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Avir at Knox City

605 S Ave F, Knox City, TX 79529 · For profit - Corporation · 66 certified beds · (940) 658-3543 Medicare & Medicaid certified

Call the home — (940) 658-3543 Need help choosing, fast? Free, unbiased: Eldercare Locator 1-800-677-1116
Abuse/neglect citation on record (F0602) — cited Jun 20241 actual-harm citation$8,018 in federal fines
Insights

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

In its favor
  • a middle-of-the-pack inspection score (3/5)
Worth asking about
  • it has an abuse, neglect, or exploitation citation (F0602), cited Jun 2024
  • it has 1 actual-harm citation
  • a high number of inspection citations overall (24) — worth reading through, though larger and more-often-surveyed homes tend to accrue more lower-severity tags
  • the CMS record shows $8,018 in federal fines (most recent 2024-06-26)

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.

3/5
CMS overall
3 of 5
Health inspectionSurveyor-assigned, ranked within your stateInspector-verified 3 of 5
StaffingFrom payroll records (PBJ) 3 of 5
Quality measuresSelf-reported by the facility 4 of 5

Location & what’s nearby

Hospital
Emergency dept. usually open 24/7 · ER 24/7
Urgent care / clinic
1303 Mabee Dr · (325) 773-3800 · Call to confirm hours
Pharmacy
502 S Avenue F · (940) 657-3210 · Call to confirm hours
Grocery
206 W Main St · (940) 658-3715 · Call to confirm hours
Park
Typically dawn to dusk
Place of worship
507 SE 2nd St · (940) 657-3331

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 4 of 5
Long-stay residentspeople who live here 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 1 to 3 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 rating3★
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 increased3.5%15.8%15.4%better
Long-stay residents who lose too much weight3.6%3.0%5.4%better
Long-stay residents with a catheter left in their bladder0.6%0.3%0.9%worse than state — see note marked double-dagger below the table
Long-stay residents with a urinary tract infection0.0%0.8%2.0%better than 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 injury5.8%3.3%3.3%worse
Long-stay residents whose ability to walk worsened4.8%14.0%16.1%better
Long-stay residents on antianxiety or hypnotic medication15.3%18.0%18.9%better
Long-stay residents given the seasonal flu vaccine100.0%98.0%95.3%typical
Long-stay residents with pressure ulcers2.1%3.8%4.7%better
Long-stay residents with worsening bladder/bowel control11.8%13.4%21.2%better
Long-stay residents who got an antipsychotic medication — see the note below the table26.7%9.6%17.1%worse
Long-stay hospitalizations per 1,000 resident days1.402.171.67better
Long-stay outpatient ER visits per 1,000 resident days1.802.061.80typical

* 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.

0.18U.S. median 0.31
Therapy hours / resident / day
0.03hours / resident / day
Physical therapy
0.11hours / resident / day
Occupational therapy
0.03hours / resident / day
Speech therapy

Therapy staffing: this home’s payroll records show 0.18 therapist hours per resident per day in 2026Q1 — more than 17% of the 13,892 homes that report any therapy hours at all.

Weekend therapy: weekend therapy hours are 2% of this home’s weekday level — it runs therapy on weekdays, with essentially none at the weekend. 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 SNFnot reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure.
Went back to hospitalRate of potentially preventable hospital readmissions 30 days after discharge from a SNFnot reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure.
Met the expected recoveryPercentage of residents who are at or above an expected ability to care for themselves and move around at dischargenot reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure.
Self-care at dischargePercentage of residents who are at or above an expected ability to care for themselves at dischargenot reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure.
Moving around at dischargePercentage of residents who are at or above an expected ability to move around at dischargenot reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure.
Medication problems followed upPercentage of residents whose medications were reviewed and who received follow-up care when medication issues were identifiednot 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 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 — Newly certified nursing home with less than 12-15 months of data available or the nursing home opened less than 6 months ago, and there were no data to submit or claims for this measure.
Falls with major injuryPercentage of SNF residents who experience one or more falls with major injury during their SNF staynot reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure.
New or worsened pressure ulcersPercentage of residents with pressure ulcers/pressure injuries that are new or worsenednot reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure.
Infections that led to hospitalPercentage of infections residents got during their SNF stay that resulted in hospitalizationnot reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure.
Medicare spending per stayMedicare Spending Per Beneficiary (MSPB) for residents in SNFsnot reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality 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

0.36
RN hours/ resident / day
0.73
LPN hours/ resident / day
2.15
Aide hours/ resident / day
3.24
Total nurse hours/ resident / day
0.30
RN hoursweekends
39.3%
Total nursing turnover
RN turnover

How full it usually is: this home is certified for 66 beds and averages 39.4 residents a day — about 60% occupied, or roughly 27 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 3.24 hrs/resident/day is below the 3.48-hour benchmark and RN staffing of 0.36 is below the 0.55-hour RN benchmark and nurse-aide staffing of 2.15 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 2.77 hrs/resident/day on weekends vs 3.43 on weekdays — 19% thinner on weekends. RN hours go from 0.38 to 0.30 per resident-day. (Payroll-based daily records; the national median home is 15% thinner on weekends.)

This home’s total nursing-staff turnover of 39% is about the same as the national median of 45%. 1 administrator has left in the past year.

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

9
deficiencies at the latest standard inspection (2025-12-18)
5
at the previous standard inspection (2024-10-04)

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.

24 citations, most serious first. The 11 most serious are shown; the remaining 13 are one tap away and print in full.

  • Actual harm · G2024-06-26 · tag F0689 — failed to keep residents free of avoidable accidents; supervise adequately — isolated
    Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
    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 each resident received adequate supervision and assistive devices to prevent accidents for 1 of 8 residents (Resident #2) reviewed for accidents. The facility failed to use an appropriate transfer for Resident #2 which resulted in a fall for Resident #2 and caused Resident #2's surgical wound from a below the right knee amputation to bleed. This failure could place residents at risk for harm and further injuries. The findings included: Record review of Resident #2's undated face sheet reflected Resident #2 was a [AGE] year-old male whose current admission date was on 2/4/2021, and a readmission to the facility on 4/7/24. Resident #2 had the following diagnoses: chronic obstructive pulmonary disease (airflow blockage and breathing-related problems), muscle weakness, acquired absence of right leg below knee (partial amputation of the right leg), complete traumatic amputation at knee level, left lower leg, subsequent encounter (partial amputation…

    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 · E2025-12-18 · tag F0583 — failed to protect personal privacy — pattern
    Keep residents' personal and medical records private and confidential.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on observation and interview, the facility failed to respect the resident's right to personal privacy in 1 of 3 common hallways reviewed for privacy in that: A list of residents that received incontinence care services was posted on the wall in a hallway at a nurse charting station which was visible to potential passersby. This failure could place residents at risk of having medical information personal, or care instructions exposed to others and misuse of personal information. During an observation on 12/16/25 at 4:05 PM revealed a list of 14 residents names that received incontinence care services was posted on the wall in a hallway on the secured unit at the nurse charting station which was located across from the doorway of a dining room. During an interview on 12/18/25 at 11:30 AM, the ADON stated she posted the incontinence care list on the wall in the hallway at the charting station. She stated she posted it on the wall but did not think about how it affected resident's privacy when she did that. She stated she did not remember when she posted it there. She stated she…

    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 · E2025-12-18 · tag F0584 — failed to keep a safe, clean, comfortable home — pattern
    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.
    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 each resident had a right to a safe, clean, comfortable, and homelike environment in the facility and failed to provide housekeeping and maintenance services necessary to maintain a sanitary, orderly, and comfortable interior in 1 of 2 common dining rooms and 10 of 33 resident rooms (24, 25, 26, 28, 30, 31, 32, 33, 34, and 35) reviewed for environment. The facility failed to ensure residents that used common areas and rooms were clean, safe, and did not need repair. These failures could place residents at risk of living in an unsafe, unclean, uncomfortable, and unhomelike environment which could cause a decline in resident psychosocial well-being. The findings included: During an observation on 12/16/25 at 11:42 AM in room [ROOM NUMBER] revealed, the vertical blinds in the bedroom window were missing 1 slat. During an observation on 12/16/25 at 12:14 PM room [ROOM NUMBER] revealed 2 broken and/or cracked planks on the flooring in…

    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 · E2025-12-18 · 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

    Based on observation and interview, the facility failed to provide information to residents and their representatives on their rights related to filing grievances or concerns for 4 of 4 confidential residents. The facility failed to ensure 4 of 4 confidential residents were provided, per the facility policy through postings in prominent locations: the grievance procedure, access to grievance forms, information regarding who the facility grievance officer was with their contact information, and accommodations to file an anonymous grievance. This failure could place the residents at risk of unresolved grievances and decreased quality of life. Findings included: Observation of prominent posting on 12/17/2025 at 9:44 AM revealed the facility did not have instructions regarding the grievance procedure with any of their prominent postings. Grievance forms were not readily available to residents in the facility, and there was no accommodation to submit grievance anonymously. During a confidential interview on 12/17/2025 at 10:00 AM with the resident council, 4 confidential residents stated…

    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 before2025-12-18 · tag F0761 — failed to label and store drugs safely — pattern
    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

    Based on observation, interview, and record review, the facility failed to ensure all drugs and biologicals were stored properly for 1 of 2 medication carts (Medication Cart A) reviewed for medication storage. LVN B left Medication Cart A unlocked and unattended in the hallway by the nurse's station. The facility failed to ensure Medication Cart A's medications were stored separately by route. These failures could place residents at risk for drug diversion and an increased risk for medication errors. The findings included: During an observation on 12/16/25 at 11:31 AM, Medication Cart A was observed unlocked and unattended in the hallway by the nurse's station. No staff members or residents were observed in the area around Medication Cart A.During an interview on 12/16/25 at 11:33 AM, LVN B stated she knew she was supposed to lock the medication cart when she walked away from it. LVN B stated she forgot to lock it when she went to check on a resident. LVN B stated a potential negative outcome to the residents was they could get into it [the medication cart]. During an observation on…

    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 · Ecited before2025-12-18 · tag F0803 — failed to meet residents' dietary needs — pattern
    Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on observation, interviews, and record review, the facility failed to ensure that the menu met the nutritional needs of residents and was followed for the lunch meal on 12/16/25 reviewed for nutritional adequacy. The facility failed to: 1) Ensure lunch item served on 12/16/2025 reflected what was on the DM's menu. 2) Ensure residents on special diet (pureed bread) receive pureed bread for the 12/16/2025 lunch meal. These failures could affect all residents who ate food from the kitchen by placing them at risk of not receiving adequate nutritive food value needed to promote/maintain health. The findings included: Review of the weekly menu week 3 Tuesday lunch revealed Beef goulash, Squash medley, tossed salad, Cornbread, Margarine, Dressing of choice, Fresh baked cookie and a Beverage. During an observation on 12/16/25 from 12:15 PM to 12:30 PM revealed a message written on a white board hanging on a wall in the secured unit dining room said that reflected, Lunch: goulash, green beans, bread slice, fruit. Three items of pureed food were observed to be included on four pureed…

    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 · Ecited before2025-12-18 · 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 store, prepare, distribute, and serve food in accordance with professional standards for food service safety in the facility's only kitchen reviewed for food safety. 1) The facility failed to ensure food items in the freezers (4), were labeled and stored in accordance with the professional standards for food service. 2) The facility failed to protect foods from potential contamination. These failures could place residents at risk for food-borne illness and cross contamination.The findings included: The following observations were made during a kitchen tour on 12/16/25 that began at 11:01 AM and concluded at 11:38 AM: The facility failed to have vent hood located directly above the cooktop on the right side of the kitchen free from dust and cobwebs. Walk-in Freezer #1 revealed the following: What appeared to be chicken breasts, ground beef, and chicken wings in three different clear plastic bags with no label, no date on bag. Walk-in Freezer #2 revealed the following: What appeared to be sausage in a clear…

    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 · E2025-12-18 · tag F0914 — pattern
    Provide bedrooms that don't allow residents to see each other when privacy is needed.
    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 and interview, the facility failed to respect the resident's right to personal privacy in 10 of 33 resident rooms (24, 25, 26, 28, 30, 31, 32, 33, 34, and 35) reviewed for privacy in that: 1. Resident rooms [ROOM NUMBERS], beds B, didn't have privacy curtains that were designed or equipped to allow for full visual privacy. 2. Resident rooms 24, 25, 26, 28, 30, 31, 32, 33, 34, and 35 had slats missing from the window vertical blinds, which allowed potential passersby to see inside the rooms. These failures could also cause residents to feel uncomfortable, disrespected, and possible exposure to anyone passing by. Findings included: During an observation on 12/16/25 at 11:42 AM in room [ROOM NUMBER] revealed, the vertical blinds on the bedroom window were missing 1 slat which left an opening of approximately 3 inches wide of the window from top to bottom to be uncovered when the blinds were closed. During an observation on 12/16/25 at 12:14 PM in room [ROOM NUMBER] revealed the vertical blinds…

    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 · Dcited before2025-12-18 · 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 establish and 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 diseases and infections for 2 of 3 residents (Resident #5 and Resident #6) reviewed for infection control.-CNA A did not perform hand hygiene after touching a trash can, before touching wipes, and did not perform hand hygiene between all glove changes when providing incontinence care to Resident #6.-LVN A did not perform hand hygiene between all glove changes when providing wound care to Resident #5. These failures could place residents at risk for cross contamination and infection. The findings include: Resident #6 Record review of the admission record for Resident #6, dated 12/18/25 revealed a [AGE] year-old female who was admitted to the facility on [DATE] and readmitted on [DATE] with the following diagnoses: atherosclerotic heart…

    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
  • Potential for harm · D2025-12-18 · tag F0925 — failed to control pests — isolated
    Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on observations, interviews, and record review, the facility failed to maintain an effective pest control program so that facility was free of pests and rodents for the facility's only kitchen. The facility did not maintain an effective pest control program to ensure the facility was free of flies in the kitchen. These findings could place residents at risk for an unsanitary environment and a decreased quality of life.The findings included: Record review of the facility's pest control binder 2025 pest control visited the facility bi-weekly to treat pests and insects. The kitchen was last treated for rats on 06/11/2025 and there was no mention of flies. Observation of the facility's kitchen on 12/16/2025 at 11:16 AM, revealed approximately four flies flying around DM as he prepared meal before lunch was served. The flies were observed landing on food preparation stations that were not in use, on top of the plate warming station and on cooking utensils. No fly trap tapes observed. In an interview on 12/18/2025 at 9:53 AM with the DM, he stated It is the maintenance personnel…

    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 before2024-10-04 · tag F0727 — failed to provide required RN coverage — widespread
    Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis.
    What the surveyor found here — an excerpt from the official record, may be distressing

    Based on interviews and record review, the facility failed to use the services of a Registered Nurse (RN) for at least eight consecutive hours a day, seven days a week in the facility for 34 (4/1, 4/3, 4/6, 4/7, 4/8, 4/10, 4/11, 4/12, 4/13, 4/14, 4/20, 4/21, 4/27, 4/28, 5/7, 5/10, 5/11, 5/12, 5/24, 5/25, 5/28, 5/29, 5/30, 5/31, 6/1, 6/2, 6/7, 6/8, 6/14, 6/15, 6/21, 6/22, 6/25, and 6/29/2024) of 91 days reviewed for RN coverage. The facility failed to maintain RN coverage of eight hours a day for 34 days. This failure could place residents at risk of not having their nursing and medical needs met and receiving improper care. Findings included: Record review of the facility's employee survey roster dated 10/2/24 revealed there were no RNs employed at the facility. Record review of Schedule Sheet dated April 2024 revealed there was not an RN scheduled to work on (4/1, 4/3, 4/6, 4/7, 4/8, 4/10, 4/11, 4/12, 4/13, 4/14, 4/20, 4/21, 4/27, and 4/28/2024). Record review of Schedule Sheet dated May 2024 revealed there was not an RN scheduled to work on (5/7, 5/10, 5/11, 5/12, 5/24, 5/25,…

    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.

    Nursing and Physician Services Deficiencies · Deficient, Provider has date of correction
Show the remaining 13 citations
  • Potential for harm · Ecited before2024-10-04 · tag F0880 — failed to prevent and control infections — pattern
    Provide and implement an infection prevention and control program.
    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 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 diseases and infections for 3 of 14 residents (Resident #11, #30 and #34) and 1 of 4 staff (LVN A) reviewed for infection control. LVN A failed to properly clean a multi-use medical device between each resident during medication administration for Resident #11, #30 and #34. These failures could place residents at risk for spread of infection and cross contamination. Findings included: During a medication pass observation on 10/03/24 at 08:58 AM, LVN A picked up the wrist blood pressure device from the top of the medication cart and took it to the room of Resident #11 and took her blood pressure on the left wrist. She then took the wrist blood pressure device and placed it on top of the medication cart. LVN A did not sanitize the wrist blood pressure device before or after use. During a medication pass observation on 10/03/24…

    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
  • Potential for harm · D2024-10-04 · tag F0695 — failed to provide proper breathing / tracheostomy care — isolated
    Provide safe and appropriate respiratory care for a resident when needed.
    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 that a resident who needed respiratory care, was provided such care, consistent with professional standards of practice for 1 (Resident #28) of 5 residents reviewed for respiratory care. The facility failed to ensure that Resident #28's oxygen tubing was replaced every seven (7) days, according to physician's orders. This failure could place residents at risk for respiratory compromise and infection. Findings included: Review of Resident #28's face sheet revealed a [AGE] year-old male with an admission date of 02/04/21 with the following diagnoses: Chronic Obstructive Pulmonary Disease (airflow blockage and breathing-related problems), Congestive Heart Failure (heart condition), Chronic Kidney Disease (condition causing kidneys to not function properly ), Gastroesophageal Reflux Disease (digestive condition), Peripheral Vascular Disease (circulatory condition that reduces blood flow to the limbs), acquired absence of right leg…

    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 · Dcited before2024-10-04 · 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 observation, interview and record review, the facility failed to maintain clinical records in accordance with accepted professional standards and practices that were complete and accurately documented for 1 (Resident #28) of 13 residents reviewed for clinical records. The facility failed to accurately document an oxygen tubing change for resident #28. This failure could place residents at risk of inaccurate and incomplete care. Findings included: Review of Resident #28's face sheet revealed a [AGE] year-old male with an admission date of 02/04/21 with the following diagnoses: Chronic Obstructive Pulmonary Disease (airflow blockage and breathing-related problems), Congestive Heart Failure (heart condition), Chronic Kidney Disease (condition causing kidneys to not function properly ), Gastroesophageal Reflux Disease (digestive condition), Peripheral Vascular Disease (circulatory condition that reduces blood flow to the limbs), acquired absence of right leg below the knee, complete traumatic amputation of…

    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 · D2024-10-04 · tag F0921 — failed to keep a safe, functional, sanitary building — isolated
    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

    Based on observations, interviews, and record reviews the facility failed to provide a safe, functional, sanitary, and comfortable environment for residents, staff, and the public, on facility grounds in 1 of 2 smoking areas (North patio smoking area). The facility failed to ensure the grounds in the smoking area was free from trash. This failure could attract unwanted pests and cause the facility to have an unsightly appearance. The findings included: On 10/03/24 at 2:47 PM, an observation was made of the North patio smoking area. 1 plastic spoon, 10 pieces of white and clear miscellaneous trash, and 11 cigarette butts were noted in the grass area. On 10/03/24 at 4:51 PM, an observation was made of the North patio smoking area. 1 plastic spoon, 10 pieces of white and clear miscellaneous trash, and 11 cigarette butts were noted in the grass area. On 10/04/24 at 9:51 AM, an observation was made of the North patio smoking area. 1 plastic spoon, 10 pieces of white and clear miscellaneous trash, and 11 cigarette butts were noted in the grass area. On 10/04/24 at 10:16 AM, an interview…

    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 · Ecited before2024-09-05 · tag F0761 — failed to label and store drugs safely — pattern
    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 were stored and labeled in accordance with currently accepted professional principles when applicable for 2 of 7 residents (Resident #1 and #2) reviewed for pharmacy services. The facility failed to prevent the misappropriation of Resident #1's Depakote (Divalproex for mood/behavior), when LVN A took a blister pack of Depakote from Resident #2 and placed Resident #1's pharmacy label on top of Resident #2's pharmacy label. This failure could place residents at an increased risk for not receiving their prescribed medication as ordered. This failure could result in residents not receiving an accurate dose of medication as well as not being maintained at their best therapeutic level. Findings include: Record review of Resident #1's Resident Face Sheet dated 09/05/24 indicated she was a [AGE] year-old female who was admitted to the facility 05/05/16. Resident #1 diagnoses included Schizophrenia (a disorder that…

    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 · D2024-06-26 · tag F0602 — failed to protect residents from theft of their belongings — isolated
    Protect each resident from the wrongful use of the resident's belongings or money.
    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 a resident had the right to be free from abuse, neglect, misappropriation of property, and exploitation for 1 of 8 residents (Resident #1) reviewed for misappropriation of property. The facility failed to prevent the misappropriation of Resident #1's Synthroid/Levothyroxine (thyroid medication), when LVN B took the medication out LVN C's medication cart for her own personal use between 4/21/2024 through 4/28/2024 and/or 5/2/2024. This incident was witnessed by LVN C. This failure could place residents at an increased risk for not receiving their prescribed medication as ordered. Findings included: Record review of Resident #1's undated face sheet reflected Resident #1 was a [AGE] year-old male whose latest readmission to the facility on was 6/11/24, a current readmission date of 6/14/24, as well as a discharge date of 6/24/24. Resident #1 was his own resident representative with the following diagnoses: acute on chronic diastolic (congestive)…

    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 · Dcited before2024-06-26 · 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

    Based on interview and record review, the facility failed to ensure all drugs and biologicals were stored in locked compartments for 1 of 2 medication carts (medication cart on front hall). The facility failed to ensure that medication 1 of 2 medication carts were secured when unattended on or about 4/21/2024 through 4/28/2024 and/or 5/2/2024. This failure could place residents at risk of having access to unauthorized medications and/or lead to possible harm, drug overdose, or drug diversions. Findings included: During an interview on 6/25/24 at 2:30 PM, the DON stated LVN B notified the facility she received a letter from The Texas Board of Nursing that LVN B was being investigated for taking a resident's medication. The DON stated the medication that LVN B took from the medication cart was Synthroid. The DON stated LVN B told another nurse (LVN C), she was going to take the medication out of the take and take it for herself. The DON stated LVN B told her she decided to not take the pill and discarded it in the sharps container. During an interview on 6/26/24 at 3:26 PM, the DON…

    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 · Dcited before2024-06-26 · 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 maintained on each resident were accurately documented for 1 of 8 residents (Resident #1) reviewed for accuracy of records. LVN B failed to document a fall with injury in the medical record progress note for Resident #2. This failure could place residents at risk for not receiving needed care or treatment after an incident occurred. The findings included: Record review of Resident #2's undated face sheet reflected Resident #2 was a [AGE] year-old male whose current admission date was on 2/4/2021, and a readmission to the facility on 4/7/24. Resident #2 had the following diagnoses: chronic obstructive pulmonary disease (airflow blockage and breathing-related problems), muscle weakness, acquired absence of right leg below knee (partial amputation of the right leg), complete traumatic amputation at knee level, left lower leg, subsequent encounter (partial amputation of…

    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 · Fcited before2023-09-15 · tag F0727 — failed to provide required RN coverage — widespread
    Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis.
    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 use the services of a Registered Nurse (RN) for at least eight consecutive hours a day, seven days a week for 9 of 30 days (08/13/23, 08/19/23, 08/20/23, 08/26/23, 08/27/23, 09/02/23, 09/03/23, 09/09/23, and 09/10/23) reviewed for RN coverage. The facility failed to ensure they had RN coverage 8 hours a day, 7 days a week for the following days: 08/13/23, 08/19/23, 08/20/23, 08/26/23, 08/27/23, 09/02/23, 09/03/23, 09/09/23, and 09/10/23 This failure could place residents at risk for inconsistency in care and services. Findings include: Record review of the facility's employee roster dated 08/04/23 revealed there were one RN employed at the facility. Record Review of the employee roster update provided by the ADM dated 09/13/23 revealed RN A termination date 07/20/23 and had written on document No RN time sheet for last 30 days. During an interview on 09/13/23 at 11:45 AM with the ADM he stated there were no RN times for the last 30 days. During an…

    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.

    Nursing and Physician Services Deficiencies · Deficient, Provider has date of correction
  • Potential for harm · Fcited before2023-09-15 · 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

    NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY 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 in 1 of 1 kitchen reviewed for dietary services, in that: 1) The facility failed to ensure to date and label all food. 2) Dietary staff failed to store foods in a manner to prevent contamination. 3) Dietary staff failed to clean two vents observed in the kitchen area and the inside dry storage area. 4) Dietary Staff stored dented cans with the remaining cans used for resident consumption (. 5) Dietary Staff used 1 of 2 dented cans for resident consumption on 09/13/23. 6) Dietary Staff failed to properly thaw chicken 7) Dietary staff failed to cover food that was not actively being served. These failures could place residents at risk for food contamination and foodborne illness. The findings include: The following observations of the kitchen was made on 09/13/23: -At 8:58 AM - a partially used bottle of water and a personal cup with…

    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 · E2023-09-15 · tag F0690 — failed to manage incontinence, catheters, and urinary infections — pattern
    Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
    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 who were incontinent of bladder or had a urinary catheter received appropriate treatment and services to prevent urinary tract infections and to restore continence to the extent possible for 2 of 3 Residents (Resident #28 and #40) reviewed for incontinent care. 1. CNA A failed to proper clean penis and buttocks while providing incontinent care to Resident #28. 2. TNA B used multiple swipes with the same wipe across resident #40 abdomen and buttocks while providing incontinent care to Resident #40. These failures had the potential to affect residents by placing them at an increased risk of infections. Findings include: Resident #28 Record review of face sheet for Resident #28, undated, revealed an [AGE] year-old male admitted to the facility on [DATE] with the following diagnoses: lung cancer, COPD (lung disease), Alzheimer's disease (cognitive loss) and hypertension (high blood pressure). Review of Resident #28's MDS,…

    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 · Dcited before2023-09-15 · tag F0803 — failed to meet residents' dietary needs — isolated
    Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the 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 that the menu was followed, for 2 out of 2 residents that received pureed food (Residents #26 & 33), in that: 1. The facility failed to ensure Resident # 26 received pureed bread on 09/13/23 and on 09/14/23. 2. The facility failed to ensure Resident # 33 received pureed bread on 09/13/23 and on 09/14/23 These failures could place residents at risk for unwanted weight loss, hunger, unwanted weight gain, and metabolic imbalances. The findings include: On 09/13/23 at 11:31 AM an observation of the pureed process was conducted. Dietary [NAME] A began the process at 11:31 AM. No cornbread was pureed during this process. On 09/14/23 at 10:45 AM an observation of the pureed process was conducted. Dietary [NAME] A began the process at 11:45 AM. No bread was pureed during this process. An observation was made on 09/13/23 at 12:20 PM of Resident #33 lunch tray and it did not have any puree bread on the plate. An observation was made on…

    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 · D2023-09-15 · tag F0805 — failed to prepare food in a form residents can eat — isolated
    Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs.
    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 each resident received, and the facility provided food prepared in a form designed to meet individual needs for 2 of 2 puréed meals (9/13/23 - Lunch and 09/14- Lunch) observe for 2 of 2 residents with orders for puréed diet (Residents #26 and 33); in that: The facility failed to provide food that was in a form to meet resident needs Residents #26 and #33 with the orders for puréed diets. This failure could place residence at risk of decreased food intake and choking. The findings include: On 09/13/23 at 11:31 AM an observation of the pureed process was conducted. Dietary [NAME] A began the process at 11:31 AM. The following steps were taken: Entrée: dietary cook a use two cups of mechanical soft pork chop. She added three scoops of juice from the mechanical soft pork chop. She blended it and added two scoops of thickener. She blended then added two slices of white bread. She blended then added two more slices of white bread. She…

    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

“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

$8,018 in federal fines across 1 penalty.

  • $8,018 — penalty dated 2024-06-26

Dates are the dates CMS records the penalty, not the date of the conduct behind it. CMS publishes penalties on a rolling window, so this is what is currently on the public file — not the home’s lifetime history, and an older fine may attach to a problem that has since been corrected. The amounts are as imposed: the CMS file does not record whether a penalty was appealed, reduced, or paid, so we don’t say. Ask the home what each one was for and what changed since.

Part of a chain

This home belongs to AVIR HEALTH GROUP — 116 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 3 of 52.3+0.7 vs chain
Health inspection 3 of 52.4+0.6 vs chain
Staffing 3 of 51.8+1.2 vs chain
Quality measures 4 of 53.6+0.4 vs chain
The other 115 homes this chain runs (chain average 2.3★, per CMS)
1 of 5Avir At BanderaBandera, TX 1 of 5Avir At Cowhorn CreekTexarkana, TX 1 of 5Avir At DallasDallas, TX 1 of 5Avir At LindaleLindale, TX 1 of 5Avir At StephenvilleStephenville, TX 1 of 5Avir at AdamsTemple, TX 1 of 5Avir at Arbor TerraceSan Angelo, TX 1 of 5Avir at BeaumontBeaumont, TX 1 of 5Avir at BeltonBelton, TX 1 of 5Avir at BoerneBoerne, TX 1 of 5Avir at BradburnGrand Saline, TX 1 of 5Avir at CaldwellCaldwell, TX 1 of 5Avir at Camp WoodCamp Wood, TX 1 of 5Avir at Citizens TrailTexarkana, TX 1 of 5Avir at ConverseConverse, TX 1 of 5Avir at GainesvilleGainesville, TX 1 of 5Avir at GarlandGarland, TX 1 of 5Avir at GiddingsGiddings, TX 1 of 5Avir at Heritage OaksLubbock, TX 1 of 5Avir at HillsboroHillsboro, TX 1 of 5Avir at HoustonHouston, TX 1 of 5Avir at Johnson CityJohnson City, TX 1 of 5Avir at KennedaleKennedale, TX 1 of 5Avir at KerrvilleKerrville, TX 1 of 5Avir at LongviewLongview, TX 1 of 5Avir at LubbockLubbock, TX 1 of 5Avir at Meadow CreekSan Angelo, TX 1 of 5Avir at MineolaMineola, TX 1 of 5Avir at New BraunfelsNew Braunfels, TX 1 of 5Avir at PatriotEl Paso, TX 1 of 5Avir at PortlandPortland, TX 1 of 5Avir at Rose TrailTyler, TX 1 of 5Avir at San AngeloSan Angelo, TX 1 of 5Avir at SeguinSeguin, TX 1 of 5Avir at TexarkanaTexarkana, TX 1 of 5Avir at Tierra EsteEl Paso, TX 1 of 5Avir at Veterans MemorialHouston, TX 1 of 5Avir at WestonTemple, TX 1 of 5Avir at WinnsboroWinnsboro, TX 1 of 5Avir at WoodlandsEastland, TX

Showing 40 of 115; 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 / managerTypeRoleSince
605 S AVENUE F HOLDINGS LLCOrganizationDIRECT OWNERSHIP INTERESTsince 10/01/2025
ANA TX HOLDINGS, LLCOrganizationINDIRECT OWNERSHIP INTERESTsince 10/01/2025
GRAF HOLDINGS LLCOrganizationINDIRECT OWNERSHIP INTERESTsince 10/01/2025
TX SNF HOLDINGS II LLCOrganizationINDIRECT OWNERSHIP INTERESTsince 10/01/2025
TX SNF HOLDINGS III LLCOrganizationINDIRECT OWNERSHIP INTERESTsince 10/01/2025
DAGAN, AMITAIIndividualINDIRECT OWNERSHIP INTERESTsince 10/01/2025
FREUND, NOCHUMIndividualINDIRECT OWNERSHIP INTEREST; CORPORATE OFFICERsince 10/01/2025
GOLDBERGER, ABRAHAMIndividualINDIRECT OWNERSHIP INTERESTsince 10/01/2025
GOLDBERGER, FAIGYIndividualINDIRECT OWNERSHIP INTERESTsince 10/01/2025
TRAVITSKY, AARONIndividualINDIRECT OWNERSHIP INTEREST; OPERATIONAL/MANAGERIAL CONTROLsince 10/01/2025
605 S AVENUE F PROPERTY OWNER LLCOrganizationADP OF THE SNFsince 10/01/2025
WELLTOWER INCOrganizationADP OF THE SNFsince 10/01/2025
WELLTOWER NNN GROUP, LLCOrganizationADP OF THE SNFsince 10/01/2025
WELLTOWER OP, LLCOrganizationADP OF THE SNFsince 10/01/2025
GRIMSLEY, CHRISTYIndividualADP OF THE SNFsince 10/01/2025
MARTINEZ IRIZARRY, AXELIndividualADP OF THE SNFsince 10/01/2025

CMS files one row per role, so the 18 rows in the source record cover these 16 parties — each is shown once here with every role it holds. Nothing is omitted. The source lists no ownership percentage for any of them — PECOS records a share only for equity interests, not for board or management roles.

9 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.

$3.0M
Net patient revenuemost recent cost report
+8.0%
Operating marginrevenue minus expenses
$192K
Related-party expense7% of expenses
Who pays — share of resident-days
Medicaid 86%Medicare 5%Other / private 9%

About 86% of this home’s resident-days are paid by Medicaid, which reimburses well below the cost of care in most states. Heavily Medicaid-dependent homes run on thinner budgets — a context worth holding next to the staffing and inspection record, not a fault in itself. This home reported $192K paid to related parties (affiliated landlords or management companies) in its most recent cost report.

Source: CMS Healthcare Provider Cost Reporting Information System (HCRIS), Medicare cost report Form CMS-2540 · fiscal year 2023. 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

$177per resident / day
operating cost
$5,395per month
≈ monthly operating cost
$193per day
avg. revenue, all payers

Straight from this home’s Medicare cost report (CMS, FY2023). 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 675989. CMS refreshes its data monthly, and the star rating rests on the last standard inspection — dated 2025-12-18, 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.

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