Inspection visit
Health inspection
3 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 3 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0690
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate
catheter care, and appropriate care to prevent urinary tract infections.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, interview, and record review, the facility failed to maintain an infection prevention and control
program designed to provide a safe, sanitary, and comfortable environment and to help prevent the
development and transmission of communicable diseases and infections for 1 of 3 Residents (Resident
#39) reviewed for incontinent care.
-CNA D and E failed to use proper hand hygiene techniques when providing incontinent care to Resident
#39.
This failure had the potential to affect all residents in the facility receiving incontinent care by exposing them
to care that could lead to the spread of viral infections, secondary infections, tissue breakdown,
communicable diseases, and feelings of isolation related to poor hygiene.
Findings include:
Record review of Resident #39 face sheet dated 12/12/22 reviewed an [AGE] year-old female admitted to
the facility on [DATE] with diagnose included, but were not limited to, Alzheimer's disease with late onset,
metabolic encephalopathy, urinary tract infection site not specified.
Record review of Resident #39 Quarterly MDS dated [DATE] revealed BIMS of 09 of 15 indicating
moderately impaired cognition. MDS revealed resident is always incontinent of urine and frequently
incontinent of bowel.
Record review of Resident #39 care plan last reviewed 09/26/22 revealed the resident has bladder and
bowel incontinence.
During an observation of incontinent care on 12/11/22 at 02:45 pm for Resident #39, CNA E returned to the
room with a bag of incontinent supplies for incontinent care for the resident. Both CNA D and CNA E
proceeded to tell the resident what they were intending to do, however they did not wash their hands with
soap and warm water or utilize ABHR prior to starting care. Both CNA D and CNA E placed gloves on and
completed the incontinent care. No gloves or handwashing or use of ABHR was observed when the dirty
brief was removed and prior to the new brief was picked up and placed on the resident. All dirty supplies
were placed in a bag at the end of the care and both CNAs removed their gloves. CNA D washed her
hands first and then CNA E washed her hands with warm water and soap from resident's sink.
During an interview on 12/11/22 at 03:15 pm with CNA D, she was asked about not seeing her washing
(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 7
Event ID:
676455
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
676455
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
12/13/2022
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Five Points Nursing and Rehabilitation
1625 Point West Parkway
Amarillo, TX 79124
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 0690
Level of Harm - Minimal harm
or potential for actual harm
her hands prior to the incontinent care and was this appropriate. CNA D answered, she did not know she
was supposed to do this. CNA D was asked about not changing gloves or washing her hands prior to
putting on the resident's new brief and what the consequences of this could cause. CNA D responded that
she was nervous and forgot to do this as a part of her procedure and that not doing this could cause
contamination to the brief.
Residents Affected - Few
During an interview on 12/11/22 at 03:25 pm with CNA E, she was asked not seeing her washing her
hands prior to incontinent care was this appropriate. CNA E stated this could cause infection. CNA E was
asked about not changing gloves or washing her hands prior to putting on the resident's new brief and what
the consequences of this could cause. CNA E responded this could contaminate the clean material and
that she did not learn this when she became certified.
During an interview on 12/13/22 at 08:13 am with the DON, she was asked when do you expect hand
hygiene to be completed during incontinent care. DON stated, before they start, after peri-care, from dirty to
clean portion, at end and every time they touch the resident. She was asked what do you feel the
consequences could be if hand hygiene is not performed. DON stated UTI's and infection control.
Record review of facility provided policy titled, Perineal Care dated effective 5/11/22 revealed the following:
. Purpose:
This procedure aims to maintain the resident dignity and self-worth and reduce embarrassment by
providing cleanliness and comfort to the resident, preventing infections and skin irritation, and observing the
resident's skin condition
Procedure Content .
10) Perform hand hygiene .
24) Doff gloves and PPE
25) Perform hand hygiene .
Record review of facility provided competency titled, Nurse Aide Incontinence Care-Proficiency Assessment
not dated, revealed the following:
This is a supplement to the competencies listed in the competency verification form .
Technical competence necessary for safe clinical practice . Complete visual observation and return
demonstration .
Demonstrates proficiency in performing technical procedures safely in accordance with division standards
as evidences by unit-specific criteria.
Washes hands before gathering supplies .
Washes hands .
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
676455
If continuation sheet
Page 2 of 7
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
676455
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
12/13/2022
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Five Points Nursing and Rehabilitation
1625 Point West Parkway
Amarillo, TX 79124
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 0690
Puts on gloves .
Level of Harm - Minimal harm
or potential for actual harm
Washes hands/changes gloves .
Residents Affected - Few
Record review of facility provided policy titled, Fundamentals of Infection Control Precautions, dated 2018,
revealed the following:
.Hand Hygiene
Hand hygiene continues to be the primary means of preventing the transmission of infection. The following
is a list of some situations that require hand hygiene:
.Before and after assisting a resident with toileting (hand washing with soap and water);
.Consistent use by staff of proper hygienic practices and techniques is critical to preventing the spread of
infections. It is necessary for staff to have access to proper hand washing facilities with available soap
(regular or anti-microbial), warm water, and disposable towels and/or heat/air drying methods.
.Except for situations where hand washing is specifically required, antimicrobial agents such as ABHR are
also appropriate for cleaning hands and can be used for direct resident care.
.Gloving .
Wearing gloves does not replace the need for hand washing because gloves may have small inapparent
defects or be torn during use, and hands can become contaminated during removal of gloves .
Failure to change gloves between resident contacts is an infection control hazard
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
676455
If continuation sheet
Page 3 of 7
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
676455
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
12/13/2022
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Five Points Nursing and Rehabilitation
1625 Point West Parkway
Amarillo, TX 79124
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0755
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a
licensed pharmacist.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, interview, and record review the facility failed to provide pharmaceutical services that include
procedures to ensure accurate acquiring, receiving, dispensing, and administering of all drugs for 1 of 4
residents (Resident #5) reviewed for medications.
The facility failed to ensure Resident #5 did not receive expired medications.
This failure could place the residents in the facility at risk for not receiving needed medications to maintain
optimum health and/or deterioration in their condition.
Findings included:
Record review of Resident #5's face sheet dated 12/11/22 revealed a [AGE] year-old female admitted to the
facility on [DATE]. Resident #5's diagnoses included, but were not limited to, heart failure unspecified,
cellulitis unspecified, essential primary hypertension, permanent atrial fibrillation.
Record review of Resident #5's quarterly MDS completed 11/26/2022 revealed she had a BIMS of 12 out of
15 indicating she was moderately cognitive. Active diagnosis revealed she has heart failure unspecified,
mild cognitive impairment of uncertain or unknown etiology and permanent atrial fibrillation
Record review of Resident #5's physicians orders listed as Active Orders As Of 11/14/2022 revealed the
following order:
Furosemide Tablet 40mg give 1 tablet by mouth one time a day related to Essential Primary Hypertension,
started 04/30/33 06:30, revision date 04/29/22, status Active.
Record review of Resident #5's Medication Administration Record: for November 2022 revealed that
Resident #5 received Furosemide 40mg 1 tablet every day for the entire month of November.
Record review of Resident #5's Medication Administration Record: for December 2022 revealed that
Resident #5 received Furosemide 40mg 1 tablet every day from December 1 through December 11, 2022,
when record was pulled.
During an observation of medication storage on 12/11/22 at 09:45 am, a bottle of Furosemide 40mg tablets
belonging to Resident #5 was in drawer 3 of the medication cart on the 300 Hall of a facility. The bottle was
labeled with Resident #5's name, medication, dosage, and frequency. The expiration date indicated
11/6/22.
During an interview with MA G on 12/11/22 at 09:47 am, she was asked if Resident #5 had a blister pack
for Resident #5 of medication Furosemide in the medication cart. MA G checked the medication cart and
stated, no there was not a blister pack for furosemide for this resident.
During an interview and observation with MA G on 12/12/22 at 08:58 am, she was asked if Resident #5 had
any medication of Furosemide in medication cart. MA G looked in all drawers for medication and stated no
the resident did not have any Furosemide in the cart. She was asked if there was any
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
676455
If continuation sheet
Page 4 of 7
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
676455
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
12/13/2022
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Five Points Nursing and Rehabilitation
1625 Point West Parkway
Amarillo, TX 79124
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0755
Level of Harm - Minimal harm
or potential for actual harm
medication on hand that Resident #5 would be able to receive. MA G stated yes, they have a pyxis here
and I will have to ask the nurse to get it for me.
During record review on 12/13/22 at 09:16 am, surveyor attempted to contact pharmacy, and left voicemails
2 times. No returned calls.
Residents Affected - Few
Record review of Resident #5's pyxis/E-kit report StatSafe revealed 2 tablets were pulled for Furosemide on
12/11/22 by ADON B. The report indicated no Furosemide was given from pyxis/E-kit from admission date
until 12/10/22. The first time date retrieved Furosemide via pyxis/E-kit for administration was on 12/11/22.
During an interview with CRN F stated on 12/13/22 at 09:50 am revealed that the Furosemide bottle
belonged to Resident #5 prior to her admission and was brought to the facility by Resident #5's family.
Pharmacy had been providing Furosemide through blister packs until August. Nursing staff was providing
Resident #5 medication Furosemide from the blister packs until they became unavailable from the
pharmacy. The facility pharmacy discontinued Furosemide without an order in August. Nursing staff began
using Resident #5's personal bottle of Furosemide located in medication cart. Unable to determine reason
why discontinued.
During an interview with the DON with CRN F present on 12/13/22 at 10:11 am, The DON stated that the
Pharmacy completed reviews monthly. DON asked if the staff check the cart for expired medications, the
DON stated, It is supposed to be completed with the night staff. When asked what was the possible
negative outcome using expired medications, the DON responded, There is a reason why medications have
expiration dates. When expired medications given it's possible not going to be effective or the resident is not
going to receive any of the medication.
Record review of the facility provided policy titled, Medication Labeling dated effective 2003 revealed no
information
Record review of the facility provided policy titled, Recommended Medication Storage, dated 07/2012
revealed no information.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
676455
If continuation sheet
Page 5 of 7
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
676455
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
12/13/2022
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Five Points Nursing and Rehabilitation
1625 Point West Parkway
Amarillo, TX 79124
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
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve
food in accordance with professional standards.
Based on observations, interviews, and record reviews the facility failed to store food in accordance with
professional standards for food service safety to prevent food borne illness in one of one kitchen observed
for safe food storage in that:
Food stored in the walk-in refrigerator, walk-in freezer, and dry storage area was not properly labeled,
dated, and stored.
These failures could place residents who eat food served by the kitchen at risk of food-borne illness.
Findings included:
An observation on 12/11/22 at 08:35 AM of the refrigerator revealed the following:
1. A small white bowl of what appeared to be collard greens covered with plastic wrap, unlabeled and
undated;
2. Opaque square plastic tub with red lid labeled as gravy with only one date of 12/06;
3. Orange slices in a steam table tray labeled and dated 12/05 and 12/06;
4. Sausage in resealable plastic bag dated 11/29 and 12/5;
5. Bologna in a resealable plastic bag with only one date of 11/28;
6. BBQ Rib meat in a resealable plastic bag dated 12/01 and 12/07;
7. Pot roast in a resealable plastic bag with only one date of 12/07;
8. Flour tortillas in a resealable plastic bag with only one date of 11/23;
9. Cooked spaghetti noodles in a resealable plastic bag with only one date of 12/07
An observation on 12/11/22 at 08:42 AM of the pantry revealed the following:
1. The lid to the plastic bucket of cornmeal was not sealed leaving the cornmeal open to air.
2. The lid to the plastic bucket of sugar was not sealed leaving the sugar open to air.
3. An almost empty plastic bottle of Hershey's chocolate syrup was sitting on a shelf with the lid partially
open. The lid was unable to close due to a buildup of a gummy brown substance around the lid. The bottle
was labeled and dated but the label and date were unreadable. The manufacturer's directions on the bottle
indicated the bottle needed to be refrigerated after opening.
An observation on 12/11/22 at 08:52 AM of the freezer revealed the following:
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
676455
If continuation sheet
Page 6 of 7
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
676455
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
12/13/2022
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Five Points Nursing and Rehabilitation
1625 Point West Parkway
Amarillo, TX 79124
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
1. A resealable plastic bag of what appeared to be biscuits with no label or date.
Level of Harm - Minimal harm
or potential for actual harm
During an interview on 12/12/22 at 10:53 AM, [NAME] A stated leftover items in the refrigerator should be
dated with two dates, the date we make and 6 days afterward. She stated items in the freezer should be
dated, the day we got it. [NAME] A said whoever grab[sic] it was responsible for dating leftovers. When
asked who was responsible for clearing expired food from the refrigerator she stated, whoever checks, me,
her (gestured to the DM), the other cook. [NAME] A said a possible negative outcome of having food
improperly labelled, dated, and stored would be, somebody can get sick.
Residents Affected - Many
During an interview on 12/12/22 at 10:59 AM DM stated leftover food in the refrigerator should be dated,
The day we use it and then from that day, 7 days out. She stated kitchen staff label freezer food the day it
arrives at the facility. DM said she and the cooks are responsible for labeling and dating food as well as
clearing expired food from the refrigerator. She said a possible negative outcome for improperly dated food
was, it could make them (residents) sick. She said the same outcome could be true for items not
refrigerated properly. When asked to provide a possible negative outcome for improperly sealed food in the
pantry, DM said, I would think dust or bugs could get into it.
During an interview on 12/13/22 at 11:46 AM ADM stated DM is responsible for labelling and dating food as
well as removing expired food from the refrigerator and pantry. She said a possible negative outcome of
food being improperly dated or stored was, You know, illness.
Record review of the facility provided policy titled Left - Over Foods and dated 2012 revealed the following:
1.
Left-over foods shall be refrigerated, dated, labeled, and properly covered promptly after meal service.
4. The guidelines from the 'Texas Food Establishment Rules' will be used when determining the shelf life of
leftovers.
Record review of the facility provided policy titled Cooling Methods Fact Sheet and dated 02/24/17 revealed
the following:
. Once the food item has been properly cooled, it should be stored properly - covered and labeled with the 7
day use by date, with the day of preparation being day one.
Record review of the facility provided Record of Departmental In Service and Meetings given by DM and
attended by 7 kitchen staff on 12/11/22 at 09:30 AM revealed the following:
. Summary/Objectives .Date all left over food for 7 days the day it's cooled is day 1. We follow the Texas
Food Establishment Rules for left over food storage. After 7 days food is thrown out. All food must have an
in date and an out date and product name.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
676455
If continuation sheet
Page 7 of 7
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Back to topCitations
3 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.
F690 - Incontinence
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
F755 - Pharmacy Services
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
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 December 13, 2022 survey of Five Points Nursing and Rehabilitation?
This was a inspection survey of Five Points Nursing and Rehabilitation on December 13, 2022. The surveyor cited 3 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at Five Points Nursing and Rehabilitation on December 13, 2022?
Yes, 3 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, an..."
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.