5915 Elysian Fields Road, Marshall, TX 75672 · Harrison County · (903) 935-6700
125 certified beds, about 67 residents a day · For profit - Individual · Medicare and Medicaid since 2008
CMS Care Compare ratings, data as of September 1, 2026 · CCN 676187 · See it on Medicare.gov · Compare with other homes
At its most recent standard inspection, on July 29, 2025, inspectors cited 2 health deficiencies (the Texas average is 9.4, the national average 9.2).
Of 49 health citations since May 2023, 1 was rated as actual harm or immediate jeopardy to residents (1 immediate jeopardy).
CMS lists 1 fine totaling $67,706 in the last three years; the largest was $67,706, and the latest is dated June 26, 2024.
Nurses and nurse aides worked 3.29 hours per resident per day, against 3.39 across Texas and 3.86 nationally. Registered nurses accounted for 0.18 of those hours.
91.7% of nursing staff left within the year CMS measured (Texas average 55.3%).
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 49 health citations on file.
Inspectors wroteBased on record review and interviews, the facility failed to ensure the resident's right to dignity and respect by regarding financial matters by not providing necessary assistance with a Medicaid application for 2 (Resident #11 and Resident #22) of 4 residents resulting in delayed eligibility and a coverage gap. The facility failed to ensure the residents were treated with dignity and respect regarding financial matters by not providing necessary assistance with a Medicaid application, resulting in delayed eligibility and a coverage gap for Resident #11 and Resident #22. These failures compromised the resident's right of personal dignity and self-determination.
Inspectors wroteBased on interview and record review the facility failed to provide pharmaceutical services, including procedures that assured the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals, to meet the needs of each resident for 1 of 6 residents (Resident #32) reviewed for pharmacy services. The facility failed to administer the injectable Repatha (a prescription-strength, injectable used to significantly lower bad [LDL-low density lipoprotein] cholesterol and reduce the risk of heart attack and stroke) for Resident #32 on 01/26/2026. This failure could place residents at risk for not receiving the intended therapeutic benefit of their medications.
Inspectors wroteBased on interview, and record review the facility failed to develop and implement comprehensive person-centered care plan that includes measurable objectives and time frames to meet a resident medical and nursing needs to be furnished to attain or maintain the residents highest practicable physical, mental, and psychosocial well-being for 1 (Resident #1) of 1 resident reviewed for care plans in that: The facility failed to ensure CNA D followed the comprehensive person-centered care plan for a proper transfer on 11/10/25 with Resident #1. This failure could place residents in the facility at risk of injury, not receiving the necessary care and services and having personalized plans developed to address their needs. [...]
Inspectors wroteBased on interview and record review the facility failed to ensure the notice to residents when changes in coverage were made to items and services covered by Medicare as soon as is reasonably possible was provided to 2 of 3 residents (Resident #15 and Resident #39) reviewed for Medicare services. 1. The facility failed to notify Resident #15 at least 2 days before the end of Medicare Part A coverage.2. The facility failed to notify Resident #15 with a complete Skilled Nursing Facility Advance Beneficiary Notice of Non-Coverage (SNF ABN) form before the end of Medicare Part A coverage.3. The facility failed to notify Resident #39 and/or his representative in writing of potential non-coverage due to the end of Medicare Part A coverage. These failures could affect residents who use skilled services and could place them at risk of not being aware of changes to provided services.
Inspectors wroteBased on observation, interview and record review the facility failed to ensure parenteral fluids was maintained consistent with professional standards of practice for 1 of 1 residents (Resident #76) reviewed for parenteral fluids central venous lines (a thin, flexible tube that's inserted into a large vein to provide access to the circulatory system. The facility failed to change a midline catheter (a type of central venous line) dressing according to facility protocol for Resident #76. Resident #76 midline catheter dressing change was due on 7/25/25 and was not changed until 7/27/25. This failure could place residents with central venous lines at risk of an infection and hospitalization.
Inspectors wroteBased on interview and record review, the facility failed to treat each resident with respect and dignity and provide care in a manner that promoted maintenance or enhancement of his or her quality of life for 2 of 8 residents reviewed for resident rights. (Resident #1 and Resident #2) The facility failed to provide care to Resident #1 in a respectful manner on 4/4/25. The facility failed to provide care to Resident #2 in a respectful manner within the last three months. These failures could place residents at risk for decreased quality of life, decreased self-esteem and increased anxiety.
Inspectors wroteBased on interview and record review, the facility failed to ensure each resident had the right to be free from misappropriation of property, and exploitation for 1 of 5 residents (Resident #3) reviewed for misappropriation of property. The facility failed to prevent the misappropriation of Resident #3's Promethazine-Dextromethorphan (is commonly used to reduce coughing and other symptoms from allergies or common cold) on 2/25/25. The noncompliance was identified as PNC. The noncompliance began on 2/25/25 and ended on 2/27/25. The facility had corrected the noncompliance before the investigation began on 4/8/25. This failure could place residents at risk for misappropriation of physician ordered medications which could result in residents not having medications/treatments available and a decline in health.
Inspectors wroteBased on interview and record review the facility failed to ensure that all alleged violations involving abuse are reported immediately, but not later than 2 hours after the allegation is made, if the events that cause the allegation involve abuse or result in serious bodily injury, to the administrator of the facility and to other officials (including to the State Survey Agency and adult protective services where state law provides for jurisdiction in long-term care facilities) in accordance with State law through established procedures for 1 of 8 (Resident #4) residents reviewed for abuse and neglect. Confidential Staff C failed to report to the Administrator CNA B allegedly called Resident #4 pissy and smelly. Confidential Staff C said the incident had happened within the last 3-6 months. [...]
Inspectors wroteBased on observation, interview, and record review the facility failed to provide pharmaceutical services including procedures that assure the accurate acquiring, receiving, and dispensing of routine drugs and biologicals to meet the needs of each resident for 4 of 4 resident's reviewed for pharmacy services. (Resident's #1, #2, #3, and #4) 1. The facility failed to ensure LVN A reconciled Resident #1's hydrocodone-acetaminophen (controlled medication used for pain) on the individual control drug record after it was given on 01/28/25. 2. The facility failed to ensure LVN A reconciled Resident #2's hydrocodone-acetaminophen (controlled medication used for pain) on the individual control drug record after it was given on 01/28/25. 3. [...]
Inspectors wroteBased on observation, interview, and record review, the facility did not ensure treatment and services was provided, consistent with professional standards of practice, to promote healing and prevent new ulcers from developing for 1 of 4 residents reviewed for quality of care. (Resident #38) 1. The facility failed to appropriately assess Resident #38's skin and wounds after readmission from 06/20/24 through 06/23/24. A new wound to the right lateral glute was identified by the facility on 06/24/24 when it was a Stage III pressure injury (a full thickness loss of skin extending to the subcutaneous tissue). 2. The facility failed to follow previous wound care recommendations from the wound care physician for wounds to the sacrum and left foot for Resident #38 from 06/20/24 through 06/23/24. 3. [...]
Inspectors wroteBased on interview and record review the facility failed to consider the views of a resident or family group and act promptly upon the grievances and recommendations of such groups concerning issues of resident and life in the facility and be able to demonstrate their response and rationale for the response for 7 of 7 anonymous residents (AR) reviewed for grievances. (AR#1-AR#7) The facility failed to follow-up and monitor previous grievances to resolve resident concerns for AR#1-AR#7. This failure could place residents at risk of not having the right to voice their concerns and grievances to be followed-up on in a timely manner.
Inspectors wroteBased on interview and record review the facility failed to ensure assessments accurately reflected the resident's status for 4 of 16 resident reviewed (Residents #30, #36, #45 and #212) for assessments. 1. The facility failed to ensure Resident #30's diagnosis of anxiety was coded on her MDS. 2. The facility failed to ensure Resident #36's dialysis (is a procedure to remove waste products and excess fluid from the blood when the kidneys stop working properly) status was coded on his MDS. 3. The facility failed to ensure Resident #45's vision impairment was reflected on his MDS. 4. The facility failed to ensure Resident #212's fall on 04/03/24 was coded on her MDS. These failures could place residents at risk of not having individual needs met.
Inspectors wroteBased on interview and record review, the facility failed to ensure dialysis service were provided consistently with professional standards of practice for 3 of 3 resident reviewed for dialysis services. (Resident #36, Resident #212, and Resident #112) 1. The facility failed to ensure post-dialysis assessments were completed and documented on Resident #36 and Resident #212's dialysis communication forms. 2. The facility failed to document Resident #112's dialysis communications. These failures could place residents who received dialysis at risk for complications and not receiving proper care and treatment to meet their needs.
Inspectors wroteBased on interview and record review, the facility failed to provide pharmaceutical services including procedures that assure the accurate administering of all drugs and biologicals, to meet the needs of 1 of 16 residents reviewed for pharmacy services. (Residents #45) The facility failed to keep, in stock, medications for Resident #45. Resident #45 did not receive Levetiracetam (is a medicine used to treat epilepsy (seizures)), Hydrochlorothiazide (is commonly used to treat high blood pressure), or Scopolamine patch (helps prevent nausea and vomiting) on 06/04/24, 06/05/24 and 06/06/24. This failure could place residents at risk for inaccurate drug administration.
Inspectors wroteBased on interview and record review, the facility failed to ensure an infection prevention and control program designed to provide a safe and sanitary environment and to help prevent the development and transmission of communicable diseases and infections for 2 of 3 resident reviewed for infection control. (Resident #46 and Resident #50) The facility failed to isolate Resident #46 and Resident #50 after urine cultures (test checks urine for germs (microorganisms) that cause infections) revealed ESBL (enzymes break down and destroy some commonly used antibiotics) in their urine. This failure could place residents at risk for being exposed to health complications and infectious diseases. Find included: 1. [...]
Inspectors wroteBased on interview and record review the facility failed to ensure each resident was informed before, or at the time of admission, and periodically during the residents stay, of services available in the facility and of charges for those services, which included charges for services not covered under Medicare/Medicaid or by the facility's per diem rate for 2 of 3 residents (Resident #31 and Resident #212) reviewed for Medicare/Medicaid coverage. 1. The facility failed to ensure Resident #31 and Resident #212 were given a NOMNC (is a notice that indicates when your care is set to end from a home health agency, skilled nursing facility, comprehensive outpatient rehabilitation facility, or hospice) when discharged from skilled services prior to his covered days being exhausted. 2. [...]
Inspectors wroteBased on interview and record review the facility failed coordinate assessments with the Pre-admission Screening and Resident Review (PASRR) program under Medicaid for 1 of 5 residents (Resident #23) reviewed for PASRR screenings. The facility failed to conduct an accurate PASRR Level 1 and 2 screening for Resident #23. This failure could place residents at risk for not receiving appropriate services, depression, and decreased quality of life.
Inspectors wroteBased on interviews and record review, the facility failed to ensure all Pre-admission Screening and Resident Review (PASRR) Level I residents with mental illness and intellectual disabilities were provided with a PASRR Evaluation assessment for 2 of 5 residents (Residents #32 and #58) reviewed for PASRR screening, in that: 1. The facility failed to coordinate with the Local Intellectual/Developmental Disability and/or Local Mental Health Authority (Local Authority) to ensure an accurate PASRR Level I Evaluation and a PASRR Level II Evaluations were conducted for Resident #32 who had a serious mental illness. 2. [...]
Inspectors wroteBased on interview and record review the facility failed to ensure a baseline care plan was developed and implemented for each resident that included the instructions for resident care needed to provide effective and person-centered care of the resident that met professional standards of quality of care for 2 of 4 residents (Residents #163 and #213) reviewed for baseline care plans. 1. The facility failed to complete a baseline care plan with Resident #163 and Resident #213 within 48 hours of admission. 2. The facility failed to provide Resident #213 or Resident #213's RP, a copy of the summary of the baseline care plan. These failures 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 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 are identified in the comprehensive assessment for 1 of 16 residents (Resident #45) reviewed for care plans. The facility failed to ensure Resident #45 care plan was implemented when the resident did not have his abdominal binder (is a wide compression belt that encircles your abdomen) over his PEG feeding tube (Percutaneous endoscopic gastrostomy; is a tube inserted surgically into the stomach through the abdominal wall) on 06/24/24 which was a care plan intervention. [...]
Inspectors wroteBased on interview and record review the facility failed to ensure residents had a discharge summary that included a recapitulation of the resident's stay that included, but was not limited to diagnoses, course of illness/treatment or therapy, and pertinent lab, radiology, and consultation results for 1 of 2 residents (Resident #61) reviewed for discharge summaries. The facility failed to ensure Resident #61 had a discharge summary. This failure could place residents at risk for interruption of care after discharge, receiving the wrong care after discharge, and rehospitalization after discharge.
Inspectors wroteBased on observation, interview, and record review, the facility failed to provide the necessary services to maintain personal hygiene for 1 of 4 resident reviewed for quality of life. (Resident #213) The facility failed to remove Resident #213's unwanted facial hair. This failure 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, feelings of poor self-esteem, lack of dignity and health.
Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure that each resident received adequate supervision and assistance devices to prevent accidents for 3 of 10 residents (Resident #54, Resident #16, Resident #52) reviewed for quality of care. 1. The facility failed to distribute Residents #54, #16, and #52 protective smoking aprons. Residents #54, #16, and #52 were observed smoking without a protective smoking apron on 06/24/2024 at the 9:00 a.m., smoke break. This failure could place residents at the facility who smoked at risk for contributing to burns or serious injuries. Findings Included: 1. [...]
Inspectors wroteBased on observation, interview, and record review the facility failed to ensure that a resident who was incontinent of bladder received appropriate treatment and services, and an indwelling catheter is not used unless there is valid medical justification for catheterization and the catheter is discontinued as soon as clinically warranted for 1 of 3 residents (Resident #213) reviewed for quality of care. 1. The facility failed to ensure LVN L placed an order by MD K, to consult MD J, a local urologist (is a doctor who specializes in diagnosing and treating diseases of the urinary system), about removal of Resident #213 indwelling catheter and bladder retraining. 2. The facility failed to ensure LVN L successfully contact MD J's office to for consultation of removal of Resident #213 indwelling catheter and possible bladder retraining. [...]
Inspectors wroteBased on interview and record review, the facility failed to ensure each resident's drug regimen was free from unnecessary medications (a medication used in excessive doses and including duplicate therapy or for excessive duration; or without adequate monitoring, or without adequate indications for its use; or in the presence of adverse consequences which indicated the dose should be reduced or discontinued) for 1 of 3 residents reviewed for pharmacy services. (Resident #30) The facility failed to ensure Resident #30 antibiotic was discontinued after her urine culture (checks urine for germs (microorganisms) that cause infections) results showed no organism growth. [...]
Inspectors wroteBased on interview, and record review, the facility failed to ensure residents do not receive psychotropic drugs pursuant to a PRN order unless that medication is necessary to treat a diagnosed specific condition that is documented in the clinical record and PRN orders for psychotropic drugs are limited to 14 days. Except if the attending physician or prescribing practitioner believes that it is appropriate for the PRN order to be extended beyond 14 days, he or she should document their rationale in the resident's medical record and indicate the duration for the PRN order for 1 (Resident #4) of 16 residents reviewed for pharmacy services. The facility failed to ensure Resident # 4's prn lorazepam was discontinued or reviewed by a physician to extend usage after 14 days. [...]
Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that residents were free of significant medication errors for 1 of 5 residents (Residents #45) reviewed for pharmacy services. The facility failed to ensure Residents #45 received his prescribed Levetiracetam (is a medicine used to treat epilepsy (seizures)) as scheduled for 06/05/24 and 06/06/24. This failure could place residents at risk of medical complications and not receiving the therapeutic effects of their medications.
Inspectors wroteBased on interview and record review, the facility failed to ensure the activities program was directed by a qualified professional who was a qualified therapeutic recreation specialist or an activities professional who completed a training course approved by the State for 1 of 1 facility reviewed for quality of life. The facility did not ensure the Activity Director was qualified to serve as the director of the activities program. This failure could place residents at risk of not receiving a program of activities that meets their assessed activity needs.
Inspectors wroteBased on interview and record review the facility failed to ensure within 14 days after a facility completed a resident's assessment, a facility must transmit encoded, accurate, and complete MDS data, to the CMS System for 16 of 46 residents (Residents #25, #53, #162, #113, #5, #212, #115, # 20, # 117, #9, # 12, # 31, # 52, # 114, #112, and # 10) records reviewed for transmitted MDS records. The facility failed to ensure the MDS assessments were electronically transmitted as required for: Resident #25's discharge assessment dated [DATE] and entry record dated 05/28/2024. Resident #53's comprehensive assessment dated [DATE]. Resident # 162's discharge assessment dated [DATE] and entry record dated 06/04/2024. Resident #113's entry record dated 06/04/2024. Resident #5's quarterly assessment dated [DATE]. Resident #212's discharge assessment dated [DATE]. [...]
Inspectors wroteBased on observation, interview and record review, the facility failed to implement written policies and procedures that prohibit and prevent abuse, neglect, exploitation, or mistreatment of residents for 1 of 4 residents (Resident #1) reviewed for abuse and neglect. The facility failed to suspend an alleged perpetrator immediately following an accusation of abuse. This failure could place residents at risk for continued abuse and neglect due to inappropriate interventions and failure to report the allegations of abuse timely.
Inspectors wroteBased on observation, interview and record review the facility failed to ensure that all alleged violations involving abuse, neglect, exploitation or mistreatment, were reported immediately, but not later than 2 hours after the allegation was made, if the events that caused the allegation involved abuse or resulted in serious bodily injury, or not later than 24 hours if the events that caused the allegation did not involve abuse and did not result in serious bodily injury, to the administrator of the facility and to other officials (including to the State Survey Agency and adult protective services where state law provides for jurisdiction in long-term care facilities) in accordance with State law through established procedures for 1 of 6 residents (Resident #1) reviewed for abuse and neglect. [...]
Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure each resident received adequate supervision and assistance devices to prevent accidents for 1 of 3 residents (Resident #2) reviewed for accidents and supervision, in that: Resident #2 was transferred with only (1) staff member using a mechanical hydraulic lift by CNA D causing her foley catheter to become dislodged spilling urine on the resident and causing pain to Resident #2 by not supporting her right fractured leg that was non-weight bearing on 06/10/2024. This failure could place residents who are transferred by mechanical hydraulic lift at risk for avoidable accidents and could result in a decline in physical condition.
Inspectors wroteBased on interview, and record review, the facility failed to provide Pharmaceutical Services that accuratly ensured the facility met the needs of each Resident for 1 of 29 residents reviewed for pharmacy services. (Resident #1) 1. The facility failed to ensure LVN A followed the facility's policy to reconcile medications for Resident #1 when admitted on [DATE]. 2. The facility failed to ensure LVN B followed the facility's policy to reconcile medications for Resident #1 when discharging on 09/26/23. This failure could place residents at risk of drug diversion and misuse of medication.
Inspectors wroteBased on interview and record review the facility failed to demonstrate a response and rationale for resident council concerns and requests for 9 of 9 residents in a confidential interview. The facility did not provide a response or rationale to the resident council on their concerns regarding employee cell phone usage, privacy in the shower area, call lights being answered timely, laundry smelling of urine after being laundered, and the dining area not being cleaned between meals. This failure could place residents at risk for not having their needs met, diminished resident rights, and diminished feelings of 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 resident rights, that included measurable objectives and time frames to meet residents' mental and psychosocial needs; and, services that were to be furnished to attain or maintain the residents' highest practicable physical, mental and psychosocial well-being for 7 (Residents #06, #07, #11, #15, #26, #33, and #48) of 16 residents reviewed for care plans. 1. The facility failed to develop a care plan for Resident #07's falls. 2. The facility failed to develop a care plan for Resident #15's PASRR diagnoses and goals. 3. The facility failed to follow a comprehensive person-centered care plan for Resident #26 by not monitoring or properly documenting skin changes. 4. [...]
Inspectors wroteBased on observation, interview and record review, the facility failed to ensure that respiratory care was provided consistent with professional standards of practice for 3 of 6 residents reviewed for respiratory care. (Resident #6, Resident #11, Resident #50). The facility failed to properly store Resident #50's respiratory equipment. The facility failed to clean the oxygen concentrator filter of Resident #6, Resident #11, and Resident #50. These failures could place residents at risk of respiratory infections.
Inspectors wroteBased on observation, interview, and record review, the facility failed to provide pharmaceutical services including procedures that assure the accurate administering of all drugs and biologicals, to meet the needs of 4 of 16 residents reviewed for pharmacy services. (Residents #6, #11, #16, and #42) The facility failed to keep in stock all medications for Resident #6, #11, #16, and #42. This failure could place residents at risk for inaccurate drug administration and cause Resident #11 and #42 increased pain.
Inspectors wroteBased on interview and record review, the facility failed to promote antibiotic stewardship by ensuring the appropriate use of antibiotic therapy and providing written rationale, by the provider, when an antibiotic was used despite criteria, to determine the appropriate the use of an antibiotic for 5 of 8 residents reviewed antibiotic use. (Resident #27, Resident #28, Resident #33, Resident #40, Resident #214) The facility failed to ensure Resident #33, Resident #40, and Resident #214 had lab work to support use of antibiotics. The facility failed to ensure physician order had diagnosis to support antibiotic therapy for Resident # 27, Resident #28, Resident #33, and Resident #40. The facility failed to ensure Resident #28 received the appropriate antibiotic to treat his urinary tract infection. [...]
Inspectors wroteBased on observations, interviews, 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 16 residents (Resident #07 and Resident #36) reviewed for resident rights in that: The facility failed to provide a shower curtain for Residents #07 and #36 while bathing in a multi-stall shower room while being observed by CNAs. This failure could place residents at risk for diminished quality of life, loss of dignity and self-worth.
Inspectors wroteBased on interviews and record reviews the facility failed to ensure the residents had the right to be informed of the risks, and participate in, his or her treatment which included the right to be informed in advance, by the physician or other practitioner or professional, of the risks and benefits of proposed care, of treatment and treatment alternatives or treatment options and to choose the alternative or option he or she preferred, for 2 of 13 residents ( Resident #35, Resident #38) reviewed for resident rights . [...]
Inspectors wroteBased on interview and record review the facility failed to ensure each resident was informed before, or at the time of admission, and periodically during the resident's stay, of services available in the facility and of charges for those services, which included charges for services not covered under Medicare/Medicaid or by the facility's per diem rate for 2 of 3 residents (Resident #50, and Resident #54) reviewed for beneficiary notice. The facility failed to ensure Resident #50, and Resident #54 were given a Skilled Nursing Facility Advance Beneficiary Notice (SNF ABN) when discharged from skilled services at the facility prior to covered days being exhausted. This failure could place the residents who were discharged at risk of not having knowledge of changes to services in a timely manner to allow the resident or their representative the option of appealing the denial of services.
Inspectors wroteBased on interview and record review, the facility failed to ensure the right of the residents to be free from abuse for 2 of 9 residents reviewed for abuse and neglect. (Resident #6, Resident #47) The facility failed to ensure Resident #6, and Resident #47 did not experience abuse from CNA M. This failure could place residents at risk of abuse, physical harm, mental anguish, and emotional distress.
Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that all alleged violations involving abuse, neglect, or mistreatment, including injuries of unknown source are reported immediately or not later than 24 hours for 1 of 16 residents reviewed for abuse and neglect. Resident #26 sustained an injury of unknown source that was not reported timely as required. This failure could place residents at risk for abuse and neglect .
Inspectors wroteBased on interview and record review, the facility failed to assess each resident quarterly (every 3 months) using the MDS (minimum data set) form specified by the state and approved by CMS for 2 of 5 residents (Resident # 51, and Resident # 52) reviewed for quarterly assessments. The facility failed to ensure Residents # 51, and # 52 had a quarterly MDS assessment completed within 3 months from the previous assessment. This failure could place residents at risk of not receiving necessary care or receiving inappropriate care for their conditions.
Inspectors wroteBased on interview and record review, the facility failed to ensure the baseline care plan that included the instructions for resident care needed to provide effective and person-centered care was completed and provided to the resident and/or their representative for 2 of 16 residents reviewed for new admissions (Resident #11 and Resident #44). 1. The facility did not provide a summary of the baseline care plan to Resident #11. 2. The facility failed to address Resident #11's social service needs and resident preference for being notified of updates to plan of care 3. The facility failed to complete a baseline care plan for Resident #44. These failures could place residents at risk of not receiving care and services to meet their needs.
Inspectors wroteBased on interviews and record reviews, the facility failed to act upon the recommendations of the pharmacist report of irregularities for 2 of 5 residents (Resident #35 and #38) reviewed for (DRR) Drug Regimen Review. 1. The facility failed to clarify PRN use of Lorazepam (antianxiety) for Resident #35 and Resident #38 after pharmacist recommendations on 03/07/23. 2. The facility failed to clarify Resident #38's diagnosis and rationale for antipsychotic use after pharmacist recommendation on 03/07/23. 3. The facility failed to confirm correct diagnosis was included on the Form 3713 Antipsychotic consent for Resident #38 after pharmacist recommendation on 03/07/23. [...]
Inspectors wroteBased on interview and record review, the facility failed to ensure, based on the comprehensive assessment of a resident, residents who had not used psychotropic drugs were not given these drugs unless the medication was necessary to treat a specific condition as diagnosed and documented in the clinical record for 2 of 5 residents (Resident #35, Resident #38) reviewed for unnecessary psychotropic medications. The facility failed to have an appropriate diagnosis or indication of use for Resident #38's Seroquel (antipsychotic). The facility failed to limit Resident #35's and Resident #38's Lorazepam (anti-anxiety) prn medications to 14 days and the prescribing practitioner did not provide a rationale for extended use. These failures could put residents at risk of receiving unnecessary psychotropic medications.
Inspectors wroteBased on interview and record review, the facility failed to ensure the resident's medical record included documentation that indicates the resident received education on the influenza and the pneumococcal immunizations of 2 of 16 residents (Residents #6, Resident #11) reviewed for immunizations. The facility failed to ensure Resident #6 received education on influenza and the pneumococcal immunization. The facility failed to offer and administer the influenza and pneumococcal vaccination to Resident #6. The facility failed to offer and administer the pneumococcal vaccination to Resident #11. These failures could place residents at risk for contracting a viral disease and cause respiratory complications, and potential adverse health outcomes.
Inspectors wroteBased on interview and record review, the facility failed to ensure an encoded, accurate, and complete MDS assessment was transmitted to the CMS System within 14 days after completion for 2 of 5 residents (Resident #49, and Resident #53) reviewed for MDS assessments. The facility did not ensure Resident #49's quarterly MDS assessment and Resident #53's annual comprehensive MDS assessment were transmitted within 14 days of completion. This deficient practice could place residents at risk of not having records completed and submitted in a timely manner as required.
4 fire safety citations on file: 2 on July 29, 2025, 1 on June 26, 2024, 1 on May 11, 2023.
| Date | Penalty | Amount or length |
|---|---|---|
| June 26, 2024 | Fine | $67,706 |
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) | 3.29 | 3.39 | 3.86 |
| Registered nurses | 0.18 | 0.43 | 0.69 |
| All nursing staff on weekends | 2.81 | 2.98 | 3.42 |
| Nurse aides | 1.93 | ||
| Licensed practical nurses | 1.19 | ||
| Nursing staff turnover (share who left in a year) | 91.7% | 55.3% | 45.8% |
| Registered nurse turnover | 83.3% | 54.6% | 42.9% |
| Administrators who left | 1 |
CMS expects 3.94 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 2.81 on weekends, 19% 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 3.51 in April to June 2025 to 3.29 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 | 3.29 | 0.18 | 3.49 | 2.81 | 0.0% | 0 of 90 | 67 |
| Oct to Dec 2025 | 3.74 | 0.29 | 3.94 | 3.23 | 0.0% | 0 of 92 | 63 |
| Jul to Sep 2025 | 3.49 | 0.29 | 3.70 | 2.95 | 0.0% | 0 of 92 | 69 |
| Apr to Jun 2025 | 3.51 | 0.35 | 3.81 | 2.77 | 0.0% | 0 of 91 | 67 |
| 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 | 26.4 | 15.8 | 13.9 |
| Percentage of long-stay residents with a catheter inserted and left in their bladder Long Stay residents, 2025Q2-2026Q1 | 0.5 | 0.3 | 0.8 |
| Percentage of long-stay residents with a urinary tract infection Long Stay residents, 2025Q2-2026Q1 | 1.8 | 0.8 | 1.6 |
| Percentage of long-stay residents experiencing one or more falls with major injury Long Stay residents, 2025Q2-2026Q1 | 0.9 | 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 | 29.0 | 14.0 | 14.1 |
| Percentage of long-stay residents with pressure ulcers Long Stay residents, 2025Q2-2026Q1 | 4.0 | 3.8 | 4.6 |
| Percentage of long-stay residents who received an antipsychotic medication Long Stay residents, 2025Q2-2026Q1 | 10.7 | 9.6 | 15.4 |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission Short Stay residents, 20250101-20251231 | 25.8 | 25.7 | 23.8 |
| Percentage of short-stay residents who had an outpatient emergency department visit Short Stay residents, 20250101-20251231 | 23.0 | 12.3 | 12.0 |
| Number of hospitalizations per 1000 long-stay resident days Long Stay residents, 20250101-20251231 | 4.1 | 2.2 | 1.9 |
| Number of outpatient emergency department visits per 1000 long-stay resident days Long Stay residents, 20250101-20251231 | 3.4 | 2.1 | 1.8 |
For a stay to recover after a hospital visit, these are the results CMS publishes for Heritage House of Marshall Health & Rehabilitation's Medicare short-stay residents. On returning residents home or to the community, CMS rates it no different from the national rate (50.9% of residents, after adjusting for how sick they were). How to read these, and what Medicare pays for.
50.9% 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. 62 eligible stays.
10.2% 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. 77 eligible stays.
8.4% 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. 49 eligible stays.
45.2% 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. 31 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. 40 residents counted.
2.0% 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. 40 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. 18 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: NACOGDOCHES COUNTY HOSPITAL DISTRICT.
| Name | Role | Type | Share | Since |
|---|---|---|---|---|
| Thurman, Linda | W-2 managing employee | Individual | 09/01/2022 | |
| Southwest LTC Marshall Ltd | Operational/managerial control | Organization | 04/01/2017 | |
| Lindsey, Lynn | Operational/managerial control | Individual | 01/01/2022 |
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.