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1201 WEST FRANK STREET LUFKIN, TX 75901 | Voluntary non-profit - Private

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Health deficiencies are assigned during inspections that assess compliance with rules related to patient health and safety. Examples include violations of patients' rights and safety standards, as well as the administration of drugs and other treatments.

Life Safety deficiencies are assigned during inspections that assess a facility's compliance with National Fire Protection Association codes related to life safety in health care facilities. They are often conducted in tandem with health inspections. Examples include faulty or improperly maintained fire suppression and electrical systems.

Emergency Preparedness deficiencies can be cited during either a health or life safety inspection and relate to violations of CMS' Emergency Preparedness Rule. Examples include a lack of emergency plans, inadequate staff training and insufficient emergency supplies.

Complete reports and deficiency counts

Report date	Health Deficiencies	Life Safety	Emergency Preparedness	Total
Jan 9, 2025 Follow-up to inspection on 2024-10-15*	1	0	0	1	Read full report
Deficiencies cited in this report: STAFFING AND DELIVERY OF CARE
Oct 15, 2024	3	0	0	3	Read full report
Deficiencies cited in this report: NURSING SERVICES ADMINISTRATION OF DRUGS BLOOD TRANSFUSIONS AND IV MEDICATIONS
Jun 26, 2024	3	0	0	3	Read full report
Deficiencies cited in this report: COMPLIANCE WITH 489.24 ON CALL PHYSICIANS STABILIZING TREATMENT
Oct 21, 2022	18	0	0	18	Read full report
Deficiencies cited in this report: PATIENT RIGHTS PATIENT RIGHTS: INFORMED CONSENT PATIENT RIGHTS: CARE IN SAFE SETTING PATIENT RIGHTS: RESTRAINT OR SECLUSION MEDICAL STAFF MEDICAL STAFF CREDENTIALING STAFFING AND DELIVERY OF CARE RN SUPERVISION OF NURSING CARE VERBAL ORDERS FOR DRUGS Condition of Participation: Pharmaceutical Se FOOD AND DIETETIC SERVICES ORGANIZATION THERAPEUTIC DIETS MAINTENANCE OF PHYSICAL PLANT LIFE SAFETY FROM FIRE INFECTION PREVENTION CONTROL ABX STEWARDSHIP INFECTION CONTROL PROGRAM INFECTION CONTROL SURVEILLANCE, PREVENTION
Sep 29, 2022	0	9	0	9	Read full report
Deficiencies cited in this report: General Requirements - Other Multiple Occupancies Multiple Occupancies - Contiguous Non-Health Exit Signage Subdivision of Building Spaces - Smoke Barrie Building Services - Other Electrical Systems - Other Electrical Systems - Maintenance and Testing Electrical Systems - Essential Electric Syste
Jul 19, 2022	6	0	0	6	Read full report
Deficiencies cited in this report: PATIENT RIGHTS: REVIEW OF GRIEVANCES RN SUPERVISION OF NURSING CARE Condition of Participation: Pharmaceutical Se PHARMACY ADMINISTRATION INFECTION PREVENTION CONTROL ABX STEWARDSHIP INFECTION CONTROL PROGRAM
May 4, 2018 Follow-up to inspection on 2018-02-27*	2	0	0	2	Read full report
Deficiencies cited in this report: EMERGENCY SERVICES INTEGRATION OF EMERGENCY SERVICES
Feb 27, 2018	2	0	0	2	Read full report
Deficiencies cited in this report: COMPLIANCE WITH 489.24 APPROPRIATE TRANSFER
Apr 25, 2017 Follow-up to inspection on 2017-03-02*	2	0	0	2	Read full report
Deficiencies cited in this report: QAPI QAPI PERFORMANCE IMPROVEMENT PROJECTS
Mar 30, 2017	0	5	0	5	Read full report
Deficiencies cited in this report: Hazardous Areas - Enclosure Sprinkler System - Installation Subdivision of Building Spaces - Smoke Compar Building Services - Other Electrical Systems - Maintenance and Testing
Mar 2, 2017	22	0	0	22	Read full report
Deficiencies cited in this report: LICENSURE OF PERSONNEL GOVERNING BODY CONTRACTED SERVICES PATIENT RIGHTS PATIENT RIGHTS: GRIEVANCES PATIENT RIGHTS: CARE IN SAFE SETTING QAPI GOVERNING BODY, STANDARD TAG NURSING SERVICES STAFFING AND DELIVERY OF CARE FORM AND RETENTION OF RECORDS Standard-level Tag for Pharmaceutical Service PHARMACIST SUPERVISION OF SERVICES SECURE STORAGE UNUSABLE DRUGS NOT USED AFTER-HOURS ACCESS TO DRUGS INFECTION PREVENTION CONTROL ABX STEWARDSHIP INFECTION CONTROL PROFESSIONAL INFECTION CONTROL PROGRAM No Description Available SURGICAL SERVICES HISTORY AND PHYSICAL POST-OPERATIVE CARE
Feb 2, 2017	2	0	0	2	Read full report
Deficiencies cited in this report: NURSING SERVICES STAFFING AND DELIVERY OF CARE
Nov 20, 2014	6	0	0	6	Read full report
Deficiencies cited in this report: PATIENT RIGHTS: NOTICE OF GRIEVANCE DECISION PATIENT RIGHTS: PERSONAL PRIVACY NURSING SERVICES STAFFING AND DELIVERY OF CARE ADMINISTRATION OF DRUGS STAFFING AND DELIVERY OF CARE
Sep 17, 2014	11	0	0	11	Read full report
Deficiencies cited in this report: PATIENT RIGHTS PATIENT RIGHTS: CARE IN SAFE SETTING USE OF RESTRAINT OR SECLUSION PATIENT RIGHTS: RESTRAINT OR SECLUSION PATIENT RIGHTS: RESTRAINT OR SECLUSION PATIENT RIGHTS: RESTRAINT OR SECLUSION PATIENT RIGHTS: RESTRAINT OR SECLUSION PATIENT RIGHTS: RESTRAINT OR SECLUSION CONTENT OF RECORD: ORDERS DATED & SIGNED USE OF RESTRAINT OR SECLUSION PATIENT RIGHTS: RESTRAINT OR SECLUSION
Aug 19, 2014 Follow-up to inspection on 2014-06-26*	1	0	0	1	Read full report
Deficiencies cited in this report: QUALITY IMPROVEMENT ACTIVITIES
Jun 26, 2014	2	0	0	2	Read full report
Deficiencies cited in this report: INFECTION PREVENTION CONTROL ABX STEWARDSHIP INFECTION PREVENTION CONTROL ABX STEWARDSHIP
Jun 3, 2014	2	0	0	2	Read full report
Deficiencies cited in this report: PATIENT RIGHTS: GRIEVANCES PATIENT RIGHTS: GRIEVANCES
Apr 3, 2014	0	2	0	2	Read full report
Deficiencies cited in this report: No Description Available No Description Available
Apr 2, 2014	7	0	0	7	Read full report
Deficiencies cited in this report: PATIENT RIGHTS: GRIEVANCES PATIENT RIGHTS: CARE IN SAFE SETTING ORDERS FOR DRUGS AND BIOLOGICALS ORGANIZATION AND STAFFING FACILITIES, SUPPLIES, EQUIPMENT MAINTENANCE INFECTION CONTROL PROGRAM ORDERS FOR DRUGS AND BIOLOGICALS
Feb 26, 2014	7	0	0	7	Read full report
Deficiencies cited in this report: PATIENT RIGHTS PATIENT RIGHTS:PARTICIPATION IN CARE PLANNING PATIENT RIGHTS: CARE IN SAFE SETTING NURSING SERVICES RN SUPERVISION OF NURSING CARE PATIENT RIGHTS: CARE IN SAFE SETTING RN SUPERVISION OF NURSING CARE

Some state health departments and regional offices of the Centers for Medicare and Medicaid Services sometimes did not upload their inspection reports into a central computer system that could then be shared by us. In such cases, CMS identified the dates of the missing inspections and the number of deficiencies identified. You can request the actual reports from CMS or your state health department.

* Deficiencies cited in follow-up inspections are not counted toward a facility's total deficiency count.

HospitalInspections.org

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Complete reports and deficiency counts