F 0641
Ensure each resident receives an accurate assessment.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
interview and record review, the facility failed to ensure the comprehensive assessment accurately reflected
the resident's status for 11 of 18 Residents (Resident # 20, Resident # 38, Resident #47, Resident #16,
Resident #3, Resident #1, Resident #10, Resident #9, Resident #28, Resident #17, and Resident #4)
reviewed for accuracy of assessments, in that:
Residents Affected - Some
1.
Resident #20's MDS dated [DATE] reflected COVID, when the resident had not had COVID since 01/2022.
2.
Resident #38's MDS date 05/13/2022 reflected sepsis, when the resident had not had sepsis since
03/2021.
3.
Resident #47's MDS date 05/26/2022 reflected pneumonia and sepsis, when the resident had not had
pneumonia or sepsis since 11/2021.
4.
Resident #16's MDS date 04/04/2022 reflected sepsis, when the resident had not had sepsis since
04/2021.
5.
Resident #3's MDS date 03/08/2022 reflected pneumonia, when the resident had not had pneumonia since
08/2020.
6.
Resident #1's MDS date 06/05/2022 reflected pneumonia, when the resident had not had pneumonia since
10/2018.
7.
(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 9
Event ID:
676074
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
676074
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
06/09/2022
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Whitney Nursing and Rehabilitation Center
101 San Marcus
Whitney, TX 76692
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
Resident #10's MDS date 03/19/2022 reflected pneumonia and sepsis, when the resident had not had
pneumonia or sepsis since 12/2021.
Level of Harm - Minimal harm
or potential for actual harm
8.
Residents Affected - Some
Resident #9's MDS dated [DATE] reflected COVID, when the resident had not had COVID since 01/2022.
9.
Resident #28's MDS date 03/28/2022 reflected pneumonia, when the resident had not had pneumonia
since 09/2021.
10.
Resident #17's MDS dated [DATE] reflected COVID and Pneumonia, when the resident had not had COVID
since 12/2021 or Pneumonia since 08/2019.
11.
Resident #4's MDS dated [DATE] reflected COVID, when the resident had not had COVID since 11/2020
This failure could place residents at risk of inaccurate assessments and not receiving appropriate care
according to their current status.
Findings include:
Resident #20
Record review of the electronic face sheet on 06/09/2022 for Resident #20 revealed an admission date of
08/18/2018. Resident was a [AGE] years old male with diagnoses to include: Dementia, blood pressure,
and muscle weakness.
Record review of MDS dated [DATE] for Resident #20 reveals a BIMS score of 8 indicating moderately
impaired cognitive skills for daily decision making. Further review of MDS Section I Active Diagnoses
revealed COVID 19.
Record review of electronic physician's orders dated 02/01/2022 to 06/09/2022 for Resident #20 revealed
no orders for treatment of COVID.
Record review of electronic progress notes from 02/01/2022 to 06/09/2022 for Resident #20 revealed no
documentation of COVID and no signs and symptoms of COVID.
Record review of lab results from 02/01/2022 to 06/09/2022 for Resident #20 revealed no lab work to
diagnosis COVID.
Record review of diagnostics test from 02/01/2022 to 06/09/2022 for Resident #20 revealed no test to
diagnosis COVID.
Record review of active care plan for Resident #20 revealed resident had been diagnosed with COVID
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
676074
If continuation sheet
Page 2 of 9
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
676074
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
06/09/2022
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Whitney Nursing and Rehabilitation Center
101 San Marcus
Whitney, TX 76692
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
on 01/13/2022 and recovered 01/20/2022.
Level of Harm - Minimal harm
or potential for actual harm
Resident #38
Residents Affected - Some
Record review of the electronic face sheet on 06/09/2022 for Resident #38 revealed an admission date of
03/02/2021. Resident was an [AGE] year-old female with diagnoses to include: Dementia, stomach bleed,
Sepsis (major infection), and low potassium.
Record review of MDS date 05/13/2022 for Resident #38 reveals a BIMS score of 09 indicating moderately
impaired cognitive skills for daily decision making. Further review of MDS Section I Active Diagnoses
revealed Sepsis.
Record review of the electronic physician's orders from 01/01/2022 to 06/09/2022 for Resident #38
revealed no orders to test for or to treat sepsis.
Record review of electronic progress notes from 01/01/2022 to 06/09/2022 for Resident #38 revealed no
documentation of sepsis and signs and symptoms of sepsis.
Record review of lab results from 01/01/2022 to 06/09/2022 for Resident #38 revealed no lab work to
diagnosis sepsis.
Record review of diagnostics test from 01/01/2022 to 06/09/2022 for Resident #38 revealed no test to
diagnosis sepsis.
Record review of active care plan for Resident #38 revealed no documentation of sepsis or interventions to
treat or prevent sepsis.
Resident #47
Record review of the electronic face sheet on 06/09/2022 for Resident # 47 revealed an admission date of
11/16/2021. Resident was an [AGE] years old male with diagnoses to include: Pneumonia, Sepsis, Lung
disease, and heart failure.
Record review of MDS date 05/26/2022 for Resident #47 reveals a BIMS score of 99 indicating severely
impaired cognitive skills for daily decision making. Further review of MDS Section I Active Diagnoses
revealed Sepsis and Pneumonia.
Record review of the electronic physician's orders from 01/01/2022 to 06/09/2022 for Resident #47
revealed no orders to test for or to treat sepsis or pneumonia.
Record review of electronic progress notes from 01/01/2022 to 06/09/2022 for Resident #47 revealed no
documentation of sepsis or pneumonia and no signs and symptoms of sepsis or pneumonia.
Record review of lab results from 01/01/2022 to 06/09/2022 for Resident #47 revealed no lab work to
diagnosis sepsis or pneumonia.
Record review of diagnostics test from 01/01/2022 to 06/09/2022 for Resident #47 revealed no test to
diagnosis sepsis or pneumonia.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
676074
If continuation sheet
Page 3 of 9
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
676074
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
06/09/2022
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Whitney Nursing and Rehabilitation Center
101 San Marcus
Whitney, TX 76692
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 - Minimal harm
or potential for actual harm
Residents Affected - Some
Record review of active care plan for Resident #47 revealed no documentation of sepsis or pneumonia or
interventions to treat or prevent sepsis or pneumonia.
Resident #16
Record review of the electronic face sheet on 06/09/2022 for Resident #16 revealed an admission date of
04/12/2021. Resident was a [AGE] years old female with diagnoses to include: Alzheimer's, Respiratory
Failure, and fractur of sacrum.
Record review of MDS date 04/04/2022 for Resident #16 reveals a BIMS score of 04 indicating severely
impaired cognitive skills for daily decision making. Further review of MDS Section I Active Diagnoses
revealed Sepsis.
Record review of the electronic physician's orders from 01/01/2022 to 06/09/2022 for Resident #16
revealed no orders to test for or to treat sepsis.
Record review of electronic progress notes from 01/01/2022 to 06/09/2022 for Resident #16 revealed no
documentation of sepsis and no signs and symptoms of sepsis.
Record review of lab results from 01/01/2022 to 06/09/2022 for Resident #16 revealed no lab work to
diagnosis sepsis.
Record review of diagnostics test from 01/01/2022 to 06/09/2022 for Resident #16 revealed no test to
diagnosis sepsis.
Record review of active care plan for Resident #16 revealed no documentation of sepsis or interventions to
treat or prevent sepsis.
Resident #3
Record review of the electronic face sheet on 06/09/2022 for Resident #3 revealed an admission date of
06/09/2018. Resident was a [AGE] year-old female with diagnoses to include: heart failure, kidney failure,
and diabetes.
Record review of MDS date 04/08/2022 for Resident #3 reveals a BIMS score of 12 indicating moderate
impaired cognitive skills for daily decision making. Further review of MDS Section I Active Diagnoses
revealed Pneumonia.
Record review of the electronic physician's orders from 01/01/2022 to 06/09/2022 for Resident #3 revealed
no orders to test for or to treat pneumonia.
Record review of electronic progress notes from 01/01/2022 to 06/09/2022 for Resident #3 revealed no
documentation of pneumonia and no signs and symptoms of pneumonia.
Record review of lab results from 01/01/2022 to 06/09/2022 for Resident #3 revealed no lab work to
diagnosis pneumonia.
Record review of diagnostics test from 01/01/2022 to 06/09/2022 for Resident #3 revealed no test to
diagnosis pneumonia.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
676074
If continuation sheet
Page 4 of 9
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
676074
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
06/09/2022
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Whitney Nursing and Rehabilitation Center
101 San Marcus
Whitney, TX 76692
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 - Minimal harm
or potential for actual harm
Residents Affected - Some
Record review of active care plan for Resident #3 revealed no documentation of pneumonia or interventions
to treat or prevent pneumonia.
Resident #1
Record review of the electronic face sheet on 06/09/2022 for Resident #1 revealed an admission date of
03/30/2015. Resident was a [AGE] year-old female with diagnoses to include: Dementia, fractured femur,
High blood pressure, and depression.
Record review of MDS date 06/05/2022 for Resident #1 reveals a BIMS score of 03 indicating severely
impaired cognitive skills for daily decision making. Further review of MDS Section I Active Diagnoses
revealed Pneumonia.
Record review of the electronic physician's orders from 01/01/2022 to 06/09/2022 for Resident #1 revealed
no orders to test for or to treat pneumonia.
Record review of electronic progress notes from 01/01/2022 to 06/09/2022 for Resident #1 revealed no
documentation of pneumonia and no signs and symptoms of pneumonia.
Record review of lab results from 01/01/2022 to 06/09/2022 for Resident #1 revealed no lab work to
diagnosis pneumonia.
Record review of diagnostics test from 01/01/2022 to 06/09/2022 for Resident #1 revealed no test to
diagnosis pneumonia.
Record review of active care plan for Resident #1 revealed no documentation of pneumonia or interventions
to treat or prevent pneumonia.
Resident #10
Record review of the electronic face sheet on 06/09/2022 for Resident # 10 revealed admission date
10/02/2019. Resident was a [AGE] year-old female with diagnoses to include: Dementia, difficulty
swallowing, left eye vison loss, and heartburn.
Record review of MDS date 05/19/2022 for Resident #10 reveals a BIMS score of 02 indicating severely
impaired cognitive skills for daily decision making. Further review of MDS Section I Active Diagnoses
revealed Sepsis and Pneumonia.
Record review of the electronic physician's orders from 01/01/2022 to 06/09/2022 for Resident #10
revealed no orders to test for or to treat sepsis or pneumonia.
Record review of electronic progress notes from 01/01/2022 to 06/09/2022 for Resident #10 revealed no
documentation of sepsis or pneumonia and no signs and symptoms of sepsis or pneumonia.
Record review of lab results from 01/01/2022 to 06/09/2022 for Resident #10 revealed no lab work to
diagnosis sepsis or pneumonia.
Record review of diagnostics test from 01/01/2022 to 06/09/2022 for Resident #10 revealed no test to
diagnosis sepsis or pneumonia.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
676074
If continuation sheet
Page 5 of 9
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
676074
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
06/09/2022
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Whitney Nursing and Rehabilitation Center
101 San Marcus
Whitney, TX 76692
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 - Minimal harm
or potential for actual harm
Residents Affected - Some
Record review of active care plan for Resident #10 revealed no documentation of sepsis or pneumonia or
interventions to treat or prevent sepsis or pneumonia.
Resident #9
Record review of the electronic face sheet on 06/09/2022 for Resident #9 reveled admission date
01/02/2021. Resident was a [AGE] years old female with diagnoses to include: Dementia, chest pain,
diabetes, and high blood pressure.
Record review of MDS dated [DATE] for Resident #9 reveals a BIMS score of 03 indicating severely
impaired cognitive skills for daily decision making. Further review of MDS Section I Active Diagnoses
reveled COVID 19.
Record review of electronic physician's orders dated 02/01/2022 to 06/09/2022 for Resident #9 revealed no
orders for treatment of COVID.
Record review of electronic progress notes from 02/01/2022 to 06/09/2022 for Resident #9 revealed no
documentation of COVID and no signs and symptoms of COVID.
Record review of lab results from 02/01/2022 to 06/09/2022 for Resident #9 revealed no lab work to
diagnosis COVID.
Record review of diagnostics test from 02/01/2022 to 06/09/2022 for Resident #9 revealed no test to
diagnosis COVID.
Record review of active care plan for Resident #9 revealed resident had been diagnosed with COVID on
01/21/2022 and recovered 02/01/2022.
Resident #28
Record review of the electronic face sheet on 06/09/2022 for Resident #28 revealed admission date
09/07/2021. Resident was a [AGE] year-old male with diagnoses to include: low heart rate, pacemaker, lung
disease, and heart failure.
Record review of MDS date 05/28/2022 for Resident #28 reveals a BIMS score of 12 indicating no impaired
cognitive skills for daily decision making. Further review of MDS Section I Active Diagnoses revealed
Pneumonia.
Record review of the electronic physician's orders from 01/01/2022 to 06/09/2022 for Resident #28
revealed no orders to test for or to treat pneumonia.
Record review of electronic progress notes from 01/01/2022 to 06/09/2022 for Resident #28 revealed no
documentation of pneumonia and no signs and symptoms of pneumonia.
Record review of lab results from 01/01/2022 to 06/09/2022 for Resident #28 revealed no lab work to
diagnosis pneumonia.
Record review of diagnostics test from 01/01/2022 to 06/09/2022 for Resident #28 revealed no test to
diagnosis pneumonia.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
676074
If continuation sheet
Page 6 of 9
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
676074
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
06/09/2022
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Whitney Nursing and Rehabilitation Center
101 San Marcus
Whitney, TX 76692
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 - Minimal harm
or potential for actual harm
Residents Affected - Some
Record review of active care plan for Resident #28 revealed no documentation of pneumonia or
interventions to treat or prevent pneumonia.
Resident #17
Record review of the electronic face sheet on 06/09/2022 for Resident #17 revealed admission date
08/21/2019. Resident was a [AGE] year-old male with diagnoses to include: Dementia, Diabetes,
depression, and high blood pressure.
Record review of MDS date 06/05/2022 for Resident #17 reveals a BIMS score of 99 indicating severely
impaired cognitive skills for daily decision making. Further review of MDS Section I Active Diagnoses
revealed Pneumonia and COVID.
Record review of the electronic physician's orders from 01/01/2022 to 06/09/2022 for Resident #17
revealed no orders to test for or to treat pneumonia or COVID.
Record review of electronic progress notes from 01/01/2022 to 06/09/2022 for Resident #17 revealed no
documentation of pneumonia or COVID and no signs and symptoms of pneumonia or COVID.
Record review of lab results from 01/01/2022 to 06/09/2022 for Resident #17 revealed no lab work to
diagnosis pneumonia or COVID.
Record review of diagnostics test from 01/01/2022 to 06/09/2022 for Resident #17 revealed no test to
diagnosis pneumonia or COVID.
Record review of active care plan for Resident #17 revealed no documentation of pneumonia or COVID or
interventions to treat or prevent pneumonia or COVID.
Resident #4
Record review of the electronic face sheet on 06/09/2022 for Resident #4 revealed admission date
01/13/2018. Resident was a [AGE] years old male with diagnoses to include: Dementia, COVID, blockage of
the bladder, and high blood pressure.
Record review of MDS date 03/09/2022 for Resident #4 reveals a BIMS score of 13 indicating no impaired
cognitive skills for daily decision making. Further review of MDS Section I Active Diagnoses revealed
COVID.
Record review of the electronic physician's orders from 01/01/2022 to 06/09/2022 for Resident #4 revealed
no orders to test for or to treat COVID.
Record review of electronic progress notes from 01/01/2022 to 06/09/2022 for Resident #4 revealed no
documentation of pneumonia or COVID and no signs and symptoms of COVID.
Record review of lab results from 01/01/2022 to 06/09/2022 for Resident #4 revealed no lab work to
diagnosis COVID.
Record review of diagnostics test from 01/01/2022 to 06/09/2022 for Resident #4 revealed no test to
diagnosis COVID.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
676074
If continuation sheet
Page 7 of 9
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
676074
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
06/09/2022
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Whitney Nursing and Rehabilitation Center
101 San Marcus
Whitney, TX 76692
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 - Minimal harm
or potential for actual harm
Residents Affected - Some
Record review of active care plan for Resident #4 revealed no documentation of COVID or interventions to
treat or prevent COVID.
During an interview on 06/08/22 at 08:30 AM the MDS Coordinator stated she just copied what carried over
each quarter from the computer on to the MDS. She stated all diagnosis carried over. She stated the
diagnoses should have been removed every quarter and updated. She stated she did not realize they were
not being removed.
During a follow up interview on 06/08/22 at 03:00 PM the MDS Coordinator stated MDS are done to submit
to Medicare to receive payments. She stated they are done every 90 days to capture new diagnosis and
treatments to received proper payment. She stated she gets all of her information for MDS from the
computer and the diagnosis are carried over and she reviewed the nurses notes and new orders for any
changes. She stated that the importance of the MDS is to get the most amount of money. She stated not
removing nonactive diagnosis does not cause any problems and she never has removed them. She stated
this has no actual negative impact on residents. She stated it is not a problem if old information is not
removed and that it's only a problem if they do not capture new information.
During an interview on 06/08/22 at 04:12 PM the DON stated she stated she does not do MDS and does
not know much about the process. She stated they are done quarterly to capture any new diagnosis or
treatments to get payment for them. She stated that when doing an MDS only current information should be
on them. She stated her MDS nurse does not know how to remove old data, she just adds the new data.
She stated she was not aware the old diagnoses were not being removed and the MDS Coordinator would
learn how. She stated that claiming major infections and inaccurate diagnosis is not a problem because it
does not reflect the RUG payment.
Record review of the facilities policy titled, Senior Care Centers Operational/Resident Care Policies, with no
date, read in part . Accuracy of Assessments: The assessment must accurately reflect the resident's status.
Each resident's comprehensive assessment is conducted or coordinated by a registered nurse with the
appropriate participation of health professionals. The registered nurse who conducts or coordinates each
assessment shall sign and certify the completion of the assessment .
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
676074
If continuation sheet
Page 8 of 9
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
676074
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
06/09/2022
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Whitney Nursing and Rehabilitation Center
101 San Marcus
Whitney, TX 76692
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 - Minimal harm
or potential for actual harm
Based on observation and interview, the facility failed to post the daily nurse staffing information at the
beginning of each shift in a prominent place, readily accessible to residents and visitors that included the
facility name; the total number of hours worked per shift by the registered nurses, the licensed vocational
nurses, and the certified nurse aides directly responsible for resident care for the facility for 1 of 1 days
reviewed for nursing staff information posting.
Residents Affected - Few
The facility failed to post the required staffing with hours worked daily for the public and residents.
This failure could place the residents, families, and visitors at risk of not knowing the daily nurse staffing
information.
Findings included:
During an observation on 06/08/22 at 3:35 PM no daily nursing staff information was posted in the lobby,
halls to resident's rooms, or at the nurse station with the facility name, number of staff for each category or
actual hours worked by RNs, LVNs and CNAs, or the facility's current census.
During an observation and interview on 06/08/22 at 3:40 PM, the DON stated the ADON had the daily
nurse staffing information on her door. The DON pulled a nursing schedule in a wall pocket on the outside
of the ADON's office door.
During an interview on 06/08/22 at 3:40 pm, the ADON stated she printed the nursing schedule daily and
made it accessible to the staff by putting it in the wall pocket on the office door.
Observation on 06/08/22 at 3:40 pm of ADON's door showed nursing staffing schedule did not include the
CNAs.
During an interview on 06/08/22 at 5:00 pm, the Medical Records Director stated she was told by state
surveyors during the past 3 surveys that it was not necessary to post the information. The Medical Records
Director was not able to recall the name of the person who made the statement. The Medical Records
Director stated state just looked at time clock records.
During an interview on 06/09/22 at 9:43 AM a request for a policy on daily nursing staff posting was made
to the Administrator. She stated the facility did not have a written policy on posting nurse staffing daily.
During an interview on 06/09/22 at 11:25 AM the DON stated during the relicensure/recertification survey in
January 2019 the facility administration, responsible for ensuring regulations were being followed, was told
that since the facility was reporting direct care staffing and census information electronically every quarter
to the government as required, posting staff information daily was not necessary.
During an interview on 06/09/22 at 12:13 PM with the DON, ADON, SW, and Admin, the DON stated if
anyone wanted to know staffing information, she could access the information online. The SW stated not
posting the information may lead to resident families wondering if there was enough staff to care for all the
residents.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
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676074
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