Not rated by CMS — ratings are suppressed for new or low-volume facilities.
A standard survey is most likely before around September 2026
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 Park Manor Of Mckinney during CMS and state inspections, most recent first.
A resident with advanced dementia was admitted and, due to exit-seeking and agitated behaviors, was discharged the same day without receiving written notification of the discharge, reasons for the move, or information on appeal rights. The resident's representative and the Ombudsman were also not notified in writing, and the discharge process was handled verbally, contrary to facility policy.
A facility failed to maintain an effective Infection Prevention and Control Program, resulting in delayed isolation of a resident with C. Diff and staff non-compliance with PPE protocols. A resident tested positive for C. Diff but was not isolated until three days later, increasing the risk of infection spread. Additionally, staff entered isolation rooms without proper PPE or hand hygiene, further compromising infection control.
The facility failed to provide proper respiratory care for three residents, leading to deficiencies in infection control and equipment management. A resident's nebulizer mask was improperly stored, while two residents' nasal cannula tubing and humidity bottles lacked labeling and dating. These oversights increased the risk of infection, as confirmed by staff interviews and observations.
Two residents with severe cognitive impairments and mobility issues were found with inaccessible call lights, contrary to their care plans. One resident's call light was on the floor, and another's was behind a refrigerator, entangled with a light string. Staff interviews confirmed the importance of call lights for safety and communication, highlighting a failure to adhere to facility policy requiring call lights to be within reach.
The facility failed to provide a clean and homelike environment for three residents, as their privacy curtains were stained with brown substances. Despite reports from staff, the curtains were not replaced, posing a health risk. The housekeeping process for curtain replacement was inconsistent, leading to the continued use of unsanitary curtains.
A facility failed to accurately assess a resident's functional impairments, as the Quarterly MDS assessment did not reflect the resident's quadriplegia. Despite documentation in the Comprehensive Care Plan and Progress Notes, the MDS showed no impairments. Staff interviews confirmed the oversight, emphasizing the importance of accurate assessments for care planning. The facility's policy requires comprehensive assessments, but this was not adhered to, leading to potential confusion and inadequate care.
The facility failed to implement comprehensive care plans for two residents, one with a suprapubic catheter and another on Coumadin. The absence of these care plans was confirmed by staff, including the MDS Coordinator and DON, who acknowledged the oversight. The facility's policy requires care plans based on comprehensive assessments, which were not followed in these cases.
A resident with multiple medical conditions, including Alzheimer's and diabetes, was found with long, discolored fingernails, indicating a lack of proper nail care. Staff interviews revealed that nail care was typically performed during shower times, but there was no specific schedule, and CNAs were not allowed to clip nails for diabetic residents, leaving the task to LVNs. The DON stated that nail care should be provided daily, but there was no documentation of the resident refusing care, highlighting a potential infection control issue.
A resident with multiple stage III and IV pressure ulcers did not receive proper wound care due to the WCN's failure to perform hand hygiene and change gloves after cleaning each wound. Despite the facility's policy and professional standards requiring these actions, the WCN considered them unnecessary, leading to a deficiency in care.
A resident with dementia and other health issues experienced significant weight fluctuations, and the facility failed to obtain her weight as ordered by the physician. Despite being aware of the resident's weight loss and the need for weekly monitoring, an LVN did not complete the task and falsely documented it as done. The ADON, DON, and Administrator acknowledged the oversight and the potential risk to the resident's health.
Two residents did not receive timely re-orders of their medications, Eliquis and Gabapentin, due to staff oversight. The facility's policy of re-ordering medications seven days in advance was not followed, leading to reliance on emergency kits. Staff interviews confirmed the expectation of timely re-ordering to ensure residents' medical needs are met.
A resident with dementia and other health issues experienced significant weight fluctuations, and the facility failed to accurately document her weight as per physician orders. The responsible LVN did not obtain the weight and falsely documented it as completed. The ADON and DON were unaware of the oversight, highlighting a lapse in monitoring and documentation, posing a risk to the resident's health.
Failure to Provide Written Discharge Notification and Ombudsman Notice
Penalty
Summary
The facility failed to provide written notification to a resident and the resident's representative prior to a transfer or discharge, as well as failed to send a copy of the notice to the State Long-Term Care Ombudsman. The resident, a male with a diagnosis of major neurocognitive disorder due to vascular disease and a history of dementia and seizures, was admitted to the facility with his family present. Upon admission, the resident exhibited confusion, exit-seeking behaviors, and agitation, repeatedly expressing a desire to leave and attempting to exit the building. Staff attempted reality orientation and contacted the family, but the resident's behaviors escalated, including threats to break out of the facility. The administrator instructed staff to contact the family to pick up the resident, citing the facility's inability to meet his needs due to the lack of a secured unit. Documentation revealed that the resident's face sheet was incomplete, lacking key admission and discharge information. There was no evidence in the clinical record that the resident, his power of attorney, or the Ombudsman were notified in writing of the discharge or the reasons for it. Interviews with staff and the resident's family confirmed that no written discharge information, including appeal rights or Ombudsman contact information, was provided. The family was verbally informed to pick up the resident, and upon arrival, they transported him to a hospital due to his agitation, after which he was transferred to a behavioral health hospital. The facility's own policy requires that residents not be transferred or discharged unless appropriate criteria are met, and that written notice be provided to the resident, their representative, and the Ombudsman, including information on appeal rights. In this case, the required written notifications and documentation were not completed, and the discharge process was handled verbally and without adherence to policy requirements.
Infection Control Deficiency Due to Delayed Isolation and PPE Non-Compliance
Penalty
Summary
The facility failed to maintain an effective Infection Prevention and Control Program, resulting in the delayed isolation of a resident who tested positive for Clostridioides difficile (C. Diff). The resident, who had a history of urinary and bowel incontinence and was cognitively intact, tested positive for C. Diff on April 19, 2024, but was not placed in isolation until April 22, 2024. During this period, the resident experienced multiple episodes of diarrhea and was not informed of her infection until April 22, 2024, when she was also started on antibiotic treatment. The delay in isolation and treatment potentially increased the risk of spreading the infection to other residents. Additionally, the facility staff, including an LVN and a nurse aide, failed to adhere to proper infection control protocols while caring for residents on contact isolation. On April 23, 2024, these staff members entered the isolation room of two residents without donning appropriate personal protective equipment (PPE) or performing hand hygiene. This lapse in protocol occurred despite the presence of isolation signs and PPE supplies outside the room. The staff members acknowledged their failure to follow isolation protocols, which could have contributed to the spread of infection within the facility. Interviews with various staff members, including the ADON, CNA, and housekeeper, revealed a lack of awareness and adherence to isolation protocols. The facility's DON and Medical Director were not informed of the positive C. Diff result until several days after the test, indicating a breakdown in communication and timely response to infection control needs. The facility's failure to promptly isolate the resident and ensure staff compliance with infection control measures highlighted significant deficiencies in their infection prevention and control practices.
Deficiencies in Respiratory Care and Equipment Management
Penalty
Summary
The facility failed to provide proper respiratory care for three residents, leading to deficiencies in infection control and equipment management. Resident #15, a male with respiratory failure and moderate cognitive impairment, had his nebulizer mask improperly stored. The mask was found unbagged in a drawer, which could lead to contamination and infection. LVN A admitted to forgetting to bag the mask after use, acknowledging the importance of cleaning and storing it properly to prevent infection. Resident #20, a male with multiple diagnoses including respiratory failure, was observed using a nasal cannula without any label or date on the tubing and humidity bottle. This lack of labeling made it unclear when the equipment was last changed, posing a risk of infection. The resident was on continuous oxygen therapy and could not recall the last time the tubing was replaced. LVN K confirmed the absence of labeling and stated that night shift nurses were responsible for changing and dating the equipment weekly. Similarly, Resident #40, a female with heart failure and respiratory issues, was using a nasal cannula that was also not labeled or dated. The resident frequently used portable oxygen, and the lack of proper labeling could lead to lapses in infection control. The facility's policy required weekly replacement of oxygen equipment, but this protocol was not followed, as confirmed by the DON and ADON. The failure to adhere to these procedures increased the risk of infection for the residents.
Inaccessible Call Lights for Residents
Penalty
Summary
The facility failed to ensure the call light system was accessible to two residents, leading to a deficiency in accommodating their needs and preferences. Resident #3, an elderly female with severe cognitive impairment and a high risk for falls, was observed in her wheelchair with the call light on the floor under the bed, out of reach. The resident expressed that a CNA had forgotten to place the call light within her reach, which was a necessary intervention outlined in her care plan due to her fall risk and mobility issues. Similarly, Resident #46, also with severe cognitive impairment and decreased mobility, was found with her call light behind a small refrigerator, entangled with the string of an overhead light. The resident was unaware of the call light's location until a Respiratory Therapist discovered and repositioned it. This resident's care plan also required the call light to be within reach, highlighting a failure to adhere to the care plan and ensure the resident's ability to communicate needs effectively. Interviews with staff, including an LVN, Respiratory Therapist, ADON, DON, and the Administrator, confirmed the importance of call lights for resident safety and communication. They acknowledged the oversight and the potential risks associated with inaccessible call lights, such as falls and unmet needs. The facility's policy mandates that call lights be within residents' reach, which was not followed in these instances, leading to the deficiency noted in the report.
Failure to Maintain Clean and Sanitary Privacy Curtains
Penalty
Summary
The facility failed to maintain a safe, clean, comfortable, and homelike environment for three residents, as evidenced by the presence of stained and unsanitary privacy curtains in their rooms. Resident #18, a male with moderate cognitive impairment and multiple health issues, had privacy curtains stained with brown substances. Despite being bedridden and without a roommate, the resident's curtains were not clean, which was acknowledged by a nurse aide who noted the sanitary risk. Similarly, Resident #35, a female with moderate cognitive impairment and a history of stroke, had privacy curtains with dark and light brown smears. The resident was observed outside in a wheelchair, and the unsanitary condition of her room's curtains was noted during an inspection. Resident #52, a cognitively intact female with various health conditions, also had privacy curtains with dried brown stains. A CNA had reported the issue to a charge nurse weeks prior, but the curtains remained unchanged. Interviews with housekeeping staff revealed a lack of clarity and follow-through in the process of replacing dirty curtains. The Housekeeping Supervisor admitted awareness of some stained curtains but believed they had been addressed. Housekeepers were instructed to report dirty curtains to a specific housekeeper responsible for replacements, but the process was inconsistent, leading to the continued use of stained curtains. The facility's policy mandates a sanitary environment, yet the failure to replace stained curtains posed a health risk to residents.
Inaccurate Resident Assessment of Functional Impairments
Penalty
Summary
The facility failed to ensure that a resident received an accurate assessment reflective of their status, specifically regarding impairments to both upper and lower extremities. The resident, a male with a history of cerebral infarction, stiffness of unspecified joints, and muscle atrophy, was documented in the Quarterly MDS assessment as having no impairments in these areas. However, the resident's Comprehensive Care Plan and Progress Notes indicated quadriplegia, and observations confirmed the resident's inability to move his limbs. Interviews with facility staff, including an LVN, MDS Coordinator, ADON, DON, and PT, revealed a consensus that the resident's impairments should have been accurately reflected in the MDS assessment. The MDS Coordinator acknowledged the discrepancy and noted the importance of accurate assessments for determining the care needed by the resident. The ADON and DON emphasized the necessity of thorough assessments to ensure appropriate care planning and avoid confusion about the resident's needs. The facility's policy on Resident Assessment and Associated Processes mandates comprehensive and accurate assessments documented in the clinical health record. Despite this policy, the resident's functional limitations were not accurately coded, leading to potential confusion and inadequate care. The Administrator and PT reiterated the importance of accurate assessments for planning goals and interventions, highlighting the deficiency in the facility's assessment process.
Failure to Implement Comprehensive Care Plans for Residents
Penalty
Summary
The facility failed to develop and implement a comprehensive person-centered care plan for two residents, which was identified during a survey. Resident #12, a male with a urinary tract infection and neuromuscular dysfunction of the bladder, was admitted with a suprapubic catheter. However, his care plan, dated February 4, 2024, did not include catheter care. This omission was confirmed by LVN A, who noted the absence of a care plan for catheter care, which is essential for guiding staff on the necessary interventions. The MDS Coordinator acknowledged that the care plan should have been discussed during interdisciplinary meetings but was missed. Resident #117, a male with coronary heart disease, lung transplant, and tracheostomy, was admitted with an order for Coumadin, a blood thinner. Despite this, there was no care plan addressing the use of blood thinners. The MDS Coordinator admitted that an interdisciplinary team meeting to add Coumadin to the care plan was overlooked. The DON also confirmed that a care plan for Coumadin was necessary and did not know why it was missed. The facility's policy on comprehensive person-centered care planning, revised in January 2022, mandates that the interdisciplinary team develop a care plan for each resident based on their comprehensive assessment. The lack of care plans for catheter care and Coumadin use for the two residents indicates a failure to adhere to this policy, potentially impacting the quality of care provided to the residents.
Failure to Provide Adequate Nail Care for Resident
Penalty
Summary
The facility failed to provide necessary services for a resident who was unable to carry out activities of daily living, specifically in maintaining good grooming and personal hygiene. The deficiency was observed in a resident who required substantial assistance with personal hygiene due to multiple medical conditions, including Alzheimer's disease and diabetes. The resident was found with long, discolored fingernails, indicating a lack of proper nail care. Interviews with staff revealed that nail care was typically performed during shower times, but there was no specific schedule for this care. It was noted that CNAs were not permitted to clip nails for diabetic residents, leaving the responsibility to LVNs. The Director of Nursing (DON) stated that nail care should be provided daily, especially during shower times, and that both CNAs and LVNs were responsible for this task. However, there was no clear documentation of whether the resident had refused nail care, and the DON acknowledged that long and dirty fingernails could pose an infection control issue. The facility's policy indicated that necessary services for grooming and personal hygiene should be provided by qualified staff if a resident is unable to perform these activities themselves.
Failure in Wound Care Hygiene Practices
Penalty
Summary
The facility failed to provide necessary treatment and services consistent with professional standards of practice for a resident with pressure ulcers, leading to a deficiency in care. The resident, a male in a persistent vegetative state with chronic respiratory failure and brain damage, had two stage III and two stage IV pressure ulcers. During wound care, the Wound Care Nurse (WCN) did not perform hand hygiene or change gloves after cleaning each wound, which is contrary to the facility's policy and professional standards. This oversight was observed during a wound care session, where the WCN prepared supplies, removed soiled dressings, cleaned the wounds, applied treatment, and dressed the wounds without changing gloves or performing hand hygiene after cleaning each wound. The WCN justified her actions by stating that it was a clean procedure and did not require hand hygiene or glove changes. However, the Director of Nursing (DON) confirmed that the WCN was expected to perform hand hygiene and change gloves after cleaning wounds. The facility's policy on Skin and Wound Monitoring and Management emphasizes promoting healing and preventing infection, which includes proper hand hygiene and glove changes. The report also references a guideline from an external source that outlines the steps for changing a wound dressing, which includes washing hands and changing gloves after cleaning a wound.
Failure to Monitor Resident's Weight as Ordered
Penalty
Summary
The facility failed to ensure that a resident maintained acceptable parameters of nutritional status, as evidenced by the failure to obtain the resident's weight per physician order. The resident, a female with dementia, dysphagia, GERD, and malaise, was severely cognitively impaired and totally dependent on staff for eating and other activities. Her weight had fluctuated significantly over several months, with a notable weight loss from 169.2 pounds in September 2023 to 145 pounds in April 2024. Despite physician orders for weekly weight monitoring, the resident's weight was not obtained as required, which could place her at increased risk of further decline in nutritional status and overall health. Interviews with facility staff, including an LVN, ADON, DON, and the Administrator, revealed awareness of the resident's weight loss and the physician's order for weekly weights. However, the LVN responsible for obtaining the weight admitted to not completing the task and falsely documenting that it was done. The ADON and DON acknowledged the failure to follow physician orders and the potential risk it posed to the resident's health. They also noted that the task of weighing residents was typically delegated to an aide, but it was ultimately the nurse's responsibility to ensure it was completed. The Administrator confirmed the expectation that resident nurses ensure weights are obtained and recognized the risk to resident health and wellness if weight loss is not identified and addressed. Despite requests, the facility's policy related to the deficient practice was not provided before the exit of the surveyors.
Failure to Re-Order Medications Timely for Two Residents
Penalty
Summary
The facility failed to ensure that two residents were provided with medications and pharmaceutical services to meet their needs. Resident #3, a female with a history of transient cerebral ischemic attack and severe cognitive impairment, was on anticoagulant therapy with Eliquis 2.5 mg. During medication preparation, it was discovered that the medication was not re-ordered in a timely manner, leading to the use of an emergency kit to administer the dose. The medication aide admitted to not re-ordering the medication when it was running low, which was confirmed by the electronic medication administration record (eMAR). Resident #46, a female with severe cognitive impairment and osteoarthritis, was prescribed Gabapentin 300 mg for pain management. During medication preparation, it was noted that the blister pack contained only one capsule, and no additional supply was available. The medication aide acknowledged the failure to re-order the medication, which was also confirmed by the eMAR. The facility's policy required medications to be re-ordered seven days in advance to ensure an adequate supply, but this procedure was not followed. Interviews with staff, including the LVN, ADON, DON, and Administrator, highlighted the expectation that medications should be re-ordered in a timely manner to prevent residents from running out of necessary medications. The emergency kit was intended for emergencies or new orders, not for routine re-ordering failures. The staff acknowledged the oversight and the potential impact on residents' health if medications were not administered as prescribed.
Failure to Accurately Document Resident's Weight
Penalty
Summary
The facility failed to maintain accurate and complete medical records for a resident, identified as Resident #51, which is a violation of accepted professional standards. Resident #51, a female with dementia, dysphagia, GERD, and malaise, was admitted to the facility in April 2022. Her medical records showed significant weight fluctuations over several months, with a notable weight loss from 169.2 pounds in September 2023 to 145 pounds in April 2024. The resident's care plan included monitoring her weight weekly due to her risk of weight loss and other health issues. On April 25, 2024, it was discovered that the resident's weight was not documented for the previous day, despite a physician's order for weekly weight checks every Wednesday. LVN Z, responsible for obtaining the weight, admitted to not having checked the resident's weight and falsely documented that it was completed. The ADON and DON were unaware of the oversight until it was brought to their attention, and both acknowledged the importance of accurate documentation and the potential risk to the resident's health if weight monitoring was not conducted as ordered. The facility's failure to ensure accurate documentation and adherence to physician orders for Resident #51's weight monitoring posed a risk to her health and wellness. The administrator confirmed the responsibility of the nursing staff to ensure weights were obtained and documented correctly. Despite requests, the facility's policy related to this deficient practice was not provided before the survey exit.
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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 Mckinney
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| North Park Health And Rehabilitation Center | 0.9 mi | — | 0 | 0 |
| Belterra Health & Rehab | 3 mi | — | 0 | 0 |
| Mckinney Healthcare And Rehabilitation Center | 3.5 mi | — | 1 | 0 |
| Princeton Medical Lodge | 6.5 mi | — | 5 | 0 |
| The Belmont At Twin Creeks | 7.6 mi | — | 3 | 0 |
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