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 Houston Transitional Care during CMS and state inspections, most recent first.
The facility failed to maintain an effective infection control program, with staff not following proper hand hygiene and sanitization protocols. A CNA did not sanitize hands between glove changes during resident care, and a CMA did not wash hands before administering eye drops or sanitize a medication container. Additionally, improper storage of clean linens and inadequate handwashing by a laundry aide were observed, indicating systemic issues in infection control practices.
A resident with a Foley catheter was at risk for urinary tract infections due to improper care. The wound care nurse placed the Foley bag on the bed during wound care, causing urine to back up into the tube, contrary to facility policy. Interviews confirmed the bag should be below the bladder to prevent backflow and potential infection.
The facility failed to ensure proper oxygen administration for two residents, leading to incorrect oxygen settings on their concentrators. One resident's oxygen was set at 4 LPM instead of the ordered 2-3 LPM, and another's was set at 6 LPM instead of 3-4 LPM. The LVN on duty did not verify the settings upon starting the shift, and the DON and ADON highlighted the importance of following physician orders.
A resident at an LTC facility was nearly given a double dose of morning medications due to a failure in documentation by an RN. The RN administered the medications before the resident's dialysis but did not record it, leading an LVN to attempt a second administration. The resident, who was alert, refused the second dose, preventing a potential overdose.
The facility did not secure the door of a commercial-sized dumpster, which was found open and one-quarter full of garbage. Staff confirmed that the door should remain closed to prevent pest infestation and for infection control. Despite efforts to keep the dumpster closed, including staff training and regular checks, the door was found open. The facility's policy requires dumpsters to be kept closed and free of litter.
Infection Control Lapses in LTC Facility
Penalty
Summary
The facility failed to maintain an effective infection prevention and control program, as evidenced by multiple lapses in proper procedures by staff members. CNA K did not follow proper hand hygiene protocols during incontinent care for a resident. After cleaning the resident's peri area, CNA K changed gloves without sanitizing her hands and used the same gloves to apply a clean incontinent brief, potentially transferring germs. Additionally, she used a wet paper towel to turn off the water faucet after washing her hands, which could lead to recontamination. CMA N also demonstrated lapses in infection control practices. She did not wash her hands before administering eye drops to a resident, despite having handled a soda can for the resident. Furthermore, she failed to sanitize the plastic medication container after using it to administer medications to another resident, which is against the facility's infection control policy. These actions could contribute to the spread of infections among residents. The facility's infection control issues extended to the handling of clean linens and laundry. A deflated air mattress was improperly stored on the floor in the clean linen room, and Laundry aide A did not follow proper handwashing techniques after handling dirty linen. She turned off the water faucet with wet hands, which could lead to cross-contamination. These deficiencies highlight a systemic failure in adhering to infection control protocols, putting residents at risk for infections.
Improper Foley Catheter Care Leads to Potential UTI Risk
Penalty
Summary
The facility failed to provide appropriate care for a resident with an indwelling Foley catheter, which could lead to urinary tract infections. During an observation, it was noted that the wound care nurse placed the resident's Foley bag on the bed during wound care, causing urine to back up into the Foley tube. This action was contrary to the facility's policy, which requires the drainage bag to be positioned lower than the bladder to prevent urine from flowing back into the bladder. The resident, who had a history of hypertension, cerebral infarction, diabetes mellitus, and atherosclerotic heart disease, was at risk due to this improper handling of the Foley catheter. Interviews with the wound care nurse and the Director of Nursing (DON) confirmed the improper placement of the Foley bag. The wound care nurse acknowledged that the bag should be below the bladder level to allow urine to drain by gravity, and the DON stated that placing the bag on the bed could cause urine to flow backward, potentially leading to infection. The facility's policy on catheter care, dated 2001, emphasizes maintaining unobstructed urine flow by positioning the drainage bag lower than the bladder at all times.
Failure to Adhere to Oxygen Administration Orders
Penalty
Summary
The facility failed to provide appropriate respiratory care for two residents, Resident #10 and Resident #11, by not setting their oxygen concentrators according to physician orders. Resident #10, a female with respiratory failure and chronic obstructive pulmonary disease, was observed with her oxygen concentrator set at 4 liters per minute (LPM), contrary to the physician's order of 2-3 LPM. The Licensed Vocational Nurse (LVN) on duty admitted to not checking the oxygen setting upon starting his shift and was unaware of the correct setting, indicating a lack of adherence to the physician's order and facility protocol. Similarly, Resident #11, a male with dyspnea and chronic obstructive pulmonary disease, had his oxygen concentrator set at 6 LPM, exceeding the physician's order of 3-4 LPM. The LVN acknowledged the incorrect setting and mentioned that the resident's friend often changed the setting, which was known to the staff. Despite this, the LVN did not report the issue to the Director of Nursing (DON) and had not checked the oxygen setting since starting his shift, citing a high workload as the only nurse for 35 residents. Interviews with the DON and Assistant Director of Nursing (ADON) revealed that the facility's expectation was for nurses to verify oxygen settings according to physician orders and make regular rounds to ensure compliance. The DON and ADON emphasized the importance of following physician orders for oxygen administration and the potential negative outcomes of incorrect settings, although specific outcomes were not detailed. The facility's policy on oxygen administration requires verification of physician orders, which was not adhered to in these cases.
Medication Administration Error Due to Documentation Failure
Penalty
Summary
The facility failed to provide pharmaceutical services that ensured the accurate administration of medications for a resident, leading to a potential double dosing incident. A Registered Nurse (RN) administered the resident's morning medications before the resident's dialysis session but failed to document the administration in the electronic medication administration record (EMAR). Consequently, a Licensed Vocational Nurse (LVN) attempted to administer the same medications again, unaware that they had already been given. The resident involved was a cognitively intact male with a history of end-stage renal disease, atrial fibrillation, and hypertension, among other conditions. On the day of the incident, the resident was scheduled for dialysis at 6:00 a.m. and had received his medications from the RN around 5:00 a.m. due to high blood pressure. However, the RN did not record this administration, leading the LVN to believe the medications had not been given when she began her shift at 6:30 a.m. Interviews with the staff revealed that the RN was aware of the importance of documenting medication administration to prevent double dosing but failed to do so due to being rushed. The Director of Nursing (DON) confirmed that the facility's policy required medications to be administered within one hour of their prescribed time and that the staff member administering the medication should be the one to document it. The oversight in documentation could have resulted in the resident receiving a double dose of his medications, which he fortunately avoided by being alert and refusing the second administration.
Improper Garbage Disposal Due to Unsecured Dumpster Door
Penalty
Summary
The facility failed to ensure the proper disposal of garbage and refuse by not securing the door of a commercial-sized dumpster. During an observation and interview, it was noted that the dumpster was one-quarter full of garbage, and the door on the right side was wide open. A staff member confirmed that the dumpster door should remain closed to prevent bugs from entering. The Dietary Manager also stated that the dumpster door should remain closed for infection control purposes and to deter pests. The Administrator acknowledged that while staff made efforts to keep the dumpster closed, including conducting multiple monthly in-services on infection control and having the Dietary Manager check the dumpster at the start of his shift, the door was found open. The Administrator also noted that multiple sources outside of facility staff had access to the dumpster, but ultimately, it was the facility's responsibility to ensure it remained closed. A review of the facility's policy on garbage and refuse disposal, revised in October 2021, indicated that outside dumpsters should be kept closed and free of surrounding litter.
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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 Houston
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| University Place Nursing Center | 0.7 mi | — | 0 | 0 |
| Seven Acres Jewish Senior Care Services | 1.7 mi | — | 2 | 0 |
| Clarewood House Extended Care Center | 1.8 mi | — | 2 | 0 |
| Sharpville Residence And Rehabilitation Center | 2 mi | — | 0 | 0 |
| Focused Care At Westwood | 2.2 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.