1008 Citizens Trail, Texarkana, TX 75501 · Bowie County · (903) 838-9526
114 certified beds, about 52 residents a day · For profit - Limited Liability company · Medicare and Medicaid since 2003
CMS Care Compare ratings, data as of September 1, 2026 · CCN 675958 · See it on Medicare.gov · Compare with other homes
At its most recent standard inspection, on November 20, 2025, inspectors cited 26 health deficiencies (the Texas average is 9.4, the national average 9.2).
Of 52 health citations since July 2023, 7 were rated as actual harm or immediate jeopardy to residents (6 immediate jeopardy).
CMS lists 2 fines totaling $120,751 in the last three years; the largest was $104,696, and the latest is dated July 17, 2024.
Nurses and nurse aides worked 3.53 hours per resident per day, against 3.39 across Texas and 3.86 nationally. Registered nurses accounted for 0.48 of those hours.
66.7% of nursing staff left within the year CMS measured (Texas average 55.3%).
CMS links it to Avir Health Group, an affiliated group of 118 nursing homes.
Federal rules call for a standard inspection at least every 15 months, plus a visit whenever a complaint is filed. Each mark below is one citation, colored by how serious inspectors rated it. How to read a citation.
Under each citation, the quoted text is the inspector's own summary from the federal statement of deficiencies (CMS form 2567), word for word apart from a privacy scrub; CMS removes residents' and staff names before it publishes the text. The full notes are on Medicare.gov.
CMS rates every citation by how much harm it caused (rows) and how many residents it touched (columns). The count in each box is this home's, across all 52 health citations on file.
Inspectors wroteBased on observations, interviews, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food safety for 1 of 1 kitchen reviewed. The facility did not ensure:1. Food items were labeled and dated.2. The microwave was clean and free of food debris.3. The toaster was clean and free of food debris 4. The juice machine spigot was free from a red gooey substance where the juice was dispersed. 5. The deep fryer was clean and had clear grease.6. [NAME] Q personal cell phone was stored properly.7. A personal drink was stored properly. These failures could place residents at risk for foodborne illness.
Inspectors wroteBased on observation, interview and record review the facility failed to effectively 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 5 (Resident's #2, #31, and Resident #3) residents and 1 of 1 linen cart reviewed for infection control. 1. The facility did not ensure RN A had prepared a barrier to place supplies on when checking Resident #2 and 31's blood sugar. The facility did not ensure RN A cleaned the glucometer between Resident #2 and Resident #31's blood sugar. The facility did not ensure RN A performed hand hygiene while checking Resident #2's blood sugar. 2. The facility did not ensure linen carts were covered. 3. The facility did not ensure A/C wing nurses' carts were cleaned. 4. [...]
Inspectors wroteBased on interviews and record reviews, the facility failed to develop and implement an infection prevention and control program to include antibiotic use protocols and a system to monitor antibiotic use for 1 of 1 facility reviewed for antibiotic stewardship. The facility failed to utilize an antibiotic tracking log for the months of August 2025 through September 2025. This failure could place residents at risk for inappropriate antibiotic useFindings included: Record review of the facility's antibiotic tracking log, the last month the tracking and trending on antibiotic usage was completed in July 2025. The tracking logs for August 2025 and September 2025 were not completed. During an interview on 09/23/25 at 9:15 a.m., the DON stated infection control for August 2025 and September 2025 were not completed yet. [...]
Inspectors wroteBased on observation, interview, and record review the facility failed to treat each resident with respect and dignity and provide care in a manner that promotes maintenance or enhancement of his or her quality of life for 2 of 8 residents (Resident #30, Resident #2, and Resident #31) reviewed for resident rights. 1. The facility failed to ensure Resident #30 was treated with respect and dignity when Resident #30 asked an unknown staff member to take him to the restroom before he ate his lunch and the staff member failed to comply with Resident #30's request during lunch on 09/22/25.2. The facility did not ensure RN A provided privacy when administering Resident #2 and #31's insulin. These failures could place residents at risk for diminished quality of life, loss of dignity, and self-worth.
Inspectors wroteBased on observation, interview, and record review the facility failed to develop and implement a comprehensive person-centered care plan for each resident, consistent with the resident rights, that included measurable objectives and timeframes to meet a resident's medical, nursing, mental and psychosocial needs that were identified in the comprehensive assessment for 4 of 20 residents (Resident #3, Resident #5, Resident #17, and Resident #30) reviewed for care plans. 1. The facility failed to develop a care plan to address Resident #3's wounds and the use of enhanced barrier precautions. 2. The facility failed to develop a care plan to address Resident #17's g-tube. 3. The facility failed to ensure a care plan was developed to address Resident #30's smoking. 4. The facility failed to ensure a comprehensive care plan was developed for Resident #5. [...]
Inspectors wroteBased on observation, interview, and record review the facility failed to ensure the resident environment remained as free of accident hazards as was possible and each resident received adequate supervision and assistance devices to prevent accidents for 4 of 6 residents (Resident #2, Resident #22, Resident #29, and Resident #51) reviewed for accidents and supervision. 1. The facility failed to ensure 2-person assistance was used when Resident #2 was transferred from her bed to the wheelchair by CNA K with the use of a mechanical lift on 09/24/2025. 2. The facility failed to ensure Resident #22 did not have fingernail clippers on her dresser and hand sanitizer and hair spray on her bedside table. 3. [...]
Inspectors wroteBased on interview and record review the facility failed to ensure residents who required dialysis received such services, consistent with professional standards of practice, the comprehensive person-centered care plan and the residents' goals and preferences for 3 of 3 residents (Resident #1, Resident #8, and Resident #58) reviewed for dialysis. 1. The facility failed to keep ongoing communication with the dialysis facility for Resident #58. 2. The facility failed to obtain a dialysis contract for Resident #58's dialysis clinic. 3. The facility did not maintain communication, coordination, and collaboration with the dialysis facility for Resident #1 and Resident #8. These failures could place residents at risk for complications and not receiving proper care and treatment to meet their needs.
Inspectors wroteBased on observation and interview, the facility failed to ensure all drugs were stored in a locked compartment, only accessible by authorized personnel, and labeled and dated correctly for 1 of 6 medication carts (A-Wing nurse's medication cart) and 4 of 8 residents (Resident #24, Resident #27, Resident #28, Resident #50) observed for medication storage. 1. The facility failed to ensure Resident #24 did not have remedy cream on her room table. 2. The facility failed to ensure Resident #27 did not have triple antibiotic ointment at her bedside. 3. The facility failed to ensure Resident #28 did not have Preparation H cream (a cream used for hemorrhoids) and lantiseptic (a barrier cream used for skin breakdown) on plastic drawers next to her chair. 4. The facility failed to ensure Resident #50 did not have and unknown white cream in a specimen cup on his bedroom shelf. 5. [...]
Inspectors wroteBased on observations, and interviews, the facility failed to provide food that was palatable, attractive, and at a safe and appetizing temperature for 16 of 16 confidential residents reviewed for food and nutrition services. The facility failed to ensure dietary staff provided food that was palatable and had an appetizing temperature on 09/23/25. This failure could place residents at risk of decreased food intake, hunger, and unwanted weight loss.
Inspectors wroteBased on observation, interview, and record review the facility failed to ensure each resident had the right to reside and receive services in the facility with reasonable accommodation of resident needs and preferences except when to do so would endanger the health or safety of the resident or other residents for 2 of 2 residents (Resident #2 and Resident #51) reviewed for reasonable accommodations. 1. The facility failed to ensure Resident #2's call light was within reach on 09/23/2025. 2. The facility failed to ensure Resident #51's call light was in reach for her to use when assistance was needed on 09/22/25 and 09/23/25. These failures could place residents at risk for a delay in assistance and a decreased quality of life.
Inspectors wroteBased on observation, interview, and record review, the facility failed to provide a safe, clean, and comfortable environment for 2 of 8 residents (Resident #51 and Resident #2) reviewed for a homelike environment. 1. The facility failed to ensure Resident #51's pillow had a pillowcase on it on 09/22/25 and 09/24/25. 2. The facility failed to ensure Resident #2's fitted sheet did not have reddish-brownish particles and multiple brown stains on it on 09/23/2025 and 09/24/2025. These failures could place residents at risk for an uncomfortable, unhomelike environment, and a diminished quality of life.
Inspectors wroteBased on interview and record review the facility failed to ensure the transfer or discharge of a resident was documented in the resident's medical record and appropriate information was communicated to the receiving health care institution or provider for 2 of 4 residents (Resident #8, Resident #54) reviewed for discharge. The facility failed to provide transfer and discharge documentation in the EMR for Resident #8 and Resident #54 to include a physician's orders, reason for discharge or a discharge summary. This failure could place residents at risk of an unsafe discharge.
Inspectors wroteBased on observation, interviews, and record review, the facility failed to ensure the services provided, as outlined by the comprehensive care plan, met professional standards of quality, for 1 of 7 residents (Resident #2) reviewed for services provided to meet professional standards. The facility failed to ensure RN A administered Resident #2's Humalog KwikPen (insulin medication) according to the manufacturer's instructions. This failure could place residents at risk of inaccurate drug administration and not receiving the care and services to meet their individual needs.
Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a resident who was unable to carry out activities of daily living received the necessary services to maintain good nutrition, grooming and personal and oral hygiene for 1 of 2 residents (Resident #4) reviewed for ADLs. The facility failed to ensure Resident #4's facial hair was removed. This failure could place residents at risk of not receiving services and care, and a decreased quality of life.
Inspectors wroteBased on observation, interview, and record review the facility failed to ensure based on the comprehensive assessment of a resident, the residents received treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the residents' choices for 1 of 2 (Resident #41) residents reviewed for quality of care. The facility failed to ensure the Treatment Nurse conducted a skin assessment on 09/22/2025, after she was notified that Resident #41 had newly identified redness under both breasts. This failure could place residents at risk for not receiving appropriate care and treatment, a decreased quality of life, and pressure ulcers.
Inspectors wroteBased on observation, interview, and record review the facility failed to maintain acceptable parameters of nutritional status, such as usual body weight or desirable body weight range and electrolyte balance, unless the resident's clinical condition demonstrates that this was not possible or resident preferences indicate otherwise for 2 of 14 residents (Resident #4 and Resident #57) reviewed for nutrition and hydration. 1. The facility failed to provide fluids for Resident #57 to ensure adequate nutrition. 2. The facility failed to ensure Resident #4's RD recommendation for Boost VHC (nutritional supplement) four times a day was implemented, after it was recommended due to weight loss on 08/22/2025. These failures could place residents at risk for compromised hydration, malnourishment, illness, skin breakdown, and decreased quality of life.
Inspectors wroteBased on observation, interview and record review the facility failed to ensure, based on a resident's comprehensive assessment, a resident was fed by enteral means received the appropriate treatment and services to restore, if possible, oral eating skills and to prevent complications of enteral feeding including but not limited to aspiration pneumonia, diarrhea, vomiting, dehydration, metabolic abnormalities, and nasal-pharyngeal ulcers for 1 of 2 residents (Resident #17) reviewed for enteral nutrition. The facility failed to ensure Resident #17 received Isosource 1.5 (liquid nutrition tube-feeding formula) as ordered by the physician on 09/22/2025. This failure could place residents at risk of weight loss, nutritional imbalances, and health complications.
Inspectors wroteBased on observation, interview and record review the facility failed to ensure a resident who needed respiratory care, was provided such care, consistent with professional standards of practice, the comprehensive person-centered care plan, and the residents' goals and preferences for 1 of 2 residents (Residents #30) reviewed for respiratory care. 1. The facility failed to ensure Resident #30's oxygen filter was clean in the back of the concentrator on 09/22/25-09/24/25. 2. The facility failed to ensure Resident #30's oxygen tubing and water was dated, on 09/22/25. 3. The facility failed to ensure Resident #30 had an order in place to ensure oxygen tubing and water were changed and dated, and the filter was cleaned weekly on Sundays. These failures could place residents at risk for respiratory infections and exacerbation of respiratory disease.
Inspectors wroteBased on observation, interview and record review the facility failed to ensure pain management was provided to residents who required such services, consistent with professional standards of practice, the comprehensive person-centered care plan, and the residents' goals and preferences for 1 of 6 residents (Resident #57) reviewed for pain management. The facility failed to monitor and record pain levels per physician's order for Resident #57. This deficient practice could place residents at risk of experiencing pain, undue pain and mental distress.
Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that licensed staff were able to demonstrate the specific competencies, and skill sets necessary to care for resident's needs for 1 of 1 resident (Resident #2) and 2 of 2 nursing staff (RN A and CNA K) reviewed for competencies.1. The facility did not perform RN A's annual skill checkoffs on obtaining a fingerstick glucose level and insulin administration. 2. The facility failed to conduct CNA K's competency assessment to ensure she demonstrated competency in the use of the mechanical lift. These failures could place the residents at risk of receiving care from staff who do not have the training and competency needed for providing care.
Inspectors wroteBased on observation, interview, and record review, the facility failed to provide pharmaceutical services, including procedures that assure the accurate dispensing and administering of all drugs and biologicals to meet the needs of each resident and determined that drug records were in order and that an account of all controlled drugs was maintained and periodically reconciled for 3 of 20 residents (Resident #2, Resident #33, and Resident #62) reviewed for pharmacy services. 1. The facility failed to ensure there was not a delay in administering Resident #33's Lasix (diuretic removed fluid) and Potassium when they were ordered on 09/15/2025 and not administered until 09/19/2025. 2. The facility failed to ensure Resident #62's daptomycin (antibiotic) was administered on 04/02/2025. 3. [...]
Inspectors wroteBased on observation, interviews, and record review the facility failed to ensure that residents were free of significant medication errors for 1 of 1 resident (Resident #2) reviewed for insulin administration. The facility did not ensure RN A administered Resident #2's Humalog KwikPen (insulin medication) according to the manufacturer's instructions. This failure could place residents at risk of medical complications and not receiving the therapeutic effects of their medications.
Inspectors wroteBased on observation, interview, and record review the facility failed to accommodate residents' food preferences for 1 of 3 residents (Resident #21) reviewed for preferences. The facility failed to honor Resident #21's preference for double meat for the lunch meals on 09/22/2025 and 09/23/2025. This failure could place residents at risk for a decrease in resident choices, diminished interest in meals, and weight loss.
Inspectors wroteBased on observation, interview, and record review the facility failed to ensure safe and sanitary storage of resident's food items for 1 of 2 residents reviewed for personal food safety. (Residents #30) The facility did not develop or implement the personal food policy related to personal refrigerators for Residents #30. This failure could place residents at risk for food borne illnesses.
Inspectors wroteBased on observation, interview and record review, the facility failed to ensure medical records were kept in accordance with professional standards and practices and were complete and accurately documented for 2 of 5 residents (Resident #6 and Resident #5) review for accuracy of records. The facility failed to ensure Resident #6's diet order was updated to reflect resident signed waivers and matched the dietary meal ticket. The facility failed to complete admission assessments for Residents #5 within 24 hours following their admission to the facility on [DATE] and 08/15/25. This failure could place residents at risk of improper care due to inaccurate records and identifying information.
Inspectors wroteBased on observations, interviews, and record review, the facility failed to follow established policy regarding smoking areas, and smoking safety for 1 of 1 facility. The facility did not ensure staff kept their smoking material stored properly on 09/22/25. This failure could place residents and staff at risk of unsafe smoking and injury.
Inspectors wroteBased on interview and record review, the facility failed to promote resident self-determination through support of resident choice for 1 of 11 residents (Resident #10) reviewed for resident rights. The facility failed to ensure Resident #10 was provided a shower per his preference instead of bed baths. This failure could place dependent residents at risk for feelings of depression, lack self-determination and decreased quality of life.
Inspectors wroteBased on observation, interview, and record review, the facility failed to provide a safe, functional, sanitary, and comfortable environment 1 of 11 residents reviewed for environment. (Resident #35) The facility failed to provide Resident #35 with a pillowcase. These failures could place residents at risk of an unsafe or uncomfortable environment and a decrease in quality of life and self-worth.
Inspectors wroteBased on interview and record review, the facility failed to develop and implement a Baseline Care Plan that included the instructions for resident care needed to provide effective and person-centered care for 1 of 5 residents reviewed for new admissions. (Resident #29) The facility failed to develop and implement a Baseline Care Plan for Resident #29 within 48 hours of admission. This failure could place residents at risk of not receiving care and services to meet their needs.
Inspectors wroteBased on observation, interview, and record review, the facility failed to provide the necessary services to maintain personal hygiene for residents who are unable to carry out activities of daily living for 1 of 16 residents reviewed for ADL's. (Resident #22) The facility failed to remove facial hair from female Resident #22. This failure could place residents who required assistance from staff for ADL's at risk of not receiving care and services to meet their needs which could result in poor care, risk for skin breakdown, feelings of poor self-esteem, lack of dignity and health.
Inspectors wroteBased on interviews and record review, the facility failed to ensure each residents' drug regimen was free from unnecessary psychotropic drugs (without adequate behavior monitoring) for 1 of 7 residents (Resident #39) whose medications were reviewed in that: 1. The facility failed to ensure Resident #39 had side effect monitoring (monitoring for unintended responses to medication) for his prescribed Quetiapine (an antipsychotic medication used to treat several types of mental health conditions) during the months of July and August 2024. 2. The facility failed to ensure Resident #39 had behavior monitoring for his prescribed Quetiapine during the months of July and August 2024. These failures could place residents at risk of not receiving the intended therapeutic benefits of their psychotropic medications.
Inspectors wroteBased on interview and record review, the facility failed to ensure residents had the right to be free from abuse, neglect, misappropriation of resident property, and exploitation for 1 (Resident #1) of 7 residents reviewed for abuse and/or neglect. The facility failed to prevent CNA A from physically and verbally abusing Resident #1 when she intentionally shoved and used derogatory language towards Resident # 1. The noncompliance was identified as PNC. The IJ noncompliance began on 10/7/23 and ended on 10/8/23. The facility had corrected the noncompliance before the investigation began. This failure could place residents at risk of abuse and neglect.
Inspectors wroteBased on interview and record review the facility failed to implement written policies and procedures that prohibit and prevent abuse of residents for 1 of 7 Residents (Resident #1) whose records were reviewed for abuse. CNA B failed to report an allegation of resident abuse within 2 hours after learning about the allegation per facility policy. The facility failed to conduct a thorough investigation when the DON completed only 4 safe surveys and did not interview the resident. The facility failed to prevent CNA A from physically and verbally abusing Resident #1 when she intentionally shoved and used derogatory language towards Resident # 1. The noncompliance was identified as PNC. The IJ noncompliance began on 10/7/23 and ended on 10/8/23. The facility had corrected the noncompliance before the investigation began. [...]
Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the right of the residents to be free from abuse for 6 of 7 residents reviewed for abuse and neglect. (Resident #2, Resident #3, Resident #5, Resident #6, Resident #7, Anonymous Resident) The facility failed to ensure Resident #7 and AR did not suffer physical pain when CNA B provided ADL care to them. The facility failed to ensure Resident #3, Resident #5, Resident #7, and an AR did not suffer verbal and mental abuse, and mistreatment when CNA B would cuss and say hurtful things towards them. The facility failed to ensure CNA B did not remove Resident #5's food from him so he would not have a bowel movement on her. The facility failed to ensure Resident #2 did not experience verbal aggressive behaviors from CNA B. [...]
Inspectors wroteBased on observation, interview, and record review, the facility failed to develop and implement written policies and procedures that prohibit mistreatment, neglect, and abuse of residents, and misappropriation of resident property and establish policies and procedures to report and investigate such allegations, for 6 of 7 residents (Resident #3, Resident #5, Resident #7, Resident #2, Resident #6, Anonymous Resident) reviewed for abuse/neglect. The facility failed to follow the facility's policy to ensure CNA B did not verbally and mentally abuse Resident #7, Resident #5, Resident #3, and Anonymous Resident. The facility failed to follow the facility's policy to ensure CNA B did not cause Resident #7 and Anonymous Resident pain when providing ADL care. The facility failed to follow the facility's policy to ensure Resident #2 did not experience verbally aggressive behaviors from CNA B. [...]
Inspectors wroteBased on interview and record review, the facility failed to ensure all alleged violations involving mistreatment, neglect, abuse, or misappropriation of resident property were reported immediately, but not later than 2 hours after the allegation is made, if the event that cause the allegation involved abuse to the administrator of the facility and to other officials (including to the State Agency) for 2 of 7 residents (Resident #3 and Resident #4) and 6 of 9 staff members (ADM, CNA E, CNA J, CNA F, LVN G, and AE #1) reviewed for reporting of abuse, neglect and mistreatment. The facility failed to ensure when Resident #3 filed a complaint/grievance on 02/09/24 indicating CNA B treated him like trash, it was reported to HHSC within 2 hours of allegation by the facility's ADM/ Abuse Preventionist. [...]
Inspectors wroteBased on observation, interview, and record review, the facility has failed to ensure that the resident environment remains as free of accident hazards as possible and provide supervision to prevent avoidable accidents for 1 of 3 residents reviewed for accidents. (Residents #7) The facility failed to ensure CNA A provided Resident #7 incontinence care with staff assist x2 per the care plan, which resulted in a fall on 02/08/24. The facility failed to ensure CNA B provided Resident #7 a bed bath with staff assist x2 per the care plan, which resulted in a fall with a laceration to the right foot and probable fracture to the fifth toe on 02/09/24. The facility failed to ensure MR D was trained to operate the mechanical lift for Resident #7's transfer on 02/09/24. These failures could place residents at risk of injury from accident and hazards.
Inspectors wroteBased on observation, interview and record review, the facility failed to develop and implement a comprehensive person-centered care plan to meet each resident's medical, nursing, mental and psychosocial needs for 1 of 4 residents reviewed for care plans. (Resident# 7) The facility failed to place Resident #7's bed in the lowest position per her care plan, after she had recently returned (02/15/24) from the hospital after a fall with injury (02/09/24). This failure could place residents at risk of not having individual needs met and cause residents not to receive needed services.
Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure each resident received adequate supervision to prevent accidents for one of five residents (Resident #38) reviewed for accidents and hazards in that: 1. The facility failed to ensure Resident #38 did not elope after he was identified to be of high risk for elopement. Resident #38 eloped on 06/09/23 through his window. 2. The facility failed to put alarms on all unit windows after the elopement as indicated in the PIR. 3 windows were missing alarms. 2 of 3 windows had screws to keep them permanently closed. 3. The facility failed to establish a system to monitor alarms. 4. The facility failed to have sufficient staff to safely monitor residents on the secured unit. These failures resulted in the identification of an Immediate Jeopardy (IJ) on 07/10/23 at 03:59 PM. [...]
Inspectors wroteBased on observation, interview and record review, the facility failed to provide services by sufficient numbers of other nursing personnel, which included but not limited to nurse aides, on a 24-hour basis to provide nursing care to all residents in accordance with resident care plans for 6 of 20 residents (Residents #38, Resident #33, Resident #37, Resident #44, Resident #10, and #17) reviewed for care and services. The facility failed to provide sufficient staff on the 6a-2pm, 2pm-10pm,10pm-6am on Friday- Sunday from 04/09/2023 to 07/09/2023 to meet the needs of the residents who required assistance with activities of daily living. This failure could place residents at risk of injury, skin breakdown, low self-esteem, depression, embarrassment, and psychological harm.
Inspectors wroteBased on observation, interview, and record review the facility failed to store, prepare, distribute, and serve food in accordance with professional standards in 1 of 1 kitchen reviewed for food service safety. The facility failed to ensure cardboard boxes were not stored on the floor. The facility failed to ensure all food items were labeled and dated in Refrigerator #1, walk-in cooler, Freezer #1 and Freezer #2. The facility failed ensure all food items were properly stored in Refrigerator #1. The facility failed to safely thaw meat. The facility failed to ensure spoiled food items were removed from the pantry and walk-in cooler. The facility failed to ensure the chlorine test strips for the dishwasher were not expired. The facility failed to ensure an air conditioner, food carts, and areas of the stove top were clean. [...]
Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents had the right to reside and receive services in the facility with reasonable accommodation of resident needs and preferences for 4 of 20 residents (Residents #17, #36, #56, and #15) reviewed for reasonable accommodations. The facility failed to ensure Residents #17, #36, #56, and #15's call lights were accessible. This failure could place residents at risk of injuries, health complications and decreased quality of life.
Inspectors wroteBased on observation, interview, and record review, the facility failed to provide a safe, functional, sanitary, and comfortable environment for 3 of 10 residents reviewed for environment. (Resident #60, Resident #57, and Resident #28) The facility failed to control Resident #60's odor and provide a comfortable environment. These failures could place residents at risk of an unsafe or uncomfortable environment and a decrease in quality of life and self-worth.
Inspectors wroteBased on interview, and record review, the facility failed to develop and implement a comprehensive person-centered care plan to meet each resident's medical, nursing, mental and psychosocial needs for 3 of 20 residents reviewed for care plans. (Resident #270, Resident #47, and Resident #36) The facility failed to develop a comprehensive person-centered care plan including an active problem of diabetes mellitus for Resident #270. The facility failed to develop a comprehensive person-centered care plan including an active problem of pain for Resident #47. The facility failed to develop a comprehensive person-centered care plan for a significant change in status for Resident #36. These failures could place residents at risk of not having individual needs met, a decreased quality of life, and cause residents not to receive needed services
Inspectors wroteBased on observation, interview, and record review, the facility failed to provide the necessary services to maintain personal hygiene for 5 of 20 residents reviewed for ADLs (Resident #2, Resident #33, Resident #37, Resident #10, and Resident #44). The facility failed to remove facial hair from female Resident #2 and female resident #37. The facility failed to clean the fingernails of Resident # 33. The facility failed to provide scheduled baths/showers for Resident #10 and Resident #44. These failures could place residents who required assistance from staff for ADLs at risk of not receiving care and services to meet their needs which could result in poor care, risk for skin breakdown, feelings of poor self-esteem, lack of dignity and health.
Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure drugs and biologicals used in the facility were labeled in accordance with currently accepted professional principles, included the appropriate accessory and cautionary instructions, and the expiration date when applicable for two of three medication carts reviewed for medications storage (A Wing Nurse Medication Cart and C Wing Nurse Medication Cart). 1. The facility failed to remove expired over the counter medications from the A Wing Nurse Medication Cart. 2. The facility failed to remove expired over the counter medications from the C Wing Nurse Medication Cart. These failures could place residents at risk for not receiving the therapeutic benefit of medications or adverse reactions to medications.
Inspectors wroteBased on interview and record review, the facility failed to ensure an accurate MDS assessment was completed for 2 of 20 residents reviewed for MDS accuracy. (Resident # 36 and #17) 1. The facility failed to accurately document Resident #36's significant weight change 2. The facility failed to accurately document Resident #17's upper extremity contractures. These failures could place residents at risk for not receiving needed care and services.
Inspectors wroteBased on observation, interview, and record review, the facility failed to provide an ongoing program of activities in accordance with the comprehensive assessment to meet the interests and the physical, mental, and psychosocial well-being for 2 of 10 residents reviewed for activities. (Residents # 7 and Resident # 36.) The facility failed to provide Resident # 7 and Resident #36 with consistent, scheduled activities. This failure could place residents at risk for not having activities to meet their interests or needs and a decline in their physical, mental, and psychosocial well-being.
Inspectors wroteBased on observation, interview, and record review the facility failed to ensure a resident with pressure ulcers received necessary treatment and services, consistent with professional standards of practice, to promote healing, prevent infection and prevent new ulcers from developing for 1 of 4 residents, (Resident #4) reviewed for skin integrity in that: The facility failed to provide Resident #4 with proper wound care. This failure could place residents at risk of wound deterioration, increased pain, infection, and a decline in health.
Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure an acceptable parameter of nutritional status was maintained for 1 of 20 residents (Resident #36) who was reviewed for nutritional status, in that: 1. Resident #36 had a significant weight loss of 21.5 pounds, a 22% loss, in less than 180 days. The facility did not follow RD recommendations or provide nutritional supplements as ordered. This failure could place residents at risk for further weight loss and decline in health due to nutritional needs not being met.
Inspectors wroteBased on interviews and record review, the facility failed to ensure that pain management was provided to residents who require such services, consistent with professional standards of practice for 1 of 20 residents reviewed for pain management. (Resident #47) The facility failed to manage Resident #47's pain by not administering an ordered as needed pain medication. This failure placed residents at risk for increased pain, decline in mobility, functioning, inability to perform activities of daily living and decreased quality of life. Findings Include: Record review of a face sheet dated 07/10/23 revealed Resident #47 was [AGE] years old and was admitted on [DATE] with diagnoses including dementia, muscle spasms, and Parkinson's Disease (a disorder of the central nervous system that affects movement, including tremors). [...]
Inspectors wroteBased 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 2 of 5 residents (Residents #7, Resident #60) reviewed for infection control practices. The facility failed to ensure Resident #7 and Resident #60's room was sanitized and free from soiled adult briefs. These failures placed residents at risk for cross contamination and infection.
9 fire safety citations on file: 2 on November 20, 2025, 4 on August 21, 2024, 3 on July 12, 2023.
| Date | Penalty | Amount or length |
|---|---|---|
| July 17, 2024 | Fine | $16,055 |
| February 24, 2024 | Fine | $104,696 |
A payment denial means Medicare and Medicaid stopped paying for new admissions for that period.
Hours of care per resident per day, from the payroll records every home sends CMS. Higher means more staff time with each resident.
| Measure | This home | Texas | United States |
|---|---|---|---|
| All nursing staff (RN, LPN and aides) | 3.53 | 3.39 | 3.86 |
| Registered nurses | 0.48 | 0.43 | 0.69 |
| All nursing staff on weekends | 3.05 | 2.98 | 3.42 |
| Nurse aides | 1.91 | ||
| Licensed practical nurses | 1.13 | ||
| Nursing staff turnover (share who left in a year) | 66.7% | 55.3% | 45.8% |
| Registered nurse turnover | 71.4% | 54.6% | 42.9% |
| Administrators who left | 0 |
CMS expects 3.49 hours a day for residents as sick as this home's (its case-mix figure). The staffing star compares the two.
Every nursing home sends CMS its staff hours for each day (the Payroll Based Journal). Here they are added up by quarter. The latest quarter is the one behind the figures above. In January to March 2026, nursing staff hours per resident were 3.72 on weekdays and 3.05 on weekends, 18% lower on weekends (nationally, weekends ran 15% lower). Contract or agency staff worked 0.0% of nursing hours, against 5.3% nationally. Total nursing hours per resident went from 3.38 in April to June 2025 to 3.53 in January to March 2026.
| Quarter | All nursing staff | Registered nurses | Weekdays | Weekends | Contract staff share | Days with no RN hours | Residents a day |
|---|---|---|---|---|---|---|---|
| Jan to Mar 2026 | 3.53 | 0.48 | 3.72 | 3.05 | 0.0% | 0 of 90 | 52 |
| Oct to Dec 2025 | 3.28 | 0.50 | 3.35 | 3.11 | 8.0% | 2 of 92 | 51 |
| Jul to Sep 2025 | 3.15 | 0.46 | 3.27 | 2.84 | 1.5% | 8 of 92 | 50 |
| Apr to Jun 2025 | 3.38 | 0.56 | 3.53 | 3.00 | 1.6% | 2 of 91 | 51 |
| United States, Jan to Mar 2026 | 3.75 | 0.62 | 3.92 | 3.33 | 5.3% | 0.5% of days | |
| Texas, Jan to Mar 2026 | 3.33 | 0.40 | 3.50 | 2.93 | 2.2% | 0.7% of days |
Hours per resident per day: staff hours in the quarter divided by resident days (the daily census CMS derives from resident assessments). Registered nurses include the director of nursing and RNs with administrative duties; aides include nurse aides in training and medication aides, as in CMS's own staffing measure. How these are calculated.
Staff pay reports
No staff pay figure for this home has passed review yet. A figure appears only after at least 5 reports from at least 3 different people, sent over at least 60 days, have passed review.
| Job | Median | Middle half | Employed |
|---|---|---|---|
| Texas, all employers | |||
| CNAs (nursing assistants) | $18.03 | $16.97 to $20.71 | 88,680 |
| LPNs and LVNs | $29.92 | $27.46 to $32.89 | 57,560 |
| Registered nurses | $46.14 | $38.06 to $50.53 | 271,380 |
| United States, nursing care facilities | |||
| CNAs (nursing assistants) | $20.67 | $17.91 to $22.55 | 534,270 |
| LPNs and LVNs | $33.86 | $30.05 to $37.40 | 188,210 |
| Registered nurses | $41.11 | $37.85 to $47.68 | 142,270 |
Hourly wages; the middle half runs from the 25th to the 75th percentile. Source: U.S. Bureau of Labor Statistics, Occupational Employment and Wage Statistics, May 2025. BLS has no separate estimate for medication aides. These are survey estimates for whole occupations, not figures for any one home.
The measures CMS uses for the quality star. Lower is better for every one of them.
| Measure | This home | Texas | US |
|---|---|---|---|
| Percentage of long-stay residents whose need for help with daily activities has increased Long Stay residents, 2025Q2-2026Q1 | 13.8 | 15.8 | 13.9 |
| Percentage of long-stay residents with a catheter inserted and left in their bladder Long Stay residents, 2025Q2-2026Q1 | 0.0 | 0.3 | 0.8 |
| Percentage of long-stay residents with a urinary tract infection Long Stay residents, 2025Q2-2026Q1 | 0.5 | 0.8 | 1.6 |
| Percentage of long-stay residents experiencing one or more falls with major injury Long Stay residents, 2025Q2-2026Q1 | 6.7 | 3.3 | 3.2 |
| Percentage of short-stay residents who newly received an antipsychotic medication Short Stay residents, 2025Q2-2026Q1 | 7.1 | 1.5 | 1.6 |
| Percentage of long-stay residents whose ability to walk independently worsened Long Stay residents, 2025Q2-2026Q1 | 10.6 | 14.0 | 14.1 |
| Percentage of long-stay residents with pressure ulcers Long Stay residents, 2025Q2-2026Q1 | 5.2 | 3.8 | 4.6 |
| Percentage of long-stay residents who received an antipsychotic medication Long Stay residents, 2025Q2-2026Q1 | 12.4 | 9.6 | 15.4 |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission Short Stay residents, 20250101-20251231 | 28.8 | 25.7 | 23.8 |
| Percentage of short-stay residents who had an outpatient emergency department visit Short Stay residents, 20250101-20251231 | 11.1 | 12.3 | 12.0 |
| Number of hospitalizations per 1000 long-stay resident days Long Stay residents, 20250101-20251231 | 3.9 | 2.2 | 1.9 |
| Number of outpatient emergency department visits per 1000 long-stay resident days Long Stay residents, 20250101-20251231 | 3.8 | 2.1 | 1.8 |
For a stay to recover after a hospital visit, these are the results CMS publishes for Avir at Citizens Trail's Medicare short-stay residents. How to read these, and what Medicare pays for.
Not reported
CMS note: The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure.
US median of homes 51.5% · Texas: 116 better, 50 worse
Rate of successful return to home or community from a SNF (risk-standardized discharge to community rate). Higher is better. October 2022 to September 2024. 19 eligible stays.
11.2% this home
No different from the national rate
US median of homes 10.7% · Texas: 0 better, 9 worse
Rate of potentially preventable hospital readmissions 30 days after discharge from a SNF (risk-standardized rate). Lower is better. October 2022 to September 2024. 43 eligible stays.
9.6% this home
No different from the national rate
US median of homes 7.1% · Texas: 4 better, 11 worse
Percentage of infections residents got during their SNF stay that resulted in hospitalization (risk-standardized rate). Lower is better. October 2023 to September 2024. 27 eligible stays.
Not reported
CMS note: The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure.
Median of homes: Texas57.3% · US 56.6%
Percentage of residents who are at or above an expected ability to care for themselves and move around at discharge. Higher is better. October 2024 to September 2025. 11 residents counted.
0.0% this home
Median of homes: Texas0.0% · US 0.0%
Percentage of SNF residents who experience one or more falls with major injury during their SNF stay. Lower is better. October 2024 to September 2025. 23 residents counted.
0.0% this home
Median of homes: Texas1.3% · US 1.7%
Percentage of residents with pressure ulcers or pressure injuries that are new or worsened (adjusted rate). Lower is better. October 2024 to September 2025. 23 residents counted.
Not reported
CMS note: The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure.
Median of homes: Texas98.5% · US 98.7%
Percentage of residents where the SNF provided a current medication list to the resident, family, and/or caregiver at final discharge. Higher is better. October 2024 to September 2025. 4 residents counted.
Source: CMS Skilled Nursing Facility Quality Reporting Program - Provider Data, released 2026-09-30. Better, no different and worse are CMS's own comparisons with the national rate, after adjusting for how sick residents were. Medians of homes and the state counts are worked out by us from the same file.
Legal business name: FANNIN COUNTY HOSPITAL AUTHORITY. CMS links this home to Avir Health Group, a group of 118 nursing homes averaging 2.3 stars overall.
| Name | Role | Type | Share | Since |
|---|---|---|---|---|
| Fannin County Hospital Authority | 5% or greater direct ownership interest | Organization | 100% | 06/01/2024 |
| Holt, Erin | Corporate director | Individual | 02/25/2020 | |
| Keeton, Wendy | Corporate director | Individual | 10/29/2012 | |
| Kissling, Monica | Corporate director | Individual | 06/27/2017 | |
| McBean, Patricia | Corporate director | Individual | 08/30/2021 | |
| Owens, Angela | Corporate director | Individual | 06/22/2016 | |
| Trompler, Kelly | Corporate director | Individual | 02/22/2022 | |
| Sanderson, Clark | Corporate officer | Individual | 10/29/2012 | |
| 1008 Citizens Trail Opco, LLC | Operational/managerial control | Organization | 08/01/2025 | |
| Fannin County Hospital Authority | Operational/managerial control | Organization | 06/01/2024 | |
| Bradford, Jeffrey | Operational/managerial control | Individual | 06/01/2024 | |
| Ferguson, Clay | Operational/managerial control | Individual | 06/01/2024 | |
| Johnson, Justin | Operational/managerial control | Individual | 06/01/2024 | |
| Slimmer, Christopher | Operational/managerial control | Individual | 06/01/2024 | |
| 1008 Citizens Trail Property Owner LLC | Adp of the SNF | Organization | 08/01/2025 | |
| Welltower Nnn Group, LLC | Adp of the SNF | Organization | 08/01/2025 | |
| Welltower Op, LLC | Adp of the SNF | Organization | 08/01/2025 | |
| Bradford, Jeffrey | Adp of the SNF | Individual | 06/01/2024 | |
| Ferguson, Clay | Adp of the SNF | Individual | 06/01/2024 | |
| Johnson, Justin | Adp of the SNF | Individual | 06/01/2024 | |
| Slimmer, Christopher | Adp of the SNF | Individual | 06/01/2024 |
As listed in the CMS ownership file, which names owners with a 5% or greater stake and the people and companies with operational or managerial control.
Chosen from this home's own inspection record.
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