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Nursing Facility

Paradigm at the Oak

Owned by: For profit - Limited Liability company

Safety Pulse

AI-GENERATED FAMILY INSIGHTS

  • Immediate Needs Unmet: Facility failed to demonstrate a plan to meet residents' urgent needs within the critical 48-hour admission window, potentially jeopardizing their initial well-being.

  • Medication Management Concerns: The facility lacked assurance of adequate pharmaceutical services and licensed pharmacist oversight, raising serious questions about medication safety and accuracy.

  • Fundamental Care Deficiencies: Multiple violations concerning basic necessities like palatable food, pest control, and abuse prevention indicate a systemic failure to provide a safe and dignified living environment.

Note: This summary is generated from recently documented safety inspections and citations.

Regional Context

This Facility50
Schulenburg AVERAGE10.4

381% more violations than city average

Source: 3-year federal inspection history (CMS.gov)

Quick Stats

50Total Violations
90Certified Beds
Safety Grade
F
75/100 Score
F RATED
Safety Audit Result
Legal Consultation Available

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Violation History

CITATION DATEJanuary 1, 2026
F-TAG: 0627

Ensure the transfer/discharge meets the resident's needs/preferences and that the resident is prepared for a safe transfer/discharge.

Ensure the transfer/discharge meets the resident's needs/preferences and that the resident is prepared for a safe transfer/discharge.

Scope & Severity (CMS Alpha)
Potential for Harm
CITATION DATEJanuary 1, 2026
F-TAG: 0655

Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted

Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted

Scope & Severity (CMS Alpha)
Potential for Harm
CITATION DATEJanuary 1, 2026
F-TAG: 0755

Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

Scope & Severity (CMS Alpha)
Potential for Harm
CITATION DATEJanuary 1, 2026
F-TAG: 0804

Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.

Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.

Scope & Severity (CMS Alpha)
Potential for Harm
CITATION DATEJanuary 1, 2026
F-TAG: 0925

Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.

Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.

Scope & Severity (CMS Alpha)
Potential for Harm
CITATION DATEJanuary 1, 2026
F-TAG: 0600

Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

Scope & Severity (CMS Alpha)
Potential for Harm
CITATION DATEJanuary 1, 2026
F-TAG: 0755

Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

Scope & Severity (CMS Alpha)
Potential for Harm
CITATION DATEJanuary 1, 2026
F-TAG: 0760

Ensure that residents are free from significant medication errors.

Ensure that residents are free from significant medication errors.

Scope & Severity (CMS Alpha)
Potential for Harm
CITATION DATEJanuary 1, 2026
F-TAG: 0689

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Scope & Severity (CMS Alpha)
Harm Level Detected
CITATION DATEJanuary 1, 2026
F-TAG: 0584

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.

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.

Scope & Severity (CMS Alpha)
Potential for Harm
CITATION DATEJanuary 1, 2026
F-TAG: 0656

Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

Scope & Severity (CMS Alpha)
Potential for Harm
CITATION DATEJanuary 1, 2026
F-TAG: 0657

Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.

Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.

Scope & Severity (CMS Alpha)
Potential for Harm
CITATION DATEJanuary 1, 2026
F-TAG: 0677

Provide care and assistance to perform activities of daily living for any resident who is unable.

Provide care and assistance to perform activities of daily living for any resident who is unable.

Scope & Severity (CMS Alpha)
Potential for Harm
CITATION DATEJanuary 1, 2026
F-TAG: 0679

Provide activities to meet all resident's needs.

Provide activities to meet all resident's needs.

Scope & Severity (CMS Alpha)
Potential for Harm
CITATION DATEJanuary 1, 2026
F-TAG: 0686

Provide appropriate pressure ulcer care and prevent new ulcers from developing.

Provide appropriate pressure ulcer care and prevent new ulcers from developing.

Scope & Severity (CMS Alpha)
Potential for Harm
CITATION DATEJanuary 1, 2026
F-TAG: 0688

Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.

Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.

Scope & Severity (CMS Alpha)
Potential for Harm
CITATION DATEJanuary 1, 2026
F-TAG: 0690

Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.

Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.

Scope & Severity (CMS Alpha)
Potential for Harm
CITATION DATEJanuary 1, 2026
F-TAG: 0695

Provide safe and appropriate respiratory care for a resident when needed.

Provide safe and appropriate respiratory care for a resident when needed.

Scope & Severity (CMS Alpha)
Potential for Harm
CITATION DATEJanuary 1, 2026
F-TAG: 0757

Ensure each resident’s drug regimen must be free from unnecessary drugs.

Ensure each resident’s drug regimen must be free from unnecessary drugs.

Scope & Severity (CMS Alpha)
Potential for Harm
CITATION DATEJanuary 1, 2026
F-TAG: 0759

Ensure medication error rates are not 5 percent or greater.

Ensure medication error rates are not 5 percent or greater.

Scope & Severity (CMS Alpha)
Potential for Harm
CITATION DATEJanuary 1, 2026
F-TAG: 0812

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

Scope & Severity (CMS Alpha)
Potential for Harm
CITATION DATEJanuary 1, 2026
F-TAG: 0880

Provide and implement an infection prevention and control program.

Provide and implement an infection prevention and control program.

Scope & Severity (CMS Alpha)
Potential for Harm
CITATION DATEJanuary 1, 2026
F-TAG: 0881

Implement a program that monitors antibiotic use.

Implement a program that monitors antibiotic use.

Scope & Severity (CMS Alpha)
Potential for Harm
CITATION DATEJanuary 1, 2026
F-TAG: 0912

Provide rooms that are at least 80 square feet per resident in multiple rooms and 100 square feet for single resident rooms.

Provide rooms that are at least 80 square feet per resident in multiple rooms and 100 square feet for single resident rooms.

Scope & Severity (CMS Alpha)
Potential for Harm
CITATION DATEJanuary 1, 2026
F-TAG: 0919

Make sure that a working call system is available in each resident's bathroom and bathing area.

Make sure that a working call system is available in each resident's bathroom and bathing area.

Scope & Severity (CMS Alpha)
Potential for Harm
CITATION DATEJanuary 1, 2026
F-TAG: 0550

Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

Scope & Severity (CMS Alpha)
Potential for Harm
CITATION DATEJanuary 1, 2026
F-TAG: 0584

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.

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.

Scope & Severity (CMS Alpha)
Harm Level Detected
CITATION DATEJanuary 1, 2026
F-TAG: 0600

Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

Scope & Severity (CMS Alpha)
Harm Level Detected
CITATION DATEJanuary 1, 2026
F-TAG: 0607

Develop and implement policies and procedures to prevent abuse, neglect, and theft.

Develop and implement policies and procedures to prevent abuse, neglect, and theft.

Scope & Severity (CMS Alpha)
Harm Level Detected
CITATION DATEJanuary 1, 2026
F-TAG: 0609

Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

Scope & Severity (CMS Alpha)
Potential for Harm
CITATION DATEJanuary 1, 2026
F-TAG: 0804

Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.

Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.

Scope & Severity (CMS Alpha)
Potential for Harm
CITATION DATEJanuary 1, 2026
F-TAG: 0835

Administer the facility in a manner that enables it to use its resources effectively and efficiently.

Administer the facility in a manner that enables it to use its resources effectively and efficiently.

Scope & Severity (CMS Alpha)
Harm Level Detected
CITATION DATEJanuary 1, 2026
F-TAG: 0755

Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

Scope & Severity (CMS Alpha)
Potential for Harm
CITATION DATEJanuary 1, 2026
F-TAG: 0550

Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

Scope & Severity (CMS Alpha)
Potential for Harm
CITATION DATEJanuary 1, 2026
F-TAG: 0584

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.

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.

Scope & Severity (CMS Alpha)
Potential for Harm
CITATION DATEJanuary 1, 2026
F-TAG: 0641

Ensure each resident receives an accurate assessment.

Ensure each resident receives an accurate assessment.

Scope & Severity (CMS Alpha)
Potential for Harm
CITATION DATEJanuary 1, 2026
F-TAG: 0645

PASARR screening for Mental disorders or Intellectual Disabilities

PASARR screening for Mental disorders or Intellectual Disabilities

Scope & Severity (CMS Alpha)
Potential for Harm
CITATION DATEJanuary 1, 2026
F-TAG: 0699

Provide care or services that was trauma informed and/or culturally competent.

Provide care or services that was trauma informed and/or culturally competent.

Scope & Severity (CMS Alpha)
Potential for Harm
CITATION DATEJanuary 1, 2026
F-TAG: 0810

Provide special eating equipment and utensils for residents who need them and appropriate assistance.

Provide special eating equipment and utensils for residents who need them and appropriate assistance.

Scope & Severity (CMS Alpha)
Potential for Harm
CITATION DATEJanuary 1, 2026
F-TAG: 0812

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

Scope & Severity (CMS Alpha)
Potential for Harm
CITATION DATEJanuary 1, 2026
F-TAG: 0912

Provide rooms that are at least 80 square feet per resident in multiple rooms and 100 square feet for single resident rooms.

Provide rooms that are at least 80 square feet per resident in multiple rooms and 100 square feet for single resident rooms.

Scope & Severity (CMS Alpha)
Potential for Harm
CITATION DATEJanuary 1, 2026
F-TAG: 0600

Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

Scope & Severity (CMS Alpha)
Harm Level Detected
CITATION DATEJanuary 1, 2026
F-TAG: 0607

Develop and implement policies and procedures to prevent abuse, neglect, and theft.

Develop and implement policies and procedures to prevent abuse, neglect, and theft.

Scope & Severity (CMS Alpha)
Potential for Harm
CITATION DATEJanuary 1, 2026
F-TAG: 0584

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.

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.

Scope & Severity (CMS Alpha)
Potential for Harm
CITATION DATEJanuary 1, 2026
F-TAG: 0656

Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

Scope & Severity (CMS Alpha)
Potential for Harm
CITATION DATEJanuary 1, 2026
F-TAG: 0677

Provide care and assistance to perform activities of daily living for any resident who is unable.

Provide care and assistance to perform activities of daily living for any resident who is unable.

Scope & Severity (CMS Alpha)
Potential for Harm
CITATION DATEJanuary 1, 2026
F-TAG: 0689

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Scope & Severity (CMS Alpha)
Potential for Harm
CITATION DATEJanuary 1, 2026
F-TAG: 0690

Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.

Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.

Scope & Severity (CMS Alpha)
Potential for Harm
CITATION DATEJanuary 1, 2026
F-TAG: 0761

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 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.

Scope & Severity (CMS Alpha)
Potential for Harm
CITATION DATEJanuary 1, 2026
F-TAG: 0812

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

Scope & Severity (CMS Alpha)
Potential for Harm

Regional Safety Benchmarking

City Performance (Schulenburg)AVG: 10.4

381% more citations than local average

"Comparative analysis is essential for identifying systemic neglect. Our benchmarks are updated monthly using raw CMS files."

Critical Evidence

Full Evidence Dossier

Documented history of neglect citations, staffing failures, and ownership risk profiles. Perfect for families, legal preparation, or professional due diligence.

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Open Guide
Source: CMS.gov / Medicare.gov
Dataset Sync: Feb 2026
Audit ID: NH-AUDIT-00431DB7