No sales calls · nothing personal collected unless you ask us to · no facility pays to be here
Text size
Contrast

Stevens Nursing And Rehabilitation Center Of Halle

106 Kahn St, Hallettsville, TX 77964 · Government - Hospital district · 144 certified beds · (361) 798-3606 Medicare & Medicaid certified

Call the home — (361) 798-3606 Need help choosing, fast? Free, unbiased: Eldercare Locator 1-800-677-1116
Abuse/neglect citation on record (F0600) — cited Jan 2024
Insights

This home has serious findings on its record. Read them closely before you consider it.

In its favor
  • a strong health-inspection score (4/5) — the hardest rating to game (though it’s ranked within its own state, not nationally)
  • no federal fines or payment denials on record
  • lower-than-typical staff turnover (30% vs 45% nationally) — better care continuity
Worth asking about
  • it has an abuse, neglect, or exploitation citation (F0600), cited Jan 2024
  • it has citations for its abuse-prevention policies, restraint use, or reporting and investigating of allegations (F0607, F0609, F0610) — cited below the harm level, meaning inspectors found the process wanting but did not find a resident harmed
  • a high number of inspection citations overall (20) — worth reading through, though larger and more-often-surveyed homes tend to accrue more lower-severity tags
  • its payroll-based staffing rating is low (2/5)

One thing this read cannot see: what residents and families actually experience day to day. Public data misses the feel of a place — visit unannounced, ideally at a mealtime or on a weekend, talk to staff and families, and ask your tour questions.

A plain-English summary of the public record below — not a rating, ranking, or recommendation. We take no money from any facility.

5/5
CMS overall
5 of 5
Health inspectionSurveyor-assigned, ranked within your stateInspector-verified 4 of 5
StaffingFrom payroll records (PBJ) 2 of 5
Quality measuresSelf-reported by the facility 5 of 5

Location & what’s nearby

Hospital
★★★★ 4/5 CMS · Emergency dept. usually open 24/7 · ER 24/7
Urgent care / clinic
212 E Depot St · (361) 798-3210 · Call to confirm hours
Pharmacy
304 N Texana St · (361) 798-5010 · Call to confirm hours
Grocery
115 Fairwinds St · (361) 798-5843 · Call to confirm hours
Park
101 Fink St · Typically dawn to dusk
Place of worship
210 Kahn St · (361) 798-2758

Nearest of each type, straight-line distance. Hospitals come from the CMS Hospital General Information registry; everything else from Overture Maps (public data). Hospital and park hours are typical — call ahead to confirm.

Quality measures — how residents actually fare

Overall quality measures 5 of 5
Long-stay residentspeople who live here 5 of 5
Short-stay residentsrehab / post-hospital 4 of 5

Quality-measure stars summarize outcomes CMS tracks from the assessments each home submits — avoidable hospitalizations and ER visits, falls with injury, pressure ulcers, unplanned weight loss, and long-term antipsychotic use. Because the underlying data is self-reported, weigh a high score against the independent inspection record. Long-stay = permanent residents; short-stay = rehab and post-hospital stays.

Trend — is this home getting better or worse?

Over 2025-02 to 2026-06, this home’s CMS overall rating improved from 3 to 5 stars. From monthly CMS archive snapshots.

Horizontal axis runs 2025-02 to 2026-06. That is where CMS’s monthly archive ends, so the right-hand edge of each line is that month — not today.

Overall rating5★
Inspection scorelower = better
See all quality measures vs. state & national benchmarks
MeasureThis homeState avgTypical statevs typical state
Long-stay residents whose need for help with daily activities increased5.1%15.8%15.4%better
Long-stay residents who lose too much weight2.6%3.0%5.4%better
Long-stay residents with a catheter left in their bladder0.0%0.3%0.9%better than state — see note marked double-dagger below the table
Long-stay residents with a urinary tract infection0.8%0.8%2.0%typical for the state — see note marked double-dagger below the table
Long-stay residents with depressive symptoms0.0%2.4%6.5%check this — see note marked star below the table
Long-stay residents who were physically restrained0.0%0.0%0.1%better than state — see note marked double-dagger below the table
Long-stay residents with falls causing major injury1.6%3.3%3.3%better
Long-stay residents whose ability to walk worsened3.1%14.0%16.1%better
Long-stay residents on antianxiety or hypnotic medication19.0%18.0%18.9%typical
Long-stay residents given the seasonal flu vaccine100.0%98.0%95.3%typical
Long-stay residents with pressure ulcers1.9%3.8%4.7%better
Long-stay residents with worsening bladder/bowel control4.5%13.4%21.2%better
Long-stay residents who got an antipsychotic medication — see the note below the table15.2%9.6%17.1%better
Short-stay residents who newly got an antipsychotic medication2.4%1.5%1.4%worse
Short-stay residents given the seasonal flu vaccine100.0%88.0%79.4%better
Short-stay residents rehospitalized after admission8.1%25.7%22.6%better
Short-stay residents with an outpatient ER visit3.7%12.3%12.0%better
Long-stay hospitalizations per 1,000 resident days2.302.171.67worse
Long-stay outpatient ER visits per 1,000 resident days1.952.061.80typical

* This home reported 0% on a measure where lower is better. That can mean genuinely excellent care — but because the number is self-reported, a zero can also mean the problem was not recorded. Weigh it against the inspection record above.

On this measure the state average is at least twice (or half) the typical state — a gap that size is usually how the state codes and reports the measure, not how its homes actually perform. Against a benchmark this state does not sit on, a “vs typical state” verdict would mostly be measuring the state, so we compare this home with its own state instead and show both averages.

§ Antipsychotics carry an FDA boxed warning — they raise the risk of death in older people with dementia-related psychosis, and are not approved for that use. So this measure is partly a read on whether a home sedates residents instead of staffing for them. But read a low rate carefully in both directions: CMS excludes residents coded with schizophrenia (and Tourette's or Huntington's) from this measure, and federal auditors have found implausible increases in schizophrenia coding since the measure was published — so a very low rate can reflect recoding rather than less prescribing. Ask the home what share of its residents carry a schizophrenia diagnosis, and how it handles behavioral symptoms without medication.

CMS quality measures, as Care Compare shows them. For most rows lower is better (fewer falls, ulcers, hospitalizations); vaccination rates are the exception. Not every row is risk-adjusted. CMS adjusts some measures for resident mix, but falls with major injury, antipsychotic use, physical restraints and the vaccination rates are unadjusted rates — so a home caring for heavier or more behaviorally complex residents can look worse on them without providing worse care. The “typical state” column is the median of the 50 state averages — not a national average of all homes. We use it because a plain average across homes is pulled badly off course by a few states’ reporting habits (long-stay depressive symptoms is the clearest case: Illinois codes it several times higher than most states, which alone lifted the all-homes figure to about twice what a typical state records). The median of state averages resists that — but it does weigh every state equally, so a large state counts no more than a small one, and it is a benchmark of our construction rather than a CMS-published figure. better/worse means the home differs from that benchmark by more than 10% of it; closer than that reads typical. CMS does not publish how many residents each measure covers, and the counts are often small — a single resident can move a rate by several points — so treat small gaps as noise. These come from data the facility reports, so weigh them against the independent inspection record above.

Short-stay rehab — if you are coming here from a hospital

Arriving from a hospital right now? Read the discharge guide → — your appeal rights, how to slow a rushed discharge, and what to ask about the numbers below.

41.7% of the Medicare patients who left this home got back to the community and stayed there for at least 31 days — which CMS reads as no different from the national rate. This is CMS’s risk-adjusted rate over 36 Medicare stays in Oct 2022–Sep 2024, and CMS’s own comparison — not ours.

41.7%U.S. median 51.5%
Got home and stayed home
11.2%U.S. median 10.7%
Went back to hospital
51.7%U.S. median 56.6%
Met the expected recovery
0.26U.S. median 0.31
Therapy hours / resident / day
0.16hours / resident / day
Physical therapy
0.08hours / resident / day
Occupational therapy
0.02hours / resident / day
Speech therapy

Met the expected recovery: 51.7% of this home’s Medicare short-stay residents left it at or above the ability to care for themselves and move around that CMS predicted for them, across 29 stays in Oct 2024–Sep 2025. The median of the 11,061 homes CMS publishes this for is 56.6%. Read it beside the getting-home figure, not instead of it: unlike the two measures above, CMS makes no better-or-worse call on this one and publishes no confidence interval for it, so this is a comparison and not a verdict — but it is the short-stay measure that separates homes most, and the one to ask about.

Therapy staffing: this home’s payroll records show 0.26 therapist hours per resident per day in 2026Q1 — more than 38% of the 13,892 homes that report any therapy hours at all.

Weekend therapy: weekend therapy hours are 17% of this home’s weekday level — it runs some therapy at the weekend, at a lower level than on weekdays. The median home that reports therapy runs 13% — weekday-focused therapy is the industry norm, not a shortfall. But recovery does not pause on a Saturday: ask what the weekend actually looks like here.

This section is about rehab stays, not living here. Most of this page — the stars, the quality measures, the inspection record — describes the home the way a permanent resident experiences it. These figures describe the short Medicare stay after a hospital discharge: a hip, a stroke, a bad infection, six weeks and home. They are different residents, different staff, often a different wing. Therapy hours are per resident in the building, not per rehab patient — the count includes every long-stay resident, and they mostly get no therapy at all. So a home with a small rehab wing inside a large nursing population reads low here even if its rehab patients get plenty of therapy, and a mostly-rehab home reads high. Use it to compare homes doing similar work, ask what a rehab resident actually gets in a day, and remember that CMS does not publish therapy minutes per patient — nobody does.

See every short-stay measure CMS publishes for this home
MeasureThis homeU.S. medianPeriod coveredCMS’s call
Got home and stayed homeRate of successful return to home or community from a SNF41.7%CMS range 30.2–52.551.5%Oct 2022–Sep 2024no different from U.S.
Went back to hospitalRate of potentially preventable hospital readmissions 30 days after discharge from a SNF11.2%CMS range 7.2–17.510.7%Oct 2022–Sep 2024no different from U.S.
Met the expected recoveryPercentage of residents who are at or above an expected ability to care for themselves and move around at discharge51.7%56.6%Oct 2024–Sep 2025CMS makes no comparison for this measure
Self-care at dischargePercentage of residents who are at or above an expected ability to care for themselves at discharge31.0%52.8%Oct 2024–Sep 2025CMS makes no comparison for this measure
Moving around at dischargePercentage of residents who are at or above an expected ability to move around at discharge55.2%50.0%Oct 2024–Sep 2025CMS makes no comparison for this measure
Medication problems followed upPercentage of residents whose medications were reviewed and who received follow-up care when medication issues were identified100.0%98.7%Oct 2024–Sep 2025CMS makes no comparison for this measure
Medication list to the next providerPercentage of residents where the SNF provided a current medication list to the next health care settingnot reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure.
Medication list to the familyPercentage of residents where the SNF provided a current medication list to the resident, family, and/or caregiver at final dischargenot reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure.
Falls with major injuryPercentage of SNF residents who experience one or more falls with major injury during their SNF stay0.0%0.0%Oct 2024–Sep 2025CMS makes no comparison for this measure
New or worsened pressure ulcersPercentage of residents with pressure ulcers/pressure injuries that are new or worsened2.6%1.9%Oct 2024–Sep 2025CMS makes no comparison for this measure
Infections that led to hospitalPercentage of infections residents got during their SNF stay that resulted in hospitalization6.8%CMS range 3.7–14.27.1%Oct 2023–Sep 2024no different from U.S.
Medicare spending per stayMedicare Spending Per Beneficiary (MSPB) for residents in SNFs1.321.02Oct 2022–Sep 2024CMS makes no comparison for this measure

From the CMS Skilled Nursing Facility Quality Reporting Program — Medicare short-stay outcomes, which is a different dataset from the long-stay quality measures above and describes a different set of residents. Where CMS risk-adjusts a measure we show its adjusted rate, and the CMS range beside it is the confidence interval CMS publishes: a home whose range is wide is a home with few stays, where one patient moves the number several points. Read the period column. These measures do not share a window — the claims-based ones (getting home, readmission, spending) lag by a year or more, because a stay has to finish and its claims settle before it can be counted. CMS’s call is CMS’s, not ours: it is the only place anyone tests whether this home differs from the national rate at all, and most homes on most measures do not. Two caveats on it. CMS tests only three of these measures — getting home, readmission, and infections that led to hospital; on the other nine it publishes a rate and no comparison, and rather than compute a verdict CMS declined to make, we say so in the column. And on readmission almost every home in the country lands on “no different”, so that row separates homes far less than getting-home does — which is why met the expected recovery, a measure CMS does not test but which spreads across the whole range, is called out above the table rather than left in this list. The U.S. median column is our own, taken across every home CMS publishes that measure for in this same file; it is not a CMS-published benchmark. Homes CMS gives no rate for are left out of it rather than counted as zero. Medicare spending per stay is a ratio, not a percentage — 1.00 means this home’s Medicare spending for a stay matched the national figure CMS compares it against, and it measures cost to Medicare, not quality of care.

Staffing

0.35
RN hours/ resident / day
1.00
LPN hours/ resident / day
2.09
Aide hours/ resident / day
3.43
Total nurse hours/ resident / day
0.16
RN hoursweekends
30.2%
Total nursing turnover
RN turnover

How full it usually is: this home is certified for 144 beds and averages 64.7 residents a day — about 45% occupied, or roughly 79 beds typically open. It often has substantial empty capacity — worth asking why, since low census can reflect either a new or shrinking home or one families are avoiding. This is a CMS average, not live availability — no public source publishes real-time vacancies, and a home can be full the day you call. Confirm with the home, and if you need a Medicaid bed specifically, ask about that separately: a home with open beds may still not have an open Medicaid bed.

Against a benchmark — not a legal minimum. In May 2024 CMS finalized the first federal staffing floor for nursing homes: 3.48 total nurse hours per resident per day, including 0.55 RN hours and 2.45 nurse-aide hours. Its hour requirements never took effect and are no longer on the books. Homes had until 2026 (2027 if rural) to comply, and that deadline never arrived: a federal court vacated the hour requirements in April 2025 (CMS has appealed), Congress then barred enforcement until 2034, and CMS formally repealed them by rule effective February 2026. This home is not required to meet these numbers, and is not violating anything by missing them. We still show the comparison because the figures are CMS’s own published estimate of adequate staffing, which makes them a useful yardstick — but they are our benchmark, not federal law: this home’s total nurse staffing of 3.43 hrs/resident/day is below the 3.48-hour benchmark and RN staffing of 0.35 is below the 0.55-hour RN benchmark and nurse-aide staffing of 2.09 is below the 2.45-hour aide benchmark. What federal law does require today is unchanged: “sufficient” nursing staff for residents’ needs and an RN on duty at least 8 consecutive hours a day, 7 days a week (42 CFR 483.35). Those are judged by inspectors on site, not by these averages, so read this comparison alongside the inspection record rather than as a pass/fail.

Weekend coverage: total nurse staffing is 3.14 hrs/resident/day on weekends vs 3.55 on weekdays — 12% thinner on weekends. RN hours go from 0.43 to 0.16 per resident-day. (Payroll-based daily records; the national median home is 15% thinner on weekends.)

This home’s total nursing-staff turnover of 30% is below the national median of 45%.

Payroll-based (PBJ) staffing hours, as reported for Jan–Mar 2026 (CMS PBJ CY2026Q1) — the most recent quarter CMS has published, so they can lag a change of operator or staffing agency. Higher is generally better. Registered-nurse coverage and weekend staffing are the numbers families most often overlook — an RN on site matters most when something goes wrong, and coverage usually thins on weekends. High turnover means residents rarely see the same caregiver twice. One caveat: these are hours as reported, not adjusted for how sick or heavy-care this home’s residents are. CMS separately publishes a case-mix-adjusted view; we show the reported hours. A home caring for higher-acuity residents needs more hours to deliver the same care, so compare these figures against homes doing similar work, and read them next to the inspection record rather than alone.

Inspection trend

6
deficiencies at the latest standard inspection (2026-05-01)
1
at the previous standard inspection (2025-03-07)

Deficiencies are more than at the previous inspection — worsening. Fewer citations over time suggests a home is fixing problems; a rising count is a warning sign — though two surveys are a short record, and survey teams differ. These counts are from the standard annual health survey only; the full citation list below may also include findings from complaint investigations, so the two won’t always add up.

Inspection deficiencies

State health-inspection citations, most serious first. Each carries an F-code (the federal rule it cites, e.g. F-684 = quality of care) and a letter A–L marking how serious and how widespread the problem was — we translate that grid into the plain tiers shown here. Wording is the official federal description.

ABCDEFGHIJKL

Each letter is a CMS scope-severity level; highlighted ones are where this home has citations. A–C = no harm found; D–F = potential for harm; G–I = actual harm; J–L = immediate jeopardy. Within each band the later letter is the more widespread finding (an isolated G is one resident; a widespread I is a pattern), so rightward and downward is worse.

20 citations, most serious first. The 10 most serious are shown; the remaining 10 are one tap away and print in full.

  • Potential for harm · D2026-06-02 · tag F0558 — failed to accommodate residents' needs and preferences — isolated
    Reasonably accommodate the needs and preferences of each resident.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview and record review, the facility failed to ensure residents received services in the facility, 1 of 4 residents (Resident #2), reviewed for reasonable accommodation. The facility failed to ensure the call light was within reach for Resident #2. This failure could place residents at risk of not being able to call for help as needed. Findings included: Record review of Resident #2's face sheet, dated 06/02/2026, revealed she was admitted [DATE], re-admitted on [DATE] and again on 5/22/2026 diagnoses included: spinal stenosis (narrowing of the space in the spine), encephalopathy (disturbance of brain function), and major depressive disorder (persistent depressed mood). Record review of Resident #2's MDS assessment, dated 5/13/2026, revealed the resident's BIMS score was 11, which indicated moderate cognitive impairment. Record review of Resident #2's care plan, dated 6/2/2026, revealed Resident #2 is at risk for falls d/t impaired balance, incontinence, psychotropic med use,…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Resident Rights Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Ecited before2026-05-01 · tag F0812 — failed to store, cook, and serve food safely — pattern
    Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on observation, interview, and record review, the facility failed to prepare, distribute, and serve food in accordance with professional standards for food service safety for 1 of 1 kitchen observed for food and nutrition services. The facility failed to ensure dietary staff maintained proper hand hygiene during meal service. These failures could place residents at risk for food borne illness. Findings included: During an observation on 04/30/2026 at 11:54 a.m. Dietary Aide A was observed to assist with tray preparation for the secure unit. When the trays were ready to leave the kitchen on the meal cart Dietary Aide A was observed opening the kitchen door, picking up the phone on the kitchen wall, and paged out letting staff know the trays were ready for the secure unit. Dietary Aide then pushed the tray cart out into the dining room; after grabbing a chair from the dining room to hold the door up as he pushed the trays out Dietary Aide A was then observed to wipe his nose with his hand and returned to the kitchen and did not wash his hands before returning to the line and…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Nutrition and Dietary Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2026-05-01 · tag F0755 — failed to provide safe pharmacy services — isolated
    Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview and record review the facility failed to provide pharmaceutical services (including procedures that assured the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of each resident for 1 of 1 medication room (main medication room) and 1 of 3 medication carts (100-hall nursing cart) reviewed and 1 of 1 Resident (Resident #20) reviewed for medication storage. 1. The facility failed to ensure an expired packet (total 15 tablets) of gas relief (simethicone 125 mg) was not stored inside the main medication room on 04/29/2026. The medication expired on 02/2025. 2. The facility failed to ensure an expired bottle of cream compound (Ketamine 10%, Diclofenac 5%, and Gabapentin 6% cream) was not stored inside the 100-hall nursing cart on 04/29/2026. The medication expired on 02/11/2026. 3. The facility failed to ensure the blood pressure instructions on Resident #20's blister packet of Lisinopril, for high blood pressure, matched the…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Pharmacy Service Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2026-05-01 · tag F0756 — failed to review each resident's drug regimen — isolated
    Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review the facility failed to ensure any irregularities reported by the pharmacist to the attending physician, the facility's medical director , and the director of nursing were acted upon for 1 of 5 residents (Resident #35) reviewed for medications. The facility failed follow the facility's Pharmacy Consultant Recommendation for Resident #35's lipid panel (a blood test that measures the amount of fat molecules called lipid in the blood) order due to Simvastatin for high cholesterol. The resident's physician agreed with the recommendation on 04/06/2026. This failure could place residents at risk for adverse consequences and could cause a decline in their physical, mental, and psychosocial condition. The findings were: Record review of Resident #35's face sheet, dated 05/01/2026, revealed a 64-years-old female who was originally admitted to the facility on [DATE], and readmitted to the facility on [DATE]. Resident #35 had diagnoses which included pure hypercholesterolemia (lipid…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Pharmacy Service Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2026-05-01 · tag F0761 — failed to label and store drugs safely — isolated
    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.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview and record review the facility failed to ensure drugs and biologicals used in the facility were labeled in accordance with currently accepted professional principles, and included the appropriate accessory and cautionary instructions, and the expiration date when applicable and failed to ensure in accordance with State and Federal laws, all drugs and biologicals were stored in locked compartments under proper temperature controls, and permitted only authorized personnel to have access to the keys for 1 of 8 residents (Resident #57) reviewed for medication storage and labels. 1. The facility failed to ensure nurses put a normal saline 10 cc syringe in the cart, instead of leaving it unattended on the nightstand inside Resident #57's room. This failure could place residents at risk of not having medications as ordered due to diversion of medication and incorrect instructions. Findings include: 1. Record review of Resident #57's face sheet, dated 05/01/2026, revealed a 92-years-old…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Pharmacy Service Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2026-05-01 · tag F0813 — isolated
    Have a policy regarding use and storage of foods brought to residents by family and other visitors.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview and record review the facility failed to have a policy regarding use and storage of foods brought to residents by family and other visitors to ensure safe and sanitary storage, handling, and consumption, for 1 of 8 residents (Residents #57) reviewed for food and nutrition services. The facility failed to ensure foods stored in Resident #57's personal refrigerator were labeled and dated. The failure could place residents at risk for food borne illness. The findings include:Record review of Resident #57's face sheet, dated 05/01/2026, revealed a 92-years-old male who was originally admitted to the facility on [DATE], and readmitted to the facility on [DATE]. Resident #57 had diagnoses which included chronic obstructive pulmonary disease (common lung disease causing restricted airflow and breathing problems), muscle wasting and atrophy (loss of skeletal muscle mass), and Alzheimer's disease (progressive disease that destroy memories and other important mental functions). Record…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Nutrition and Dietary Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2026-05-01 · tag F0842 — failed to keep accurate, complete medical records — isolated
    Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review the facility failed to ensure, in accordance with accepted professional standards and practices, medical records were maintained that were complete and accurately documented for 1 of 8 residents (Resident #8) reviewed for clinical records. The facility failed to ensure Resident #8's diagnosis of major depression was updated in the residents medical record. This deficient practices could result in errors in care and treatment. The findings were: Record review of Resident #8's face sheet, dated 05/01/2026, revealed a 90-years-old female who was admitted to the facility on [DATE]. Resident #8 had diagnoses which included dementia (loss of memory and thinking ability), muscle wasting and atrophy (loss of skeletal muscle mass), and type 2 diabetes mellitus (a condition where the body has trouble regulating blood sugar levels, leading to persistently high blood glucose levels). Record review of Resident #8's significant change in status MDS assessment, dated 04/14/2026, revealed…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · E2025-03-07 · tag F0921 — failed to keep a safe, functional, sanitary building — pattern
    Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, interviews, and record review, the facility failed to provide a safe, functional, sanitary, and comfortable environment for residents, staff, and the public on 1 of 3 resident hallways (Hallway 100), and 1 of 1 kitchen reviewed for environmental concerns, in that: 1. The facility failed to ensure resident room [ROOM NUMBER], located on hallway 100, had repaired 3 and 5 foot wall scrapes near bed-A and had removed dust and lint from the bathroom ceiling vent. 2. The facility failed to ensure resident room [ROOM NUMBER], located on hallway 100, had repaired a 3x3 inch bathroom door penetration and had repaired an unsecured bathroom wall vent. 3. There was a 4.5- foot piece of floor baseboard molding under the prep table on the right side of the main kitchen that was missing. 4. There was a 7.0- foot piece of floor baseboard molding behind the ice machine and juice bar on the left side of the main kitchen that was not attached to the wall. 5. There were 2 broken 1x1 ft floor tiles in the main…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Environmental Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Fcited before2024-01-26 · tag F0812 — failed to store, cook, and serve food safely — widespread
    Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on observation, interview, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety for 1 of 1 kitchen, in that: 1. There was a paper bag containing personal food items from an unapproved source on a cart in the kitchen. 2. [NAME] A had facial hair and was not wearing a facial hair restraint while engaged in food preparation and service in the kitchen. 3. [NAME] B wore jewelry on her right wrist while engaged in food preparation and service in the kitchen. These failures could place residents who received meals and/or snacks from the kitchen at risk for food borne illness. The findings included: 1. Observation on 01/23/2023 at 11:20 AM in the kitchen next to the steam table revealed a white paper bag on a rolling cart. The bag was open and inside were a container of French fries and a wrapped sandwich. Next to the paper bag was a closed disposable cup filled with a beverage. During an interview on 01/23/2023 at 11:21 AM with [NAME] A he stated the bag containing the French fries and…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Nutrition and Dietary Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · E2024-01-26 · tag F0585 — failed to handle grievances — pattern
    Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interviews, and record reviews the facility failed to ensure residents' rights to voice grievances to the facility or other agencies or entities that heard grievances without discrimination or reprisal and without fear of discrimination or reprisal for 2 of 8 residents (Resident #34, and #56) reviewed for grievances, in that; 1. The facility failed to ensure the Physical Therapy Director initiated a grievance report on behalf of Resident #34's grievance on 11/21/2023. 2. The facility failed to ensure the Physical Therapy Director, The DON, and the Administrator initiated a grievance report on behalf of Resident #56's grievance on 11/17/2023. This failure could place residents at risk by denying their right to make and have grievances heard and contributed to ill feelings of not being heard and unresolved issues. The findings included: 1. Record review of Resident #34's admission record dated 01/24/2024 revealed an admission date of 12/11/2023 with diagnoses which included dementia (a general term for…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Resident Rights Deficiencies · Deficient, Provider has date of correction
Show the remaining 10 citations
  • Potential for harm · E2024-01-26 · tag F0607 — failed to have anti-abuse policies — pattern
    Develop and implement policies and procedures to prevent abuse, neglect, and theft.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review the facility failed to develop and implement written policies and procedures that prohibit and prevent abuse, neglect, and exploitation of residents and misappropriation of resident property and establish policies and procedures to investigate any such allegations for 1 of 1 resident (Resident #34) reviewed for reporting and investigations of alleged abuse, neglect, exploitation, and mistreatment and 14 of 19 staff (RN C, RN D, RN E, LVN G, CNA H, CNA I, CNA J, CNA K, CNA L, CNA M, CNA N, CNA O, the FSS and the AD) reviewed for employee misconduct registry screenings, in that: 1. The facility failed to screen, through the employee misconduct registry, 14 staff, which included; RN C, RN D, RN E, LVN G, CNA H, CNA I, CNA J, CNA K, CNA L, CNA M, CNA N, CNA O, the FSS and the AD. 2. The Administrator, the DON and the Physical Therapy Director did not report to the state agency and or investigate Resident #34's Representative's allegations of mistreatment on 11/22/2023. This…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Freedom from Abuse, Neglect, and Exploitation Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · E2024-01-26 · tag F0609 — failed to report abuse allegations — pattern
    Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interviews and record reviews the facility failed to ensure all alleged violations involving abuse, neglect, exploitation or mistreatment, including injuries of unknown source and misappropriation of resident property, are reported immediately, but not later than 2 hours after the allegation is made, if the events that cause the allegation involve abuse or result in serious bodily injury, or not later than 24 hours if the events that cause the allegation do not involve abuse and do not result in serious bodily injury, to the administrator of the facility and to other officials, including to the State Survey Agency, for 4 of 10 residents (Residents #1, #7, #10, #34) reviewed for allegations of abuse, neglect, exploitation, and mistreatment, in that: 1. The Administrator, the DON and the Physical Therapy Director did not report to the state agency and or investigate Resident #34's Representative's allegations of mistreatment on 11/22/2023. 2. The Administrator and the DON did not report to the state…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Freedom from Abuse, Neglect, and Exploitation Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2024-01-26 · tag F0578 — failed to honor advance directives / code status — isolated
    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.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review, the facility failed to ensure residents' right to formulate an advance directive for 2 of 8 residents (Resident #2 and #37) reviewed for advanced directives, in that: 1. Resident #2's attending physician had not printed his name on the OOHDNR when it was signed on [DATE], rendering the document invalid. 2. Resident #37's attending physician had not dated the OOHDNR when it was signed by the family on [DATE] or when the order was written on [DATE], rendering the document invalid. This failure could place residents at-risk of having their end of life wishes dishonored, and of having CPR performed against their wishes. The findings include: 1. Record review of Resident #2's face sheet, dated [DATE], revealed an admission date of [DATE] and diagnoses which included: dementia, with other behavioral disturbance, other malaise (general feeling of being unwell), anemia and essential hypertension (high blood pressure that has no clearly identifiable cause). Further review of Resident…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Resident Rights Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2024-01-26 · tag F0600 — failed to protect residents from abuse and neglect — isolated
    Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, interviews, and record reviews the facility failed to ensure residents had the right to be free from abuse, neglect, misappropriation of resident property. The facility must not use verbal, mental, sexual, or physical abuse, corporal punishment, or involuntary seclusion, for 1 of 1 resident (Resident #34) reviewed for abuse, in that: CNA P was identified in a recorded video transferring Resident #34 from a wheelchair to a bed, against Resident #34's will; evidenced by his calling out Owww! and simultaneously grabbing the wheelchair he was seated in and attempting to stop CNA P from the transfer. This failure could place residents at risk for abuse by denying residents of their rights. The findings included: A Record review of Resident #34's admission record dated 01/24/2024 revealed an admission date of 12/11/2023 with diagnoses which included dementia (a general term for the impaired ability to remember, think, or make decisions that interferes with doing everyday activities). A record…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Freedom from Abuse, Neglect, and Exploitation Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2024-01-26 · tag F0610 — failed to investigate and act on abuse reports — isolated
    Respond appropriately to all alleged violations.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, interviews, and record reviews the facility failed to have evidence that all alleged violations are thoroughly investigated; Prevent further potential abuse, neglect, exploitation, or mistreatment while the investigation is in progress; and report the results of all investigations to the administrator or his or her designated representative and to other officials in accordance with State law, including to the State Survey Agency, within 5 working days of the incident, and if the alleged violation is verified appropriate corrective action must be taken for 1 of 1 Resident (Resident #34) reviewed for an investigation of allegations of abuse and neglect, in that: The facility failed to investigate to the state agency allegations of abuse and neglect received on 11/22/2023 for Resident #34. This failure could place residents at risk for abuse and neglect by not investigating and reporting the results of their investigation. The findings included: A Record review of Resident #34's admission…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Freedom from Abuse, Neglect, and Exploitation Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2024-01-26 · tag F0655 — isolated
    Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, interviews, and record reviews the facility failed to develop and implement a baseline care plan for each resident that includes the instructions needed to provide effective and person-centered care of the resident that meet professional standards of quality care. The baseline care plan must include the minimum healthcare information necessary to properly care for a resident for 1 of 8 residents (Resident #269) reviewed for healthcare information necessary to properly care for a Resident, in that: The facility failed to care plan Resident #269's need for a peripherally inserted central catheter (also known as a PICC line - percutaneous indwelling central catheter, is a form of intravenous access that can be used for a prolonged period for administration of intravenous in the vein medications). This failure could place residents at risk for harm by not receiving care for their indwelling intravenous catheters. The findings include: A record review of Resident #269's admission record dated…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2024-01-26 · tag F0657 — failed to keep the care plan current — isolated
    Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review, the facility failed to ensure that the comprehensive care plan was reviewed and revised by the interdisciplinary team after each assessment for 2 of 8 residents (Residents #2 and #49) for care plan revisions, in that: 1. Resident #2's care plan was not revised to reflect fall interventions after a fall on 12/27/2023 and had not been updated to address Resident #2's new respiratory needs. 2. Resident #49's care plan was not revised to reflect smoking interventions identified in an updated smoking assessment on 10/26/2023. This failure could place residents at risk of receiving inappropriate care. The findings were: 1. Record review of Resident #2's face sheet, dated 01/26/2024, revealed an admission date of 10/26/2021 and diagnoses which included: dementia, with other behavioral disturbance, other malaise (general feeling of being unwell), anemia and essential hypertension (high blood pressure that has no clearly identifiable cause). Record review of Resident #2's Quarterly…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2024-01-26 · tag F0699 — isolated
    Provide care or services that was trauma informed and/or culturally competent.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interviews and record reviews the facility failed to ensure residents who are trauma survivors received culturally competent, trauma-informed care in accordance with professional standards of practice and accounting for residents' experiences and preferences in order to eliminate or mitigate triggers that may cause re-traumatization of the Resident for 1 of 8 residents (Resident #56) reviewed for surviving trauma, in that: The facility failed to provide care in a manner to eliminate and/or mitigate triggers for Resident #56's Post Traumatic Stress due to a rape assault. This failure could place residents at risk for triggering re-traumatization. The findings included: A record review of Resident #56's admission record dated 01/26/2024 revealed an admission date of 07/03/2022 with diagnoses which included Post Traumatic Stress Syndrome (PTSD a disorder that develops in some people who have experienced a shocking, scary, or dangerous event) and dementia (a general term for the impaired ability to…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2024-01-26 · tag F0804 — failed to serve food at safe, palatable temperature — isolated
    Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
    What the surveyor found here — an excerpt from the official record, may be distressing

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, interviews, and record reviews, the facility failed to provide food that was palatable, attractive, and prepared by methods which conserved the nutritive value, flavor, and appearance for 1 of 1 meal (noon meal) reviewed for food palatability and nutritive value, in that: 1. The facility served Resident #40 a hamburger with a greenish-gray color substance on the bottom bun. 2. The facility failed to follow the recipe for Resident #32's tuna salad sandwich. This failure could place all residents who ate meals prepared from the kitchen at risk of food borne illness, possible weight loss, altered nutritional status, and diminished quality of life. The findings were: 1. Record review of Resident #40's face sheet, dated 01/26/2024, revealed an initial admission date of 03/02/2020 with a most recent admission of 08/06/2020 and diagnoses which included: chronic obstructive pulmonary disease (a group of lung diseases that block airflow and make it difficult to breathe), cognitive communication…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Nutrition and Dietary Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · D2023-11-30 · tag F0880 — failed to prevent and control infections — isolated
    Provide and implement an infection prevention and control program.
    What the surveyor found here — an excerpt from the official record, may be distressing

    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 disease and infection for 1 of 3 residents (Resident #1) reviewed for infection control, in that: CNA A did not wash or sanitize her hands between change of gloves during incontinent care for Resident #1. These deficient practices could place residents at-risk for infection due to improper care practices. The findings include: 1 .Record review of Resident 1's face sheet, dated 11/28/2023, revealed an admission date of 11/26/2016 and, a readmission date of 08/21/2023, with diagnoses which included: Dementia (decline in cognitive abilities), Anemia (Blood disorder in which the blood has a reduced ability to carry oxygen), Hypothyroidism (under active thyroid), Hyperlipidemia (Elevated level of any or all lipids(fat) in the blood), Major depressive disorder…

    This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

    Infection Control Deficiencies · Deficient, Provider has date of correction

“Cited before” means this same F-tag appears on at least one other survey date in the record we hold — counting complaint investigations as well as standard surveys, with no time limit. It is our own read of the data, not CMS’s: CMS uses repeat deficiency as a formal term tied to consecutive standard surveys, and that is a narrower test than this one. A tag marked here may or may not meet it.

Worried about a resident here? There are three different people you can turn to, and they do different jobs:
  • Long-Term Care Ombudsman — a free, confidential advocate for the resident. They act only with the resident’s consent and work to resolve the problem. Find yours at theconsumervoice.org/get_help.
  • Adult Protective Services — the state agency that investigates suspected abuse, neglect, or exploitation of a vulnerable adult. Not sure of your state’s APS number? The federal Eldercare Locator will route you: 1-800-677-1116 or eldercare.acl.gov.
  • State survey agency — the regulator that licenses and inspects the home. Every state has an official nursing-home complaint line and most take complaints online; the Ombudsman or Eldercare Locator can connect you.
Not sure where to start, or need other help? Dial 2-1-1 for local resources — and if a call is hard or impossible for you, many local 211s also take a text (send your ZIP code to 898-211) or a web chat at 211.org; both vary by area, and 211.org will show what yours offers. Deaf or hard of hearing: dial 711 for the telecommunications relay service, then any number above. In an emergency, call 911.
It is illegal for a facility to retaliate against a resident or family for reporting a concern: federal law gives a resident the right to voice grievances — to the home or to any outside agency — without discrimination or reprisal (42 CFR §483.10(j)(1)). You may report anonymously.

Fines & penalties

No federal fines in the current CMS record.

Part of a chain

This home belongs to WELLSENTIAL HEALTH — 67 facilities. Here is how its ratings compare with the chain’s average across all its homes: See the whole chain — ratings, flags, fines and finances →

RatingThis homeChain avg
Overall 5 of 52.7+2.3 vs chain
Health inspection 4 of 52.9+1.1 vs chain
Staffing 2 of 51.6+0.4 vs chain
Quality measures 5 of 54.2+0.8 vs chain
The other 66 homes this chain runs (chain average 2.7★, per CMS)
1 of 5Bastrop Lost Pines Nursing and Rehabilitation CentBastrop, TX 1 of 5Briarcliff Nursing and Rehabilitation CenterMcAllen, TX 1 of 5Brownsville Nursing and Rehabilitation CenterBrownsville, TX 1 of 5Fort Worth Transitional Care CenterFort Worth, TX 1 of 5Hidalgo Nursing and Rehabilitation CenterEdinburg, TX 1 of 5Houston Heights Nursing and Rehabilitation CenterHouston, TX 1 of 5Jefferson Nursing And Rehabilitation CenterBeaumont, TX 1 of 5Laredo West Nursing and Rehabilitation CenterLaredo, TX 1 of 5Lavaca Bay Nursing And Rehabilitation CenterPort Lavaca, TX 1 of 5Longview Hill Nursing and Rehabilitation CenterLongview, TX 1 of 5Spindletop Hill Nursing And Rehabilitation CenterBeaumont, TX 1 of 5Town and Country Nursing and Rehabilitation CenterBoerne, TX 1 of 5Wharton Nursing and Rehabilitation CenterWharton, TX 1 of 5Windsor Nursing And Rehabilitation Center Of RaymoRaymondville, TX 2 of 5Brenham Nursing and Rehabilitation CenterBrenham, TX 2 of 5Cityview Nursing and Rehabilitation CenterFort Worth, TX 2 of 5Corpus Christi Nursing And Rehabilitation CenterCorpus Christi, TX 2 of 5Edinburg Nursing and Rehabilitation CenterEdinburg, TX 2 of 5Elgin Nursing And Rehabilitation CenterElgin, TX 2 of 5Guadalupe Valley Nursing And Rehabilitation CenterSeguin, TX 2 of 5Hallettsville Nursing And Rehabilitation CenterHallettsville, TX 2 of 5Heritage Park Rehabilitation And Skilled Nursing CAustin, TX 2 of 5Live Oak Nursing and Rehabilitation CenterGeorge West, TX 2 of 5Maverick Nursing and Rehabilitation CenterEagle Pass, TX 2 of 5Memorial City Nursing and Rehabilitation CenterHouston, TX 2 of 5Robstown Nursing And Rehabilitation CenterRobstown, TX 2 of 5Southpark Meadows Nursing and Rehabilitation CenteAustin, TX 2 of 5Windsor AtriumHarlingen, TX 2 of 5Windsor Nursing And Rehabilitation Center Of SeguiSeguin, TX 2 of 5Windsor Nursing And Rehabilitation Center Of WeslaWeslaco, TX 2 of 5Windsor Nursing and Rehabilitation Center of AliceAlice, TX 2 of 5Windsor Nursing and Rehabilitation Center of BastrBastrop, TX 2 of 5Windsor Nursing and Rehabilitation Center of MorgaCorpus Christi, TX 2 of 5Yoakum Nursing And Rehabilitation CenterYoakum, TX 3 of 5Harlingen Nursing and Rehabilitation CenterHarlingen, TX 3 of 5Magnolia Crossing Nursing and Rehabilitation CenteHouston, TX 3 of 5Port Lavaca Nursing And Rehabilitation CenterPort Lavaca, TX 3 of 5The Woodlands Nursing And Rehabilitation CenterThe Woodlands, TX 3 of 5Val Verde Nursing And Rehabilitation CenterDel Rio, TX 3 of 5Windsor Mission OaksSan Antonio, TX

Showing 40 of 66; lowest-rated first.

A home rated well below its chain’s average can signal local problems; a chain with a low average across the board is a bigger pattern worth researching. CMS chain data under-reports private-equity and REIT ownership, so treat this as a floor, not the full picture.

Who owns this facility

Owner / managerTypeRoleShareSince
CITIZENS MEDICAL CENTER COUNTY OF VICTORIAOrganization5% OR GREATER DIRECT OWNERSHIP INTEREST; OPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNF100%since 03/01/2014
REGENCY IHS OF HALLETTSVILLE LLCOrganizationDIRECT OWNERSHIP INTEREST; OPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNFsince 03/01/2014
CSV RHEA MANAGEMENT HOLDCO, LLCOrganizationINDIRECT OWNERSHIP INTERESTsince 03/01/2014
DWD TX HOLDINGS LLCOrganizationINDIRECT OWNERSHIP INTERESTsince 03/01/2014
JACK AND NANCY DWYER WORKFORCE DEVELOPMENT CENTER INCOrganizationINDIRECT OWNERSHIP INTERESTsince 03/01/2014
REG HG OPCO 1, LLCOrganizationINDIRECT OWNERSHIP INTERESTsince 03/01/2014
REG HG OPCO LLCOrganizationINDIRECT OWNERSHIP INTERESTsince 03/01/2014
REG OPERATOR HOLDCO LLCOrganizationINDIRECT OWNERSHIP INTERESTsince 03/01/2014
REGENCY TEXAS HOLDINGS LLCOrganizationINDIRECT OWNERSHIP INTERESTsince 03/01/2014
BAIRD, DANIELIndividualMANAGING CONTROL - GOVERNING BODYsince 04/13/2021
CARVAJAL, ANTONIOIndividualMANAGING CONTROL - GOVERNING BODYsince 05/16/2024
CLAPP, BARBARAIndividualMANAGING CONTROL - GOVERNING BODYsince 06/01/2021
CORTESE, DARENIndividualMANAGING CONTROL - GOVERNING BODYsince 08/10/2021
GALVIN, BENIndividualMANAGING CONTROL - GOVERNING BODYsince 06/16/2014
GIBSON, PATRICIAIndividualMANAGING CONTROL - GOVERNING BODYsince 08/01/2021
GONZALES, VERONICAIndividualMANAGING CONTROL - GOVERNING BODYsince 05/16/2024
GOROUHI, FARIBORZIndividualMANAGING CONTROL - GOVERNING BODYsince 07/01/2023
GUERRA, LUISIndividualMANAGING CONTROL - GOVERNING BODYsince 01/01/2009
HOLM, PAULIndividualMANAGING CONTROL - GOVERNING BODYsince 01/01/2007
KAUFMAN, NICOLEIndividualMANAGING CONTROL - GOVERNING BODYsince 08/10/2021
MANDELBAUM, ELLIOTIndividualMANAGING CONTROL - GOVERNING BODYsince 01/01/2025
MARSHALL, RUSSELLIndividualMANAGING CONTROL - GOVERNING BODYsince 04/23/2014
NEUMANN, JAMESIndividualMANAGING CONTROL - GOVERNING BODYsince 05/31/2016
OLSON, MICHAELIndividualMANAGING CONTROL - GOVERNING BODY; CORPORATE OFFICERsince 11/12/2015
THOMAS, ASHLIEIndividualMANAGING CONTROL - GOVERNING BODYsince 07/01/2023
REGENCY INTEGRATED HEALTH SERVICES LLCOrganizationOPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNFsince 03/01/2014
DEKOWSKI, DONOVANIndividualOPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNFsince 03/01/2014
VELASCO, NEHEMIASIndividualOPERATIONAL/MANAGERIAL CONTROL; ADP OF THE SNFsince 04/25/2019
106 KAHN STREET LLCOrganizationADP OF THE SNFsince 03/01/2014
REGENCY IHS CLINICAL CONSULTING, LLCOrganizationADP OF THE SNFsince 03/01/2014
REGENCY IHS MASTER TENANT LLCOrganizationADP OF THE SNFsince 03/01/2014
REGENCY IHS REHAB LLCOrganizationADP OF THE SNFsince 03/01/2014
HEARD, MARKIndividualADP OF THE SNFsince 01/01/2025

CMS files one row per role, so the 41 rows in the source record cover these 33 parties — each is shown once here with every role it holds. Nothing is omitted.

14 organizational owners listed — a facility can be part of a larger chain. CMS ownership data is known to under-report private-equity and REIT ties; treat as a starting point.

Follow the money — this home’s finances

Where a nursing home’s revenue comes from and where it goes — including money paid to companies under the same ownership. Most consumer sites never show this; we reproduce it straight from the Medicare cost report.

$6.1M
Net patient revenuemost recent cost report
-3.2%
Operating marginrevenue minus expenses
Who pays — share of resident-days
Medicaid 67%Medicare 5%Other / private 28%

Source: CMS Healthcare Provider Cost Reporting Information System (HCRIS), Medicare cost report Form CMS-2540 · fiscal year 2024. Facilities self-file these reports; figures are unaudited and a year or two behind. A home with no Medicare cost report on file shows no figures here.

Cost & finances

$258per resident / day
operating cost
$7,844per month
≈ monthly operating cost
$250per day
avg. revenue, all payers

Straight from this home’s Medicare cost report (CMS, FY2024). These are its operating economics — what it costs to run per resident-day and what it collects on average across Medicare, Medicaid, and private pay — not a private-pay quote. Your out-of-pocket cost depends on payer and room type, so ask the facility directly; a higher operating cost can reflect richer staffing or a sicker population. The cost-of-care planner shows regional benchmarks by care type.

What families pay in TX

Paying with Medicaid

This is a Medicare- and Medicaid-certified nursing home, so it can accept Medicaid for long-term care — like nearly all U.S. nursing homes. The private-pay figures below are what families without Medicaid pay; once a resident qualifies for Medicaid, out-of-pocket cost for covered nursing-home care is typically close to $0 (almost all of their income goes to the home as their share of the cost; they keep a small personal needs allowance — for clothing, haircuts, a phone — and Medicaid pays the rest). The amount of that allowance is set by each state. Confirm Medicaid-bed availability with the home, and see the Texas Medicaid page.

Typical monthly cost in Texas
$5,627/mo
Nursing home (semi-private)
$7,604/mo
Nursing home (private)
$5,666/mo
Assisted living

Median private-pay cost, CareScout (Genworth) 2025 Cost of Care Survey — a regional midpoint, not any single community’s rate. Private rooms and higher care levels cost more; ask for a current quote. Project your own in the cost-of-care planner.

Every figure above is reproduced from the CMS Provider Data Catalog (a public record), from the CMS extract processed 2026-08-01 — CMS provider number 675226. CMS refreshes its data monthly, and the star rating rests on the last standard inspection — dated 2026-05-01, which can lag current conditions. Staffing hours are CMS PBJ CY2026Q1 (Jan–Mar 2026). Check this record against the government’s own page for it: this home on Medicare Care Compare ↗ — the authoritative source, and the place to confirm anything here before you act on it. How we present it →

Not a government site. Eldercare Lens is not affiliated with, endorsed by, or authorized by the Centers for Medicare & Medicaid Services (CMS), Medicare, or any government agency. The star ratings, citations, and inspection wording on this page are reproduced from the public CMS record; the plain-English summaries, tiers, and comparisons around them are ours. We do not speak for CMS, and CMS has not reviewed this page. For the official record, go to Medicare Care Compare. How we’re funded →

Are you this operator? If the record here is out of date, or misses what you have since fixed, tell us and we will look: hello@eldercarelens.com. We reproduce the public CMS record and cannot change what it says — corrections to the underlying data go through CMS and your state survey agency — but we will correct anything we have got wrong about it, and we will say so on the page.

What to do next