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Onion Creek Nursing and Rehabilitation Center

1700 Onion Creek Pkwy, Austin, TX 78748 · Travis County · (512) 291-4900

125 certified beds, about 110 residents a day · For profit - Corporation · Medicare and Medicaid since 2011

Last standard inspection more than 2 years ago Certified for Medicaid Certified for Medicare
Overall
1 of 5
Health inspections
2 of 5
Staffing
1 of 5
Quality measures
4 of 5

CMS Care Compare ratings, data as of September 1, 2026 · CCN 676271 · See it on Medicare.gov · Compare with other homes

The record in brief

At its most recent standard inspection, on February 29, 2024, inspectors cited 6 health deficiencies (the Texas average is 9.4, the national average 9.2).

Of 27 health citations since September 2021, 3 were rated as actual harm or immediate jeopardy to residents (2 immediate jeopardy).

CMS lists 2 fines totaling $51,337 in the last three years; the largest was $42,224, and the latest is dated April 5, 2025.

Nurses and nurse aides worked 3.09 hours per resident per day, against 3.39 across Texas and 3.86 nationally. Registered nurses accounted for 0.22 of those hours.

50.5% 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.

Health inspections

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.

Potential for minimal harm Potential for more than minimal harm Actual harm Immediate jeopardy Found on a complaint visit

Where its citations fall on CMS's grid

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 27 health citations on file.

Severity
Isolated
Pattern
Widespread
Immediate jeopardy
1J
1K
0L
Actual harm
0G
1H
0I
Potential for more than minimal harm
12D
10E
2F
Potential for minimal harm
0A
0B
0C
June 5, 2026Complaint inspection · 1 citation
  1. D
    Ensure that residents are free from significant medication errors.
    F760 · Pharmacy Service · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) July 16, 2026
    Inspectors wroteBased on observation, record review and interviews, the facility failed to ensure residents remained free of any significant errors for 1 of 3 residents (Resident # 1) reviewed for medication error. The facility failed to ensure resident #1 received physician ordered medication Apixaban 2.5 mg and Insulin Glargine 16 units on May 31,2026 as prescribed. This failure could place residents at risk of complications such as blood clots or high blood sugars levels. Observation of pyxis system (automated medication cabinet that stores frequently used medications) on 6/5/2026 at 09:00 AM reflected the medication Apixaban 2.5 mg (medication used to decrease the risk of blood clot formation) was available for administration to the resident with 9 tablets available, there was no insulin glargine (medication used to lower blood sugar) available in the pyxis. [...]
January 28, 2026Complaint inspection · 1 citation
  1. D
    Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
    F580 · Resident Rights · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) March 3, 2026
    Inspectors wroteBased on interviews, and record review, the facility failed to immediately inform the resident and the resident representative(s) when there is a a need to alter treatment significantly for one (Resident #1) of five residents reviewed for change in condition. The facility failed to ensure that Resident #1's RP was notified when Resident #1's MD discontinued his Amoxicillin-Potassium Clavulanate, Alprazolam, Divalproex Sodium, Mirtazapine, Furosemide, Eplerenone, Glipizide and Potassium Chloride, on 01/13/2026. This failure could result in decreased continuity of care, and a delay in the treatment and services needed.
November 5, 2025Complaint inspection · 1 citation
  1. E
    Ensure that residents are free from significant medication errors.
    F760 · Pharmacy Service · No actual harm, potential for more than minimal harm, pattern · found on a complaint visit · Corrected (the home has a date of correction) December 12, 2025
    Inspectors wroteBased on interviews and records review the facility failed to ensure Residents were free of any significant medication error for one (Resident #1) of three Residents review for medication. The facility failed to follow physician's orders for Resident #1 when she was discharged from the hospital on [DATE]. Resident #1's order for Divalproex Sodium (Depakote) [A type of drug that is used to prevent or treat seizures or convulsions by controlling abnormal electrical. It can also be used as mood stabilizer) for this with intervention to give medications as ordered.] Oral Tablet Delayed Release 250 MG (Divalproex Sodium) Give 1 tablet BID was never carried out and Resident #1 did not receive six doses of the medication. This deficient practice placed residents at risk of not receiving therapeutic dose of medication and hospitalization.
July 3, 2025Complaint inspection · 2 citations
  1. D
    Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
    F656 · Resident Assessment and Care Planning · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) July 26, 2025
    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 timetables to meet a resident's medical, nursing, and mental and psychosocial needs for one (Resident #1) of five residents reviewed for care plans, in that: The facility failed to care plan Resident #1's history of refusal of care and medication from 01/02/2025 to present. This failure placed residents at risk of not receiving goals and interventions for the residents' individual needs for person-centered care.
  2. D
    Assist a resident in gaining access to vision and hearing services.
    F685 · Quality of Life and Care · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) July 18, 2025
    Inspectors wroteBased on interview and record review the facility failed to ensure that residents received proper treatment to maintain vision abilities by not assisting the resident in making appointments for 1 of 20 residents (Resident #1) reviewed for vision. The facility failed to address Resident #1's glasses and vision issues, first requested by Resident #1's family via email in March of 2025. Resident #1 did not corrective lenses to assist her vision. This deficient practice could affect residents who need vision and hearing services and could result in avoidable vision loss and a decreased quality of life.
April 5, 2025Complaint inspection · 1 citation
  1. K
    Provide appropriate pressure ulcer care and prevent new ulcers from developing.
    F686 · Quality of Life and Care · Immediate jeopardy to resident health or safety, pattern · found on a complaint visit · Corrected (the home has a date of correction) April 21, 2025
    Inspectors wroteBased on observation, interview, and record review the facility failed to ensure residents received care, consistent with professional standards of practice, to prevent pressure ulcers and does not develop pressure ulcers unless the individual's clinical condition demonstrates that they were unavoidable for 1 of 14 residents at risk of pressure ulcers. The facility failed to ensure Resident #1 had interventions in place to prevent an Unstageable Pressure ulcer in the thoracic spine (thoracic spine is the middle section of your spine. It starts at the base of your neck and ends at the bottom of your ribs). From 02/28/2025 to 03/04/2025 Resident #1 did not receive wound care treatment or interventions to prevent the abrasion found at admission from developing into an Unstageable Pressure ulcer in the thoracic spine. An IJ was identified on 04/03/2025. [...]
February 19, 2025Complaint inspection · 2 citations
  1. J
    Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
    F689 · Quality of Life and Care · Immediate jeopardy to resident health or safety, isolated · found on a complaint visit · Corrected (the home has a date of correction) March 5, 2025
    Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the residents environment remained as free of accident hazards as is possible and ensure each resident received adequate supervision for one (Resident #1) of three residents reviewed for accidents and hazards. The facility failed to ensure Resident #1 did not leave the facility with nursing staff being aware as she was found approximately 2.5 hours later and approximately 4.2 miles away (at a store off a major highway - 65 MPH) after being contacted by an outside party 02/16/25. The temperature was approximately 58 degrees. This failure resulted in an identification of an Immediate Jeopardy (IJ) on 02/18/25 at 2:16 PM and an IJ template was given. [...]
  2. D
    Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
    F609 · Freedom from Abuse, Neglect, and Exploitation · No actual harm, potential for more than minimal harm, isolated · found on a complaint visit · Corrected (the home has a date of correction) March 5, 2025
    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 one (Resident #1) of three residents reviewed for abuse and neglect. The facility failed to report to the State Agency an incident when Resident #1 left the facility without nursing staff being aware on 02/16/25. This failure could place residents at risk of abuse or and neglect.
October 2, 2024Complaint inspection · 1 citation
  1. H
    Provide appropriate treatment and care according to orders, resident’s preferences and goals.
    F684 · Quality of Life and Care · Actual harm, pattern · found on a complaint visit · Corrected (the home has a date of correction) October 3, 2024
    Inspectors wroteBased on 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 one (Resident #1) of three residents reviewed for quality of care. The facility failed to implement orders from the hospital for blood glucose monitoring four times a day and administering of a sliding scale insulin four times a day upon Resident #1's admission on [DATE]. Orders were not implemented until 10/01/24 and during that timeframe Resident #1 was worried about his diabetes, felt sick to his stomach, funny, different, and really off. This failure could place residents at risk of not receiving necessary medical care, harm, and hospitalization.
July 1, 2024Complaint inspection · 2 citations
  1. E
    Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
    F755 · Pharmacy Service · No actual harm, potential for more than minimal harm, pattern · found on a complaint visit · Corrected (the home has a date of correction) July 9, 2024
    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 two (Resident #1 and Resident #2) of four residents reviewed for pharmacy services. The facility failed to administer scheduled time-sensitive medications to Residents #1 and #2 until 2.5 - 6 hours after the ordered scheduled time from 06/24/24 - 06/27/24. This deficient practice could place residents at risk of not receiving the intended therapeutic benefit of the medications and supplements, worsening or exacerbation of chronic medical conditions, and hospitalization.
  2. E
    Ensure that residents are free from significant medication errors.
    F760 · Pharmacy Service · No actual harm, potential for more than minimal harm, pattern · found on a complaint visit · Corrected (the home has a date of correction) July 2, 2024
    Inspectors wroteBased on interview and record review, the facility failed to ensure residents were free of any significant medication errors for two (Resident #1 and Resident #2) of four residents reviewed for pharmacy services. The facility failed to administer scheduled time-sensitive medications to Residents #1 and #2 until 2.5 - 6 hours after the ordered scheduled time from 06/24/24 - 06/27/24. This deficient practice could place residents at risk of not receiving the intended therapeutic benefit of the medications and supplements, worsening or exacerbation of chronic medical conditions, and hospitalization.
February 29, 2024Standard inspection · 6 citations
  1. F
    Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
    F812 · Nutrition and Dietary · No actual harm, potential for more than minimal harm, widespread · Corrected (the home has a date of correction) March 8, 2024
    Inspectors wroteBased on observation, interview and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for foods safety for 1 of 1 kitchen reviewed for food safety and sanitation. The facility failed to ensure all food items were labeled and dated. The facility failed to ensure dishes were sanitized at the correct concentration of sanitizer (50 ppm). The facility failed to ensure employee's personal food items were stored separately from resident food items. These failures placed residents at risk of foodborne illness.
  2. E
    Keep residents' personal and medical records private and confidential.
    F583 · Resident Rights · No actual harm, potential for more than minimal harm, pattern · Corrected (the home has a date of correction) March 1, 2024
    Inspectors wroteBased on observation, interview, and record review the facility failed to ensure personal privacy for residents during care by two (Resident #298, Resident #73) of seven resident reviewed for privacy. The facility failed to ensure that MDS B, LVN C, CNA G and CNA H, CNA J knocked/announced themselves before entering Resident #298 and #73's rooms. This failure puts all residents at risk of not having their privacy respected by staff.
  3. E
    Provide care and assistance to perform activities of daily living for any resident who is unable.
    F677 · Quality of Life and Care · No actual harm, potential for more than minimal harm, pattern · Corrected (the home has a date of correction) March 15, 2024
    Inspectors wroteBased on observation, interview and record review, the facility failed to ensure all residents who were unable to carry out activities of daily living received the necessary services to maintain good grooming and person hygiene for 4 of 8 (Resident #4, Resident #8, Resident #70 and Resident #83) residents reviewed for ADLs. The facility failed to ensure Resident #70's fingernails were trimmed. The facility failed to ensure Resident #8's fingernails were trimmed and cleaned. The facility failed to ensure Resident #83's toenails were trimmed. The facility failed to ensure Resident #4 received a facial shave.
  4. D
    Ensure each resident receives an accurate assessment.
    F641 · Resident Assessment and Care Planning · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) March 15, 2024
    Inspectors wroteBased on interviews and record review the facility failed to have an assessment that accurately reflected the status for 2 of 3 Residents (Resident #96 and Resident #97) reviewed for assessment accuracy in that: 1. Resident #96's discharge MDS dated [DATE] reflected she was discharged to Short Term General Hospital (acute hospital) when she was discharged home. 2. Resident #97's discharge MDS dated [DATE] reflected he was discharged home when he was discharged to Short Term General Hospital (acute hospital). This failure could place residents at risk of not receiving the proper care and services due to inaccurate records.
  5. D
    Provide activities to meet all resident's needs.
    F679 · Quality of Life and Care · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) March 29, 2024
    Inspectors wroteBased on observation, interview and record review, the facility failed to ensure all residents were provided, based on the preferences of each resident, an ongoing program to support residents in their choice of activities, both facility-sponsored group and individual activities, designed to meet the interests and support the physical, mental, and psychosocial well-being of each resident for 1 of 8 (Resident #89) residents reviewed for activities. The facility failed to provide regular, individualized activities to Resident #89. This failure placed residents at risk of decreased physical, mental, and psychosocial well-being.
  6. D
    Ensure therapeutic diets are prescribed by the attending physician and may be delegated to a registered or licensed dietitian, to the extent allowed by State law.
    F808 · Nutrition and Dietary · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) March 8, 2024
    Inspectors wroteBased on observation, interview and record review, the facility failed to provide the physician prescribed therapeutic diet to 1 of 4 residents (Resident #298) reviewed for therapeutic diets, in that: Resident #2 did not receive no salt added diet as ordered. This failure affected one resident and placed her at risk for using the salt and causing further health issues.
December 2, 2022Standard inspection · 4 citations
  1. F
    Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
    F812 · Nutrition and Dietary · No actual harm, potential for more than minimal harm, widespread · Corrected (the home has a date of correction) December 9, 2022
    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 2 of 2 nourishment refrigerators (MC Refrigerator and Refrigerator B) reviewed for food handling sanitation. 1. The facility failed to ensure temperature logs were completed and maintained. 2. The facility failed to ensure expired milk was removed from the reach-in nourishment refrigerators. 3. The facility failed to ensure foods in the memory care unit refrigerator were labeled and dated. These failures could place residents at risk for cross-contamination and foodborne illnesses.
  2. E
    Ensure medication error rates are not 5 percent or greater.
    F759 · Pharmacy Service · No actual harm, potential for more than minimal harm, pattern · Corrected (the home has a date of correction) December 9, 2022
    Inspectors wroteBased on observation, interview, and record review the facility failed to ensure a medication error rate was not 5% or greater. The facility had a medication error rate of 18%, based on 5 errors out of 27 opportunities, which involved 1 of 5 residents (Resident #56) and 1 of 4 staff (LVN B) reviewed for medication administration. The facility failed to ensure LVN B administered medications according to the physician's orders and per professional standards which resulted in an 18% medication administration error rate. This deficient practice could place residents at risk of not receiving therapeutic effects of their medications and possible adverse reactions.
  3. D
    Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.
    F578 · Resident Rights · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) December 9, 2022
    Inspectors wroteBased on interview and record review, the facility failed to ensure the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive for 2 of 18 residents (Residents #13 and #53) reviewed for advance directives. 1. The facility failed to ensure Resident #13's OOH-DNR had the attending physician's medical license number documented on the form. 2. The facility failed to ensure Resident #34's OOH-DNR form included the physician's license number, date signed, and printed name. These deficient practices could place residents at-risk of having their end of life wishes dishonored and having CPR performed against their wishes.
  4. D
    Provide and implement an infection prevention and control program.
    F880 · Infection Control · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) December 9, 2022
    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 disease and infections for 2 of 4 staff (CNA C and CNA D) and 1 of 2 residents (Resident #53) reviewed for infection control. 1. The facility to ensure CNA C, while assisting CNA D with perineal/incontinent care to Resident #53, did not place the clear plastic bag with incontinent supplies on the floor. 2. The facility failed to ensure CNA D changed gloves when going from dirty to clean sites when providing perineal/incontinent care to Resident #53. These deficient practices could place residents at risk for cross contamination and/or spread of infection.
September 10, 2021Standard inspection · 6 citations
  1. E
    Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
    F656 · Resident Assessment and Care Planning · No actual harm, potential for more than minimal harm, pattern · Corrected (the home has a date of correction) September 28, 2021
    Inspectors wroteBased on 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 includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment. The comprehensive care plan must describe the following The services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being as required for 3 of 7 ( #4, #13, #26) reviewed for PASSAR care plans in that: 1. Resident #4's PASSAR care plan was not developed. 2. Resident #13's PASSAR care plan was not developed. 3. Resident #26's PASSAR care plan was not developed. [...]
  2. E
    Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
    F756 · Pharmacy Service · No actual harm, potential for more than minimal harm, pattern · Corrected (the home has a date of correction) September 28, 2021
    Inspectors wroteBased on interview and record review the facility failed to ensure all irregularities identified by the licensed pharmacist were reviewed and what, if any, action was taken to address it by the attending physician for 1 of 5 residents (Resident #86) reviewed for unnecessary medications, in that: The facility failed to ensure Resident #86's Pharmacist consultant recommendation reviews for, the necessity of continued use of as needed PRN Ativan (anti-anxiety medication), provide a stop date for the medication, and ensured a physician responded to the recommendations for 4 months. This deficient practice could affect residents who received monthly pharmacy reviews at risk of receiving unnecessary medications and dosages.
  3. E
    Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.
    F758 · Pharmacy Service · No actual harm, potential for more than minimal harm, pattern · Corrected (the home has a date of correction) September 28, 2021
    Inspectors wroteBased on interview and record review, the facility failed to ensure that PRN orders for psychotropic drugs were limited to 14 days for 1 of 5 residents (Resident #86) reviewed for psychotropic drugs, in that: Resident #86 had a PRN order for Ativan (an anti-anxiety medication) for more than 14 days without physician documentation re-evaluating the medication to continue its use and did not have a stop date for 4 months. This deficient practice could place residents who received psychotropic medications at risk of adverse drug consequences, receiving unnecessary medications, and decline in their physical and psychosocial well-being.
  4. E
    Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
    F761 · Pharmacy Service · No actual harm, potential for more than minimal harm, pattern · Corrected (the home has a date of correction) September 28, 2021
    Inspectors wroteBased on observations, interviews, and record reviews the facility failed to store all drugs and biologicals in locked compartments under proper temperature controls, and permit only authorized personnel to have access to the keys, for 2 of 9 medication carts reviewed and 1 of 2 residents (Resident #34) reviewed for drugs and biologicals in locked compartments, in that: 1. The medication cart on hall 100 was left unattended, unlocked, and out of sight from Medication Aide D (MA D). 2. The medication cart on hall 300 was left unattended and unlocked, and out of site from Licensed Vocational Nurse E (LVN E). 3. Resident #34 had non prescribed, unsecured, medications at the bedside. This deficient practice could place residents at risk for loss of control of prescribed medications.
  5. D
    Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
    F690 · Quality of Life and Care · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) September 28, 2021
    Inspectors wroteBased on observation, interview and record review the facility failed to ensure that a resident who is incontinent of bladder receives appropriate treatment and services to prevent urinary tract infections for 1 of 1 Resident (Resident #59) who was observed for catheter placement. Nursing staff did not ensure Resident #59's indwelling urinary catheter tubing was securely anchored to his upper thigh by applying a strap. This deficient practice could affect residents with an indwelling urinary catheter causing penile laceration from prolonged traction from the unsecured catheter and it could contribute to urinary infections.
  6. D
    Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
    F842 · Resident Assessment and Care Planning · No actual harm, potential for more than minimal harm, isolated · Corrected (the home has a date of correction) September 28, 2021
    Inspectors wroteBased on interview and record review the must maintain medical records on each resident that are accurately documented for 1 of 7 (#21) record reviewed for resident records in that: Resident #21's code status on face sheet and care plan did not match. This failure could affect all residents at risk of documentation errors and receiving inaccurate care and services.

Fire safety inspections

3 fire safety citations on file: 1 on February 29, 2024, 2 on September 10, 2021.

Every fire safety citation3 citations
  1. F
    Have generator or other power source capable of supplying service within 10 seconds.
    K 918 · February 29, 2024 · Corrected (the home has a date of correction)
  2. F
    Have generator or other power source capable of supplying service within 10 seconds.
    K 918 · September 10, 2021 · Corrected (the home has a date of correction)
  3. E
    Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.
    K 222 · September 10, 2021 · Corrected (the home has a date of correction)

Fines and payment denials

DatePenaltyAmount or length
April 5, 2025Fine $42,224
February 19, 2025Fine $9,113

A payment denial means Medicare and Medicaid stopped paying for new admissions for that period.

Staffing

Hours of care per resident per day, from the payroll records every home sends CMS. Higher means more staff time with each resident.

MeasureThis homeTexasUnited States
All nursing staff (RN, LPN and aides)3.093.393.86
Registered nurses0.220.430.69
All nursing staff on weekends2.762.983.42
Nurse aides1.84
Licensed practical nurses1.04
Nursing staff turnover (share who left in a year)50.5%55.3%45.8%
Registered nurse turnover55.6%54.6%42.9%
Administrators who left0

CMS expects 3.44 hours a day for residents as sick as this home's (its case-mix figure). The staffing star compares the two.

Staffing by quarter, from daily payroll records

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 3.22 on weekdays and 2.76 on weekends, 14% 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 3.24 in April to June 2025 to 3.09 in January to March 2026.

QuarterAll nursing staffRegistered nursesWeekdaysWeekendsContract staff shareDays with no RN hoursResidents a day
Jan to Mar 20263.090.223.222.76 0.0%2 of 90110
Oct to Dec 20253.120.273.262.74 0.0%1 of 92111
Jul to Sep 20253.110.253.272.70 0.0%0 of 92109
Apr to Jun 20253.240.233.432.75 0.0%3 of 91111
United States, Jan to Mar 20263.750.623.923.335.3%0.5% of days
Texas, Jan to Mar 20263.330.403.502.932.2%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

Staff pay at this home

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.

Official wage estimates for Texas

JobMedianMiddle halfEmployed
Texas, all employers
CNAs (nursing assistants)$18.03$16.97 to $20.7188,680
LPNs and LVNs$29.92$27.46 to $32.8957,560
Registered nurses$46.14$38.06 to $50.53271,380
United States, nursing care facilities
CNAs (nursing assistants)$20.67$17.91 to $22.55534,270
LPNs and LVNs$33.86$30.05 to $37.40188,210
Registered nurses$41.11$37.85 to $47.68142,270

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.

Work here? Share your pay anonymously

For Onion Creek Nursing and Rehabilitation Center. No name, email or phone, and nothing you could type about a resident: every answer is a number or a choice.

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Every report is reviewed before it counts; what it says about the home never decides whether it counts. How pay reports are handled.

How staff pay reports work · CNA pay by state

Quality measures

The measures CMS uses for the quality star. Lower is better for every one of them.

MeasureThis homeTexasUS
Percentage of long-stay residents whose need for help with daily activities has increased
Long Stay residents, 2025Q2-2026Q1
19.215.813.9
Percentage of long-stay residents with a catheter inserted and left in their bladder
Long Stay residents, 2025Q2-2026Q1
0.00.30.8
Percentage of long-stay residents with a urinary tract infection
Long Stay residents, 2025Q2-2026Q1
0.30.81.6
Percentage of long-stay residents experiencing one or more falls with major injury
Long Stay residents, 2025Q2-2026Q1
2.93.33.2
Percentage of short-stay residents who newly received an antipsychotic medication
Short Stay residents, 2025Q2-2026Q1
0.81.51.6
Percentage of long-stay residents whose ability to walk independently worsened
Long Stay residents, 2025Q2-2026Q1
14.714.014.1
Percentage of long-stay residents with pressure ulcers
Long Stay residents, 2025Q2-2026Q1
1.93.84.6
Percentage of long-stay residents who received an antipsychotic medication
Long Stay residents, 2025Q2-2026Q1
8.29.615.4
Percentage of short-stay residents who were rehospitalized after a nursing home admission
Short Stay residents, 20250101-20251231
24.925.723.8
Percentage of short-stay residents who had an outpatient emergency department visit
Short Stay residents, 20250101-20251231
9.312.312.0
Number of hospitalizations per 1000 long-stay resident days
Long Stay residents, 20250101-20251231
2.52.21.9
Number of outpatient emergency department visits per 1000 long-stay resident days
Long Stay residents, 20250101-20251231
0.92.11.8

Short-term rehab results

For a stay to recover after a hospital visit, these are the results CMS publishes for Onion Creek 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 (49.7% of residents, after adjusting for how sick they were). How to read these, and what Medicare pays for.

Went home or back to the community

49.7% 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. 76 eligible stays.

Potentially preventable readmissions

10.6% 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. 90 eligible stays.

Infections that led to a hospital stay

6.8% 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. 64 eligible stays.

Self-care and mobility at discharge

53.9% 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. 52 residents counted.

Falls with major injury

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. 81 residents counted.

New or worsened pressure ulcers

3.3% 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. 81 residents counted.

Medication list given at discharge

94.7% 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. 38 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.

Owners and operators

Legal business name: HAMILTON COUNTY HOSPITAL DISTRICT. CMS links this home to The Ensign Group, a group of 344 nursing homes averaging 3.2 stars overall.

NameRoleTypeShareSince
Cooper, BrianManaging control - governing bodyIndividual10/01/2022
Talley, CaushaManaging control - governing bodyIndividual10/01/2022
Burnam, SoonCorporate officerIndividual01/18/2022
Hooper, GradyCorporate officerIndividual12/01/2015
Keetch, ChadCorporate officerIndividual03/01/2011
Roadrunner Healthcare, Inc.Operational/managerial controlOrganization10/01/2022
Cooper, BrianOperational/managerial controlIndividual10/01/2022
Talley, CaushaOperational/managerial controlIndividual10/01/2022
Ensign Services IncAdp of the SNFOrganization01/18/2022
Roadrunner Healthcare, Inc.Adp of the SNFOrganization10/23/2025
Cooper, BrianAdp of the SNFIndividual10/01/2022
Talley, CaushaAdp of the SNFIndividual10/01/2022

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.

Questions to ask on a visit

Chosen from this home's own inspection record.

  1. How are medications reviewed, and how often are antipsychotic or sedating drugs used?Inspectors cited 8 problems in this area, most recently on June 5, 2026: "Ensure that residents are free from significant medication errors."
  2. How do you prevent falls and pressure injuries, and how are families told when one happens?Inspectors cited 7 problems in this area, most recently on July 3, 2025: "Assist a resident in gaining access to vision and hearing services."
  3. When is the care plan meeting, and can family attend it?Inspectors cited 4 problems in this area, most recently on July 3, 2025: "Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured."
  4. How do residents and families raise a complaint or grievance, and how fast is it answered?Inspectors cited 3 problems in this area, most recently on January 28, 2026: "Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident."
  5. Who is on the floor on Saturday and Sunday, and how many residents does each aide care for?Weekend nurse staffing here was 2.76 hours per resident per day, below the Texas average of 2.98.

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Common questions

What is Onion Creek Nursing and Rehabilitation Center's Medicare star rating?
CMS rates Onion Creek Nursing and Rehabilitation Center 1 out of 5 stars overall, with 2 for health inspections, 1 for staffing and 4 for quality measures (CMS data as of September 1, 2026).
How many deficiencies did Onion Creek Nursing and Rehabilitation Center get at its last inspection?
6 health deficiencies at the standard inspection on February 29, 2024. The Texas average is 9.4.
Has Onion Creek Nursing and Rehabilitation Center been fined?
Yes. CMS lists 2 fines totaling $51,337 in the last three years.
Does Onion Creek Nursing and Rehabilitation Center accept Medicaid?
It is certified to take Medicaid (CMS lists it as "Medicare and Medicaid"). Certification does not mean a Medicaid bed is open: ask the admissions office.
Who owns Onion Creek Nursing and Rehabilitation Center?
CMS lists 12 owners and managers, and links the home to The Ensign Group. Legal business name: HAMILTON COUNTY HOSPITAL DISTRICT.

Sources

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