LEGEND OAKS HEALTHCARE AND REHABILITATION - NEW BR

Also known publicly as Legend Oaks Healthcare and Rehabilitation - New Braunfels

NEW BRAUNFELS, TX

CMS provider ID 676392CMS source updated July 29, 2026

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CMS overview

CMS rating overview

CMS overall

3 of 5 CMS stars

Health inspection

3 of 5 CMS stars

Staffing

2 of 5 CMS stars

Quality-measure

4 of 5 CMS stars

No proprietary TrustHub score. These ratings are published separately by CMS.

How CMS describes these ratings
CMS overall rating
The CMS overall rating summarizes health inspections, staffing, and quality measures within Medicare's Five-Star system.
Health inspection rating
The CMS health inspection rating reflects findings from standard and complaint inspections used in Medicare's Five-Star system.
Staffing rating
The CMS staffing rating reflects staffing levels and related measures used in Medicare's Five-Star system.
Quality-measure rating
The CMS quality-measure rating summarizes selected resident assessment and claims-based measures used in Medicare's Five-Star system.
CMS certified beds
126
Ownership descriptor
Government - Hospital district
Medicare participation
Yes
Medicaid participation
Yes

Facility information

Contact

CMS remains the primary federal record. Public website and additional contact details appear only when independently verified.

Phone
8304206500Verified public information · checked Aug 2026
Also known publicly as
Legend Oaks Healthcare and Rehabilitation - New BraunfelsVerified public information · checked Aug 2026

State regulatory evidence

State License & Oversight

Texas Health and Human Services Commission is the state source for this license record. It does not replace CMS federal certification, ratings, or certified-bed counts.

Texas Health and Human Services Commission

State license
307212
License type
Nursing Facility

State regulatory data · checked Aug 2026

View source details · Official TX source

Decision guide

What to review

Factual evidence to examine before you decide. These summaries are not a score or recommendation.

Staffing

CMS publishes a 2-star staffing rating for this facility.

RN staffing was 0.45 hours per resident day in 2026Q1, calculated from CMS PBJ records.

View staffing evidence

Ownership

CMS-published records list 16 ownership or control parties.

CMS records show an ownership change effective April 2019.

View ownership evidence

Chain context

CMS groups this facility with a chain covering 347 facilities across 17 states or territories.

View chain evidence

Ownership & operation

Ownership & Operation

Operator, licensee, owner, manager, and chain stay separate. A connected organization is not automatically the party that runs daily operations.

Ownership type
Government - Hospital districtCMS
Chain
THE ENSIGN GROUPCMS identifies this facility as part of the THE ENSIGN GROUP chain.
Related facilities
26Current CMS organization identity
Ownership changes
1 recordedCMS enrollment records

Explore ownership network →

Who is behind this facility?

SeniorTrustHub found evidence connecting this facility to:

  • 1 CMS-reported ownership organization
  • CMS reports 9 individual ownership interests
  • a CMS chain / common-control group
  • recorded ownership-change events

Related facilities

26 currently connected nursing homes share this CMS organization identity with GUADALUPE COUNTY HOSPITAL BOARD.

Average CMS overall rating
2.2 stars across 26 reporting facilities
CMS monetary penalties
21 of 26 facilities had a recorded monetary penalty in the available CMS period.
Recent CMS penalties
11 facilities had a CMS penalty in the last 18 months.
Recent high-value CMS enforcement
10 facilities had a high-value CMS fine or payment denial in the last 18 months.
Recent CMS complaint inspections
24 facilities had a CMS complaint inspection in the last 18 months.
Total recorded CMS fines
$1,214,776

These figures summarize currently connected CMS-certified nursing homes. Some facilities have incomplete measures; missing values are omitted, not treated as zero. Ownership structures can change. State operator or licensee evidence may differ from CMS ownership disclosures.

Ownership

Who CMS records show is connected to this facility

These are CMS-published ownership disclosures. Medicare enrollment ownership and managerial-control information is reported by enrolled providers through CMS forms; it is not an independent determination of beneficial ownership.

Reported party records
16
Organizations shown
7
Individuals shown
9
Latest ownership source update
Jul 27, 2026

CMS-published ownership and control parties

  • GUADALUPE COUNTY HOSPITAL BOARD

    Organization · 5% OR GREATER DIRECT OWNERSHIP INTEREST

    Published ownership percentage: 100%

    Association date reported to CMS: Apr 1, 2019

    Other facilities connected through this exact CMS organization identity: 0 across TX.

    View ownership source details
    Source organization
    Centers for Medicare & Medicaid Services (CMS)
    Dataset
    Ownership
    CMS dataset identifier
    y2hd-n93e
    Source updated
    Jul 1, 2026
    Retrieved
    Aug 15, 2026
    View official CMS source
  • ENSIGN SERVICES INC

    Organization · ADP OF THE SNF

    Association date reported to CMS: May 1, 2016

    Other facilities connected through this exact CMS organization identity: 0 across TX.

    View ownership source details
    Source organization
    Centers for Medicare & Medicaid Services (CMS)
    Dataset
    Ownership
    CMS dataset identifier
    y2hd-n93e
    Source updated
    Jul 1, 2026
    Retrieved
    Aug 15, 2026
    View official CMS source
  • NATIONAL HEALTH INVESTORS, INC.

    Organization · ADP OF THE SNF

    Association date reported to CMS: Apr 1, 2019

    Other facilities connected through this exact CMS organization identity: 0 across TX.

    View ownership source details
    Source organization
    Centers for Medicare & Medicaid Services (CMS)
    Dataset
    Ownership
    CMS dataset identifier
    y2hd-n93e
    Source updated
    Jul 1, 2026
    Retrieved
    Aug 15, 2026
    View official CMS source
  • NEWSOME, GARRETT

    Individual · ADP OF THE SNF

    Association date reported to CMS: Nov 12, 2020

    View ownership source details
    Source organization
    Centers for Medicare & Medicaid Services (CMS)
    Dataset
    Ownership
    CMS dataset identifier
    y2hd-n93e
    Source updated
    Jul 1, 2026
    Retrieved
    Aug 15, 2026
    View official CMS source
  • RIVERWALK HEALTHCARE INC

    Organization · ADP OF THE SNF

    Association date reported to CMS: Oct 7, 2025

    Other facilities connected through this exact CMS organization identity: 0 across TX.

    View ownership source details
    Source organization
    Centers for Medicare & Medicaid Services (CMS)
    Dataset
    Ownership
    CMS dataset identifier
    y2hd-n93e
    Source updated
    Jul 1, 2026
    Retrieved
    Aug 15, 2026
    View official CMS source
  • TEXAS NHI INVESTORS, LLC

    Organization · ADP OF THE SNF

    Association date reported to CMS: Apr 1, 2019

    Other facilities connected through this exact CMS organization identity: 0 across TX.

    View ownership source details
    Source organization
    Centers for Medicare & Medicaid Services (CMS)
    Dataset
    Ownership
    CMS dataset identifier
    y2hd-n93e
    Source updated
    Jul 1, 2026
    Retrieved
    Aug 15, 2026
    View official CMS source
  • YU, HAORAN

    Individual · ADP OF THE SNF

    Association date reported to CMS: Nov 1, 2017

    View ownership source details
    Source organization
    Centers for Medicare & Medicaid Services (CMS)
    Dataset
    Ownership
    CMS dataset identifier
    y2hd-n93e
    Source updated
    Jul 1, 2026
    Retrieved
    Aug 15, 2026
    View official CMS source
  • BURNAM, SOON

    Individual · CORPORATE OFFICER

    Association date reported to CMS: Apr 1, 2019

    View ownership source details
    Source organization
    Centers for Medicare & Medicaid Services (CMS)
    Dataset
    Ownership
    CMS dataset identifier
    y2hd-n93e
    Source updated
    Jul 1, 2026
    Retrieved
    Aug 15, 2026
    View official CMS source
  • GANN, KODY

    Individual · CORPORATE OFFICER

    Association date reported to CMS: Feb 1, 2021

    View ownership source details
    Source organization
    Centers for Medicare & Medicaid Services (CMS)
    Dataset
    Ownership
    CMS dataset identifier
    y2hd-n93e
    Source updated
    Jul 1, 2026
    Retrieved
    Aug 15, 2026
    View official CMS source
  • KEETCH, CHAD

    Individual · CORPORATE OFFICER

    Association date reported to CMS: Mar 1, 2011

    View ownership source details
    Source organization
    Centers for Medicare & Medicaid Services (CMS)
    Dataset
    Ownership
    CMS dataset identifier
    y2hd-n93e
    Source updated
    Jul 1, 2026
    Retrieved
    Aug 15, 2026
    View official CMS source
  • NEWSOME, GARRETT

    Individual · MANAGING CONTROL - GOVERNING BODY

    Association date reported to CMS: Nov 12, 2020

    View ownership source details
    Source organization
    Centers for Medicare & Medicaid Services (CMS)
    Dataset
    Ownership
    CMS dataset identifier
    y2hd-n93e
    Source updated
    Jul 1, 2026
    Retrieved
    Aug 15, 2026
    View official CMS source
  • YU, HAORAN

    Individual · MANAGING CONTROL - GOVERNING BODY

    Association date reported to CMS: Nov 1, 2017

    View ownership source details
    Source organization
    Centers for Medicare & Medicaid Services (CMS)
    Dataset
    Ownership
    CMS dataset identifier
    y2hd-n93e
    Source updated
    Jul 1, 2026
    Retrieved
    Aug 15, 2026
    View official CMS source
  • NEWSOME, GARRETT

    Individual · OPERATIONAL/MANAGERIAL CONTROL

    Association date reported to CMS: Nov 12, 2020

    View ownership source details
    Source organization
    Centers for Medicare & Medicaid Services (CMS)
    Dataset
    Ownership
    CMS dataset identifier
    y2hd-n93e
    Source updated
    Jul 1, 2026
    Retrieved
    Aug 15, 2026
    View official CMS source
  • RIVERWALK HEALTHCARE INC

    Organization · OPERATIONAL/MANAGERIAL CONTROL

    Association date reported to CMS: Apr 1, 2019

    Other facilities connected through this exact CMS organization identity: 0 across TX.

    View ownership source details
    Source organization
    Centers for Medicare & Medicaid Services (CMS)
    Dataset
    Ownership
    CMS dataset identifier
    y2hd-n93e
    Source updated
    Jul 1, 2026
    Retrieved
    Aug 15, 2026
    View official CMS source
  • YU, HAORAN

    Individual · OPERATIONAL/MANAGERIAL CONTROL

    Association date reported to CMS: Nov 1, 2017

    View ownership source details
    Source organization
    Centers for Medicare & Medicaid Services (CMS)
    Dataset
    Ownership
    CMS dataset identifier
    y2hd-n93e
    Source updated
    Jul 1, 2026
    Retrieved
    Aug 15, 2026
    View official CMS source
  • GUADALUPE COUNTY HOSPITAL BOARD

    Organization · Medicare-enrolled legal organization

    Other facilities connected through this exact CMS organization identity: 25 across TX.

    View ownership source details
    Source organization
    Centers for Medicare & Medicaid Services (CMS)
    Dataset
    Skilled Nursing Facility Enrollments
    CMS dataset identifier
    5f2c306f-3b1c-42cd-b037-187b2ce22126
    Source updated
    Jul 27, 2026
    Retrieved
    Aug 15, 2026
    View official CMS source

Ownership changes reported in CMS enrollment records

  1. CHANGE OF OWNERSHIPRIVERWALK HEALTHCARE INC to GUADALUPE COUNTY HOSPITAL BOARD
    View ownership source details
    Source organization
    Centers for Medicare & Medicaid Services (CMS)
    Dataset
    Skilled Nursing Facility Change of Ownership
    CMS dataset identifier
    f557a6ed-95b3-4a22-8433-4175db2dec1c
    Source updated
    Jul 27, 2026
    Retrieved
    Aug 15, 2026
    View official CMS source

What this means

Roles are shown as CMS publishes them. Different CMS sources can describe different enrollment, ownership, and control concepts, so TrustHub keeps each source-specific disclosure distinct.

Questions to ask

  • CMS records list several organizations with ownership or control roles. Which entity is responsible for day-to-day operations at this facility?
  • CMS enrollment records show a change of ownership effective Apr 1, 2019. What operational or leadership changes followed that event?
  • CMS records connect GUADALUPE COUNTY HOSPITAL BOARD to 26 facilities. Which policies and staffing decisions are managed centrally versus locally?

Chain context

CMS groups this facility with THE ENSIGN GROUP

Chain-level values describe this CMS-defined group, not any one facility. CMS Chain ID 507 is a grouping identifier, not a legal organization.

Facilities
347
States and territories
17
Average overall rating
3.2
Average staffing rating
2.7
Average total nurse HPRD
3.7
Total fines
304
Review CMS chain evidence

CMS-published history

Monthly chain measures
MonthFacilitiesOverall ratingStaffing rating
Wed Jul3473.22.7
Mon Jun3423.22.4
Fri May3383.22.4
Wed Apr3343.22.4
Sun Mar3293.22.7
Sun Feb3243.22.7

Questions to ask

  • CMS groups facilities in 17 states or territories under this chain. Which operational policies are set at the chain level?
  • CMS reports 304 fines across the chain in this dataset. What compliance functions are managed centrally?
CMS chain source and methodology

Nursing Home Chain Performance Measures, fixed version da2db00a-0f3d-40a9-a535-588ff1220c55. Membership comes separately from CMS Skilled Nursing Facility Enrollments.

View official CMS source

Inspections & deficiencies

What CMS inspection records show

Scope and severity terms below are CMS classifications. They are not a TrustHub score.

Latest recorded inspection

Date
May 20, 2026
Survey type
Fire Safety Standard
Linked findings
0
Highest linked CMS classification
No linked health-deficiency finding in the loaded record
View source details
Dataset
Inspection Dates
CMS dataset ID
svdt-c123
CMS source updated
Jul 1, 2026
CMS provider ID
676392
Source record locator
csv-row:148199:ccn:676392
View official CMS source
May 20, 2026Fire Safety Standard 0 linked findings

No health-deficiency rows were deterministically linked to this inspection.

May 20, 2026Health Standard 7 linked findings
  • F0655Resident Assessment and Care Planning Deficiencies

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

    CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Jun 11, 2026)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    676392
    Source record locator
    csv-row:415184:ccn:676392
    View official CMS source
  • F0695Quality of Life and Care Deficiencies

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

    CMS scope/severity E: Pattern; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (May 27, 2026)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    676392
    Source record locator
    csv-row:415183:ccn:676392
    View official CMS source
  • F0755Pharmacy Service Deficiencies

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

    CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Jun 11, 2026)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    676392
    Source record locator
    csv-row:415185:ccn:676392
    View official CMS source
  • F0761Pharmacy Service Deficiencies

    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.

    CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Jun 11, 2026)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    676392
    Source record locator
    csv-row:415186:ccn:676392
    View official CMS source
  • F0812Nutrition and Dietary Deficiencies

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

    CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Jun 11, 2026)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    676392
    Source record locator
    csv-row:415187:ccn:676392
    View official CMS source
  • F0813Nutrition and Dietary Deficiencies

    Have a policy regarding use and storage of foods brought to residents by family and other visitors.

    CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Jun 11, 2026)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    676392
    Source record locator
    csv-row:415188:ccn:676392
    View official CMS source
  • F0814Nutrition and Dietary Deficiencies

    Dispose of garbage and refuse properly.

    CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Jun 11, 2026)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    676392
    Source record locator
    csv-row:415189:ccn:676392
    View official CMS source
Apr 29, 2026Health Complaint 1 linked finding
  • F0761Pharmacy Service Deficiencies

    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.

    CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (May 6, 2026)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    676392
    Source record locator
    csv-row:415190:ccn:676392
    View official CMS source
Sep 10, 2025Health Complaint 2 linked findings
  • F0804Nutrition and Dietary Deficiencies

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

    CMS scope/severity E: Pattern; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Sep 15, 2025)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    676392
    Source record locator
    csv-row:415191:ccn:676392
    View official CMS source
  • F0887Infection Control Deficiencies

    Educate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status.

    CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Sep 15, 2025)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    676392
    Source record locator
    csv-row:415192:ccn:676392
    View official CMS source
Mar 28, 2025Fire Safety Standard 0 linked findings

No health-deficiency rows were deterministically linked to this inspection.

Mar 28, 2025Health Complaint 0 linked findings

No health-deficiency rows were deterministically linked to this inspection.

Mar 28, 2025Health Standard 14 linked findings
  • F0641Resident Assessment and Care Planning Deficiencies

    Ensure each resident receives an accurate assessment.

    CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Mar 31, 2025)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    676392
    Source record locator
    csv-row:415196:ccn:676392
    View official CMS source
  • F0656Resident Assessment and Care Planning Deficiencies

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

    CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Mar 31, 2025)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    676392
    Source record locator
    csv-row:415197:ccn:676392
    View official CMS source
  • F0692Quality of Life and Care Deficiencies

    Provide enough food/fluids to maintain a resident's health.

    CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Apr 3, 2025)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    676392
    Source record locator
    csv-row:415198:ccn:676392
    View official CMS source
  • F0695Quality of Life and Care Deficiencies

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

    CMS scope/severity E: Pattern; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Apr 2, 2025)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    676392
    Source record locator
    csv-row:415193:ccn:676392
    View official CMS source
  • F0700Quality of Life and Care Deficiencies

    Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail.

    CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Mar 31, 2025)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    676392
    Source record locator
    csv-row:415199:ccn:676392
    View official CMS source
  • F0761Pharmacy Service Deficiencies

    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.

    CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Mar 31, 2025)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    676392
    Source record locator
    csv-row:415200:ccn:676392
    View official CMS source
  • F0812Nutrition and Dietary Deficiencies

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

    CMS scope/severity E: Pattern; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Mar 29, 2025)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    676392
    Source record locator
    csv-row:415195:ccn:676392
    View official CMS source
  • F0940Administration Deficiencies

    Develop, implement, and/or maintain an effective training program for all new and existing staff members.

    CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Apr 3, 2025)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    676392
    Source record locator
    csv-row:415201:ccn:676392
    View official CMS source
  • F0941Administration Deficiencies

    Develop, implement, and/or maintain an effective training program that includes effective communications for direct care staff members.

    CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Apr 3, 2025)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    676392
    Source record locator
    csv-row:415202:ccn:676392
    View official CMS source
  • F0943Freedom from Abuse, Neglect, and Exploitation Deficiencies

    Give their staff education on dementia care, and what abuse, neglect, and exploitation are; and how to report abuse, neglect, and exploitation.

    CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Apr 3, 2025)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    676392
    Source record locator
    csv-row:415203:ccn:676392
    View official CMS source
  • F0944Administration Deficiencies

    Conduct mandatory training, for all staff, on the facility’s Quality Assurance and Performance Improvement Program.

    CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Apr 3, 2025)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    676392
    Source record locator
    csv-row:415204:ccn:676392
    View official CMS source
  • F0945Infection Control Deficiencies

    Include as part of its infection prevention and control program, mandatory training that includes written standards, policies, and procedures for the program.

    CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Apr 3, 2025)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    676392
    Source record locator
    csv-row:415205:ccn:676392
    View official CMS source
  • F0946Administration Deficiencies

    Provide training in compliance and ethics.

    CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Apr 3, 2025)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    676392
    Source record locator
    csv-row:415206:ccn:676392
    View official CMS source
  • F0949Administration Deficiencies

    Provide behavior health training consistent with the requirements and as determined by a facility assessment.

    CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Apr 3, 2025)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    676392
    Source record locator
    csv-row:415207:ccn:676392
    View official CMS source
Feb 6, 2025Health Complaint 4 linked findings
  • F0602Freedom from Abuse, Neglect, and Exploitation Deficiencies

    Protect each resident from the wrongful use of the resident's belongings or money.

    CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Feb 7, 2025)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    676392
    Source record locator
    csv-row:415208:ccn:676392
    View official CMS source
  • F0657Resident Assessment and Care Planning Deficiencies

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

    CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Feb 7, 2025)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    676392
    Source record locator
    csv-row:415209:ccn:676392
    View official CMS source
  • F0695Quality of Life and Care Deficiencies

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

    CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Feb 12, 2025)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    676392
    Source record locator
    csv-row:415210:ccn:676392
    View official CMS source
  • F0842Resident Assessment and Care Planning Deficiencies

    Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.

    CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Feb 7, 2025)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    676392
    Source record locator
    csv-row:415211:ccn:676392
    View official CMS source
Aug 3, 2024Health Complaint 2 linked findings
  • F0684Quality of Life and Care Deficiencies

    Provide appropriate treatment and care according to orders, resident’s preferences and goals.

    CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Aug 4, 2024)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    676392
    Source record locator
    csv-row:415212:ccn:676392
    View official CMS source
  • F0842Resident Assessment and Care Planning Deficiencies

    Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.

    CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Aug 4, 2024)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    676392
    Source record locator
    csv-row:415213:ccn:676392
    View official CMS source
Feb 29, 2024Health Complaint 1 linked finding
  • F0677Quality of Life and Care Deficiencies

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

    CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Past Non-Compliance (Feb 27, 2024)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    676392
    Source record locator
    csv-row:415214:ccn:676392
    View official CMS source
Jan 27, 2024Fire Safety Standard 0 linked findings

No health-deficiency rows were deterministically linked to this inspection.

Jan 27, 2024Health Complaint 0 linked findings

No health-deficiency rows were deterministically linked to this inspection.

Jan 27, 2024Health Standard 4 linked findings
  • F0623Resident Rights Deficiencies

    Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.

    CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Feb 16, 2024)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    676392
    Source record locator
    csv-row:415216:ccn:676392
    View official CMS source
  • F0636Resident Assessment and Care Planning Deficiencies

    Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months.

    CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Feb 29, 2024)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    676392
    Source record locator
    csv-row:415217:ccn:676392
    View official CMS source
  • F0756Pharmacy Service Deficiencies

    Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.

    CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Feb 29, 2024)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    676392
    Source record locator
    csv-row:415218:ccn:676392
    View official CMS source
  • F0812Nutrition and Dietary Deficiencies

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

    CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Jan 29, 2024)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    676392
    Source record locator
    csv-row:415219:ccn:676392
    View official CMS source
Jan 20, 2024Health Complaint 1 linked finding
  • F0695Quality of Life and Care Deficiencies

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

    CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.

    Correction status: Deficient, Provider has date of correction (Mar 20, 2024)

    View source details
    Dataset
    Health Deficiencies
    CMS dataset ID
    r5ix-sfxw
    CMS source updated
    Jul 1, 2026
    CMS provider ID
    676392
    Source record locator
    csv-row:415220:ccn:676392
    View official CMS source

Tags appearing across inspections

  • F0695 appears in 4 linked inspections.
  • F0761 appears in 3 linked inspections.
  • F0812 appears in 3 linked inspections.
  • F0842 appears in 2 linked inspections.

Penalties & enforcement

CMS penalty records in the loaded three-year dataset

No penalty records were found for this provider in the currently loaded CMS Penalties dataset.

Questions to ask

Questions generated from the evidence above

  • CMS records show F0695 in 4 inspections in the available record. What changes has the facility made to address this issue?
  • CMS records show F0761 in 3 inspections in the available record. What changes has the facility made to address this issue?
  • CMS records show F0812 in 3 inspections in the available record. What changes has the facility made to address this issue?
  • CMS records show F0842 in 2 inspections in the available record. What changes has the facility made to address this issue?

Facility history

Facility History

13 historical events available. Dates and values come from published CMS and official state regulator evidence, not a score.

What changed recently?

  • Health inspection completed7 deficiencies were recorded.
  • Total nurse staffing decreasedTotal nurse staffing decreased from 3.52 to 3.30 hours per resident day between 2025Q3 and 2025Q4. Staffing declined across those reported periods.

2026

  1. Health inspection completed

    7 deficiencies were recorded.

    CMS · Recorded event date · View related evidence

  2. Complaint inspection recorded

    1 deficiency was recorded.

    CMS · Recorded event date · View related evidence

2025

  1. Total nurse staffing decreased

    Total nurse staffing decreased from 3.52 to 3.30 hours per resident day between 2025Q3 and 2025Q4. Staffing declined across those reported periods.

    3.523.30

    CMS · Reported in a source release · View related evidence

  2. Complaint inspection recorded

    2 deficiencies were recorded.

    CMS · Recorded event date · View related evidence

  3. Complaint inspection recorded

    No linked health-deficiency findings were recorded for this survey.

    CMS · Recorded event date · View related evidence

  4. Health inspection completed

    14 deficiencies were recorded.

    CMS · Recorded event date · View related evidence

  5. Complaint inspection recorded

    4 deficiencies were recorded.

    CMS · Recorded event date · View related evidence

2024

  1. Complaint inspection recorded

    2 deficiencies were recorded.

    CMS · Recorded event date · View related evidence

  2. Complaint inspection recorded

    1 deficiency was recorded.

    CMS · Recorded event date · View related evidence

  3. Health inspection completed

    4 deficiencies were recorded.

    CMS · Recorded event date · View related evidence

  4. Complaint inspection recorded

    No linked health-deficiency findings were recorded for this survey.

    CMS · Recorded event date · View related evidence

  5. Complaint inspection recorded

    1 deficiency was recorded.

    CMS · Recorded event date · View related evidence

Staffing

Reported nursing staffing at a glance

CMS staffing rating: 2 of 5 stars. CMS calculates that rating separately using its published methodology. The values below are calculations from daily PBJ records for 2026Q1 (current source quarter).

Inspect a PBJ quarter
Total nursing
3.303
reported hours per resident day
RN categories
0.45
reported hours per resident day
LPN/LVN categories
0.707
reported hours per resident day
CNA
1.693
reported hours per resident day

Weekday and weekend calculations

2026Q1 reported hours per resident day
MeasureMonday–FridaySaturday–Sunday
Total nursing3.4782.871
RN categories0.4630.418

Contract staff accounted for 4.9% of reported nursing hours included in this quarter calculation.

Reported RN-category hours per resident day were 0.042 higher than the prior loaded quarter.

Staffing over time

Solid bar: Total nursing · Outlined bar: RN categories

Calculated reported hours per resident day by PBJ quarter
QuarterTotal nursingRN categoriesLPN/LVNCNAContract shareDays
2025Q23.3490.4430.7421.7340%91
2025Q33.5160.3680.9261.7810%92
2025Q43.2980.4070.7861.6560%92
2026Q13.3030.450.7071.6934.9%90

Questions to ask

  • PBJ records show lower calculated RN-category hours per resident day on weekends this quarter. How does the facility plan RN coverage on Saturdays and Sundays?
  • PBJ records show that some reported nursing hours were contract hours. How does the facility orient and integrate contract staff?
Staffing source and calculation details
Source
Centers for Medicare & Medicaid Services (CMS)
Dataset
Payroll Based Journal Daily Nurse Staffing
CMS dataset ID
7e0d53ba-8f02-4c66-98a5-14a1c997c50d
Quarter
2026Q1
Coverage
Jan 1, 2026Mar 31, 2026
Days represented
90 (90 with positive MDS census)
CMS source updated
Jul 29, 2026
Calculation version
pbj-quarter-ratio-of-sums-v1

Hours-per-resident-day values are calculated by this platform from CMS-published daily PBJ hours and MDS census. For each displayed period, included hours are summed and divided by the summed census for days with a positive census. They are not CMS case-mix-adjusted staffing measures or a staffing rating.

View official CMS PBJ source

What we can verify today

Current Provider Information facts

These measures come from the current successfully ingested CMS Nursing Home Provider Information release.

  • CMS reports a 3-star overall rating.
  • CMS reports a 3-star health inspection rating.
  • CMS reports a 2-star staffing rating.
  • CMS reports a 4-star quality-measure rating.

Planned evidence layers

Additional public-source research

These areas require separate authoritative CMS datasets. No findings are shown until those sources are ingested and reviewed.

    Trust participation

    See something that needs correction?

    Claims, corrections, and factual context are free. Submissions never replace CMS evidence or affect ranking.

    How corrections work

    Source register

    See where this record came from

    Provider Information
    Source organization
    Centers for Medicare & Medicaid Services (CMS)
    Dataset identifier
    4pq5-n9py
    Source updated
    Jul 29, 2026
    Retrieved
    Aug 14, 2026
    Supports
    Overview, facility facts, and CMS ratings
    View official CMS source
    Inspection Dates
    Source organization
    Centers for Medicare & Medicaid Services (CMS)
    Dataset identifier
    svdt-c123
    Source updated
    Jul 1, 2026
    Retrieved
    Aug 14, 2026
    Supports
    Inspections and facility history
    View official CMS source
    Health Deficiencies
    Source organization
    Centers for Medicare & Medicaid Services (CMS)
    Dataset identifier
    r5ix-sfxw
    Source updated
    Jul 1, 2026
    Retrieved
    Aug 14, 2026
    Supports
    Health deficiencies and facility history
    View official CMS source
    Payroll Based Journal Daily Nurse Staffing
    Source organization
    Centers for Medicare & Medicaid Services (CMS)
    Dataset identifier
    7e0d53ba-8f02-4c66-98a5-14a1c997c50d
    Coverage
    Apr 1, 2025–Mar 31, 2026
    Source updated
    Jul 29, 2026
    Retrieved
    Aug 15, 2026
    Supports
    PBJ staffing cards, history, and transparent calculations
    View official CMS source
    Ownership
    Source organization
    Centers for Medicare & Medicaid Services (CMS)
    Dataset identifier
    y2hd-n93e
    Source updated
    Jul 1, 2026
    Retrieved
    Aug 15, 2026
    Supports
    Ownership parties, organization connections, and ownership history
    View official CMS source
    Skilled Nursing Facility Enrollments
    Source organization
    Centers for Medicare & Medicaid Services (CMS)
    Dataset identifier
    5f2c306f-3b1c-42cd-b037-187b2ce22126
    Source updated
    Jul 27, 2026
    Retrieved
    Aug 15, 2026
    Supports
    Ownership parties, organization connections, and ownership history
    View official CMS source
    Skilled Nursing Facility Change of Ownership
    Source organization
    Centers for Medicare & Medicaid Services (CMS)
    Dataset identifier
    f557a6ed-95b3-4a22-8433-4175db2dec1c
    Source updated
    Jul 27, 2026
    Retrieved
    Aug 15, 2026
    Supports
    Ownership parties, organization connections, and ownership history
    View official CMS source
    Nursing Home Chain Performance Measures
    Source organization
    Centers for Medicare & Medicaid Services (CMS)
    Dataset identifier
    97ecfad1-d3f1-4d42-b774-d74661d830bc
    Coverage
    Wed Jul
    Source updated
    Aug 12, 2026
    Retrieved
    Aug 16, 2026
    Supports
    CMS chain context, performance, and monthly history
    View official CMS source
    Verified public facility information
    Source organization
    Public facility listing
    Dataset identifier
    commercial-corroboration:public-listing
    Source updated
    Aug 18, 2026
    Retrieved
    Aug 18, 2026
    Supports
    Independently verified public website, phone, or publicly used name. Not a CMS rating or regulatory status.
    How sources work
    Directory of Nursing Facilities with an Active License
    Source organization
    Texas Health and Human Services Commission
    Dataset identifier
    state-regulator:tx
    Coverage
    State license 307212
    Source updated
    Aug 18, 2026
    Retrieved
    Aug 18, 2026
    Supports
    state license, and license type. Separate from CMS certification, ratings, and ownership.
    View official state source

    No paid placements. Facilities cannot pay to rank higher. We cite. You decide.