Inspection visit
Inspection
9 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 9 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0641
Ensure each resident receives an accurate assessment.
Level of Harm - Potential for
minimal harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
interview and record review, the facility failed to ensure the assessment accurately reflected the resident
status for 1 of 12 residents (Resident #3) whose MDS assessments were reviewed, in that:
Residents Affected - Some
Resident #3's MDS assessment dated [DATE] was coded as not being PASRR positive when the resident
was positive.
This failure could affect residents in the facility and put them at risk of inadequate care based on inaccurate
assessment.
The findings were:
Record review of Resident #3's admission record dated 09/26/2024 indicated she was admitted to the
facility on [DATE]. Diagnoses included schizoaffective disorder and mild intellectual abilities. She was [AGE]
years of age.
Record review of Resident #3's PASRR level 1 screening dated 05/25/2021 indicated in part: Is there
evidence or an indicator this is an individual that has a mental illness? Yes. Is there evidence or an indicator
this is an individual that has an intellectual disability? Yes. Is there evidence or indicators that this is an
individual that has a developmental disability (related condition) other than an intellectual disability (e.g.,
Autism, Cerebral palsy, Spina bifida)? Yes.
Review of Resident #3's MDS assessment dated [DATE], indicated in part: Is the resident currently
considered by the state level II PASRR process to have serious mental illness and/or intellectual disability
or a related condition? Coded 0 indicating No. Level II Preadmission Screening and Resident Review
(PASRR) Conditions. Check all that apply A. Serious mental illness. B. Intellectual Disability - None
checked. Active Diagnoses - checked for Schizophrenia (e.g., schizoaffective and schizophreniform
disorders).
During an interview on 09/26/24 at 02:56 PM the MDS coordinator said Resident #3 was indeed PASRR
positive as she would be seen for PASRR services although Resident #3 had refused them. The MDS
coordinator said Resident #3 had been PASRR positive since admission. The MDS coordinator was asked
regarding Resident #3's annual MDS assessment having Resident #3 coded as no for the resident having a
have serious mental illness or intellectual disability. The MDS coordinator said she had not noticed that she
had accidentally coded the wrong answer and that it should have been coded yes for PASRR for Resident
#3. The MDS coordinator said she would change that to the correct code. The MDS coordinator said they
did not have particular policy for MDS, and they went based on the Resident Assessment Instrument (RAI)
manual instructions.
(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 11
Event ID:
675599
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
675599
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/26/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Robert Lee Care Center
307 West 8th St
Robert Lee, TX 76945
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 0641
Level of Harm - Potential for
minimal harm
Residents Affected - Some
During an interview on 09/26/24 at 03:18 PM the DON was made aware of Resident #3's MDS being coded
as no for PASRR when it should have been yes. The DON said it was due to human error and they would
get that fixed.
During an interview on 09/26/24 at 03:22 PM the Administrator was made aware of Resident #3's MDS
being coded as no for PASRR when it should have been yes. The Administrator said he was aware of the
error and that they would get that fixed.
Record review of CMS's RAI version 3.0 manual dated October 2019 indicated in part: A1500:
Preadmission Screening and Resident Review (PASRR). Code 1, yes: if PASRR Level II screening
determined that the resident has a serious mental illness and/or ID/DD or related condition, and continue to
A1510, Level II Preadmission Screening and Resident Review (PASRR) Conditions.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
675599
If continuation sheet
Page 2 of 11
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
675599
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/26/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Robert Lee Care Center
307 West 8th St
Robert Lee, TX 76945
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 0656
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Develop and implement a complete care plan that meets all the resident's needs, with timetables and
actions that can be measured.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, interview and record review the facility failed to develop and implement a comprehensive,
person-centered care plan for each resident that included measurable objectives and time frames to meet,
attain, and/or maintain the resident's highest practicable physical, mental, and psychosocial well-being for 1
of 5 residents (Resident #24) reviewed for care plans in that:
Resident #24 did not have a care plan addressing the use of her ankle splint.
This failure could affect resident by placing her at risk of not receiving individualized care and services to
meet her needs.
The findings included:
Review of Resident #24's admission Record dated 9/26/24 revealed she was a [AGE] year-old female
admitted to the facility for paralysis following a stroke affecting her dominant side.
Review of Resident #24's Quarterly MDS Assessment, dated 9/12/24 revealed:
She scored a 13 of 15 on her mental status exam (indicating she was cognitively intact);
She had range of motion impairment of the upper and lower extremities on one side;
She used a walker and wheelchair;
She needed supervision to walk 150 feet.
She received 170 minutes of physical therapy in the previous 7 days.
Splint use was not identified.
Review of Resident #24 Care Plan, last reviewed 9/19/24, revealed no care plan for the splint.
Review of Resident #24' 9/26/24 revealed no order for the splint.
Observation and interview on 9/24/24 at 10:26 a.m. revealed Resident #24 had a hard ankle splint at the
end of her bed. Resident #24 stated it was bed because she had a stroke, and her foot did not work right.
In an interview on 09/26/24 at 1:38 PM the MDS Coordinator and DON stated Resident #24 was a stroke
victim who came to the facility within the last three months. The DON stated Resident #24's main issue was
balance. The DON stated Resident #24 used a specialized walker with therapy and an electric wheelchair
when not with therapy. The DON stated Resident #24 did have a brace. The MDS Coordinator stated she
was unaware of a brace. The DON told the MDS Coordinator it was to prevent drop foot (a condition where
the front of the foot/toes drag). The MDS Coordinator said she did not see the brace on Resident #24's care
plan or MDS. The MDS Coordinator stated Resident #24 just had a care plan update on 9/19/24. The DON
said Resident #24 came in with the brace, but now that surveyor asked, she
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
675599
If continuation sheet
Page 3 of 11
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
675599
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/26/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Robert Lee Care Center
307 West 8th St
Robert Lee, TX 76945
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 0656
could picture Resident #24 wearing it. The DON stated Resident #24 took it on and off at will.
Level of Harm - Minimal harm
or potential for actual harm
Review of the facility's policy and procedure on Care Planning - Interdisciplinary Team, revised March 2022,
revealed: The interdisciplinary team is responsible for the development of resident care plans.
Residents Affected - Few
Policy Interpretation and Implementation. Resident care plans are developed according to the timeframes
and criteria established by regulation. Comprehensive, person-centered care plans are based on resident
assessments and developed by an interdisciplinary team.
Review of the facility's policy and procedure on Resident Mobility and Range of Motion, revised July 2017,
revealed: Residents with limited mobility will receive appropriate services, equipment, and assistance to
maintain or improve mobility unless reduction in mobility is unavoidable.
The care plan will be developed by the interdisciplinary team based on the comprehensive assessment and
will be revised as needed. The care plan will include specific interventions, exercises, and therapies to
maintain, prevent avoidable decline in, and/or improve mobility and range of motion.
Interventions may include therapies, the provision of necessary equipment, and/or exercises and will be
based on professional standards of practice and be consistent with state laws and practice acts.
The care plan will include the type, frequency, and duration of interventions, as well as measurable goals
and objectives.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
675599
If continuation sheet
Page 4 of 11
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
675599
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/26/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Robert Lee Care Center
307 West 8th St
Robert Lee, TX 76945
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 0684
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
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 residents received treatment and
care in accordance with professional standards of practice, the comprehensive person-centered care plan,
and the residents' choices for 1 of 5 residents reviewed for quality of care. (Resident #24)
Residents Affected - Few
The facility did not assess, obtain orders or monitor Resident #24's ankle splint.
This failure could place the residents at risk of not receiving the care and services to maintain their highest
practicable physical, mental, and psychosocial well-being.
Findings included:
Review of Resident #24's admission Record dated 9/26/24 revealed she was a [AGE] year-old female
admitted to the facility for paralysis following a stroke affecting her dominant side.
Review of Resident #24's Quarterly MDS Assessment, dated 9/12/24 revealed:
She scored a 13 of 15 on her mental status exam (indicating she was cognitively intact);
She had range of motion impairment of the upper and lower extremities on one side;
She used a walker and wheelchair;
She needed supervision to walk 150 feet.
She received 170 minutes of physical therapy in the previous 7 days.
Splint use was not identified.
Review of Resident #24 Care Plan, last reviewed 9/19/24, revealed no care plan for the splint.
Review of Resident #24's Order Summary Report, dated 9/26/24, revealed orders:
There was no order for the ankle splint.
OT/PT evaluate and treat for decline in personal hygiene, toileting and bed mobility beginning 6/17/24.
Observation and interview on 9/24/24 at 10:26 a.m. revealed Resident #24 had an ankle splint at the end of
her bed. Resident #24 stated it was bed because she had a stroke, and her foot did not work right.
In an interview on 09/26/24 at 01:38 PM the MDS Coordinator and DON stated Resident #24 was a stroke
victim who came to the facility within the last three months. The DON stated Resident #24's main issue was
balance. The DON stated Resident #24 used a specialized walker with therapy and an electric wheelchair
when not with therapy. The DON stated Resident #24 did have a brace. The MDS Coordinator stated she
was unaware of a brace. The DON told the MDS Coordinator it was to prevent drop foot (a
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
675599
If continuation sheet
Page 5 of 11
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
675599
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/26/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Robert Lee Care Center
307 West 8th St
Robert Lee, TX 76945
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 0684
Level of Harm - Minimal harm
or potential for actual harm
condition where the front of the foot/toes drag). The MDS Coordinator said she did not see the brace on
Resident #24's care plan or MDS. The MDS Coordinator stated Resident #24 just had a care plan update
on 9/19/24. The DON said Resident #24 came in with the brace, but now that surveyor asked, she could
picture Resident #24 wearing it. The DON stated Resident #24 took it on and off at will. The DON said the
nurses checked Resident #24's skin to make sure there was no break down from the brace.
Residents Affected - Few
In an interview on 09/26/24 at 01:48 PM the DON said Resident #24 got the splint from an outpatient
rehabilitation provider prior to coming to the facility. The DON said the staff were aware Resident #24 had
the splint but were not aware that therapy did not initiate the order for the splint. The DON said Resident
#24 could take the splint on and off at will so she was probably not wearing it when Resident #24 was
admitted .
In an interview on 09/26/24 at 01:56 PM the DON stated the therapist who originally worked with Resident
#24 and was aware of the splint no longer worked with the facility. The DON said the nurses were educated
about taking on and off the splint and checking skin integrity. The DON said they called for orders that just
didn't get initiated here.
Review of the facility's policy and procedure on Resident Mobility and Range of Motion, revised July 2017,
revealed: Residents with limited mobility will receive appropriate services, equipment, and assistance to
maintain or improve mobility unless reduction in mobility is unavoidable. During the resident's assessment,
the nurse will identify the underlying factors that contribute to his or her range of motion or mobility
problems, if any, including: conditions that limit or immobilize movement of limbs or digits (e.g. splints). The
care plan will be developed by the interdisciplinary team based on the comprehensive assessment and will
be revised as needed. The care plan will include specific interventions, exercises, and therapies to
maintain, prevent avoidable decline in, and/or improve mobility and range of motion. Interventions may
include therapies, the provision of necessary equipment, and/or exercises and will be based on
professional standards of practice and be consistent with state laws and practice acts.
The care plan will include the type, frequency and duration of interventions, as well as measurable goals
and objectives.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
675599
If continuation sheet
Page 6 of 11
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
675599
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/26/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Robert Lee Care Center
307 West 8th St
Robert Lee, TX 76945
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 needs respiratory
care is provided such care, consistent with professional standards of practice for 1 (Resident #19) of 6
residents observed for oxygen management.
Residents Affected - Few
The facility failed to ensure Oxygen (O2) in use signage was on Resident #19's doorway.
This failure could place residents at risk of not receiving appropriate respiratory care.
The findings were:
Record review of Resident #19 's admission record dated 09/26/2024 revealed Resident #19 was a [AGE]
year-old male with an admission date to the facility of 07/19/2024. admission record revealed Resident #19
had diagnoses that included Chronic obstructive pulmonary disease (progressive lung disease
characterized by chronic respiratory symptoms and airflow limitation), shortness of breath, heart failure,
dependence on supplemental oxygen, and muscle weakness.
Record review of Resident #19 's MDS revealed the resident had a BIMS of 14 indicating the resident was
cognitively intact.
Record review of Resident #19 's order summary dated 09/26/24 revealed an order of OXYGEN AT 2-5
LITERS PER NASAL CANNULA. every day and night shift related to CHRONIC OBSTRUCTIVE
PULMONARY DISEASE, UNSPECIFIED (COPD).
Record review of Resident #19 's Care plan dated 08/15/2024 revealed a focus of is dependent on staff for
meeting physical and social needs. He has Heart Failure. SOB (Shortness of breath) r/t (Related to) COPD
and is on oxygen. chooses not to attend activities or monthly events. He prefers to stay in his room.
Observation on 09/24/24 at 09:52 AM during revealed that there was not a No smoking oxygen in use sign
on Resident #19's door.
Interview on 09/26/24 at 01:55 PM the DON stated that the residents who had an oxygen sign on the
doorway was to inform anyone who entered the resident's, room that the resident was on oxygen. The DON
stated that the sign was for safety, even though no one was supposed to smoke inside the facility, they had
to put the sign indicating there was a combustible material in the room. The DON stated the sign was on the
room that Resident #19 was in previously to being moved on 09/11/2024. The DON states that the medical
record staff was responsible for ensuring the residents had a No smoking oxygen in use sign on the door.
Interview on 09/26/24 at 02:16 PM with the Medical Records, stated that she was responsible for ensuring
the residents who were admitted into the facility that were on oxygen received the sign for the door. The
Medical Records stated that she was aware that the resident had moved rooms but did not know the sign
was not moved. The Medical Records stated that if the residents were moved when she was off that the
floor staff would move the sign to the new room. The Medical Records stated that the sign was used to
indicate who was using oxygen in the building. The Medical Records did not think there was a negative
outcome of not having the sign on the door.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
675599
If continuation sheet
Page 7 of 11
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
675599
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/26/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Robert Lee Care Center
307 West 8th St
Robert Lee, TX 76945
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
Level of Harm - Minimal harm
or potential for actual harm
Record review of the facility's policy titled Oxygen Administration with a revision date of October 2010
revealed that under the section steps in the procedure - 2. Place an Oxygen in Use sign on the outside of
the room entrance door.
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
675599
If continuation sheet
Page 8 of 11
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
675599
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/26/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Robert Lee Care Center
307 West 8th St
Robert Lee, TX 76945
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 0732
Post nurse staffing information every day.
Level of Harm - Potential for
minimal harm
Based on observation, interview, and record review, the facility failed to post daily information that included
the facility name, total number and actual hours worked by registered nurses, licensed practical or licensed
vocational nurses, certified nurse aides directly responsible for resident care per shift and the resident
census for 2 days (09/25/2024 to 09/26/2024) of 3 days observed for staff posting.
Residents Affected - Many
The facility failed to post the daily staffing information for 09/25/2024 and 09/26/2024.
This failure could place all residents, their families, and facility visitors at risk of not having access to
information regarding staffing data and the facility census.
The findings included:
During an observation and record review on 09/25/2024 and 09/26/2024 at 11:50 a.m. revealed the facility's
daily nursing posting located behind the nurses' station failed to indicate the actual hours worked for each
direct care staffing, the facility name, the total number and actual hours worked by the staff and resident
census. The posting indicated the following CMA - 2, CNA-4, LVN-1, RN-1, Admin - 1, RN-1 and LVN 2.
During an interview on 09/26/24 at 11:22 AM the DON and Administrator said the postings boards placed
behind each nurse's station was their daily staffing post. They said the number by each staff title was the
number of that particular staff working the floor. They said they were not aware the posting had to indicate
the number of hours, the facility name and census.
Record review of the facility's policy titled Nurse staffing posting information and dated August 2024
indicated in part: It is the policy of this facility to make sure staffing information readily available in a
readable format to residents and visitors at any given time. The nurse staffing sheet will be posted on a
daily basis and will contain the following information: Facility name. The current date. Facility's current
census. The total number and the actual hours worked by the following categories of licensed and
unlicensed nursing staff directly responsible for resident care per shift: Registered Nurses. Licensed
Practical Nurses/Licensed Vocational Nurses. Certified Nurse Aides.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
675599
If continuation sheet
Page 9 of 11
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
675599
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/26/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Robert Lee Care Center
307 West 8th St
Robert Lee, TX 76945
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 observation, interview and record review, the facility failed to store, prepare, distribute, and serve
food in accordance with professional standards for food service safety in the facility's one of one kitchen.
Residents Affected - Many
The facility failed to ensure:
Food debris was not on the floor in the freezer.
Staff did not transport dishes by holding them against their body.
Staff completed hand hygiene appropriately.
Dishes were stored in a manner to prevent contamination.
Prevention of contamination of salad bar containers by staff handling practices.
Frozen meat was stored in a manner to prevent contamination in the event of thawing.
These failures could affect residents who received meals prepared from the kitchen at risk for food borne
illness and cross contamination.
Findings included:
Observation on 9/24/24 between 9:18 a.m. and 9:36 a.m. revealed:
Bowls stored against the long wall of the kitchen were stored face up.
The outside walk-in refrigerator had a bucket of pickles on the ground.
The walk-in freezer had meat stored over vegetables and bread.
The dry storage had individual serving of jelly and packets of sugar on the floor under the shelves.
The inside of the walk-in refrigerator had a brisket thawing over pickles, eggs and bacon.
During the noon meal preparation on 9/25/24 beginning at 9:50 a.m. and 11:35 a.m. revealed:
Cook B was observed washing her hands turning off the faucet with her bare hands three times.
DA D had a stack of dishes she was putting up from the clean dish area. DA D had the plates stacked
directly against her body as she brought them to the storage area. DA C had containers for the salad bar
that she carried from the clean dish area to the food preparation area with her bare hands and her fingers
in each container touching the food surface. DA D returned from outside of the kitchen, did not wash her
hands, did don gloves and continued with food preparation.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
675599
If continuation sheet
Page 10 of 11
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
675599
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/26/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Robert Lee Care Center
307 West 8th St
Robert Lee, TX 76945
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 - Many
In an interview on 9/26/24 at 2:03 p.m. the Dietary Manager said the staff knew to have dishes face down,
she clarified which bowls were face up and stated those were the bowls used for the salad bowls. The
Dietary Manager said the pickle bucket was the only thing that would be on the floor in the refrigerator, but
everything needed to be at least six inches off the floor due to contamination. The Dietary Manager said
staff needed to wash their hands when they returned in from the kitchen due to cross contamination issues.
The Dietary Manager asked for clarification on the salad bar container food surface being touched all at
once, she said she had previously had numerous conversations with that staff member about that and that
putting clean dishes against dirty scrubs just contaminated the dishes. The Dietary Manager said it did not
matter what kind of container the meat was being thawed in it still could not be thawed over other food.
In an interview on 9/26/24 at 2:22 p.m. the Administrator was informed of the kitchen observations, he
stated they were pretty straight forward, and they would monitor it.
Review of the Cleaning Schedule revealed the cook was responsible for cleaning the refrigerator and
freezer and the outside coolers were last documented as completed on 9/24/24.
Review of the 5/24/24 in-service on Maintaining a Clean Kitchen revealed: food items are not stored on the
floor.
Example of Monthly list: clean under and behind equipment
Review of the Dietary In-service dated 1/25/24 revealed:
Dry storage - what items, how far off the ground and proper storage methods. Store food at least 6 inches
from the floor to prevent contamination and allow cleaning. Cold Storage - Don't store any items on the
floor. Keeping appliances and equipment clean - cleaning interior and exterior Floors - keeping floors free of
debris and trash to prevent accidents and help to prevent rodent and pest infestations. Keeping interior
walk-ins free of spills, meat or food drippings etc. Personal Hygiene - when and how often to wash hands.
Avoid cross-contamination - letting microorganisms from one food get into another store meats on the
bottom shelf of your refrigerator so juices will not contaminate other foods.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
675599
If continuation sheet
Page 11 of 11
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Back to topCitations
9 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.
- 0222GeneralS&S Dpotential for harm
Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.
- 0521GeneralS&S Cno actual harm
Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.
F914 - Be designed or equipped to assure full visual privacy for each
Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing.
F695 - Respiratory care, including tracheostomy care and tracheal suctioning
Provide safe and appropriate respiratory care for a resident when needed.
F641 - Accuracy of Assessments
Ensure each resident receives an accurate assessment.
F656 - Comprehensive Care Plans
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
F684 - Quality of care
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
F732 - Nurse Staffing Information
Post nurse staffing information every day.
F812 - Food safety requirements
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
FAQ · About this visit
Common questions about this visit
What happened during the September 26, 2024 survey of ROBERT LEE CARE CENTER?
This was a inspection survey of ROBERT LEE CARE CENTER on September 26, 2024. The surveyor cited 9 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at ROBERT LEE CARE CENTER on September 26, 2024?
Yes, 9 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arra..."
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.
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Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.