Inspection visit
Inspection
2 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 2 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0584
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited
to receiving treatment and supports for daily living safely.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, interview, and record review, the facility failed to ensure residents have a right to a safe, clean,
comfortable, and homelike environment for 4 of 89 residents (Resident #1, and Resident #2, Resident #3,
and Resident #4 reviewed for safe, clean, and comfortable environment.
The facility failed to repair water damage to the wall and ceiling, in two rooms in which there were occupied
by Residents #1, #2, #3 and #4. 2 residents in each room.
This deficient practice failure could place residents at risk of a diminished quality of life due to exposure to
an environment that is unpleasant, unsanitary, and unsafe.
The findings included:
1) Record review of Resident #1's admission Record, dated 10/16/2024, reflected she was a [AGE] year old
female, initially admitted on [DATE], with diagnoses of dementia (a general term for loss of memory,
language, problem-solving and other thinking abilities that are severe enough to interfere with daily life),
psychotic disorder with delusions (a mental disorder characterized by a disconnection from reality in which
the person cannot tell what is real from what is imagined), spastic hemiplegia cerebral palsy (uncontrolled
or involuntary muscle movements that affects one side of the body).
Record review of Resident #1's Annual MDS dated [DATE], reflected Resident #1 had a BIMS score of 12
which suggests moderate cognitive impairment. Resident #1 was occasionally incontinent of bowel and
frequently incontinent of bladder according to section H in the MDS.
Record review of Resident #1's Care Plan, dated 07/24/2024, revealed, she had chest x-ray results on
07/29/2024 with diagnosis of pneumonia with interventions.
2) Record review of Resident #2's admission Record, dated 10/16/2024, reflected she was a 96- year old
female, initially admitted on [DATE], with diagnoses of dementia (a general term for loss of memory,
language, problem-solving and other thinking abilities that are severe enough to interfere with daily life),
Alzheimer's Disease (a progressive disease that destroys memory and other important mental functions),
and chronic obstructive pulmonary disease (a group of lung diseases that block airflow and make it difficult
to breathe).
Record review of Resident #2's Quarterly MDS dated [DATE], reflected Resident #2 had a BIMS score of
03 which suggests severe cognitive impairment.
(continued on next page)
Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other
safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the
date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date
these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER
REPRESENTATIVE'S SIGNATURE
TITLE
(X6) DATE
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Facility ID:
If continuation sheet
Page 1 of 18
Event ID:
455802
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
455802
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/17/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Spanish Meadows
440 E Ruben Torres Blvd
Brownsville, TX 78520
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0584
Record review of Resident #2''s Care Plan, dated 08/25/2024, revealed
Level of Harm - Minimal harm
or potential for actual harm
FOCUS: I am at risk for SOB and congestion as I have Dx. Of SOB, allergic rhinitis, COPD, and episodes of
cough.
Residents Affected - Few
GOALS: no episodes of shortness of breath daily by next review.
INTERVENTIONS/TASKS: o ADMINISTER ADVAIR DISKUS AS PER ORDERS RN/LVN MED-A o
ALBUTEROL PER MD ORDER RN/LVN o BENZONATATE PER MD ORDER RN/LVN o CHEST XRAY Q
YEAR IN OCTOBER TO RULE OUT TB RN/LVN o GUAIFENESIN PER MD ORDER RN/LVN o
MEDICATION AS ORDERED: RN/LVN o ADMINISTER NEBULIZER TREATMENTS AS ORDERED:
RN/LVN o HAVE O2 AVAILABLE IF NEEDED RN/LVN o LABS AND X-RAYS AS ORDERED AND
REPORT RESULTS TO MD RN/LVN o MONITOR FOR CONGESTION OR ELEVATED TEMPERTURE
AND NOTIFY MD IF OCCURS RN/LVN o ENCOURAGE FLUIDS AND MONITOR SKIN TURGOR RN/LVN
CNA o ENCOURAGE RESIDENT TO BE OUT OF BED DAILY AND PARTICIPATE WITH EXERCISES
RN/LVN Physical Therapist CNA o NOTIFY MD IF O2 SATS DROP BELOW 90% RN/LVN o MONITOR
VITAL SIGNS AND NOTIFY MD OF ANY CHANGES RN/LVNo MONITOR FOR SOB/CONGESTION AND
ADMINISTER TREATMENTS AS ORDERED RN/LVN o PROVIDE ORAL/NASAL CARE AS NEEDED
RN/LVN CNA
Record review of Resident #3''s admission Record, dated 10/16/2024, reflected she was a [AGE] year-old
female, initially admitted on [DATE], with diagnoses of wedge compression fracture of T11 -- T12 vertebra
(a type of spinal compression fracture that occurs when the front of the vertebra collapses, causing it to
take on a wedge shape) and type 2 diabetes mellitus.
Record review of Resident #3''s Quarterly MDS dated [DATE], reflected Resident #3 had a BIMS score of
12 which suggests moderate cognitive impairment.
Record review of Resident #3's Care Plan, dated 08/10/2024, reflected
FOCUS: o I'M AT RISK FOR INEFFECTIVE AIRWAY CLEARANCE RELATED TO ACCUMULATION OF
NASAL SECRETIONS SECONDARY TO INFLAMMATION OF THE SINUSES.
GOALS: o I WILL HAVE ADEQUATE LEVEL OF COMFORT AND RELIEF FROM RHINITIS SYMPTOMS
AS EVIDENCED BY EXPRESSING COMFORT AND EXHIBITING NO S/SX OR DECREASED S/SX
THROUGH NEXT REVIEW DATE IN 90 DAYS Target Date: 11/10/2024
INTERVENTIONS/TASKS: o I WILL HAVE ADEQUATE LEVEL OF COMFORT AND RELIEF FROM
RHINITIS SYMPTOMS AS EVIDENCED BY EXPRESSING COMFORT AND EXHIBITING NO S/SX OR
DECREASED S/SX THROUGH NEXT REVIEW DATE IN 90 DAYS Target Date: 11/10/2024.
4) Record review of Resident #4's admission Record, dated 10/16/2024, reflected she was a [AGE] year old
female, initially admitted on [DATE], with diagnoses of dementia (a general term for loss of memory,
language, problem-solving and other thinking abilities that are severe enough to interfere with daily life),
asthma (a condition in which a person's airways become inflamed, narrow and swell, and produce extra
mucus, which makes it difficult to breathe), and dependence on supplemental oxygen.
Record review of Resident #4's Quarterly MDS dated [DATE], reflected Resident #4 had a BIMS score of
00, which suggests severe cognitive impairment.
Record review of Resident #4's Care Plan, dated 09/22/2024, revealed,
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
455802
If continuation sheet
Page 2 of 18
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
455802
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/17/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Spanish Meadows
440 E Ruben Torres Blvd
Brownsville, TX 78520
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0584
Level of Harm - Minimal harm
or potential for actual harm
FOCUS: o I'M AT RISK FOR SOB, COUGH AND CONGESTION AS I HAVE DX: REACTIVE AIRWAY
DISEASE, (ASTHMA). I AM SHORT OF BREATH WHEN LYING FLAT
GOALS: o I WILL HAVE NO EPISODES OF SHORTNESS OF BREATH DAILY BY NEXT REVIEW IN 90
DAYS Target Date: 12/21/2024
Residents Affected - Few
INTERVENTIONS/TASKS: o ADMINISTER GUAIFENESIN PER MD ORDERS MED-A RN/LVN o HOB
ELEVATED WHEN IN BED DUE TO SHORTNESS OF BREATH WHEN LYING FLAT CNA RN/LVN o
CHECK SPO2 Q SHIFT AND NOTIFY MD IF O2 SATS DROP BELOW 90% RN/LVN o ELEVATE HEAD
OF BED AT LEAST 30-45 DEGREES AT ALL TIMES RN/LVN CNA o CHANGE OXYGEN TUBING AS
ORDERED RN/LVN o CLEAN OXYGEN CONCENTRATOR FILTERS AS ORDERED RN/LVN o ANNUAL
FLU AND PNEUMOVAX IF RESIDENT/FAMILY IN AGREEMENT RN/LVN
FOCUS: I HAVE CHRONIC KIDNEY DISEASE III AND I'M AT RISK FOR SHORTNESS OF BREATH,
CHEST PAIN AND ELEVATED BLOOD PRESSURE.
GOALS: o I WILL HAVE NO SOB, CHEST PAIN OR ELEVATED B/P DAILY BY NEXT REVIEW IN 90 DAYS
Target Date: 12/21/2024
INTERVENTIONS/TASKS: o URETHRAL STENT EXCHANGE BY DR. EWANE RN/LVN o DIET AND
MEDICATION AS ORDERED RN/LVN o DIETICIAN CONSULT AS NEEDED RN/LVN o ENCOURAGE
RESIDENT TO GET OUT OF BED DAILY AND EXERCISE RN/LVN CNA o GOOD PERSONAL HYGIENE
RN/LVN CNA o LAB AND X-RAY AS ORDERED RN/LVN o MONITOR FEET AND HANDS FOR EDEMA
RN/LVN CNA o MONITOR OUTPUT RN/LVN o NOTIFY MD IF RESIDENT IS C/O ITCHING RN/LVN o
NOTIFY MD IF SOB, CHEST PAIN, EDEMA OR ELEVATED B/P OCCUR RN/LVN.
During an observations and interview on 10/12/24 at 10:10 a.m., the ceiling in room where Resident #1 and
Resident #2 were, showed where there had been water damage around vent. The wall on the window side
showed water damage with bubbling and some black discoloration. The wall was dry. Resident #1, who was
in the room, stated she was moved to that room because they were fixing her other room because the
ceiling had leaked, and she was in that room for now and it also leaked. Resident #1 stated they had to
move her bed because she had gotten wet with the ceiling leaking on her. Resident #1 stated she had no
cough or illness. Resident stated she had no complaints or concerns.
In an observation and interview on 10/12/24 at 12:00 p.m., RN A and LVN B were sitting at nurse's station
on the north side of the building. RN A stated she only worked weekends and if it rained, the ceilings
leaked, but today it was not raining. LVN B stated she worked PRN and she had not noticed any leaking
except down North 10 -20 hallway.
In an interview on 10/12/24 at 04:20 p.m., LVN C stated none of her residents in the 30's hall had any new
onset respiratory issues and neither did staff that she knew of. LVN C stated there were no leaks on the
30's hallway that she knew of. She said she knew they were working on the other side of the building, but
that was all she knew. LVN C came back and reported discoloration on ceiling in room [ROOM NUMBER].
She said she had not noticed before.
In an interview on 10/12/24 at 04:25 p.m., Resident #3 in room stated the vent dripped from all four sides
and would get her sheets, blankets, and floor wet when it drizzled or rained outside. She said her bed was
moved so it did not get her wet. Resident stated she had not gotten sick from the water dripping. Resident
stated she had no complaints about anything.
In an interview on 10/12/24 at 04:36 p.m., LVN D stated he worked in 40's hall. LVN D stated he had
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
455802
If continuation sheet
Page 3 of 18
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
455802
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/17/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Spanish Meadows
440 E Ruben Torres Blvd
Brownsville, TX 78520
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0584
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
not seen any leaking or dripping from vents. He said he had mostly seen it in the dining room. LVN D stated
there was not a fear the ceiling would fall, but there was always that risk. LVN D stated none of his residents
had any acute respiratory problems.
In an interview on 10/12/24 at 05:30 p.m., the administrator said they had the roof replaced north to south.
The administrator stated they were going to have the whole roof replaced but were doing it in chunks. He
said the worst had been replaced. The administrator said they had not tested the vents. He said they
sprayed the black discoloration with Clorox and wiped it off. The administrator stated the water damage
started with Hurricane [NAME] back in June or July.
Record review on 10/13/24 at 01:30 p.m., the infection control mapping revealed there were no increases in
any respiratory infections from June through September.
Observation of facility on 10/16/24 at 09:23 a.m., revealed:
room [ROOM NUMBER]:
Water damage to ceiling with bubbled area above dresser.
Water damage to ceiling above A bed area.
Water damage to ceiling in corner on B bed side.
Water damage to wall on B bed side.
Black discoloration on wall by B bed.
Water damage below window.
Water damage with black discoloration to window sill and window frame.
Water damage to restroom ceiling.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
455802
If continuation sheet
Page 4 of 18
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
455802
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/17/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Spanish Meadows
440 E Ruben Torres Blvd
Brownsville, TX 78520
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0584
-
Level of Harm - Minimal harm
or potential for actual harm
Black discoloration to restroom ceiling and walls.
-
Residents Affected - Few
Black discoloration to vent in restroom.
room [ROOM NUMBER]:
Water damage to ceiling in room.
Black discoloration to vent and around vent in room.
Water damage to wall with black discoloration.
Black discoloration to restroom vent and ceiling.
In an interview on 10/16/24 at 02:05 p.m., Resident #1 was in another room, sitting on her bed. She said
they moved her to a new room. She said she does not think the room will rain on her. Resident #1 stated
the room seemed smaller than her other room.
In an interview on 10/16/24 at 02:10 p.m., Resident #2, who was the roommate to Resident #2, was in her
wheelchair in the hallway. Resident #2 had a dripping nose. When surveyor told Resident #2 would get a
CNA to wipe her nose, Resident #2 stated it was no problem and pulled her shirt up and wiped her nose.
Resident #2 stated, See? No problem. Resident stated she liked her new room because she was closer to
therapy. DON notified of Resident #2's dripping nose.
In an observation on 10/16/24 at 02:14 p.m., men were painting the ceilings of the dining room.
In an observation and interview on 10/16/24 at 02:15 p.m., Resident #3 in her room was lying in her bed
with head of bed elevated. Resident #3 stated they fixed her ceiling a couple days ago and so far it had not
dripped. Resident #3 stated it had not dripped on her, it had dripped on the floor. Resident #3 stated they
painted the ceiling, put a new vent in, and it had been perfect. Resident stated she had no complaints.
In an observation on 10/16/24 at 02:14 p.m., Resident #4, roommate of Resident #3, was sleeping on right
side with head of bed inclined. Resident #4 snoring lightly. Resident #4 not easily rousable. Rise and fall of
chest noted.
In an interview on 10/16/24 at 02:40 p.m., the administrator stated the gentleman who was doing the
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
455802
If continuation sheet
Page 5 of 18
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
455802
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/17/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Spanish Meadows
440 E Ruben Torres Blvd
Brownsville, TX 78520
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0584
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
testing (mold) was walking around with his maintenance man right now and had not been given the report
yet.
In an interview on 10/16/24 at 03:25 p.m., the DON stated they were putting orders in every resident's chart
for respiratory signs and symptoms. The DON notified of Resident #2's dripping nose. The DON went to
assess Resident #2 and said that was what they were looking for when they put the orders in to check for
respiratory signs and symptoms.
Observation on 10/17/24 at 10:25 a.m., room [ROOM NUMBER] no leakage noted from ceiling vent and
wall on window side after it had rained overnight.
In an observation on 10/17/24 at 10:27 a.m., room [ROOM NUMBER] had men working in room. The wall
was torn down on window side. Men were reinsulating pipes. Plastic barrier was up at the door.
In an observation and interview on 10/17/24 at 10:29 a.m. the room where Residents #3 and #4 were
located showed no leakage of rain from the night. Resident #3 and a FM stated there had been no leakage
from ceiling even though it rained. Resident #3 stated she was happy about it.
Record review of Visual Indoor Mold Inspection Report dated 10/16/24, revealed No visible suspected
Fungal Growth was identified on the Door Frames and Air Vents during the inspection.The maintenance
crew had been wet wiping the ceilings and door frames using a mold and mildew disinfectant and had
changed all air vents with new vents. All intake and return air vents showed no signs of any suspected
fungal growth and looked clean.
Record review of facility's Resident Rights Policy, Nursing Services Policy and Procedure Manual for
Long-Term Care 2001 MED-PASS, Inc. (Revised February 2021), revealed,
Policy Statement
Employees shall treat all residents with kindness, respect, and dignity.
Policy Interpretation and Implementation
1.
Federal and state laws guarantee certain basic rights to all residents of this facility. These rights include the
resident's right to:
a. a dignified existence;
b. be treated with respect, kindness, and dignity;
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
455802
If continuation sheet
Page 6 of 18
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
455802
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/17/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Spanish Meadows
440 E Ruben Torres Blvd
Brownsville, TX 78520
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0921
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and
the public.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, interview, and record review the facility failed to provide a safe, functional, sanitary, and
comfortable environment for 4 of 6 halls (Hall 1-10, 11-20, 21-30, room [ROOM NUMBER], and room
[ROOM NUMBER]) reviewed for environment.
The facility did not address moisture damage and discoloration around vents, ceilings and walls.
This failure could place residents at risk of not living in a safe, functional, sanitary, and comfortable
environment.
The findings included:
In an interview on 10/12/24 at 04:36 p.m., LVN D stated he worked in 40's hall. LVN D stated he had not
seen any leaks in the rooms however had seen it in the dining room. LVN D stated none of his residents
had any acute respiratory problems.
In an interview on 10/12/24 at 05:30 p.m., the administrator said they had the roof replaced north to south.
The administrator stated they were in the process of having the whole roof replaced but were doing it in
chunks. He added that the worst had been replaced. The administrator said the facility had been cleaning
the black discoloration as it was identified. The administrator stated the water damage started after
Hurricane [NAME] back in June or July.
Record review on 10/13/24 at 01:30 p.m., the infection control mapping revealed there were no increases in
any respiratory infections from June through September.
Observation with DON of facility on 10/16/24 at 09:23 a.m., revealed:
Women's restroom across from conference room:
Vents with black discoloration.
Men's restroom across from conference room:
Vents with black discoloration
room [ROOM NUMBER]:
Black discoloration on bathroom vent and beside vent.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
455802
If continuation sheet
Page 7 of 18
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
455802
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/17/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Spanish Meadows
440 E Ruben Torres Blvd
Brownsville, TX 78520
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0921
Water damage to ceiling in room.
Level of Harm - Minimal harm
or potential for actual harm
room [ROOM NUMBER]:
-
Residents Affected - Some
Water damage to ceiling in room painted over.
Black discoloration to vent in room.
Black discoloration to restroom ceiling.
room [ROOM NUMBER]:
Water damage to ceiling round area peeling from ceiling. Black discoloration seen under patch that was
peeling.
Vent in room with black discoloration.
Water damage under window.
Bathroom vent with black discoloration.
Black discoloration on walls below ceiling all the way around bathroom approximately 12 - 15 down from
ceiling.
room [ROOM NUMBER]:
Water damage to ceiling with bubbled area above dresser.
Water damage to ceiling above A bed area.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
455802
If continuation sheet
Page 8 of 18
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
455802
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/17/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Spanish Meadows
440 E Ruben Torres Blvd
Brownsville, TX 78520
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0921
-
Level of Harm - Minimal harm
or potential for actual harm
Water damage to ceiling in corner on B bed side.
-
Residents Affected - Some
Water damage to wall on B bed side.
Black discoloration on wall by B bed.
Water damage below window.
Water damage with black discoloration to window sill and window frame.
Water damage to restroom ceiling.
Black discoloration to restroom ceiling and walls.
Black discoloration to vent in restroom.
room [ROOM NUMBER]:
Black discoloration to vent in restroom.
Black discoloration to wall in restroom.
room [ROOM NUMBER]:
Water damage patched to ceiling in room. One spot black discoloration bleeding through.
room [ROOM NUMBER]:
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
455802
If continuation sheet
Page 9 of 18
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
455802
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/17/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Spanish Meadows
440 E Ruben Torres Blvd
Brownsville, TX 78520
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0921
-
Level of Harm - Minimal harm
or potential for actual harm
Water damage to ceiling patched.
-
Residents Affected - Some
Black discoloration to vent and beside vent.
room [ROOM NUMBER]:
Water damage patched to ceiling in room.
Vent with black discoloration.
Black discoloration to walls.
room [ROOM NUMBER]:
Hole in drywall under window.
Vent in room with black discoloration.
Vent in bathroom with black discoloration.
North side Nurse's restroom:
Vent with no cover and black discoloration.
Under sink with black discoloration.
Wall/ceiling with water damage painted over.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
455802
If continuation sheet
Page 10 of 18
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
455802
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/17/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Spanish Meadows
440 E Ruben Torres Blvd
Brownsville, TX 78520
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0921
North side Nurse's station:
Level of Harm - Minimal harm
or potential for actual harm
Black discoloration on ceiling.
Residents Affected - Some
room [ROOM NUMBER]:
Water damage to ceiling painted over.
room [ROOM NUMBER]:
Black discoloration on vent and around vent in room.
Black discoloration around restroom door that had been painted over and is bleeding through.
Black discoloration on walls in restroom.
Black discoloration on vent and around vent in restroom.
room [ROOM NUMBER]:
Water damage to ceiling
Black discoloration bleeding through paint in restroom.
Black discoloration on and around vent in restroom.
Hallway Rooms 1 - 9:
Vent with black discoloration.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
455802
If continuation sheet
Page 11 of 18
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
455802
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/17/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Spanish Meadows
440 E Ruben Torres Blvd
Brownsville, TX 78520
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0921
-
Level of Harm - Minimal harm
or potential for actual harm
Water damage around vent.
room [ROOM NUMBER]:
Residents Affected - Some
Black discoloration on vent.
Black discoloration to light in restroom.
room [ROOM NUMBER]:
Black discoloration to ceiling by window with water damage.
Water damage to windowsill and window frame.
Black discoloration to vent in room.
Water damage to restroom behind toilet.
room [ROOM NUMBER]:
Water damage to window with black discoloration to window frame.
Black discoloration to ceiling.
room [ROOM NUMBER]:
Water damage patched to ceiling.
room [ROOM NUMBER]:
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
455802
If continuation sheet
Page 12 of 18
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
455802
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/17/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Spanish Meadows
440 E Ruben Torres Blvd
Brownsville, TX 78520
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0921
-
Level of Harm - Minimal harm
or potential for actual harm
Patched painted water damage to ceiling.
room [ROOM NUMBER]:
Residents Affected - Some
Water damage to ceiling. Some areas patched and painted, some not patched.
room [ROOM NUMBER]:
Black discoloration on vent and around vent in room.
Water damage to windowsill.
Black discoloration to portable air conditioning vent to outside at window.
Water damage painted to wall in room by window.
Water damage pained to ceiling above window.
Vent with black discoloration in restroom.
Black discoloration on wall behind peeling floorboard in restroom.
room [ROOM NUMBER]:
No one in room. Used as storage. Water damage to ceiling. Patched.
room [ROOM NUMBER]:
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
455802
If continuation sheet
Page 13 of 18
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
455802
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/17/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Spanish Meadows
440 E Ruben Torres Blvd
Brownsville, TX 78520
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0921
No one in room. Room being painted.
Level of Harm - Minimal harm
or potential for actual harm
room [ROOM NUMBER]:
-
Residents Affected - Some
No one in room. Storage. Room being painted. Discoloration bleeding through paint under window.
Hallway outside room [ROOM NUMBER]:
Black discoloration on vent.
room [ROOM NUMBER]:
No one in room. Room being painted.
Black discoloration on and around vent.
Black discoloration on walls.
room [ROOM NUMBER]:
No one in room. Room being painted. Used as storage.
room [ROOM NUMBER]:
No one in room. Room being painted.
Black discoloration on and around vent.
room [ROOM NUMBER]:
No one in room. Room being painted.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
455802
If continuation sheet
Page 14 of 18
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
455802
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/17/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Spanish Meadows
440 E Ruben Torres Blvd
Brownsville, TX 78520
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0921
-
Level of Harm - Minimal harm
or potential for actual harm
Black discoloration behind removed floorboards.
-
Residents Affected - Some
Water damage under window being painted.
Assisted Dining Room:
Just painted.
Water damage to ceiling. Painted.
Discoloration to wall at ceiling.
Damaged area to doorsill.
Hallway from dining room to south side:
Black discoloration on vent and around vent.
room [ROOM NUMBER]:
Water damage painted on ceiling of room.
Black discoloration to ceiling/wall.
Vent with black discoloration and around vent.
Black discoloration around PVC venting in ceiling.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
455802
If continuation sheet
Page 15 of 18
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
455802
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/17/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Spanish Meadows
440 E Ruben Torres Blvd
Brownsville, TX 78520
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0921
room [ROOM NUMBER]:
Level of Harm - Minimal harm
or potential for actual harm
Water damage to ceiling in room.
Residents Affected - Some
Black discoloration to vent and around vent in room.
Water damage to wall with black discoloration.
Black discoloration to restroom vent and ceiling.
room [ROOM NUMBER] (Resident in room):
Water damage to wall under window.
Black discoloration to wall behind/beside bed.
Black discoloration along wall 12 - 15 deep below ceiling.
room [ROOM NUMBER]:
Water damage painted on walls by window.
Black discoloration on floorboard on window side.
Under restroom sink with black discoloration.
room [ROOM NUMBER]:
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
455802
If continuation sheet
Page 16 of 18
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
455802
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/17/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Spanish Meadows
440 E Ruben Torres Blvd
Brownsville, TX 78520
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0921
Water damage to ceiling. Painted over.
Level of Harm - Minimal harm
or potential for actual harm
Water damage to wall under window.
Residents Affected - Some
Black discoloration along floorboard under window.
Black discoloration on windowsill and window frame.
Vent with black discoloration.
Dining room:
Tape peeling at peak.
Black discoloration beside 2 new vents in ceiling.
Water damage to ceiling in the side dining room (white ceiling).
Black discoloration to ceiling in the side dining room (white ceiling).
Water damage to window area between main dining room and assisted dining room.
Vents with black discoloration in white dining room.
In an observation on 10/16/24 at 02:14 p.m., men were painting the ceilings of the dining room.
In an interview on 10/16/24 at 02:40 p.m., the administrator stated the gentleman who was doing the testing
(mold) was walking around with his maintenance man right now and had not been given the report yet.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
455802
If continuation sheet
Page 17 of 18
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
455802
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/17/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Spanish Meadows
440 E Ruben Torres Blvd
Brownsville, TX 78520
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0921
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
In an interview on 10/16/24 at 03:25 p.m., the DON stated they were putting orders in every resident's chart
for respiratory signs and symptoms. The DON notified of Resident #2's dripping nose. The DON went to
assess Resident #2 and said that was what they were looking for when they put the orders in to check for
respiratory signs and symptoms.
Observation on 10/17/24 at 10:25 a.m., room [ROOM NUMBER] no leakage noted from ceiling vent and
wall on window side after it had rained overnight.
In an observation on 10/17/24 at 10:27 a.m., room [ROOM NUMBER] had men working in room. The wall
was torn down on window side. Men were reinsulating pipes. Plastic barrier was up at the door.
Record review of Visual Indoor Mold Inspection Report dated 10/16/24, revealed No visible suspected
Fungal Growth was identified on the Door Frames and Air Vents during the inspection.The maintenance
crew had been wet wiping the ceilings and door frames using a mold and mildew disinfectant and had
changed all air vents with new vents. All intake and return air vents showed no signs of any suspected
fungal growth and looked clean.
Record review of facility's Resident Rights Policy, Nursing Services Policy and Procedure Manual for
Long-Term Care 2001 MED-PASS, Inc. (Revised February 2021), revealed,
Policy Statement
Employees shall treat all residents with kindness, respect, and dignity.
Policy Interpretation and Implementation
2.
Federal and state laws guarantee certain basic rights to all residents of this facility. These rights include the
resident's right to:
a. a dignified existence;
b. be treated with respect, kindness, and dignity;
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
455802
If continuation sheet
Page 18 of 18
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Back to topCitations
2 citations recorded*CMS
What do CMS severity letters mean?
Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.
General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.
Each letter combines severity with scope: how many residents the deficiency affected.
F584 - Safe Environment
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
F921 - Other Environmental Conditions
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
FAQ · About this visit
Common questions about this visit
What happened during the October 17, 2024 survey of Spanish Meadows?
This was a inspection survey of Spanish Meadows on October 17, 2024. The surveyor cited 2 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at Spanish Meadows on October 17, 2024?
Yes, 2 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receivin..."
What type of survey was this?
This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.
SourceView on CMS Care Compare
Next steps
Concerned about a resident’s care?Find your local ombudsman through the Eldercare Locatoror file a complaint with your state survey agency.
Researching this visit professionally?Book a 15-minute calland we will walk through what we have on file.
Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.