Inspection visit
Health inspection
1 citation recorded
Inspector’s narrative
What the inspector wrote
This survey cited 1 deficiency. 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
record review and interview, the facility failed to develop a comprehensive care plan to meet the highest
practicable physical, mental, psychosocial well-being for 1 of 5 residents (Residents #2) reviewed for care
plans as follows:
Facility failed to develop care plans for Resident #2's regarding hospice care, mechanical lift, weight loss,
oxygen therapy and ADL's.
These failures could place residents at risk of not receiving the care required to meet their individualized
needs.
Findings include:
Resident #2
Record review of Resident #2's face sheet, dated 12/18/2023, revealed [AGE] year-old female admitted
[DATE] with diagnoses that included, but were not limited to, acute on chronic diastolic (congestive) heart
failure (heart's main pumping chamber (left ventricle) becomes stiff and unable to fill properly);
hypothyroidism (under active thyroid- thyroid gland doesn't make enough thyroid hormone), type 2 diabetes
(a condition that happens because of a problem in the way the body regulates and uses sugar as a fuel);
hypertension (high blood pressure), atherosclerotic heart disease of native coronary artery (the buildup of
fats, cholesterol and other substances in and on the artery walls); chronic atrial fibrillation (an irregular and
often very rapid heart rhythm); dysphagia following other cerebrovascular disease (difficult to swallow after
a stroke); speech and language deficits after stroke; chronic obstructive pulmonary disease (COPD) (a
common lung disease causing restricted airflow and breathing problems); muscle weakness; osteomyelitis
(inflammation or swelling of bone tissue that is usually the result of an infection); stage 4 chronic kidney
disease (severe); pain; and cognitive communication deficit.
Record review of Resident #2's quarterly MDS dated [DATE] revealed Resident #2 had a BIMS of 11 which
indicates moderate cognitive impairment. The functional status section revealed Resident #2 requires an
wheelchair for ambulation; requires more than half the assistance with toilet hygiene and with transferring
on/off toilet, shower/bathing and getting in/out of shower, upper & lower dressing, putting on/taking off
footwear, personal hygiene. The special treatments, procedures and program section reveal Resident #2
was on oxygen therapy and received hospice care.
Record reviewed of Resident #2's physician order as of 12/18/2023 revealed an order for
(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 3
Event ID:
676318
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
676318
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/11/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Windmill Village Rehabilitation & Care Center
507 Martin Luther King Blvd
Lubbock, TX 79403
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
O2@ 2-5 ml to maintain O2 stats above 90% active and start date 02/02/2023;
Level of Harm - Minimal harm
or potential for actual harm
O2 NC 2-4L as needed to maintain an O2 sat of 90% or greater every shift for SOB, start date and active
date 08/02/2022;
Residents Affected - Few
Resident may use Hoyer lift to get out of bed each day to her chair, and to transfer back into bed per
hospice, start date 09/12/2023.
Record reviewed of Resident #2's care plan revealed no care plan for ADLs, Hospice, Oxygen therapy or
Mechanical Lift.
In an interview on 12/10/2023 at 8:48 AM, Resident #2 stated baths are given on Mondays and Fridays
from hospice. Resident #2 stated to be transferred from bed to chair, a mechanical lift is used. Resident #2
continued to state when she has asked the facility staff if she can have a bath during the week, they said
they don't get paid to give her a bath. Resident stated she has not notified anyone because she does not
know how to.
In an interview on 12/18/2023 at 5:10 PM, DON stated the facility does give bath/showers to residents who
received hospice services; they will give a resident a shower in between showers given by hospice and if
hospice does not show to give a shower, the facility staff will shower the resident. DON did not indicate who
was responsible for care plan but continue to state they have had several staff to leave, and they now are
working on getting documentation caught up.
Record review Comprehensive Resident Care Plans (no date available)
A comprehensive care plan is developed for each resident using the results of the comprehensive
assessment. Each resident's care plan shall include measurable objectives and timetables to meet all
resident needs identified in the comprehensive assessment. All items or services ordered to be provided or
withheld shall be included in each resident's plan of care. The comprehensive care plan describes services
furnished to attain or maintain the resident's highest practicable physical, mental and psychosocial
well-being. Resident's right to refuse care and treatment shall also be included in the comprehensive care
plan.
Each resident's plan of care shall be developed within seven days after completion of the comprehensive
assessment. Comprehensive care plans are prepared by an interdisciplinary team. The interdisciplinary
team includes:
The resident's attending physician;
A registered nurse with responsibility for resident;
Other appropriate staff in disciplines as determined by the resident's needs; and
The resident, the resident's family, or the resident's legal representative to the extent practical.
Each resident's plan of care shall be reviewed by an interdisciplinary team after each MDS assessment is
conducted and revised as necessary to reflect the resident's current care needs. Resident's care plans are
reviewed at least quarterly. Care plans are revised as necessary to address the current
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
676318
If continuation sheet
Page 2 of 3
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
676318
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/11/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Windmill Village Rehabilitation & Care Center
507 Martin Luther King Blvd
Lubbock, TX 79403
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
needs of each resident .
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:
676318
If continuation sheet
Page 3 of 3
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Back to topCitations
1 citation 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.
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 January 11, 2024 survey of WINDMILL VILLAGE REHABILITATION & CARE CENTER?
This was a inspection survey of WINDMILL VILLAGE REHABILITATION & CARE CENTER on January 11, 2024. The surveyor cited 1 deficiency, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at WINDMILL VILLAGE REHABILITATION & CARE CENTER on January 11, 2024?
Yes, 1 deficiency was cited, each with a CMS Scope and Severity grade. The first was: "Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be ..."
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.