Close up image of a caretaker helping older woman walk

A Texas skilled nursing facility won’t receive a review of a decision from the Department of Health and Human Services that levied a nearly $33,000 civil monetary penalty.

Surveyors penalized Cedar Manor Nursing & Rehabilitation Center in San Angelo, TX after a 2013 survey found the facility neglected to move catheter tubing and the straps of a sling away from the wheels of a resident’s wheelchair. That resident fell out of his wheelchair and broke both femurs; similar obstructions were found on a second resident’s wheelchair.

Additional penalties were added after a 2014 survey found violations of pressure-sore prevention regulations, adding to what became a total fine of $33,000. Cedar Manor appealed the fines and requested a hearing with an administrative law judge, who sided with the surveyors and upheld the penalties.

While Cedar Manor “does not dispute the facts that support the findings of non-compliance,” the facility argued “that neither isolated incidents nor a generalized finding of neglect can be the basis for a finding of noncompliance,” according to an records published Thursday by the U.S. Court of Appeals for the Fifth Circuit.

The court denied Cedar Manor’s request for review, stating the imposition of the fines were “neither arbitrary nor capricious and are supported by substantial evidence.”