, elevated pulse, and complaints of dizziness and tiredness. The nurse contacted the NP on-call, who ordered a nebulizer treatment, suctioning, and monitoring. Despite these interventions, the resident's condition did not improve significantly, and he was eventually sent to the emergency room for further evaluation. The deficiency arose because LVN C did not document follow-up observations or assessments after initiating treatments for the resident's condition. Although the nurse recalled the resident's condition improving temporarily, she failed to record these changes in the progress notes. The DON confirmed that she expected all assessments to be documented to ensure timely and appropriate care. The facility's Change of Condition Policy did not address nursing documentation, contributing to the lack of proper record-keeping.
Failure to Ensure Resident Consumed Medication
Penalty
Summary
The facility failed to ensure that a resident consumed her morning medication, as observed on 04/03/24. The resident, who has severe cognitive impairment and no swallowing disorders, was seen spitting her medication into a trash can. LVN A, who was administering the medication, witnessed the incident but did not confirm the resident's consumption of the medication. LVN A mentioned it was her first day in the Memory Care Unit (MCU) and was unaware of the resident's history of pocketing or spitting out medication. She attempted to mix the medication with apple sauce, which the resident found too tart, and planned to try again with chocolate pudding. The Director of Nursing (DON) from a sister facility stated that the expectation during medication pass is for the nurse or medication aide to ensure that each resident consumes their medication. The facility's Medication and Preparation Administration Policy also requires staff to confirm resident consumption of the medication. The failure to ensure the resident consumed her medication could result in the resident not receiving the intended therapeutic benefits and potentially exacerbating her chronic medical conditions.
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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 Round Rock
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Park Valley Inn Health Center | 0.5 mi | — | 7 | 0 |
| Ignite Medical Resort Round Rock, Llc | 1.8 mi | — | 12 | 0 |
| The Center At Parmer | 1.9 mi | — | 2 | 0 |
| Trinity Care Center | 2.6 mi | — | 9 | 0 |
| San Gabriel Rehabilitation And Care Center | 3.8 mi | — | 5 | 2 |
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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.