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 Rambling Oaks Courtyard Extensive Care Community during CMS and state inspections, most recent first.
A resident with COPD and moderate cognitive impairment was found self-administering a nasal spray without a physician's order or assessment for self-administration. The medication was kept at bedside and used without staff knowledge, and there was no documentation or process in place to ensure safe medication management. Staff and administration confirmed that facility policy requires medications to be administered by licensed personnel and only with a physician's order.
Surveyors found that medications, including a nasal spray and zinc oxide barrier creams, were left unsecured in the rooms of three residents with cognitive impairments. Staff interviews confirmed that these medications should have been stored in locked carts or otherwise secured, but they were left accessible on side tables after use, contrary to facility policy and professional standards.
A resident with respiratory failure and other complex conditions received oxygen therapy without a current physician order, as staff relied on an outdated order from a previous admission. The error was not identified during admission or order transcription, and the resident's care plan noted confusion and frequent removal of the nasal cannula, requiring ongoing redirection. Facility leadership and staff acknowledged the oversight and the importance of following current orders.
A resident with Parkinson's disease and bed confinement did not receive scheduled bed baths from October 1 to October 16, 2024, despite requiring total assistance for ADLs. The resident expressed dissatisfaction with the lack of care, preferring bed baths over mechanical lifts. Facility staff interviews revealed inconsistencies in documentation and care provision, with a CNA admitting to forgetting to complete shower forms. This failure risked skin breakdown and dignity concerns for the resident.
Two residents were found using scoop mattresses without physician orders or assessments, posing potential accident hazards. Staff believed the mattresses were therapeutic and did not require orders, contrary to facility policy.
The facility failed to provide proper respiratory care for three residents, leading to deficiencies in the storage and maintenance of respiratory equipment. A resident with COPD had an empty humidifier and an unbagged nebulizer mask, another receiving hospice care had a yankauer suction tip improperly stored, and a third with acute respiratory failure had a nasal cannula not in a sealed container. These issues were acknowledged by the attending LVNs, who admitted to neglecting proper storage protocols, risking cross-contamination and infection.
The facility failed to securely store medications for four residents, leaving items like zinc oxide and Miralax accessible on side tables and TV stands. This oversight posed risks of accidental ingestion, especially for residents with cognitive impairments. Staff interviews confirmed the expectation for secure storage, aligning with facility policy.
The facility's skilled nursing kitchen failed to meet food safety standards, with issues such as improperly sealed foods, an unclean ice machine, and unlabeled food items. During lunch service, a cleaning bucket was found empty, compromising sanitation. The Dietary Manager and Administrator acknowledged these deficiencies, which could lead to food contamination.
A LTC facility failed to maintain an effective Infection Prevention and Control Program, as evidenced by improper hand hygiene and glove use by staff. An LVN did not change gloves or sanitize hands after touching a trash can while administering ointment, and a CNA failed to sanitize hands and change gloves appropriately during incontinent care. These actions could lead to cross-contamination and infection.
A facility failed to accurately assess a resident's impairment, specifically a contracture in the right hand, in the MDS Assessment. Despite the resident's diagnosis of joint contracture and observations by staff, the assessment did not reflect this impairment. The MDS Nurse initially did not recognize the contracture as an impairment, but later acknowledged the oversight. The DON and ADON stressed the importance of accurate assessments for proper care planning.
A facility failed to implement a comprehensive care plan for a resident with a colostomy, despite having a physician's order for ostomy care. The resident, diagnosed with systemic lupus erythematosus, did not have a care plan addressing her colostomy, which was confirmed through observations and staff interviews. The oversight was acknowledged by the MDS Nurse and other staff, highlighting the importance of care plans in ensuring consistent and appropriate care.
A facility failed to provide appropriate colostomy care for a resident due to the absence of comprehensive physician orders. The resident, with a history of systemic lupus erythematous, had a colostomy but lacked a care plan addressing her needs. The only order was to change the colostomy bag twice a week, with no instructions for routine emptying or stoma examination. Interviews with staff confirmed the absence of necessary orders, which could lead to missed care. The facility's policy requires all treatments to have corresponding orders, highlighting the deficiency.
A resident with dementia and on hospice care fell from her bed, suffering a hip fracture. Despite cries of pain and verbal indications of leg pain, the facility failed to promptly notify the physician and responsible party, delaying medical intervention. The resident was later hospitalized with multiple complications.
Failure to Ensure Safe Medication Administration and Oversight
Penalty
Summary
A deficiency occurred when a resident with chronic obstructive pulmonary disease and moderate cognitive impairment was found to be self-administering a nasal spray medication without a physician's order or an assessment for self-administration. The resident kept the nasal spray on his side table and used it regularly without informing the nursing staff. There was no documentation in the resident's records of an order for the nasal spray, nor any assessment to determine the resident's competency to self-administer medications. During medication administration rounds, a nurse did not notice the nasal spray in the resident's room and was unaware that the resident was self-administering it. The nurse later acknowledged that medications should not be kept in residents' rooms and that she was unsure if the resident was permitted to self-administer any medication. The Director of Nursing confirmed that medications should be administered by nurses and that a physician's order is required. The facility's policies also require that all medications be administered by licensed personnel and only upon written physician orders. Interviews with staff and the administrator revealed that there was no process in place to ensure that residents were not keeping medications at bedside or self-administering without proper assessment and orders. The administrator stated that residents should not self-administer medications unless assessed as competent, and that staff are expected to check for medications in residents' rooms. The facility's failure to follow these procedures led to the resident self-administering a medication without oversight.
Failure to Secure Medications and Biologicals in Locked Storage
Penalty
Summary
The facility failed to ensure that medications and biologicals were properly stored in locked compartments or otherwise secured, as required by professional standards. During observations, surveyors found that a nasal spray belonging to a male resident with moderate cognitive impairment and chronic obstructive pulmonary disease was left on the resident's side table in his room. There was no physician's order for the nasal spray, no assessment for self-administration, and no documentation indicating the resident was competent to manage his own medications. The nasal spray was accessible to the resident and not secured as required. Additionally, a female resident with severe cognitive impairment and protein-calorie malnutrition was observed with a tube of zinc oxide left on her side table. The resident was unable to communicate clearly, and staff assigned to her care did not notice the medication was left at bedside. The physician's order indicated the barrier cream was to be applied as needed, but it was not secured after use. Similarly, a male resident with moderate cognitive impairment and incontinence was found with a tube of zinc oxide on his side table. The staff member responsible for his care could not recall if she had put the cream away after use, and the medication was left accessible in the resident's room. Interviews with staff, including CNAs, an LVN, the DON, and the Administrator, confirmed that medications such as nasal sprays and zinc oxide should not be left in resident rooms and should be stored in locked carts or otherwise secured. The facility's policy also required medications to be stored in a locked medication room or secured after administration. The failure to secure these medications resulted in them being left in plain view and accessible to residents, contrary to facility policy and professional standards.
Failure to Ensure Current Physician Order for Oxygen Administration
Penalty
Summary
The facility failed to ensure that a resident requiring respiratory care received such care in accordance with professional standards, the comprehensive care plan, and the resident's goals and preferences. The resident, who had diagnoses including acute respiratory failure, pneumonia, thrombocytopenia, and chronic atrial fibrillation, was admitted with a need for supplemental oxygen. The baseline care plan indicated the resident was confused, removed the nasal cannula, and required frequent redirection for oxygen therapy. However, the facility did not have a current physician's order for oxygen administration during the resident's stay. The only available order was from a previous admission, and staff administered oxygen based on this outdated order. Interviews with nursing staff and facility leadership revealed that the outdated order was mistaken for a current one due to similar admission dates, and the discrepancy was not identified during the admission or order transcription process. The Director of Nursing and other staff acknowledged the importance of verifying and following current physician orders, but the oversight resulted in the resident receiving oxygen therapy without a valid, current order. The facility's policy required medications and treatments to be administered as prescribed, but this was not followed in this instance.
Failure to Provide Scheduled Bed Baths for a Resident
Penalty
Summary
The facility failed to provide necessary assistance with activities of daily living (ADL) for a resident who required total assistance due to conditions such as Parkinson's disease and bed confinement. Specifically, the facility did not ensure that the resident received scheduled bed baths from October 1, 2024, to October 16, 2024. The resident, who had a moderate cognitive impairment, expressed dissatisfaction with not receiving her scheduled bed baths, which were supposed to occur on Mondays, Wednesdays, and Fridays. She preferred bed baths over mechanical lifts and reported feeling unclean due to the missed baths. Interviews with facility staff, including an LVN, ADON, and CNA, revealed inconsistencies in the documentation and provision of care. The LVN and ADON believed the resident had received her scheduled bed baths, but acknowledged the lack of documentation. The CNA admitted to forgetting to complete the shower forms and was unsure of the exact dates when the resident received her bed baths. The facility's policy required documentation of all showers or refusals, but this was not adhered to, leading to a risk of skin breakdown and dignity concerns for the resident.
Failure to Obtain Physician Orders for Scoop Mattresses
Penalty
Summary
The facility failed to ensure that the environment for two residents was free from accident hazards by not obtaining physician orders or assessments for the use of scoop mattresses. Resident #12, a cognitively intact female with a history of falling, and Resident #30, a female with moderately impaired cognition and a moderate risk of falling, were both observed using scoop mattresses without the necessary physician orders or assessments. The scoop mattresses had raised sides, which could pose a risk if the residents attempted to get out of bed. Interviews with facility staff, including an LVN, the ADON, and the DON, revealed a misunderstanding regarding the requirement for physician orders and assessments for therapeutic mattresses. The staff believed that since the mattresses were considered therapeutic, they did not require physician orders or assessments. However, the absence of these assessments could result in the residents injuring themselves, as confirmed by the staff. The facility's policy on medication and treatment orders, dated July 2016, requires that orders for treatments be consistent with safe and effective order writing, which was not adhered to in this case.
Improper Storage and Maintenance of Respiratory Equipment
Penalty
Summary
The facility failed to provide proper respiratory care for three residents, leading to deficiencies in the storage and maintenance of respiratory equipment. Resident #2, diagnosed with chronic obstructive pulmonary disease, was observed with an empty humidifier bottle on his oxygen concentrator and a nebulizer breathing mask improperly stored in a drawer without a protective bag. The resident was unaware of these issues, and the attending LVN admitted to neglecting to bag the mask and refill the humidifier, acknowledging the risk of cross-contamination and respiratory infection. Resident #5, who was receiving hospice care for encephalopathy, had a yankauer suction tip improperly stored on a table rather than in a protective bag. The LVN responsible for the resident's care admitted to not noticing the improperly stored yankauer and acknowledged that it should have been bagged to prevent contamination. The yankauer was discarded as it was considered dirty due to improper storage. Resident #15, diagnosed with acute respiratory failure with hypoxia, had a nasal cannula coiled on her bed instead of being stored in a sealed container. The LVN responsible for her care was unsure why the nasal cannula was not properly stored and recognized the risk of infection due to improper storage. The facility's policies on oxygen administration and infection prevention were not followed, leading to potential risks for the residents involved.
Medication Storage Deficiency
Penalty
Summary
The facility failed to ensure the safe and secure storage of medications for four residents, leading to potential risks of accidental ingestion or misuse. Observations revealed that medications such as zinc oxide, Miralax, eye drops, and nasal spray were left on top of residents' side tables or TV stands, making them accessible to residents and visitors. This was particularly concerning given the cognitive impairments of some residents, such as Resident #1, who had a severe impairment in cognition due to metabolic encephalopathy. Resident #13, diagnosed with glomerular disease in systemic lupus erythematous, had stoma powder left on her side table, which was not included in her care plan for colostomy care. Similarly, Resident #14, with ulcerative proctitis and altered mental status, had zinc oxide left on her side table. Resident #35, who was cognitively intact but incontinent, had zinc oxide left on her TV stand, visible from the hallway. These medications were not stored in locked compartments as required, posing a risk of accidental ingestion or misuse. Interviews with staff, including LVNs and CNAs, confirmed that medications should not be left accessible and should be stored securely. The DON and ADON acknowledged the risk of adverse reactions if medications were ingested and emphasized the need for proper storage. The facility's policy on medication labeling and storage mandates that all medications be stored in locked compartments, which was not adhered to in these instances.
Food Safety and Sanitation Deficiencies in Kitchen
Penalty
Summary
The facility failed to adhere to professional standards for food service safety in its skilled nursing kitchen, as observed during a survey. Several deficiencies were noted, including improper sealing of foods in the refrigerator, inadequate cleaning of the ice machine, and failure to label and date food stored in the refrigerator and freezer. Specifically, the ice machine had rust on the inside door hinges and dark stains with mineral deposits on the inside walls. Various food items, such as a stainless-steel container of sauce, cut-up melons, gluten-free bagels, onion rings, frozen carrots, and mixed vegetables, were found without stored dates. Additionally, a large box of frozen catfish was not sealed properly, exposing it to airborne contaminants. During lunch service, it was observed that the cleaning/sanitizing bucket under the serving table was empty, containing only a dried-up cloth, which compromised the cleanliness of the serving area. Interviews with the Dietary Manager and the Administrator revealed that the cooks were responsible for labeling and dating foods, and everyone was expected to ensure foods were covered and sealed. The Dietary Manager acknowledged the condition of the ice machine and the oversight regarding the cleaning bucket. Both the Dietary Manager and the Administrator recognized that these issues could lead to food contamination, as per the facility's policies and FDA guidelines.
Infection Control Lapses in LTC Facility
Penalty
Summary
The facility failed to maintain an effective Infection Prevention and Control Program, as evidenced by the actions of LVN A and CNA C, which could lead to cross-contamination and infection. LVN A did not change her gloves or perform hand hygiene after touching a trash can while administering ointment to a resident's nose. This oversight occurred despite LVN A acknowledging that the trash can was dirty and her actions could cause cross-contamination. CNA C also failed to adhere to proper infection control practices while providing incontinent care to another resident. She did not sanitize her hands after removing gloves and before putting on new ones, nor did she change gloves before handling a new brief after cleaning the resident. These lapses in hand hygiene and glove use were acknowledged by CNA C, who admitted that her actions could result in cross-contamination and infection. Additionally, LVN A did not perform hand hygiene when changing gloves during wound care for the same resident. This was attributed to being in a hurry, but LVN A recognized the importance of hand hygiene in preventing cross-contamination. The facility's policies on hand hygiene and perineal care emphasize the necessity of handwashing and glove changes to prevent infections, which were not followed in these instances.
Inaccurate Assessment of Resident's Impairment
Penalty
Summary
The facility failed to ensure that assessments accurately reflected the status of a resident, specifically regarding an impairment in the resident's right upper extremity. The resident, an elderly female, was admitted with a diagnosis of unspecified joint contracture, which affects the muscles and joints, causing them to stiffen. Despite this, the resident's Comprehensive MDS Assessment did not indicate any impairment in the upper extremity, contradicting other documentation and observations. Observations and interviews revealed that the resident had a contracture in her right hand, which was consistently noted by various staff members, including a Licensed Vocational Nurse (LVN), a Certified Nursing Assistant (CNA), and a Physical Therapist (PT). The LVN observed the contracture while administering medication, and both the CNA and PT confirmed the presence of the contracture and its impact on the resident's functionality. The MDS Nurse initially did not consider the contracture as an impairment but later acknowledged it should have been recorded as such. The Director of Nursing (DON) and Assistant Director of Nursing (ADON) both emphasized the importance of accurate assessments to ensure appropriate care. They noted that the MDS should reflect the actual functionality of residents, and any impairments should be documented to avoid confusion in care provision. The facility's policy on comprehensive assessments also highlighted the need for accurate and standardized assessments to develop person-centered care plans.
Failure to Implement Comprehensive Care Plan for Resident with Colostomy
Penalty
Summary
The facility failed to develop and implement a comprehensive person-centered care plan for a resident with a colostomy, which was identified during a survey. The resident, a female with systemic lupus erythematosus, was admitted with a colostomy but did not have a care plan addressing this specific need. The absence of a care plan was confirmed through observations, interviews, and record reviews, indicating a lapse in ensuring the resident's medical, nursing, and psychosocial needs were met. During the survey, it was observed that the resident's colostomy care was not documented in her care plan, despite having a physician's order for changing the ostomy bag twice weekly and as needed. Interviews with the resident and staff, including an LVN and the MDS Nurse, revealed that the care plan for the colostomy was overlooked during the interdisciplinary team meeting. The LVN acknowledged the importance of a care plan to ensure consistent care, while the MDS Nurse admitted the oversight and emphasized the necessity of a care plan to guide staff in providing appropriate care. Further interviews with the DON, ADON, and the Administrator highlighted the expectation for all residents to have comprehensive care plans. They acknowledged the importance of care plans in coordinating care and ensuring that all staff members are informed about the specific needs and interventions required for each resident. The lack of a care plan for the resident's colostomy was recognized as a deficiency that could lead to missed care and services.
Lack of Physician Orders for Colostomy Care
Penalty
Summary
The facility failed to provide appropriate colostomy care for a resident, as evidenced by the lack of physician orders for comprehensive colostomy care. The resident, a female with a history of glomerular disease in systemic lupus erythematous, was admitted with a colostomy but did not have a care plan addressing her colostomy needs. The only existing order was to change the colostomy bag twice a week and as needed, with no orders for routine emptying, stoma examination, or skin assessment. This oversight was confirmed through interviews with the resident, a Licensed Vocational Nurse (LVN), the Director of Nursing (DON), and the Assistant Director of Nursing (ADON), all of whom acknowledged the absence of necessary orders. The deficiency was further highlighted by the facility's policy, which mandates that all treatments and medications must have corresponding orders recorded in the resident's chart. The DON and ADON admitted that the lack of orders could lead to missed care, as new staff might not be aware of the necessary treatments and assessments. The facility's failure to ensure proper documentation and orders for colostomy care placed the resident at risk of inadequate care, as there was no structured guideline for the staff to follow.
Failure to Notify Physician and Family of Resident's Condition Change
Penalty
Summary
The facility failed to promptly notify a resident's physician and responsible party following an accident and significant change in the resident's condition. The resident, who had a history of dementia and was on hospice care, fell from her bed and suffered a fracture of the right femoral neck. Despite exhibiting cries of pain and verbally indicating leg pain, the resident did not receive an X-ray until several days later, after a family member sent a video of her in distress to the hospice provider. This delay in medical intervention resulted in the resident being admitted to the hospital with a hip fracture, acute kidney injury, altered mental status, hypernatremia, hypoxic respiratory failure, and sepsis. The incident report completed by an RN noted that the resident was found on the floor beside her bed, which was in the lowest position. Initial assessments by facility staff did not reveal any visible injuries, and the resident was reported to be moving all extremities. However, subsequent observations by various staff members and a video recording by a family member indicated that the resident was in significant pain, particularly in her leg. Despite these signs, the facility staff failed to notify the physician or the responsible party about the resident's cries of pain and change in condition over the weekend. Interviews with facility staff revealed a lack of communication and documentation regarding the resident's condition. Several staff members, including LVNs and CNAs, noted the resident's pain and changes in behavior, but these observations were not adequately communicated to the physician or hospice provider. The facility's policy required notification of the physician and responsible party in the event of a significant change in condition, but this protocol was not followed, leading to a delay in the resident receiving appropriate medical care.
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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 Highland Village
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Hollymead | 2.5 mi | — | 2 | 0 |
| Cross Timbers Rehabilitation And Healthcare Center | 2.5 mi | — | 17 | 1 |
| Lake Village Nursing And Rehabilitation Center | 3.5 mi | — | 4 | 0 |
| Denton Rehabilitation And Nursing Center | 4.8 mi | — | 4 | 0 |
| Corinth Rehabilitation Suites On The Parkway | 5.3 mi | — | 18 | 0 |
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