1900 Medical Parkway, San Marcos, TX 78666 · Hays County · (512) 396-1888
116 certified beds, about 93 residents a day · For profit - Corporation · Medicare and Medicaid since 1991
CMS Care Compare ratings, data as of September 1, 2026 · CCN 455960 · See it on Medicare.gov · Compare with other homes
At its most recent standard inspection, on March 5, 2026, inspectors cited 6 health deficiencies (the Texas average is 9.4, the national average 9.2).
Of 26 health citations since September 2023, 2 were rated as actual harm or immediate jeopardy to residents (2 immediate jeopardy).
CMS lists 1 fine totaling $8,226 in the last three years; the largest was $8,226, and the latest is dated May 2, 2024.
Nurses and nurse aides worked 3.27 hours per resident per day, against 3.39 across Texas and 3.86 nationally. Registered nurses accounted for 0.46 of those hours.
37.9% of nursing staff left within the year CMS measured (Texas average 55.3%).
CMS links it to The Ensign Group, an affiliated group of 344 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 26 health citations on file.
Inspectors wroteBased on observations, interviews, 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 except when to do so would endanger the health or safety of the resident or other residents for four of twenty-five residents (Resident #4, Resident 73, Resident #83, and Resident #1) reviewed for reasonable accommodation of needs. 1. The facility failed to ensure the call light system in Resident #4's room was in a position accessible to the resident on 03/03/2026. 2. The facility failed to ensure the call light system in Resident #73's room was in a position accessible to the resident on 03/03/2026. 3. The facility failed to ensure the call light system in Resident #83's room was in a position accessible to the resident on 03/03/2026. 4. [...]
Inspectors wroteBased on observation, interview and record review the facility failed to ensure the resident had the right to a safe, clean, comfortable and homelike environment including but not limited to receiving treatment and supports for daily living safely for 5 of 11 residents (Residents #42, #48, #20, #66, and #8) reviewed for environment. The facility failed to ensure the privacy curtains in the rooms of Residents #42, #48, #20, #66 and #8 were clean. This failure could place residents at risk of infection and diminished quality of life.
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 4 of 9 residents (Residents #1, #17, #45 and #35) reviewed for ADL care. The facility failed to ensure Residents #1, #17, #45 and #35 did not have long, jagged, and dirty fingernails from 03/03/2026 to 03/05/2026. This failure could place residents at risk of skin tears, infection, and embarrassment.1. Record review of Resident #1's, undated, face sheet reflected a [AGE] year-old female who was admitted to the facility on [DATE]. [...]
Inspectors wroteBased on observation, interview and record review the facility failed to store, prepare, distribute and serve food in accordance with professional standards for food service safety in one of one kitchen reviewed for kitchen and food sanitation. The facility failed to ensure CK L cleaned and sanitized the kitchen countertop prior to preparing pureed food for lunch service on 03/03/2026. The facility failed to ensure CK L sanitized the food processor and spatula before and after use when preparing pureed food for lunch service on 03/03/2026. The facility failed to ensure CK L used proper hand hygiene while preparing pureed food for residents on 03/03/2026. These failures could place residents at risk for food contamination and foodborne illness.
Inspectors wroteBased on observation, interview and record review the facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 2 of 8 1 of 1 residents (Resident #20 and Resident #62) reviewed for infection control. 1. The facility failed to ensure medications and biologicals in the refrigerator of the facility's medication room were maintained in a clean and sanitary condition. 2. The facility failed to ensure LPN C and CNA G changed gloves and performed hand hygiene during incontinent care provided to Resident #20. 3. [...]
Inspectors wroteBased on observation, interview and record review the facility failed to provide special eating equipment and utensils for residents who needed them and appropriate assistance to ensure that the resident could use the assistive devices when consuming meals and snacks for 1 of 8 residents (Resident #1) reviewed for special eating equipment. The facility failed to ensure Resident #1 received a two-handled drinking cup on her tray as ordered by the dietitian. This failure could place residents at risk of aspiration and dehydration. Record review of Resident #1's, undated, face sheet reflected a [AGE] year-old female who was admitted to the facility on [DATE]. [...]
Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure resident rights for personal privacy for 3 of 10 residents (Resident #34, Resident #40, and Resident #54) residents reviewed for resident rights. The facility failed to knock on Resident #34, Resident #40, and Resident #54's door when going into the residents' rooms. The deficient practice could place residents at risk of feeling like their privacy is being invaded or the facility is not their home.
Inspectors wroteBased on observation, interview, and record review, the facility failed to provide an ongoing program to support residents in their choice of activities, both facility-sponsored group and individual activities and independent activities, designed to meet the interests of and support the physical, mental, and psychosocial well-being for 3 of 5 (Residents #86, #87 and #13) residents reviewed for activities. This facility failed to implement an ongoing resident centered activities program for Residents #86, #87 and #13 that incorporated these residents interests, hobbies and cultural preferences. This failure could put residents at risk for a decrease quality of life.
Inspectors wroteBased on interviews and record review, the facility failed to ensure the drug regimen review recommendations from the pharmacy consultant were filled out completely for 2 of 9 residents (Residents #56, and 66) reviewed for pharmacy services. 1. The facility did not follow up on the pharmacy consultant's recommendations for Resident # 56 dated 10/31/2024 and 12/30/2024. 2. The facility did not follow up on the pharmacy consultant's recommendations for Resident # 66 dated 05/30/2024 and 06/26/2024. These failures could put the residents at risk for medications errors, unnecessary medications, and incorrect administration.
Inspectors wroteBased on observation, interview, and record review the facility failed to provide pharmaceutical services to assure the accurate acquiring, receiving, dispensing, and administrating of all drugs and biologicals in accordance with currently accepted practices for 3 of 9 (hall 400 and 200 cart) medication carts and 1 of 2 medication rooms (overstock medication room) reviewed in that: The medication cart for the 400 hall and 200 halls had nine unidentified loose pills. The medication room had 39 expired Acetaminophen oral solution medications. These deficient practices could result in a drug diversion due to medications not being properly disposed of in the drug buster and secured.
Inspectors wroteBased on observations, interviews, and record review, the facility failed to provide a safe, comfortable, and homelike environment for the 1 of 8 residents (Resident #29) reviewed for a safe and comfortable environment. The facility failed to report maintenance issues to the MAIN and make repairs to a broken door in Resident #29's bathroom. This failure could have placed the resident at risk of decreased resident's satisfaction with their environment and a lack of a homelike environment.
Inspectors wroteBased on observation, interviews, and record reviews, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety for one of one kitchen reviewed for sanitation. The facility failed to ensure [NAME] B were practicing proper hand hygiene while preparing foods. This failure could place residents who were served from the kitchen at risk for consuming contaminated food, and/or developing foodborne illnesses. Observation of [NAME] B preparing puree foods on 01/15/2025 at 11:13 am revealed that he threw trash away without washing or sanitizing his hands before going back to prepare puree food . [NAME] B also did not wash his hands after wiping down the counter. An interview with [NAME] B on 01/16/2025 at 1:01 pm revealed that he had been trained on infection control and proper hand washing. [...]
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 4 of 10 residents (Resident #1, Resident #2, Resident #3, and Resident #4) reviewed for infection control. The facility failed to ensure that Resident #1 did not sleep in the bed of Resident #2 twice on 07/09/24. The facility failed to ensure that Resident #1 did not eat off Resident #3's meal tray and that Resident #3 did not eat after Resident #1. The facility failed to ensure a shared baby doll was sanitized after it had been in bed with Resident #5 and before Resident #4 came into close contact with it. These failures placed residents at risk of infectious disease.
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 set forth at §483.10(c)(2) and §483.10(c)(3), that including measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment for 1 of 10 residents (Resident #1) reviewed for care plans. The facility failed to include in Resident #1's comprehensive care plan the behaviors of sleeping in other residents' beds. This failure placed residents at risk of not having their individual care needs met.
Inspectors wroteBased on interview and record review, the facility failed to ensure the residents had the right to be free from abuse for two (Resident #1 and Resident #2) of four residents reviewed for abuse, in that: The facility failed to protect Resident #1 and Resident #2 who resided in the MCU (Memory Care Unit) from engaging in sexual activities when neither had the capacity to consent. An IJ was identified on 05/01/24. The IJ template was provided to the facility on [DATE] at 10:50 AM. While the IJ was removed on 05/02/24, the facility remained at a level of actual no actual harm at a scope of isolated that is not immediate jeopardy due to the facility's need to evaluate the effectiveness of the corrective systems. This failure placed residents at risk for abuse.
Inspectors wroteBased on interview and record review the facility failed to implement their written policies and procedures regarding prohibiting and preventing abuse for two (Resident #1 and Resident #2) of four residents reviewed for developing and implementing abuse and neglect policies, in that: The facility failed to implement facility abuse policy when they failed to protect Resident #1 and Resident #2 who resided in the MCU (Memory Care Unit) from engaging in sexual activities when neither had the capacity to consent. This failure resulted in an identification of an Immediate Jeopardy (IJ) on 05/01/24 at 10:50 AM. While the IJ was removed on 05/02/24 at 1:45 PM, the facility remained at a level of actual no actual harm at a scope of isolated that is not immediate jeopardy due to the facility's need to evaluate the effectiveness of the corrective systems. [...]
Inspectors wroteBased on interview and record review, the facility failed to ensure all alleged violations involving abuse or neglect were reported immediately or no later than 24 hours for two (Resident #1 and Resident #2) of four residents reviewed for abuse and neglect, in that: The facility failed to report to the State Agency an incident where two residents (Resident #1 and #2) who were not cognitively able to give consent were found engaging in sexual activities. This failure could place residents at risk of not required incidents reported as required and timely.
Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure mechanical, electrical, and patient care equipment was in safe operating condition for 1 of 1 dish room. The facility failed to ensure the kitchen dishwasher did not leak and the garbage disposal attached to the dishwasher worked. This failure placed residents at risk of food borne illness and staff at risk of slipping.
Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the resident's right to a safe, clean, comfortable and homelike environment for 3 of 4 halls (halls 100, 200, and 300) and 1 of 2 common areas (central great room) reviewed for environment. The facility failed to ensure that halls 100, 200, 300 (secure unit), and the common great room did not have a pervasive foul urine odor. This failure placed residents at risk of diminished quality of life.
Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that the resident environment remained as free of accident hazards as is possible for 1 of 4 halls (300 hall/secure unit) and 1 of 8 residents (Resident #66) reviewed for accident hazards. The facility failed to ensure that all electrical outlets in the secure unit were fully covered with socket plates and live parts of the outlet inaccessible to residents in the unit with dementia and wandering behaviors. This failure placed residents at risk of electric shock.
Inspectors wroteBased on observation, interview, and record review, the facility failed to provide, based on the comprehensive assessment and care plan and the preferences of each resident, an ongoing program to support residents in their choice of activities, both facility-sponsored group and individual activities and independent activities, designed to meet the interests of and support the physical, mental, and psychosocial well-being of each resident, encouraging both independence and interaction in the community for 1 of 8 residents (Resident #80) reviewed for activities. The facility failed to ensure that Resident #80 was provided activities that met his unique recreational and social needs. This failure placed residents at risk of depression, withdrawal, and diminished quality of life.
Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that 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 8 residents (Resident #5) reviewed for quality of care. The facility failed to ensure the resident's wound treatment was performed on 12/11/23 according to physician's orders. This failure placed residents at risk of infection and worsening wound condition.
Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure a resident who was incontinent of bladder received appropriate treatment and services to prevent urinary tract infections and to restore continence to the extent possible for 1 of 8 residents (Resident #5) reviewed for UTI and incontinent care. The facility failed to ensure that CNA A made a report to the charge nurse, according to the resident's care plan, when Resident #5 exhibited foul smelling urine. This failure placed residents at risk of discomfort, infection, and sepsis.
Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents maintained acceptable parameters of nutritional status, such as usual body weight or desirable body weight range and electrolyte balance for 1 of 8 residents (Resident #43) reviewed for nutritional status. The facility failed to ensure dietary orders for supplements and weekly weights were implemented promptly after the dietitian ordered them for Resident #43. The failure placed residents at risk of additional weight loss.
Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents who were unable to carry out activities of daily living received the necessary services to maintain good nutrition, grooming, and personal hygiene for 3 of 9 residents (Residents #1, 2, and 3) reviewed for ADL care. 1. Residents #1, 2, and 3 were not provided showers as scheduled and efforts to identify a root cause of their refusals had not been exhausted. 2. Residents #2 and 3 were not provided nail care as needed. These failures placed residents at risk of embarrassment and infection.
Inspectors wroteBased on observation, interview and record review the facility failed to ensure, in accordance with State and Federal laws, all drugs and biologicals were stored in locked compartments under proper temperature controls and permitted only authorized personnel to have access to the keys for 1 of 5 medication/treatment carts (Medication Cart #1) reviewed for medication storage. The facility failed to ensure Medication Cart #1 was not left unattended and unlocked. This failure could place residents at risk to having access to unauthorized medication and/or lead to possible harm or drug diversion.
6 fire safety citations on file: 4 on March 5, 2026, 2 on December 14, 2023.
| Date | Penalty | Amount or length |
|---|---|---|
| May 2, 2024 | Fine | $8,226 |
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) | 3.27 | 3.39 | 3.86 |
| Registered nurses | 0.46 | 0.43 | 0.69 |
| All nursing staff on weekends | 2.72 | 2.98 | 3.42 |
| Nurse aides | 1.85 | ||
| Licensed practical nurses | 0.96 | ||
| Nursing staff turnover (share who left in a year) | 37.9% | 55.3% | 45.8% |
| Registered nurse turnover | 22.2% | 54.6% | 42.9% |
| Administrators who left | 0 |
CMS expects 3.46 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 3.49 on weekdays and 2.72 on weekends, 22% lower on weekends (nationally, weekends ran 15% lower). Contract or agency staff worked 0.1% of nursing hours, against 5.3% nationally. Total nursing hours per resident went from 3.36 in April to June 2025 to 3.27 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 | 3.27 | 0.46 | 3.49 | 2.72 | 0.1% | 0 of 90 | 93 |
| Oct to Dec 2025 | 3.21 | 0.40 | 3.39 | 2.75 | 0.0% | 0 of 92 | 91 |
| Jul to Sep 2025 | 3.44 | 0.44 | 3.65 | 2.90 | 0.0% | 0 of 92 | 95 |
| Apr to Jun 2025 | 3.36 | 0.45 | 3.51 | 2.97 | 2.4% | 0 of 91 | 97 |
| 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. If you work here, your report helps start one.
| 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 | 15.9 | 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 | 1.1 | 0.8 | 1.6 |
| Percentage of long-stay residents experiencing one or more falls with major injury Long Stay residents, 2025Q2-2026Q1 | 4.0 | 3.3 | 3.2 |
| Percentage of short-stay residents who newly received an antipsychotic medication Short Stay residents, 2025Q2-2026Q1 | 0.0 | 1.5 | 1.6 |
| Percentage of long-stay residents whose ability to walk independently worsened Long Stay residents, 2025Q2-2026Q1 | 13.7 | 14.0 | 14.1 |
| Percentage of long-stay residents with pressure ulcers Long Stay residents, 2025Q2-2026Q1 | 1.7 | 3.8 | 4.6 |
| Percentage of long-stay residents who received an antipsychotic medication Long Stay residents, 2025Q2-2026Q1 | 5.0 | 9.6 | 15.4 |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission Short Stay residents, 20250101-20251231 | 27.6 | 25.7 | 23.8 |
| Percentage of short-stay residents who had an outpatient emergency department visit Short Stay residents, 20250101-20251231 | 12.4 | 12.3 | 12.0 |
| Number of hospitalizations per 1000 long-stay resident days Long Stay residents, 20250101-20251231 | 3.3 | 2.2 | 1.9 |
| Number of outpatient emergency department visits per 1000 long-stay resident days Long Stay residents, 20250101-20251231 | 2.0 | 2.1 | 1.8 |
For a stay to recover after a hospital visit, these are the results CMS publishes for Hays Nursing and Rehabilitation Center's Medicare short-stay residents. On returning residents home or to the community, CMS rates it no different from the national rate (45.8% of residents, after adjusting for how sick they were). How to read these, and what Medicare pays for.
45.8% this home
No different from the national rate
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. 27 eligible stays.
8.8% 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. 68 eligible stays.
6.9% 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. 34 eligible stays.
71.9% this home
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. 32 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. 47 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. 47 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. 7 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: GUADALUPE COUNTY HOSPITAL BOARD. CMS links this home to The Ensign Group, a group of 344 nursing homes averaging 3.2 stars overall.
| Name | Role | Type | Share | Since |
|---|---|---|---|---|
| Guadalupe County Hospital Board | 5% or greater direct ownership interest | Organization | 100% | 12/01/2020 |
| Chudleigh, James | Managing control - governing body | Individual | 02/01/2024 | |
| Phelps, Nelson | Managing control - governing body | Individual | 12/01/2020 | |
| Burnam, Soon | Corporate officer | Individual | 12/01/2020 | |
| Gann, Kody | Corporate officer | Individual | 04/03/2021 | |
| Keetch, Chad | Corporate officer | Individual | 03/01/2011 | |
| Willow Springs Creek Healthcare, Inc. | Operational/managerial control | Organization | 12/01/2020 | |
| Chudleigh, James | Operational/managerial control | Individual | 02/01/2024 | |
| Phelps, Nelson | Operational/managerial control | Individual | 12/01/2020 | |
| Ensign Services Inc | Adp of the SNF | Organization | 10/13/2020 | |
| San Marcos Tx Propco LLC | Adp of the SNF | Organization | 12/01/2020 | |
| Willow Springs Creek Healthcare, Inc. | Adp of the SNF | Organization | 11/25/2025 | |
| Chudleigh, James | Adp of the SNF | Individual | 02/01/2024 | |
| Phelps, Nelson | Adp of the SNF | Individual | 12/01/2020 |
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.
These are the official offices in Texas. NursingHomeClear cannot take or act on complaints.