7700 MESQUITE PASS, CONVERSE, TX 78109
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Are you the operator? Claim this listing free →Data from CMS (Centers for Medicare & Medicaid Services), updated weekly. Medicare.gov Care Compare
2.8h
Hrs/resident · weekday
Expected: 3.5h
2.9h
Hrs/resident · weekend
vs 2.8h on weekdays
Not reported
30-day hospital readmission rate
High turnover is one of the strongest predictors of care quality. National average CNA turnover is ~75%.
Administrator turnover: 0 in the past year
Provide basic life support, including CPR, prior to the arrival of emergency medical personnel , subject to physician orders and the resident’s advance directives.
Corrected: Jul 28, 2024
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected: Apr 10, 2024
Provide basic life support, including CPR, prior to the arrival of emergency medical personnel , subject to physician orders and the resident’s advance directives.
Corrected: Mar 22, 2024
Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.
Corrected: Mar 22, 2024
39 standard deficiencies in the last 3 years
View allEnsure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
Provide and implement an infection prevention and control program.
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
Provide behavior health training consistent with the requirements and as determined by a facility assessment.
Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention.
Provide training in compliance and ethics.
Conduct mandatory training, for all staff, on the facility’s Quality Assurance and Performance Improvement Program.
Develop, implement, and/or maintain an effective training program that includes effective communications for direct care staff members.
Develop, implement, and/or maintain an effective training program for all new and existing staff members.
Provide and implement an infection prevention and control program.
Have a policy regarding use and storage of foods brought to residents by family and other visitors.
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Provide safe and appropriate respiratory care for a resident when needed.
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Ensure each resident receives an accurate assessment.
Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment.
Reasonably accommodate the needs and preferences of each resident.
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Keep residents' personal and medical records private and confidential.
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
Ensure each resident receives an accurate assessment.
Keep residents' personal and medical records private and confidential.
Provide and implement an infection prevention and control program.
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Provide safe and appropriate respiratory care for a resident when needed.
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.
Ensure each resident receives an accurate assessment.
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months.
No civil monetary penalties on record.
No hospitals found within 10 miles.
Proximity to emergency care is especially important for medically complex residents.
MCCULLOCH COUNTY HOSPITAL DISTRICT· For profit - Limited Liability company
Data updated weekly from CMS. Last sync: Jun 26, 2026. Medicare.gov Care Compare →
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