Inspection visit
Inspection
2 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 2 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 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
interviews and record review the facility failed develop and implement a comprehensive person-centered
care plan for each resident, consistent with resident needs, that included measurable objectives and time
frames to meet a resident's medical, nursing, and mental and psychosocial needs, for 1 (Resident #1) of 4
residents reviewed for care plans.
The facility failed to develop a comprehensive person-centered care plan for Resident #1 to address her
behaviors (e.g. yelling, banging on bed/table, throwing items, removing brief).
The facility failed to care plan the fall mat for Resident #1.
This failure could place the residents at risk of not receiving appropriate interventions and care to meet
their current needs as indicated on the comprehensive care plans.
The findings included:
Record review of Resident #1's face sheet dated 03/06/25 reflected the resident was a [AGE] year-old
female who was admitted to the facility on [DATE] with diagnoses that included: traumatic subdural
hemorrhage (brain bleed), hemiplegia (left side paralysis), muscle wasting and atrophy, unsteadiness on
feet, cognitive communication deficit, type 2 diabetes (high levels of sugar in blood), unspecified dementia,
cerebral infarction (stroke), and chronic kidney disease.
Record review of Resident #1's MDS assessment dated [DATE] reflected Resident #1 had a BIMS score of
7, indicating severe cognitive impairment. Verbal behavioral symptoms directed toward others (e.g.,
threatening others, screaming at others, cursing at others) reflected no behaviors exhibited.
Record review of Resident #1's care plan dated 03/06/25 reflected Resident #1 had an ADL self-care
performance deficit related to cognitive deficit, weakness, and subdural hematoma. Date initiated: 02/13/25.
Resident #1's care plan did not reflect behaviors (yelling, banging on bed/table, throwing items, removing
brief). Resident #1 was at risk for falls related to history of falls with subdural hematoma. Date initiated:
02/13/25. Resident #1's care plan did not reflect the fall mat.
Interview attempted with Resident #1 on 03/06/25 at 1:00 PM, revealed Resident #1 was discharged .
Interview with MDS N on 03/13/25 at 11:00 AM, revealed MDS N said Resident #1 would yell out and was
very vocal since she was admitted . MDS N said Resident #1 would mostly yell that she wanted to go home
or would sometimes curse at others so it took a lot of redirection and reassuring. MDS N said
(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 4
Event ID:
676087
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
676087
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
03/13/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Cimarron Place Health & Rehabilitation Center
3801 Cimarron
Corpus Christi, TX 78414
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
since it was Resident #1's normal behaviors since admission, the behaviors would not need to be care
planned. MDS N said if there was an increase in behaviors or change noted, then that would be care
planned. MDS N said whenever they noticed an increase or change of behaviors, then at that point they
would have to update the care plan as soon as possible. MDS N said the care plan was updated by the
team as they discussed things every morning during their meeting and then decided what could be
implemented.
Interview with the DON on 03/13/25 at 3:10 PM, revealed the DON said when Resident #1 was first
admitted , she would repetitively call out and said hello or I want to go home. The DON said Resident #1
also had behaviors of throwing items since admission. The DON said she recalled the hospital records
indicated Resident #1 was on a 1:1 at the hospital and she speculated it was due to behaviors. The DON
said Resident #1 would holler out, bang on the bed or table, and throw other items like her brief. The DON
said she did not think Resident #1's behaviors had really increased during her stay but her behaviors
fluctuated depending on the time of the day. The DON said Resident #1 was more vocal some days than
others. The DON said Resident #1's behaviors would have been care planned. The DON said it was
important for Resident #1's behaviors to be care planned so that staff were aware and knew what to do if
Resident #1 exhibited behaviors. The DON said the care plan would have reflected the interventions
implemented specific for Resident #1's behaviors. The DON said for Resident #1 it was a lot of redirection
and distraction to address her behaviors. The DON said she was not sure why Resident #1's behaviors
were not care planned. The DON said Resident #1 did not have any falls at the facility but they were aware
of Resident #1's history of falls prior to admission so Resident #1 had a fall mat at her bedside and the bed
low during her stay. The DON said fall mats were care planned for those residents at risk for falls as the fall
mats were an intervention. The DON said Resident #1 was at risk for falls since admission. The DON said
the fall mat was not care planned for Resident #1 and the DON said she did not know why not. The DON
said the care plans were developed by the team.
Record review of the facility's Care Plans, Comprehensive Person-Centered policy dated December 2016
reflected Policy Statement: A comprehensive, person-centered care plan that includes measurable objectives and
timetables to meet the resident's physical, psychosocial and functional needs is developed and
implemented for each resident.
8.g. Incorporate identified problem areas, incorporate risk factors associated with identified problems.
13. Assessments of residents are ongoing and care plans are revised as information about the residents
and the residents' conditions change.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
676087
If continuation sheet
Page 2 of 4
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
676087
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
03/13/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Cimarron Place Health & Rehabilitation Center
3801 Cimarron
Corpus Christi, TX 78414
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 0842
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in
accordance with accepted professional standards.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
interviews and record review, the facility failed to maintain medical records in accordance with accepted
professional standards and practices that were complete and accurately documented for 1 of 4 residents
(Resident #1) reviewed for accuracy of records, in that:
The facility failed to document in Resident #1's medical record when Resident #1 was sent to the hospital
on [DATE] for a CT scan.
The facility failed to document the physician's order for the CT scan.
This failure could affect residents whose records are maintained by the facility and could place them at risk
for errors in care.
The findings included:
Record review of Resident #1's face sheet dated 03/06/25 reflected the resident was a [AGE] year-old
female who was admitted to the facility on [DATE] with diagnoses that included: traumatic subdural
hemorrhage (brain bleed), hemiplegia (left side paralysis), muscle wasting and atrophy, unsteadiness on
feet, cognitive communication deficit, type 2 diabetes (high levels of sugar in blood), unspecified dementia,
cerebral infarction (stroke), and chronic kidney disease.
Record review of Resident #1's MDS assessment dated [DATE] reflected Resident #1 had a BIMS score of
7, indicating severe cognitive impairment. Verbal behavioral symptoms directed toward others (e.g.,
threatening others, screaming at others, cursing at others) reflected no behaviors exhibited.
Record review of Resident #1's care plan dated 03/06/25 reflected Resident #1 had an ADL self-care
performance deficit related to cognitive deficit, weakness, and subdural hematoma. Date initiated: 02/13/25.
Record review of Resident #1's orders for entire stay dated 03/06/25 reflected no physician's order
documented for the CT scan ordered on 02/25/25.
Record review of Resident #1's progress notes dated 03/06/25 reflected no progress notes documented
when Resident #1 was sent to the hospital on [DATE] for a CT scan.
Interview with LVN C on 03/12/25 at 2:00 PM, revealed LVN C said on 02/25/25, the MD ordered a CT scan
for Resident #1 as Resident #1 exhibited increased behaviors. LVN C said she took over Resident #1's hall
(hall 200) at about 5:45 PM and had to arrange the transport for Resident #1 to be taken to the hospital for
the CT scan. LVN C said in between completing tasks and documenting for 2 halls, she forgot to document
a progress note in Resident #1's medical record regarding the CT scan or transport. LVN C said the
previous nurse, LVN D, had not documented either as that nurse had a personal emergency and left. LVN C
said she was not aware if the CT scan order was entered or documented in Resident #1's orders. LVN C
said she followed directives from the DON once she took over hall 200 to arrange Resident #1's transport.
LVN C said Resident #1 was transported to the hospital on [DATE] at around 6 PM.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
676087
If continuation sheet
Page 3 of 4
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
676087
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
03/13/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Cimarron Place Health & Rehabilitation Center
3801 Cimarron
Corpus Christi, TX 78414
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 0842
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Interview with the DON on 03/12/25 at 6:40 PM, revealed the DON said there was no physician's order
documented for the CT scan ordered for Resident #1 on 02/25/25 as it was a verbal order communicated to
the hospital staff. The DON said there would be no need to document the order in the chart. The DON said
the nurse called in report and gave the hospital staff the information of what was needed and the hospital
staff knew what Resident #1 was sent for. The DON said there would be a progress note to show that
Resident #1 was sent to hospital for the CT scan and why.
Interview attempted with LVN D on 03/12/25 at 7:00 PM. LVN D did not answer. LVN D was no longer
employed by the facility.
Interview with the DON on 03/13/25 at 3:10 PM, revealed the DON said on 02/25/25, Resident #1 was sent
out to a small hospital to get a CT scan. The DON said she was not sure at what time Resident #1 was sent
out. The DON said Resident #1 was supposed to come right back so the DON would not expect there to be
a progress note documented in the medical record for when Resident #1 was sent out. The DON said she
had seen in the past where they documented a progress note when the resident returned from what
hospital or doctor's office, what occurred and if they received any new orders. The DON said Resident #1
never returned to them so there was no progress note entered. The DON said the charting and
documenting policy indicated to document changes, labs, medications, but not necessarily document a
note for sending a resident to the hospital for an in/out procedure like this CT scan for Resident #1. The
DON said they had a meeting with the MD and the MD requested a CT scan to check how Resident #1 was
doing in comparison to before her admission at the facility because she had a brain bleed. The DON said
they never documented notes in the resident's medical record based on the meetings with providers. The
DON said the policy for medication and treatment orders indicated that verbal orders must be recorded
immediately in the resident's chart. The DON said they had not taken the CT scan as a verbal order, but the
MD had requested it and they sent Resident #1 out. The DON said she did not know that an order needed
to be inputted for Resident #1 to get a CT scan that was going to be in and out, outpatient procedure.
Interview with the ADM on 03/13/25 at 4:00 PM, revealed the ADM said when they sent Resident #1 out to
get the CT scan on 02/25/25, the nurse should have documented that Resident #1 was going out for a scan
and should have documented the order. The ADM said it was important to have such things documented so
the next shift knew what was being done and so they could follow up on test results. The ADM said it was
important for the resident's medical record to be complete and accurately documented to ensure there was
proper continuity of care.
Record review of the facility's Medication and Treatment Orders policy dated July 2016 reflected 7. Verbal orders must be recorded immediately in the resident's chart by the person receiving the order and
must include prescriber's last name, credentials, the date and time of the order.
Record review of the facility's Charting and Documentation policy dated July 2017 reflected Policy Statement: All services provided to the resident, progress toward the care plan goals, or any
changes in the resident's medical, physical, functional, or psychosocial condition, shall be documented in
the resident's medical record. The medical record should facilitate communication between the
interdisciplinary team regarding the resident's condition and response to care.
3. Documentation in the medical record will be objective, complete, and accurate.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
676087
If continuation sheet
Page 4 of 4
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Back to topCitations
2 citations recorded*CMS
What do CMS severity letters mean?
Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.
General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.
Each letter combines severity with scope: how many residents the deficiency affected.
F842 - Resident-identifiable information
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
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.
FAQ · About this visit
Common questions about this visit
What happened during the March 13, 2025 survey of Cimarron Place Health & Rehabilitation Center?
This was a inspection survey of Cimarron Place Health & Rehabilitation Center on March 13, 2025. The surveyor cited 2 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at Cimarron Place Health & Rehabilitation Center on March 13, 2025?
Yes, 2 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with..."
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
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Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.