Inspection visit
Health inspection
7 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 7 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
observations, interview and record review, the facility failed to provide a safe, clean, and homelike
environment for 2 (Residents #188 and #84) of 24 residents reviewed for environment.
The facility failed to provide Residents #188 and #84 a handwashing sink that was not loose and a paper
towel dispenser that worked properly without cover coming off in resident bathroom.
This failure could place residents at risk for living in an unsanitary and uncomfortable environment.
Findings included:
Review of Resident #188's face sheet dated 10/26/23 reflected Resident #188 was a [AGE] year-old male
admitted to the facility on [DATE] with diagnoses of displace avulsion fracture of right talus (broken bone in
ankle), hypertension, diabetes, post-traumatic stress disorder, neuropathy, and heart disease.
Review of Resident #188's other MDS assessment dated [DATE] reflected Resident #188 had a BIMS
score of 15 indicating he was cognitively intact.
Observation and Interview on 10/24/23 at 10:55 AM with Resident #188 revealed since he had been
admitted to the facility, he had noticed the handwashing sink was loose and the paper towel dispenser
cover in his bathroom would come off when pulling paper towel out of it.
Observations on 10/25/23 at 1:58 PM and 10/26/23 at 8:46 AM revealed Resident # 188 and Resident
#84's bathroom had a loose sink and the paper towel dispenser cover was loose would come off when
touched.
Interview on 10/26/23 at 8:48 AM with the Maintenance Director stated he was not aware of issues with
Residents #188 and #84's bathroom sink and paper towel dispenser. He stated housekeeper should have
reported the bathroom sink and paper towel dispenser to him. He stated the bathroom sink being loose
needed to be fixed with 2 screws to secure it. He stated housekeeping had the paper towel dispenser
replacement and would have to give it to him so he could replace it. He stated he can get the bathroom sink
fixed and paper towel dispenser replaced. He stated the nurse, CNA and/or housekeeper should report any
maintenance issues in the system and then he was notified of maintenance repairs. He stated he was not
able to do rounds on all resident rooms and bathrooms and depended on facility staff to report to him any
repairs.
(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 14
Event ID:
675033
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
675033
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/26/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Mesquite Tree Nursing Center
434 Paza Dr
Mesquite, TX 75149
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
Interview on 10/26/23 at 11:35 AM with CNA H revealed she was not aware of issues with Residents #188
and #84's bathroom sink or paper towel dispenser.
Interview on 10/26/23 at 11:38 AM with CNA D revealed she was not aware of issues with Residents #188
and #84's bathroom sink or paper towel dispenser. She stated Resident #188 used the bathroom and did
not voice to her about any concerns with bathroom.
Interview on 10/26/23 at 12:52 PM with Housekeeper I revealed about three weeks ago she had noticed
Resident #188 and #84's handwashing bathroom sink was loose and paper towel dispenser cover would
come off. She stated she told Housekeeper Supervisor about it who filled out a work order.
Interview on 10/26/23 at 12:56 PM with Housekeeping Supervisor revealed she had put in a work order
when Housekeeper made her aware of Resident #188 and #84's bathroom sink and paper towel dispenser
and gave it to Receptionist. She stated receptionist told her she threw them away after they were put in
electronic system.
Interview on 10/26/23 at 2:18 PM with Receptionist revealed she put in maintenance work orders into
system but was not sure what Maintenance did with them afterwards. She did not have a copy of work
order for resident bathroom room [ROOM NUMBER].
Interview on 10/26/23 at 2:33 PM with the DON revealed the maintenance work order for room [ROOM
NUMBER] (Residents #188 and #84 bathroom) was put in this morning and facility could not locate a
maintenance work order prior to today.
Review of facility's policy Preventative Maintenance undated reflected 1. The Facility will provide a written or
computerized preventative program ensuring inspections are performed on schedule and continuously
reviewing the program to make certain that the results are meeting the goals of the program. The
preventative maintenance program .will ensure a safe, well-maintained environment for the Residents,
Visitors and Staff. 2. The facility will provide a written quality control program that ensures a clean, safe,
pleasant and functional environment for the Residents, Staff and Visitors.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
675033
If continuation sheet
Page 2 of 14
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
675033
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/26/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Mesquite Tree Nursing Center
434 Paza Dr
Mesquite, TX 75149
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 0677
Provide care and assistance to perform activities of daily living for any resident who is unable.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, interview, and record review the facility failed to provide the necessary services for residents
who are unable to carry out activities of daily living to maintain good grooming and personal hygiene for 2
(Resident #12 and Resident#30) of 8 residents reviewed for ADLs.
Residents Affected - Few
The facility failed to ensure:
1- Resident #12 had her fingernails cleaned and trimmed.
2- Resident #30 had his fingernails cleaned and trimmed.
This failure could place residents who were dependent on staff for ADL care at risk for loss of dignity, risk
for infections and a decreased quality of life.
Findings include:
1- Review of Resident #12's Quarterly MDS assessment dated [DATE] reflected Resident #12 was a [AGE]
year-old female admitted to the facility on [DATE] with diagnoses that included hemiplegia (paralysis that
affects only one side of the body), muscle weakness, lack of coordination, and type 2 diabetes mellitus.
Resident #12's BIMS score was 15, which indicated her cognition was intact. The MDS assessment
indicated Resident #12 required extensive assistance of one-person physical assistance with dressing,
toilet use, and personal hygiene.
Review of Resident #12's Comprehensive Care Plan, revised 10/16/23, reflected the following: Focus:
Resident#12 has an ADL self-care performance deficit. Goal: Resident #12 will maintain a sense of dignity
by being clean, dry, odor free, and well groomed. Interventions: Provide shower, oral care, hair care, and
nail care per schedule and when needed.
An observation and interview on 10/25/23 at 12:15 PM revealed Resident #12 was laying in her bed. The
nails on both hands were approximately 0.4cm in length extending from the tip of her fingers. The nails
were discolored tan and the underside had dark brown colored residue. Resident #12 stated she did not
like her nails long and dirty. She stated she did not tell anybody.
2- Review of Resident #30's Comprehensive MDS assessment dated [DATE] reflected Resident #30 was a
[AGE] year-old male admitted to the facility on [DATE] with diagnoses included muscle weakness, lack of
coordination, age-related cataract, and type 2 diabetes mellitus. Resident #30's BIMS was 10, which
indicated his cognition was moderately impaired. The MDS assessment indicated Resident 30 required
extensive assistance of one-person physical assistance with dressing, toilet use, and personal hygiene.
Review of Resident #30's Comprehensive Care Plan, revised 08/28/23, reflected the following: Goal:
Resident #30 will maintain optimal quality of life and not experience a decline in ADL functional abilities.
An observation and interview on 10/25/23 at 12:20 PM revealed Resident #30 was sitting in his wheelchair.
The nails on both hands were approximately 0.6cm in length extending from the tip of his fingers. The nails
were discolored tan, and the underside had dark brown colored residue. Resident #30
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
675033
If continuation sheet
Page 3 of 14
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
675033
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/26/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Mesquite Tree Nursing Center
434 Paza Dr
Mesquite, TX 75149
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 0677
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
stated he did not like his nails that long and dirty. He stated he would ask a staff member to trim his
fingernails.
Interview on 10/25/23 at 12:30 PM, CNA D stated CNAs were allowed to cut residents' nails if they were
not diabetic. CNA D stated she would check with the nurse because both Resident #12 and Resident#30
were diabetic.
Interview on 10/25/23 at 1:15 PM, LVN C stated CNAs were responsible to clean and trim residents' nails
as needed. LVN C stated only nurses cut residents' nails if they were diabetic. LVN C stated no one notified
him Resident #12, and Resident #30's nails were long and dirty, and he had not noticed the nails himself.
Interview on 10/26/23 2:14 PM, the DON stated nail care should be completed as needed. The DON stated
fingernails should be observed daily. The DON stated nurses were responsible for trimming the nails of
residents who were diabetic, and CNAs could trim other residents' nails. The DON stated she expected
CNAs to offer to cut and clean nails if they were long and dirty. The DON stated residents having long and
dirty nails could be an infection control issue. The DON stated she was responsible to do routine rounds for
monitoring.
Record review of the facility's policy titled Activity of Daily Living Care Guidelines, reviewed 2/11/2021,
reflected .Residents will receive essential services for activities of daily living to maintain good nutrition,
grooming, and personal and oral hygiene .
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
675033
If continuation sheet
Page 4 of 14
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
675033
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/26/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Mesquite Tree Nursing Center
434 Paza Dr
Mesquite, TX 75149
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 0695
Provide safe and appropriate respiratory care for a resident when needed.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, interview, and record review, the facility failed to ensure that a resident who needed respiratory
care, was provided such care, consistent with professional standards of practice for one (Resident #80) of
three residents reviewed for respiratory care.
Residents Affected - Few
The facility failed to have Resident #80's oxygen humidifier replaced weekly as ordered.
This failure could place residents at risk for infection.
Findings include:
Review of Resident #80's Quarterly MDS assessment, dated 10/17/2023, reflected that the resident was a
[AGE] year-old male admitted on [DATE]. Resident #80's BIMS score was a 15 which reveals an intact
cognition. His active diagnoses included anemia, high blood pressure, and anxiety disorder. The MDS had
oxygen therapy checked under his specialty treatment section.
Review of Resident #80's Physician orders summary dated 10/24/2023, reflected, . Change O2 tubing and
humidifier bottle. every night shift every Wed Ensure that tubing is dated when changed .order date 9/18/23
.
Review of Resident #80's care plan dated 07/10/23, reflected, .Resident uses oxygen therapy routinely or
as needed and is at risk for ineffective gas exchange. This is related to COPD (chronic bronchitis or
emphysema). Date Initiated: 07/10/2023 Revision on: 07/10/2023 . Administer oxygen therapy per
physician's orders .
An observation on 10/24/23 at 10:46 AM revealed Resident #80's oxygen concentrator on. Resident #80
was wearing his nasal cannula with humidifier bubbling and dated 9/30/2023. Resident #80 was asleep
during observation.
In an interview with LVN B on 10/25/23 at 01:31 pm revealed, that the oxygen concentrator humidifier and
tubing were to be changed once weekly and as needed. She stated changing the oxygen humidifier and
tubing reduced resident infection and contamination. She stated oxygen tubing and humidifier flagged
weekly on resident's electronic record.
In an interview with the ADON on 10/25/23 at 11:32 AM revealed that the nasal cannula tubing as well as
humidifier were to be changed and dated on night shift every Wednesday. She stated that not changing
humidifier weekly could cause contamination and infection.
In an interview with the DON on 10/26/23 at 12:06 pm revealed that the humidifiers were changed weekly.
She stated she believes every Wednesday. She stated not changing them weekly can cause infection. She
stated that herself and the ADON do the trainings and in-services regarding oxygen administration.
Review of the facility's policy, Oxygen Administration review date 1/5/2020, reflected, .
2. Order should have when to call the physician parameters .1. Use pre-filled humidifier bottle. Label bottle
with date. Change bottle when empty . 3. Change disposable parts once a week and label
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
675033
If continuation sheet
Page 5 of 14
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
675033
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/26/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Mesquite Tree Nursing Center
434 Paza Dr
Mesquite, TX 75149
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 0695
with date (tubing, plastic bag, mask, or cannula) .
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
675033
If continuation sheet
Page 6 of 14
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
675033
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/26/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Mesquite Tree Nursing Center
434 Paza Dr
Mesquite, TX 75149
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 0755
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a
licensed pharmacist.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, interview, and record review, the facility failed to provide pharmaceutical services, including
procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and
biologicals, to meet the needs of each resident for 2 (Nurses cart halls 200/300 and Med Aide cart hall 300)
of 3 carts reviewed for pharmacy services.
The facility failed to ensure:
1- MA E, responsible for Med Aide cart hall 300, counted controlled drugs every shift change.
2- Medications in unsecure containers were immediately removed from stock.
These failures could place residents at risk of not having the medication available due to possible drug
diversion and at risk of not receiving the intended therapeutic benefit of the medication.
Findings Included:
1- Record review and random count observation of hall 300 Med Aide cart with MA E on 10/24/2023 at
11:51 AM revealed missing signatures for Off duty and On duty for 10/16/2023, 10/17/2023, 10/22/2023 of
the narcotic count sheet.
Interview on 10/24/2023 at 12:01 PM, MA E stated nurses and medication aides should have signed the
narcotic sheet after counting the narcotics on 10/16/2023, 10/17/2023, and 10/22/23.
10/26/23 at 1:10 PM attempted to call LVN G, was not successful.
2- Record review and random count observation of hall 200/500 Nurses cart with LVN C on 10/24/2023 at
12:48 PM revealed the blister pack for Resident #28's alprazolam 0.5 mg tablet (controlled medication used
for anxiety) had 1 blister seal broken and the pill still inside the broken blister.
Interview on 10/24/23 at 12:56 PM, LVN C stated he was unaware when the blister pack seal was broken,
and he was not aware of who might have damaged the blister. He stated the risk of a damaged blister
would be a potential for drug diversion. He stated the nurses were responsible to check the medication
blister packs for broken seals during the count of narcotics during the change of the shift. He stated the
count was done at shift change and the count was correct. He stated he did not see the broken blister
during the count. He stated when a broken seal was observed, two nurses should discard the medication.
Interview on 10/26/23 at 1:15 PM, the DON stated she expected nurses to sign at the beginning and at the
end of their shift after they completed count with the incoming and off-going nurse. The DON stated if the
staff was not signing the narcotic count sheets, she was unable to prove they were counting. The DON
stated it was important to ensure a drug diversion did not occur. The DON stated if a blister pack
medication seal was broken the pill should be discarded. The DON stated it would not be acceptable to
keep a pill in a blister pack that was opened. The DON stated the risk would be losing the medication
because the seal was broken and would be infection control issue. She stated nurses were responsible for
checking the medication blister packs for broken seals during the count on the
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
675033
If continuation sheet
Page 7 of 14
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
675033
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/26/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Mesquite Tree Nursing Center
434 Paza Dr
Mesquite, TX 75149
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 0755
change of shifts. The DON stated the ADON, and the DON were supposed to check the cart randomly.
Level of Harm - Minimal harm
or potential for actual harm
Review of the facility's policy Storage of Controlled Substances revised [NAME] 2020, reflected the
following: . 8. At each shift change or when keys are rendered, a physical inventory of all Schedule II
controlled medications is conducted by two licensed nurses or per state regulation and is documented on
the controlled substances accountability record or verification of controlled substances count report .
Residents Affected - Few
Review of the facility's policy Medications Storage dated 1/20/21, reflected the following: . Medication Carts
are routinely inspected for discontinued, outdated, defective, or deteriorated medications with worn,
illegible, or missing labels. These medications are removed and destroyed in accordance with the facility
policy .
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
675033
If continuation sheet
Page 8 of 14
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
675033
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/26/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Mesquite Tree Nursing Center
434 Paza Dr
Mesquite, TX 75149
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 0761
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted
professional principles; and all drugs and biologicals must be stored in locked compartments, separately
locked, compartments for controlled drugs.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, interview, and record review the facility failed to label drugs and biologicals used in the facility
in accordance with currently accepted professional principles, and include the appropriate accessory and
cautionary instructions, and the expiration date when applicable for 1 (200/500 hall Nurse Medication cart)
of 3 medication carts reviewed for pharmacy services and 1 medication room of 1 reviewed for storage in
that:
The facility failed to ensure:
1The 200/500 Hall Nurse Medication cart had a control solution expired.
2Two vials of TB serum (used to test if you have a tuberculosis germs in the body) that were opened and
used were dated in the medication room refrigerator.
These failures could affect residents and staff resulting in diminished effectiveness, and not receiving the
therapeutic benefits of the medications.
The findings include:
1Record review and observation on [DATE] at 12:48 PM of hall 200/500 Nurse cart with LVN C revealed an
expired blood glucose control solution (used to calibrate the glucometers). The blood glucose control
solution was opened and expired [DATE].
Interview on [DATE] at 12:56 PM, LVN C stated he had not seen the expired blood glucose control solutions
and would have removed it immediately. He did not recall if he used the blood glucose control solution this
morning. He stated the risk was to get a wrong reading of blood sugar.
2Observation on [DATE] at 1:00 PM of the medication room revealed 2 vials of TB PPD (purified protein
derivative) serum was opened, had been used and was not dated.
Interview on [DATE] at 1:05 PM, LVN F stated the TB PPD vials were open and were not dated or initialed.
She stated the risk, when given to staff or resident, would be the wrong reading. She stated the nurse was
responsible to check the vial for the open date before use it.
Interview on [DATE] at 1:15 PM, the DON stated nurses had to check for expired blood glucose control
solutions on their carts daily. She stated the risk of using expired blood glucose control solutions could be
potential for inaccurate reading. The DON stated the staff who opened the TB vials
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
675033
If continuation sheet
Page 9 of 14
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
675033
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/26/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Mesquite Tree Nursing Center
434 Paza Dr
Mesquite, TX 75149
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 0761
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
should write the open date and the initials. She stated all nurses were responsible to check the medication
carts and the medication room for expiration and labeling of medication .
Review of the facility's policy Medications Storage dated [DATE], reflected the following: . Medication Carts
are routinely inspected for discontinued, outdated, defective, or deteriorated medications with worn,
illegible, or missing labels. These medications are removed and destroyed in accordance with the facility
policy .
Event ID:
Facility ID:
675033
If continuation sheet
Page 10 of 14
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
675033
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/26/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Mesquite Tree Nursing Center
434 Paza Dr
Mesquite, TX 75149
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 0812
Level of Harm - Minimal harm
or potential for actual harm
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve
food in accordance with professional standards.
Based on observations, interviews and record review, the facility failed to store, prepare, distribute, and
serve food in accordance with professional standards for food service safety for the facility's only kitchen.
Residents Affected - Some
1. The facility failed to ensure dish machine reached minimum of 120 degrees F for wash and rinse on
10/24/23.
2. The facility failed to ensure food in the kitchen's refrigerator and freezer were stored in sealed containers,
labeled, and dated. The facility failed to ensure food item in refrigerator was not spoiled.
3. The facility failed to maintain cleanliness of the inside of the ice machine.
These failures could place residents at risk for food contamination and food-borne illness.
Findings included:
1. Observations on 10/24/23 at 10:07 AM revealed the Dietary Manager ran the dish machine with first two
wash/rinse low temperature dish machine reading 100 temp F for wash and rinse. The third time dish
machine ran cycle the temperature only reached 110 temp F for wash and rinse. Dietary Manager ran the
dish machine two more times with 115 temperature F and 118 temperature.
Interview on 10/24/23 at 10:15 AM with the Dietary Manager stated it was a low temp dish machine which
should reach at least 120 degrees F for wash and rinse. He looked at the temperature log on the wall and
stated they had not checked the dish machine temperature yet this morning. The Dietary Manager stated
there had been a couple of loads already ran through prior to checking the dish machine. He stated they
will temporarily not use the dish machine until were are able to have it working properly. He stated it was
important for the dish machine to reach at least minimum temperature to clean the dishes.
Interview on 10/26/23 at 8:48 AM with the Maintenance Director revealed dish machine representative
came out on 10/24/23 to look at dish machine on 10/24/23 verifying the dish machine water temperature
was not reaching minimum water temperature as required. He stated he had to replace the kitchen's water
heater circulator pumps before able to get hot water at minimum temperatures. He stated he was not aware
of any issues with the kitchen dish machine water temperatures until 10/24/23 when they contacted dish
machine representative. Surveyor requested service order for dish machine.
2. Observation on 10/24/23 at 10:20 AM revealed 1 of 2 freezers had frozen meat not dated or labeled.
Observation on 10/24/23 at 10:21 AM revealed 1 of 2 refrigerator contained a sealed plastic food item with
shredded purple and yellowish shredded produce labeled green cabbage not labeled or dated. No
expiration date was on the item or date on the item.
Interview on 10/24/23 at 10:22 AM the Dietary Manager revealed the frozen meat was chicken which
should have been labeled and dated when opened. The Dietary Manager stated he thought the item in the
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
675033
If continuation sheet
Page 11 of 14
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
675033
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/26/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Mesquite Tree Nursing Center
434 Paza Dr
Mesquite, TX 75149
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 0812
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
refrigerator was coleslaw and looked like it had turned bad. He stated he will throw it away. It should be
labeled and dated so they know when item was open and received. He stated if food items were not dated
when opened then they will not be able to know how long it will last.
3. Observation on 10/24/23 at 10:26 AM revealed ice machine in the kitchen had dark blackish stains and
particles covering about four inch area on the left inner part above the ice.
Interview on 10/24/23 at 10:27 AM and 10:34 AM with the Dietary Manager revealed he had not noticed the
blackish particles inside the ice machine. He stated it could drip down and contaminate the ice. He stated
Maintenance had cleaned it last month when it was not working. He stated Maintenance usually cleaned it
monthly at least.
Review of facility's policy Frozen and Refrigerated Foods Storage revised 12/5/17 reflected Items stored in
the refrigerator must be dated upon receipt, unless they contain a manufacturer use by, sell by, best by
date, or a date delivered .11. All refrigerated and frozen items in storage will contain a minimum label of
common name of product and dated as noted above .
The facility did not provide a specific policy on the ice machine or the dish machineat the date and time of
exit from the facility.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
675033
If continuation sheet
Page 12 of 14
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
675033
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/26/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Mesquite Tree Nursing Center
434 Paza Dr
Mesquite, TX 75149
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 0880
Provide and implement an infection prevention and control program.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, interview, and record review the facility failed to maintain an infection prevention and control
program designed to provide a safe, sanitary, and comfortable environment and to help prevent the
development and transmission of communicable diseases and infections for one (Residents #238) of four
residents reviewed for infection control.
Residents Affected - Few
The facility failed to ensure CNA A wore an N95 facemask, gown, gloves, and goggles or a face shield
upon entering Resident #238's room who was on droplet isolation (used to prevent the spread of pathogens
that are passed through the respiratory secretions ).
This failure could place residents at risk for the spread of infection through cross-contamination of
pathogens and illness.
Findings included:
Record review of the facility's policy titled, Transmission- Based (Isolation) Precautions, dated 10/24/2022,
reflected .9. Droplet Precautions- a. Intended to prevent transmission of pathogens spread through close
respiratory or mucous membrane contact with respiratory secretions (i.e., respiratory droplets that are
generated by a resident who is coughing, sneezing, or talking) .
f. Based upon the pathogen or clinical syndrome, if there is risk of exposure of mucous membranes or
substantial spraying of respiratory secretions is anticipated, gloves and gown as well as goggles (or face
shield) should be worn .
Record review of Resident #238's Comprehensive MDS, dated [DATE], reflected a [AGE] year-old female
admitted to the facility on [DATE] with diagnoses which included high blood pressure, bipolar disorder, and
schizophrenia. Resident #238's had a BIMS score of 03 which revealed that she was not cognitively intact.
Review of Resident #238's Physician orders summary dated 10/24/2023, reflected, .droplet isolation
precautions every shift for bacterial pneumonia for 10 Days . order date 10/23/2023 . Droplet precaution for
Rhinovirus every shift .order date 10/16/2023 .
Review of Resident #238's care plan dated 10/16/23, reflected, .Requires isolation and is at risk for:
Loneliness, anxiety, and sadness r/t isolation precautions .interventions . Isolation: droplet precautions as
ordered .
An observation on 10/24/23 at11:15 am revealed a sign posted on the door to Resident #238's room which
indicated droplet isolation. There was a bin of PPE hanging on the door in the hallway with gloves, surgical
masks, and gowns. No face shields or goggles.
An observation and interview on 10/24/23 at 1:07 pm revealed CNA A entered Resident #238's room with
her lunch tray. CNA A wore a surgical mask and gown upon entering the room. CNA A placed the resident's
tray on his bedside table, set up tray on table, and was speaking with the resident. CNA A removed PPE
before exiting room and did hand hygiene after leaving the room. Interview with CNA A revealed that she
was to wear gown, gloves, and mask and to do hand hygiene before and after entering Resident 238's
room. CNA A confirmed that the droplet precaution sign states to wear gloves and a face
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
675033
If continuation sheet
Page 13 of 14
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
675033
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/26/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Mesquite Tree Nursing Center
434 Paza Dr
Mesquite, TX 75149
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 0880
shield or goggles. CNA A confirmed no face shield or goggles provided on hanging bin on the door.
Level of Harm - Minimal harm
or potential for actual harm
Interview with LVN B on 10/25/23 at 01:21 pm revealed Resident #238 revealed that a resident on droplet
precautions required staff to put face mask, face shield, gown, and gloves on. She stated wash hands
before putting on gloves and when going inside the room put on full PPE. She stated they don off all PPE in
designated bin in room, then wash hands after PPE removed. LVN B stated that not following protocol can
cause spread of infection.
Residents Affected - Few
Interview with the ADON on 10/25/23 at 11:32 am revealed that she was the infection preventionist. She
stated a resident on droplet precautions was to have PPE outside of the door which included gown, gloves,
mask, face shield. Staff were to don and doff (put on and take off PPE) before and after resident care. Staff
were to wash hands and take face shield and mask off last. This was to prevent spread of infection.
In an interview on 10/26/23 at 12:06 pm with the DON revealed all staff were expected to wear a mask,
face shield, gown, gloves in the droplet precautions room. The DON stated so it doesn't transmit from one
person to the next. The DON stated that herself or ADON give the trainings or in-services for infection
control regarding transmission-based precautions.
Record review of TOPIC: Infection Control Quarterly Training Guidelines, dated 8/9/23, revealed Infection
control transmission-based precautions .Participants goes through skills labs for validation on (A.
handwashing and B. Donning PPE) .
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
675033
If continuation sheet
Page 14 of 14
Reading this as a family member? Your long-term care ombudsman is a free advocate for residents and families.
Back to topCitations
7 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.
F677 - A resident who is unable to carry out activities of daily living receives
Provide care and assistance to perform activities of daily living for any resident who is unable.
F695 - Respiratory care, including tracheostomy care and tracheal suctioning
Provide safe and appropriate respiratory care for a resident when needed.
F755 - Pharmacy Services
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
F761 - Labeling of Drugs and Biologicals
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
F812 - Food safety requirements
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
F880 - Infection Control
Provide and implement an infection prevention and control program.
FAQ · About this visit
Common questions about this visit
What happened during the October 26, 2023 survey of MESQUITE TREE NURSING CENTER?
This was a inspection survey of MESQUITE TREE NURSING CENTER on October 26, 2023. The surveyor cited 7 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at MESQUITE TREE NURSING CENTER on October 26, 2023?
Yes, 7 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.