2590 Loop 337 N, New Braunfels, TX 78130 · Comal County · (830) 620-0509
162 certified beds, about 138 residents a day · For profit - Corporation · Medicare and Medicaid since 1988
CMS Care Compare ratings, data as of September 1, 2026 · CCN 455732 · See it on Medicare.gov · Compare with other homes
At its most recent standard inspection, on April 10, 2026, inspectors cited 12 health deficiencies (the Texas average is 9.4, the national average 9.2).
Of 51 health citations since November 2023, 1 was rated as actual harm or immediate jeopardy to residents (1 immediate jeopardy).
CMS lists 1 fine totaling $29,026 in the last three years; the largest was $29,026, and the latest is dated March 24, 2024.
Nurses and nurse aides worked 3.17 hours per resident per day, against 3.39 across Texas and 3.86 nationally. Registered nurses accounted for 0.44 of those hours.
42.3% 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 51 health citations on file.
Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents received treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and physician's orders for one (1) of five (5) residents (Resident #1) reviewed for quality of care. The facility failed to complete Resident #1's venous stasis prevention (preventing the congestion and slowing of circulation in the veins due to blockage) and wound care prevention per physician orders. These failures could place residents at risk of not receiving necessary medical care, harm, and hospitalization.
Inspectors wroteBased on observation, interviews, and record reviews, the facility failed to maintain medical records on each resident that were complete and accurately documented for one (1) of five (5) residents (Residents #1) reviewed for accurate medical records. The facility failed to ensure nursing staff documented the exceptions to the venous stasis prevention (preventing the congestion and slowing of circulation in the veins due to blockage) and wound care prevention orders for Resident #1. These failures could place residents at risk of not recording a proper account of medical interventions, treatments, and outcomes during a residents' stay.
Inspectors wroteBased on interviews and record reviews, the facility failed to ensure the MDS assessment accurately reflected the resident's status for 4 residents (Residents #10, #13, #81 and #106) of 24 residents reviewed for MDS assessments. 1. The facility failed to ensure Resident #10 was coded Yes on her Quarterly MDS assessment, signed as completed on 01/14/2026, for Did the resident have a fall anytime in the last 2-6 months prior to admission/entry or reentry? because the resident had fall incident on 01/05/2026. 2. The facility failed to ensure Resident #13 and Resident #81's annual MDS was coded accurately for Preadmission Screening and Resident Review (PASRR). 3. The facility failed to ensure Resident #106's Annual MDS was coded accurately for Preadmission Screening and Resident Review (PASRR). [...]
Inspectors wroteBased on observations, interviews, and record review, the facility failed to treat each resident with respect and dignity and care for each resident in a manner and in an environment that promoted maintenance or enhancement of his or her quality of life for 1 (Resident #56) of 27 residents reviewed for dignity. The facility failed to ensure CNA-A did not stand next to Resident #56 while assisting the resident to eat during lunchtime on 04/07/2026. These failures could place the residents at risk of not having their right to a dignified existence maintained.
Inspectors wroteBased on interviews and record review, the facility failed to develop and implement a comprehensive person-centered care plan for each resident that included measurable objectives and timeframes to meet a resident's medical, nursing, and mental needs that were identified in the comprehensive assessment, and described services that were to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being for 1 of 27 residents (Resident #115) reviewed for care plans. The facility failed to ensure Resident #115's care plan reflected her bladder and bowel incontinence status and included a care plan regarding how to take care of the resident's bladder and bowel incontinence. This failure could place residents at risk for not receiving proper care and services due to inaccurate care plans.
Inspectors wroteBased on observation, interview, and record review, the facility failed to review and revise Resident Care Plans after each assessment for 1 of 27 Residents (Resident #10) whose records were reviewed for care plan revision/timing, in that: The facility failed to ensure Resident #10's care plan was updated after IDT meeting when the resident had a fall and changes to intervention where put in place to prevent fall from one person assist for baths to two persons assist on 01/05/2026. This failure could place residents at risk and contribute to residents not receiving the care and services they needed.
Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the residents' environment remains as free of accident hazards as possible for 1 (Resident #39) of 2 residents reviewed for transfers in that: The facility failed to engage brakes of the mechanical lift when slowly lowering Resident #39 onto the bed on 04/09/2026. This failure could place residents at risk for falls, injuries, and decline in health.
Inspectors wroteBased on observation and interview, the facility failed to ensure a resident with an indwelling catheter, received the appropriate care and services for 1 of 3 residents (Resident #43) and the facility failed to ensure a resident who is incontinent of bladder receives appropriate treatment and services to prevent urinary tract infections for 1 of 4 residents (Resident #108), reviewed for quality of care. 1. The facility failed to ensure resident #43's urinary drainage bag remained below the level of the bladder during catheter care on 4/9/26.2. When CNA-F and CNA-C were providing incontinent care to Resident #108 on 04/09/2026, CNA-F did not clean the resident's suprapubic area (the area of the abdomen located below the umbilical region) and did not separate the resident's labia area. [...]
Inspectors wroteBased on observation, interview, and record review the facility failed to ensure residents who needed respiratory care were provided such care, consistent with professional standards of practice for 2 (Resident #3 and Resident #137) of 3 residents. 1. The facility failed to ensure Resident #3's oxygen tubing attached to the AVAP machine was bagged when not in use on 04/07/2026 and 04/08/2026. 2. The facility failed to ensure Resident #137's oxygen concentrator was set to 3 liters per minute as ordered by the physician on 04/8/2026. This failure could place residents at risk of illness, and respiratory complications.
Inspectors wroteBased on observation, interview, and record review, the facility failed to provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of each resident for 1 (400-hall nursing cart) of 6 medication carts reviewed for medication storage and for 1 (Resident #134) of 10 residents reviewed for medication administration. 1. There was one bottle of blood glucose test strips inside the 400-hall nursing cart on [DATE], and the test strips expired on [DATE]. 2. The facility failed to reorder Resident #134's buspirone hydrochloride 7.5 MG Oral Table for depression on time. As a result, the medication was not available when administering the medication to the resident. This failure could place the residents at risk of not receiving therapeutic doses of their medication.
Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure medications and biologicals were stored in locked compartments for 1 of 2 medication rooms (Medication room station-2 for 100 and 500 hall) reviewed for medication storage. The facility failed to ensure the narcotic box inside the refrigerator for medications in the medication room station-2 for 100 and 500 hall was permanently affixed to the refrigerator. This failure could place residents at risk of not having controlled medications as ordered due to diversion of medication.
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 for 1 of 1 kitchen observed for plate preparation. The facility failed to ensure dietary staff properly air-dried insulated domes for tops of plates prior to meal service observed on 04/09/2026. These failures could place residents who received meals and/or snacks from the kitchen at risk of food born illness.
Inspectors wroteBased on observation, interview, and record review, the facility failed to implement their policy regarding use and storage of foods brought to residents by family and other visitors to ensure safe and sanitary storage, handling, and consumption, for 1 (Residents #1) of 27 residents reviewed, in that: Resident #1's personal refrigerator located in her room contained a small plastic container and some food wrapped with kitchen aluminum foil with no date and no label on 04/07/2026. The failure could place the residents at risk for food borne illness.
Inspectors wroteBased on interview and record review, the facility failed to ensure medical records on each resident were complete, readily accessible, and contained the results of any preadmission screening and resident review evaluations and determinations conducted by the State for 2 of 5 residents (Resident #13, and #81), reviewed for Administration. 1. The facility failed to ensure Resident #13's PASARR level 1 screening, and PASARR level 2 evaluation were included in the resident's EHR. 2. The facility failed to ensure Resident #81's PASARR level 2 evaluation, and her specialized service plans were included in the resident's EHR. This failure could place residents at risk of a delay in or not receiving their needed care and specialized services, and decreased continuity of care.
Inspectors wroteBased on interview and record review, the facility failed to provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of each resident for 1 of 5 residents (Resident #1) reviewed for accurate administration of medications. The facility failed to ensure Resident #1's mediation order of cloNIDine HCI (a medication used to treat blood pressure and/or heart rate) was entered as prescribed by a physician. This failure could place residents at risk of not receiving their prescribed medications correctly and a decreased quality of life.
Inspectors wroteBased on observation, interview, and record review, the facility failed to provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of each resident for 1 of 3 residents (Resident #1) reviewed for pharmacy services. LVN A administered Resident #1's insulin from a flex pen (Aspart) for diabetes at lunchtime to Resident #1, when it was not labeled with the resident's name. This failure could place residents at risk of inaccurate drug administration and not having appropriate therapeutic effects.
Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure all drugs and biologicals were labeled for 1 of 3 residents (Resident #1) reviewed for medication labeling. 2. An insulin flex pen (Aspart) for diabetes had no resident's name labeled and was found on the 400-hall medication cart on 06/03/2024 and assumed by LVN A to belong to Resident #1. This failure could place residents at risk of use of the medication for more than one resident which could result in contamination of a blood borne pathogen.
Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure the resident received care and services safely and the physical layout of the facility maximized resident independence and did not pose a safety risk; provided maintenance services necessary to maintain an orderly, and comfortable interior; provide adequate and comfortable lighting levels in all areas; for 2 of 2 shower rooms (600 hall shower on E and W side), maintained shower free of saftery hazards for 1 of 2 Showers (600 Hall Shower), and 1 of 1 Resident's room (Resident #68) reviewed for safety hazards. 1. The water temperature in the 600 E shower room reached 95.5 degrees and the water temperature in the W shower room reached 97.1 degrees. The safe water temperature range should be 100 to 110 degrees. 2. There was a long hole on a wall around an electrical outlet beside Resident #68's bed. 3. [...]
Inspectors wroteBased on observations, interviews, and record review, the facility failed to establish and maintain an infection control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development of communicable diseases and infections for 3 residents (Residents #52, #109, and #27) of 29 residents and for 1 of 2 shower rooms (600 W hallway) reviewed for infection control practices. 1. LVN-C provided colostomy (opening for the colon through the belly) care for Resident #52 and failed to change her gloves without sanitizing or washing her hands. 2. LVN-A entered Resident #109's room, who was on EBP, on 02/19/2025 at 4:40 p.m. and failed to put on a gown when the LVN-A was administering medications to the resident via gastrostomy tube. 3. [...]
Inspectors wroteBased on record reviews and interviews, the facility failed to ensure each PASRR Level 1 Screening done for each resident was correct for mental illness for 1 of 2 residents'(Resident #10) PASRRs reviewed, in that: Resident #10 had a PASRR Level 1 screening that did not indicate that she had a mental illness with a diagnosis of bipolar disorder and, the facility did not have Resident #10 screened again for possible services. This failure could cause the residents not to receive services needed to maintain the highest functional ability for their quality of life.
Inspectors wroteBased on interview and record review the facility failed to ensure the comprehensive care plan was reviewed and revised by the interdisciplinary team after each assessment including both the comprehensive and quarterly review assessments person-centered care plan to reflect the current condition for 1 of 8 residents (Resident #110) reviewed for care plan revisions. 1. The facility failed to ensure Resident #110's care plan was revised to reflect order to release seatbelt and harness on wheelchair every 2 hours for 10 minutes. This deficient practice could place resident at risk of not receiving appropriate interventions to meet their current needs.
Inspectors wroteBased on observation, interview and record review revealed the facility failed to ensure the resident environment remained was free of accident hazards as is possible in residents received adequate supervision and assistance devices to prevent accidents for 1 of 6 Residents (Resident #187) observed for safety hazards. 1. Nursing staff failed to put down a floor mat used as a preventative device on the right side of Resident #187's bed. This deficient practices could affect any resident and could contribute to avoidable falls and accidents.
Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure a resident who was incontinent of bowel and bladder receives appropriate treatment and services to prevent urinary tract infections and to restore continence to the extent possible for 1 of 3 residents (Resident #70) reviewed for incontinence care. When CNA-D was providing incontinent care to Resident #70 on 02/20/2025, CNA-D did not separate the resident's labia and did not clean the base of her labia. Then, CNA-D turned the resident to her left side and started cleaning the resident's bowel movement. However, the CNA-D did not clean Resident #70's bowel movement completely. This failure could place residents who required incontinence care at risk for cross contamination and the development of new or worsening urinary tract infections.
Inspectors wroteBased on observation, interviews, and record review, the facility failed to ensure that a resident who needs respiratory care, is provided such care, consistent with professional standards of practice for 2 of 4 (Resident #70 and #52) reviewed for respiratory care. 1. Resident #70's physician order indicated Changing oxygen tubing and humidifier bottle every night shift every Wednesday, but the resident's oxygen tubing labeled 02/03/2025 was not changed every week per the physician's order. 2. Resident #52's oxygen nasal cannular and mask for Bi-pap were not covered in a plastic bag when they were not used. This failure could affect residents with oxygen therapy and could lead them to lack of care including possible infection by not following the physician orders.
Inspectors wroteBased on observation, interview, and record review, the facility failed to provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of each resident for 1 of 4 residents (Resident #32) reviewed for pharmacy services. Resident #32's insulin flex pen (Lispro) for diabetes had an open date of 01/10/2025 found inside the 300-hall nursing cart on 02/19/2025. It should have been discarded 28 days after opening. The failures could place residents at risk of inaccurate drug administration and not having appropriate therapeutic effects.
Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure all drugs and biologicals were stored in locked compartments for 1 of 3 medication carts (400-hall medication aide cart) and 1 of 4 residents (Resident #83) reviewed for storage. 1. The facility failed to ensure the 400-hall medication aide cart was locked when left unattended during passing medications. 2. Resident #83's insulin flex pen (NovoLog) for diabetes had no open date, found inside 200-hall nursing cart on 02/19/2025. Per facility policy the opened and undated insulin should have been discarded. This failure could place residents at risk of misappropriation of medications or harm due to accidental ingestion of unprescribed mediations.
Inspectors wroteBased on observation, interview, and record review, the facility failed to enact a policy regarding use and storage of foods brought to residents by family and other visitors to ensure safe and sanitary storage, handling, and consumption, for 1 (Resident #56) of 8 residents reviewed, in that: Resident #56's personal refrigerator located in her room was observed on 02/18/2025, and there was a small plastic cup inside the refrigerator, but no date and no label on the plastic cup. This deficient practice could place residents at risk of foodborne illness due to consuming foods which might be spoiled.
Inspectors wroteBased on interview and record review, the facility failed to provide pharmaceutical services including procedures that assured accurate administering of all drugs to meet the needs of residents for 1 of 8 residents (Resident #1) reviewed for pharmaceutical services, in that: The facility did not reorder Resident #1's Anastrozole for chemo treatment timely, resulting in Resident #1 missing 3 doses (06/21/24, 06/22/24, and 06/23/24) of Anastrozole. The noncompliance was identified as PNC. The PNC began on 06/24/2024 and ended on 06/25/2024. The facility had corrected the noncompliance before the survey began. These failures could place residents who receive medications administered by the facility at risk of not receiving the intended therapeutic benefit of their medication.
Inspectors wroteBased on interview and record review the facility failed to, based on the comprehensive assessment of a resident, ensure 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 6 residents (Resident #1) reviewed for quality of care . 1. The facility staff administered Resident #1's digoxin (medication used to manage and treat heart failure and certain abnormal heart rhythms) without documenting the ordered blood pressure and pulse per the physician ordered parameters from [DATE] to [DATE], [DATE] to [DATE], and [DATE] to [DATE] (23 days) and failed to hold the medication as ordered per parameters on [DATE] and [DATE] . 2. [...]
Inspectors wroteBased on interview and record review the facility failed to ensure residents were free of any significant medication errors for 1 of 6 residents (Resident #1), reviewed for medication errors. 1. The facility staff failed to hold Resident #1's digoxin (medication used to manage and treat heart failure and certain abnormal heart rhythms) per physician ordered parameters on 2/18/24 and 2/25/24. 2. The facility staff failed to administer Resident #1's midodrine (medication used to raise abnormally low blood pressure) as ordered to be given PRN every 8 hours for SBP<100 on 2/11/24, 2/18/24, 2/25/24, 3/3/24, and 3/13/24 (5 instances) when the resident's SBP was below 100. These failures could place residents at risk of a critically low pulse and blood pressures, inadequate blood flow, missed signs and symptoms of illness, hospitalization, and death.
Inspectors wroteBased on interview and record review the facility failed to ensure, in accordance with accepted professional standards and practices, maintain medical records on each resident that were complete and accurately documented for 1 of 6 residents (Resident #1) reviewed for medical records. 1. The facility staff failed to document a blood pressure and a pulse prior to or after administration of Resident #1's digoxin (medication used to manage and treat heart failure and certain abnormal heart rhythms) that had ordered parameters to hold the medication if the blood pressure or pulse was outside of the parameters from 2/13/24 to 2/17/24, 2/19/24 to 2/24/24 and 2/26/24 to 3/13/24 (23 days). 2. [...]
Inspectors wroteBased on observation, interviews and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safely for 1 of 1 kitchen reviewed for kitchen sanitation during the initial tour. A. Food items were not clearly labeled to indicate safe preparation for or consumption by residents. B. Kitchen spatulas were not in good working condition and the rubber parts had tears. C. Food stored in the walk-in cooler were not completely covered. D. Kitchen Equipment was damaged and dirty. E. Areas of the kitchen floor appeared to be holding water and was dirty F. Kitchen equipment was stored on the floor. G. Nourishment rooms contained inoperable freezing units, contained expired food, and unlabeled food. These deficient practices could place residents at risk for cross-contamination and foodborne illness.
Inspectors wroteBased on interview and record review the facility failed to follow up on concerns discussed in resident's council meeting for 7 of 9 residents reviewed for resident council. The facility failed to show follow up on complaints and grievances made in resident council. This failure could place residents that participate in a resident council at risk of not having the right to their concerns and grievances followed through with.
Inspectors wroteBased on interview and record review, the facility failed to develop and implement a comprehensive person-centered care plan for each resident that included measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that were identified in the comprehensive assessment for three (Resident #23, # 74, and #164) of three residents reviewed for care plans in that: 1. The facility failed to ensure Resident #23's comprehensive care plan addressed the residents individual needs and indicated Resident #23 needed to stop smoking. 2. The Facility failed to ensure Resident #74's comprehensive care plan addressed Resident #74's fluid restriction due to kidney failure/dialysis. 3. The facility failed to ensure a comprehensive care plan for Resident #164 was completed since the resident's admission. [...]
Inspectors wroteBased on observation, interview and record review, the facility failed to provide pharmaceutical services. Including procedures that assures the accurate acquiring, receiving, dispensing, and administering of medications on 3 of 3 medication storage rooms reviewed for pharmacy services. The facility did not dispose of loose medications, expired syringes and expired odor eliminators bottles from the medication storage room. This failure could place residents who receive medications at risk of not receiving the intended therapeutic benefit of the medications.
Inspectors wroteBased on interview and record review, the facility failed to ensure residents' pharmacist medication regimen review recommendations were reviewed by the resident's attending physician and what, if any, action has been taken to address them, for 3 of 7 residents (Residents #33, #65, and #12) whose records were reviewed for pharmacy services. The facility failed to ensure the physician provided a precise clinical rationale in response to the consulting pharmacist's recommended changes for medication regimen review. This failure could place residents at risk for significant health status declines.
Inspectors wroteBased on record review and interview, the facility failed to include as part of its QAPI program, mandatory training that outlined and informed staff of the elements and goals of the facility's QAPI program, for 14 of the 15 staff members (the ADM, the DON, ADON, LVN H, RN C, LVN I, SW, AD, DM, DOR, CNA B, CNA A, CNA C, CNA D, CNA E) reviewed for mandatory training, in that: Fourteen staff members (the ADM, the DON, ADON, LVN H, RN C, LVN I, SW, AD, DM, DOR, CNA B, CNA A, CNA C, CNA D, CNA E) reviewed for mandatory training had not received training regarding the facility's QAA-QAPI program. This failure could place residents at risk of receiving inadequate care from staff who are unfamiliar with the facility's QAPI program.
Inspectors wroteBased on record review and interview, the facility failed to ensure all staff received training in compliance and ethics for 14 of the 15 staff members (the ADM, the DON, ADON, LVN H, RN C, LVN I, SW, AD, DM, DOR, CNA B, CNA A, CNA C, CNA D, CNA E) reviewed for mandatory training, in that: Fourteen staff members (the ADM, the DON, ADON, LVN H, RN C, LVN I, SW, AD, DM, DOR, CNA B, CNA A, CNA C, CNA D, CNA E) reviewed for mandatory training had not received training regarding compliance and ethics. This failure could place residents at risk of receiving inadequate care from staff who are uneducated on compliance and ethics.
Inspectors wroteBased on observations, interviews and record reviews, the facility failed to provide reasonable accommodation of resident needs for 1 of 4 (Resident #30) residents reviewed for call lights in that: The facility failed to ensure Resident #30's call light was within reach and placed for easy access. The deficient practice could place residents at risk of not receiving care or attention needed and risk of falling. The Findings Included: [...]
Inspectors wroteBased on record review and interview, the facility failed to ensure residents had the right to formulate an advanced directive for 2 of 2 residents (Resident #33, #92) reviewed for advance directives. Resident #33's OOH-DNR form was invalid because the attending physician's date signed was missing from the form. Resident #92's OOH-DNR form was invalid because the notary's date signed was missing from the form. This failure could result in resident DNR's not being properly executed.
Inspectors wroteBased on observation and interviews, the facility failed to provide a safe, functional, sanitary and comfortable environment for residents, staff and the public for 1 of 5 (Resident #87) resident room bathrooms. The bathroom sink faucet sprayed out water onto the floor when turned on. This failure could place residents at risk for an unsafe and unsanitary environment.
Inspectors wroteBased on interview and record review, the facility failed conduct initially and periodically a comprehensive, accurate, standardized reproducible assessment of each resident's functional capacity within 14 calendar days of admission, excluding readmissions in which there was no significant change in the resident's physical or mental condition for 2 of 8 residents (Resident #164 and # 108) reviewed for Comprehensive Assessments and timing. The facility failed to ensure an MDS Assessment for Resident #164 was completed within 14 days after admission. The facility failed to code the MDS Assessment for Resident #108 correctly after discharge from the facility. This failure could place residents at risk for improper or incorrect care and services necessary for their physical, mental, and psychosocial well-being.
Inspectors wroteBased on record review and interview the facility failed to accurately assess and reflect the resident's status for 1 of 26 residents (Resident #96) reviewed for accuracy of assessments in that: Resident #96's diagnosis for hypertension (high blood pressure) was not reflected on the comprehensive assessment dated [DATE]. This failure could place other residents at risk for improper or incorrect care and services necessary for their physical, mental, and psychosocial well-being.
Inspectors wroteBased on observation, interviews and record review, the facility failed to ensure the resident environment remains as free of accident hazards as was possible for 1 of 4 (Resident #44) residents reviewed for accident hazards in that: Resident #44's bed was left in a high position after receiving incontinent care from CNA B. This deficient practice could affect residents emotionally and could result in injury.
Inspectors wroteBased on observation, interview, and record review the facility failed to ensure residents were provided the fluids to maintain proper hydration for 1 of 1 (Resident #74) resident reviewed for fluid restriction in that: Resident #74's fluid restriction was not maintained as ordered, broken down as to how much nursing and dietary was to serve for meals, and nursing to use for medications being given. This failure could place residents at risk of not receiving proper hydration and could result in the residents being dehydrated.
Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure that a resident who needs respiratory care, including tracheostomy care and tracheal suctioning, is provided such care, consistent with professional standards of practice for 1 of 8 (Resident #72) reviewed for respiratory care. Resident #72's oxygen was set at 2 liters rather than the physician's order for 4 lpm and there was no humidifier bottle. This failure could affect residents administered oxygen and could lead to residents not receiving the therapeutic effects of oxygen; and could lead to a diminished quality of life.
Inspectors wroteBased on record review and interviews, the facility failed to ensure residents were given psychotropic medications to treat specific diagnoses for 2 (Resident #12 & #99) of 7 Residents, reviewed for unnecessary psychotropic medications. The facility failed to 1. Ensure the medication (Ativan) was administered to treat a specific, clinically diagnosed illness for Resident #12. 2. Ensure a PRN psychotropic medication order was limited to fourteen days for Resident #12. 3. Ensure the medication Sertraline was administered to treat a specific, clinically diagnosed illness for Resident #99. This failure could affect residents who received psychotropics in the facility and put them at risk for adverse consequences such as impairment or decline in an individual's mental or physical condition or functional or psychosocial status.
Inspectors wroteBased on interview and record review the facility failed to arrange an appointment with an outside resource for 1 of 3 residents (Resident #94) reviewed for the use of outside resources, in that: The facility did not have an order in Resident #94's electronic medical record for follow up care with the neurologist, nor follow up appointment. This failure could place residents at risk of not receiving needed medical care.
Inspectors wroteBased on interview and record review, the facility failed to maintain clinical records in accordance with accepted professional standards and practices that are complete and accurately documented for 1 of 1 residents (Resident #94), The facility failed to document the clinicial rationale or complete medication regimen for Resident #94. This failure could place residents at risk of not having accurate medical records and could create confusion in services provided or needed to be provided.
Inspectors wroteBased on interview, and record review the facility failed to ensure residents/resident representatives were 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 prefers for 1 of 2 Residents (Resident #1) reviewed for resident rights in that: The facility failed to notify Resident #1's Medical Power of Attorney or emergency contact after a behavioral incident when the resident did not have the cognitive ability to make informed medical decision before before receiving psychiatric services. This failure could place residents and their resident representatives at risk for not being informed about care and treatments that may affect the resident's well-being.
Inspectors wroteBased on record review, the facility failed to report the results of all investigations to the State Survey agency within 5 working day of the incident for 1 of 3 residents (Resident #1) reviewed for abuse and neglect. The facility did not provide the state agency with a provider investigation within 5 working days. This failure could place residents at risk of injury, abuse and neglect.
18 fire safety citations on file: 6 on April 10, 2026, 6 on February 21, 2025, 6 on January 26, 2024.
| Date | Penalty | Amount or length |
|---|---|---|
| March 24, 2024 | Fine | $29,026 |
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) | 3.17 | 3.39 | 3.86 |
| Registered nurses | 0.44 | 0.43 | 0.69 |
| All nursing staff on weekends | 2.78 | 2.98 | 3.42 |
| Nurse aides | 1.96 | ||
| Licensed practical nurses | 0.78 | ||
| Nursing staff turnover (share who left in a year) | 42.3% | 55.3% | 45.8% |
| Registered nurse turnover | 35.7% | 54.6% | 42.9% |
| Administrators who left | 0 |
CMS expects 3.70 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 3.33 on weekdays and 2.78 on weekends, 17% 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 3.17 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 | 3.17 | 0.44 | 3.33 | 2.78 | 0.1% | 0 of 90 | 138 |
| Oct to Dec 2025 | 3.27 | 0.46 | 3.42 | 2.89 | 0.0% | 0 of 92 | 134 |
| Jul to Sep 2025 | 3.48 | 0.47 | 3.65 | 3.04 | 0.1% | 0 of 92 | 123 |
| Apr to Jun 2025 | 3.36 | 0.26 | 3.52 | 2.95 | 5.2% | 0 of 91 | 134 |
| 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 | 39.7 | 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 | 0.0 | 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 | 1.0 | 1.5 | 1.6 |
| Percentage of long-stay residents whose ability to walk independently worsened Long Stay residents, 2025Q2-2026Q1 | 33.9 | 14.0 | 14.1 |
| Percentage of long-stay residents with pressure ulcers Long Stay residents, 2025Q2-2026Q1 | 2.8 | 3.8 | 4.6 |
| Percentage of long-stay residents who received an antipsychotic medication Long Stay residents, 2025Q2-2026Q1 | 5.6 | 9.6 | 15.4 |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission Short Stay residents, 20250101-20251231 | 28.7 | 25.7 | 23.8 |
| Percentage of short-stay residents who had an outpatient emergency department visit Short Stay residents, 20250101-20251231 | 9.0 | 12.3 | 12.0 |
| Number of hospitalizations per 1000 long-stay resident days Long Stay residents, 20250101-20251231 | 2.0 | 2.2 | 1.9 |
| Number of outpatient emergency department visits per 1000 long-stay resident days Long Stay residents, 20250101-20251231 | 1.0 | 2.1 | 1.8 |
For a stay to recover after a hospital visit, these are the results CMS publishes for Kirkwood Manor's Medicare short-stay residents. On returning residents home or to the community, CMS rates it no different from the national rate (54.3% of residents, after adjusting for how sick they were). How to read these, and what Medicare pays for.
54.3% 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. 85 eligible stays.
10.5% 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. 116 eligible stays.
7.1% 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. 80 eligible stays.
59.1% 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. 71 residents counted.
1.0% 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. 99 residents counted.
2.6% 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. 99 residents counted.
96.4% this home
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. 28 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: UVALDE COUNTY HOSPITAL AUTHORITY. CMS links this home to The Ensign Group, a group of 344 nursing homes averaging 3.2 stars overall.
| Name | Role | Type | Share | Since |
|---|---|---|---|---|
| Martin, Kyle | Managing control - governing body | Individual | 11/01/2019 | |
| Yu, Haoran | Managing control - governing body | Individual | 11/01/2019 | |
| Apolinar, Adam | Corporate officer | Individual | 07/01/2022 | |
| Burnam, Soon | Corporate officer | Individual | 12/20/2021 | |
| Keetch, Chad | Corporate officer | Individual | 03/01/2011 | |
| Lake Island Healthcare, Inc. | Operational/managerial control | Organization | 11/01/2019 | |
| Martin, Kyle | Operational/managerial control | Individual | 11/01/2019 | |
| Yu, Haoran | Operational/managerial control | Individual | 11/01/2019 | |
| Ensign Services Inc | Adp of the SNF | Organization | 08/14/2019 | |
| Lake Island Healthcare, Inc. | Adp of the SNF | Organization | 10/13/2025 | |
| Lakewood Health Holdings LLC | Adp of the SNF | Organization | 11/01/2019 | |
| Standard Bearer Healthcare Op, LP | Adp of the SNF | Organization | 11/01/2019 | |
| The Ensign Group Inc | Adp of the SNF | Organization | 11/01/2019 | |
| Martin, Kyle | Adp of the SNF | Individual | 11/01/2019 | |
| Yu, Haoran | Adp of the SNF | Individual | 11/01/2019 |
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.