930 Roy Richard Dr, Schertz, TX 78154 · Guadalupe County · (210) 566-9100
120 certified beds, about 97 residents a day · Government - Hospital district · Medicare and Medicaid since 2006
CMS Care Compare ratings, data as of September 1, 2026 · CCN 676121 · See it on Medicare.gov · Compare with other homes
At its most recent standard inspection, on June 12, 2026, inspectors cited 10 health deficiencies (the Texas average is 9.4, the national average 9.2).
Of 60 health citations since December 2023, 4 were rated as actual harm or immediate jeopardy to residents (4 immediate jeopardy).
CMS lists 3 fines totaling $114,303 in the last three years; the largest was $82,676, and the latest is dated October 10, 2025.
Nurses and nurse aides worked 3.26 hours per resident per day, against 3.39 across Texas and 3.86 nationally. Registered nurses accounted for 0.53 of those hours.
93.3% of nursing staff left within the year CMS measured (Texas average 55.3%).
CMS links it to Creative Solutions in Healthcare, an affiliated group of 149 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 60 health citations on file.
Inspectors wroteBased on observations, interviews and record reviews, the facility failed to ensure assessments accurately reflected the status of the residents for 4 of 24 residents (Residents #54, #57, #81 and #91) reviewed for resident assessments. 1. The facility failed to ensure Resident #54's injection type was accurately reflected on her admission MDS assessment dated [DATE]. 2. The facility failed to document Resident #57's use of antidepressant and scheduled pain medication on the quarterly MDS assessment. 3. The facility failed to ensure Resident #81s active diagnosis of respiratory failure was reflected on his quarterly MDS assessment dated [DATE]. 4. The facility failed to document Resident #91's use of opioids and scheduled pain medication on the quarterly MDS assessment. These deficient practices could place residents at risk of inadequate care.
Inspectors wroteBased on observation, interviews, and record reviews, the facility failed to develop and implement a comprehensiveperson-centered care plan for each resident, consistent with the resident rights, which includes measurable objective andtimes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in thecomprehensive assessment for 3 Residents (Resident #7, Resident #44, Resident #54, and Resident #81) of 32 residents reviewed forcare plans. 1. The facility failed to reflect Resident #7's hospice services in her comprehensive care plan. 2. The facility failed to reflect Resident #44 used a sensor pad in his comprehensive care plan. 3. The facility failed to reflect Resident #81 would take off his oxygen canula and put it on. These deficient practices place residents at risk of missed or miscommunicated care.
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 and to ensure drug records were in order and that an account of all controlled drugs was maintained and periodically reconciled for 2 of 6 residents (Resident #8 and Resident #20), 1 of 4 medication carts (the 500 hall medication aide cart), and 1 of 2 medication rooms (the long term care unit medication room) reviewed for pharmacy services.1. The facility failed to ensure Resident #8's long-acting insulin was accurately prepared before administration.2. [...]
Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure all drugs and biologicals used in the facility were stored and labeled in accordance with currently accepted professional principles for 1 of 6 residents (Resident #51), 3 of 4 medication carts (the 700/800 hall nurse cart, the 800 hall medication aide cart, and the 500/600 hall nurse cart) and 1 of 2 medication rooms (the rehabilitation unit medication room) reviewed for medication storage and labeling. The facility failed to ensure the labels of all prescription medications located inside the 700/800 hall nurse cart and the 800 hall medication aide cart, matched the orders in the electronic medical record for Resident #51. The facility failed to ensure all medications located inside the 500/600 hall nurse cart were stored in labeled containers. [...]
Inspectors wroteBased on interview and record review, the facility failed to maintain medical records for each resident that were complete and accurately documented for 2 (Residents #8 and #11) of 32 residents reviewed for complete and accurately documented clinical records, in that: 1. Resident #8's clinical record included an order to notify the Medical Doctor or Nurse Practitioner if the resident's blood sugar level was measured above 250 and an additional order to notify the Medical Doctor or Nurse Practitioner if the resident's blood sugar level was measured above 400. 2. Resident #11's diagnoses of insomnia and anxiety were not included in the resident's list of diagnoses and were therefore not listed on the resident's facesheet. These deficient practices could result in substandard level of care.
Inspectors wroteBased on observation, interview and record review, the facility failed to provide reasonable accommodation for residents.needs for 1of 8 residents (Resident #44) reviewed for quality of care. The facility failed to ensure Resident #44's call sensor pad was within reach. The deficient practice could place residents at risk of not receiving care or attention needed.
Inspectors wroteBased on interview and record review, the facility failed to electronically transmit encoded, accurate, and complete MDS data to the CMS System including. A subset of items upon a resident's transfer, reentry, discharge, and death, for 1 (Resident #83) of 4 residents reviewed for completed MDS data, in that: The facility did not complete, encode, or transmit an MDS assessment upon the discharge of Resident #83. This deficient practice could result in inaccurate MDS data regarding residents reflected in the CMS system.
Inspectors wroteBased on interviews and record review, the facility failed to ensure all Pre-admission Screening and Resident Review (PASRR) level 1 residents with mental illness were provided with a PASRR level 2 evaluation for 1 of 4 residents (Resident #2), reviewed for resident assessment. Resident #2's PASRR level 1 screening form did not indicate mental illness. This could place residents at risk of not receiving necessary specialized services to meet their individual needs.
Inspectors wroteBased on interview and record review, the facility failed to review and revise the comprehensive care plan for 2 (Residents #1 and #8) of 32 residents reviewed for comprehensive care plans, in that: 1. Resident #1's diagnoses of frequent urinary tract infections, bleeding hemorrhoids, traumatic brain injury, pneumonia, chronic kidney disease, and diverticulitis were not included in the resident's care plan. 2. Resident #8's physician order for biannual blood tests to check drug levels and screen for potential side effects of valproic acid was not included in the resident's care plan. These deficient practices could result in substandard level of care.
Inspectors wroteBased on observation, interview, and record review, the facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 2 of 32 residents (Resident #7 and Resident #81) reviewed for infection control in that: 1. The facility failed to ensure RN B maintained proper hand hygiene when administering medication through Resident #7's PEG tube (a small, flexible tube placed through the abdominal wall directly into the stomach allowing for the provision of nutrition, fluids, and medications without swallowing). 2. The facility failed to ensure Resident #81's oxygen tubing was bagged when not in use. These facility failures could place residents at risk of cross contamination and the spread of infections.
Inspectors wroteBased on interviews and record reviews, the facility failed to ensure assessments accurately reflected the resident's status of 1 of 4 residents (Resident #1) reviewed for accuracy of assessments. The facility failed to ensure Resident #1's quarterly MDS assessment dated [DATE] accurately coded to reflect Resident #1's diagnoses of GERD (gastric reflex) and hypothyroidism. The facility failed to ensure Resident #1's quarterly MDS assessment dated [DATE] and Resident #2's assessment were accurate and reviewed and signed by a Registered Nurse before submission. This failure could place residents at risk for not receiving needed care and services to maintain the highest level of well-being.
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 includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment for 1 of 4 residents (Resident #1) reviewed for care plans: The facility failed to ensure Resident #1's comprehensive care plan was accurate and included the correct diagnoses of hypothyroidism (instead of hyperthyroidism) with appropriate interventions. This deficient practice could cause confusion for staff members responsible for providing direct care to the residents and place residents at risk of receiving improper care and services.
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 4 residents (Resident #2) reviewed for medical records accuracy, in that: The facility failed to ensure Resident #2 physician progress notes were obtained by the medical provider and uploaded into the medical record. This failure could affect residents whose records were maintained by the facility and could place them at risk for an incomplete clinical picture and errors in care and treatment.
Inspectors wroteBased on observation, interview and record review the facility failed to implement a comprehensive person-centered care plan for each resident to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment for 1 of 12 residents (Resident #1) reviewed for care plans. The facility failed to ensure Resident #1 was transferred with the appropriate number of qualified staff required when using a mechanical lift. This failure could place the residents at risk of injury by not following the resident's care plan and clinical standards of practice.
Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the resident environment remained as free of accident hazards as possible and each resident received adequate supervision to prevent accidents for 1 of 6 residents (Resident #1) reviewed for accidents and supervision. The facility failed to provide appropriate supervision for Resident #1 resulting in Resident #1 leaving the facility without the facility's knowledge on 08/28/2025 between 1:20 and 1:40 AM and being found face down on the ground in the facility parking lot. The noncompliance was identified as PNC. The Immediate Jeopardy (IJ) began on 08/28/25 and ended on 08/29/25. The facility had corrected the noncompliance before the investigation began. This deficient practice could place residents at-risk of harm, serious injury, or death.
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, 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 for 2 of 8 residents (Resident #2 and #3) reviewed for care plans: The facility failed to ensure Residents #2's Care Plan reflected he refused wound treatment prior to 10/01/25. The facility failed to ensure Residents #3's Care Plan reflected her behaviors of making allegations/accusations about resident care.
Inspectors wroteBased on interviews and record reviews, the facility failed to ensure resident medical records were kept in accordance with accepted professional standards and practices, the facility must maintain medical records on each resident that are complete and accurately documented for 1 of 6 residents (Resident #2) reviewed for clinical records. The facility failed to ensure Resident #2's wound treatment was accurately documented from 10/01/25 to 10/06/25. These failures could place residents at risk of not receiving the care and services needed due to inaccurate or incomplete clinical records.
Inspectors wroteBased on observation, interview and record review the facility failed to immediately inform the resident, consult with the resident's physician and notify, consistent with his or her authority, the resident representative(s) when there was a an accident involving the resident which resulted in an injury and had the potential for requiring physician intervention, and or a significant change in the resident's physical, mental, or psychosocial status for 1 of 4 residents (Resident #1) reviewed for notification to the physician. LVN A failed to report to the physician and Resident #1's representative a change of condition when Resident #1 was discovered injured and confused on the floor by her bedside on 04/20/2025 and was hospitalized and diagnosed with acute congested heart failure fluid overload, in addition to right rib fractures to the 3rd, 7th and 9th ribs, 3 hours later. [...]
Inspectors wroteBased on observation, interview, and record review the facility failed to ensure, based on the comprehensive assessment of a resident, 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 4 residents (Resident #1) reviewed quality of care. On 4/20/2025, early morning, LVN A failed to provide quality care for Resident #1, by not following facility protocol for an unwitnessed fall with injuries to begin neurological assessments, reporting to the physician and the residents representative, when Resident #1 was discovered on the floor by her bedside and hospitalized for chronic heart failure with fluid overload in addition to fractures to right ribs 3rd, 7th and 9th ribs, 3 hours later. [...]
Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure all drugs and biologicals were stored in locked compartments for 1 (the long-term care medication room) of 2 medication rooms and 1 (Resident #80) of 20 residents reviewed for storage and medication carts. 1. The long-term care medication room was opened without locking. 2. There was one 10 cc syringe of normal saline for flushing Resident #80's PICC line (peripherally inserted central catheter: used to deliver medications and other treatments directly to the large central veins near the heart) on the resident's nightstand unattended. This failure could place residents at risk of misappropriation of medications and using normal saline to different purpose, such as drinking it.
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. The facility failed to ensure dietary staff used facial hair restraints properly during meal preparation. The facility failed to ensure the dietary staff used proper hand placement and hand hygiene during plate preparation. These failures could place residents who received meals and/or snacks from the kitchen at risk for food borne illness.
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 2 residents (Residents #37 and #20) of 20 residents reviewed for infection control practices. 1. CNA-M put a new and clean brief under Resident #37 without changing gloves after removing an old and dirty brief. 2. LVN-P changed her gloves without sanitizing or washing her hands after cleaning Resident #20's stoma (small opening in the abdomen that is used to remove body waste) with feces. 3. The facility failed to ensure CNA E and NA F wore the proper PPE when entering Resident #20's room who was isolated due to COVID-19 exposure. [...]
Inspectors wroteBased on interview and record review the facility failed to develop, implement, and maintain an effective training program for all new and existing staff for 5 of 27 (CNA G, Dietary Aide K, MA J, Dietary Manager, and ADON A) employees reviewed for training requirements. The facility failed to implement and maintain a training program that ensured CNA G, Dietary Aide K, MA J, Dietary Manager, and ADON A received required trainings annually. This failure could affect residents and place them at risk of being uninformed due to lack of staff training.
Inspectors wroteBased on interview and record review, the facility failed to provide mandatory ethics training for 3 of 27 employees (Dietary Aide K, Dietary Manager, and ADON A) employees reviewed for training, in that: The facility failed to ensure ethics training was provided to Dietary Aide K, Dietary Manager, and ADON A annually. This failure could affect residents and place them at risk of being uninformed due to lack of staff training.
Inspectors wroteBased on observations, interview, and record review, the facility failed to ensure the resident has a right to personal privacy and confidentiality of his or her personal and medical records for 1 (Resident #82) of 20 residents reviewed the privacy of medical records. RN-H left her computer open with Resident #82's personal and medical information on the nursing cart at the 400-hallway on 04/18/2025. This failure could place residents at risk of resident identifiable and medical information being accessed by unauthorized persons.
Inspectors wroteBased on observation, interview and record review, the facility failed to ensure the assessment accurately reflected the resident's status for 1 of 20 residents (Resident #140) reviewed for assessments: Resident #140's admission MDS, dated [DATE], identified the resident had a urinary indwelling catheter. However, Resident #140's urinary continence was coded to Always incontinence, instead of Not rated, resident had a catcher) in Section H (Bladder and Bowel). This failure could place residents at risk for inadequate care due to inaccurate assessments.
Inspectors wroteBased on interviews and record review, the facility failed to develop and implement a baseline care plan for each resident that included the instructions needed to provide effective and person-centered care of the resident that met professional standards of quality care within 48 hours of a resident's admission for 1 of 8 residents (Resident #244) reviewed for baseline care plans. The facility failed to ensure a baseline care plan was completed within 48 hours from admission for Resident #244. This failure could place residents at risk of not receiving care and services to meet their needs.
Inspectors wroteBased on interview, and record review, the facility failed to develop and implement a comprehensive person-centered care plan for each resident that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental needs that are identified in the comprehensive assessment, and services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being for 1 of 8 residents (Resident #78) reviewed for care plans. The facility failed to ensure Resident #78's care plan reflected the resident's code status. This failure places 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 ensure the resident environment remained as free of accident hazards as was possible for 1 (Resident #65) of 20 residents reviewed for accidents and hazards. The facility failed to ensure Resident #65 did not have a disposable razor in his restroom. This failure could place residents at risk of harm or injury and contribute to avoidable accidents and a decline in health.
Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure a resident who was incontinent of bladder received appropriate treatment and services to prevent urinary tract infections and to restore continence to the extent possible for 1 (Resident #37) of 4 residents reviewed for incontinence care. When CNA-M was providing incontinent care to Resident #37 on 04/16/2025, CNA-M did not separate and clean the resident's labia area. 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, interview, and record review, the facility failed to ensure residents who were fed by enteral means received the appropriate treatment and services to prevent complications of enteral feeding for 1 (Resident #37) of 2 residents reviewed for enteral nutrition. When RN-N flushed Resident #37's gastrostomy tube with 250 ml of water, RN-N pushed water inside barrel of syringe with plunger, instead of using gravity. This failure could place residents with gastrostomy tube at risk for complications, aspiration, and pneumonia.
Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure parenteral fluids were administered consistent with professional standards for 1 (Resident #80) of 2 resident reviewed for intravenous fluids. RN-O flushed only one lumen for medication port of Resident #80's PICC line (peripherally inserted central catheter: used to deliver medications and other treatments directly to the large central veins near the heart) with 10 cc normal saline when administering evening antibiotic dose. RN-O did not flush the other lumen for blood port of the PICC line, but the physician order said, Flush blood port with 10 cc normal saline every evening antibiotic dose. This failure could affect residents by placing them at risk for blockage of PICC line and blood clots.
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 (Residents #17 and #80) of 3 reviewed for respiratory care. 1. Resident #17's nebulizer mask was not covered in a plastic bag when it was not used on 04/15/2025. 2. Resident #80 was receiving oxygen 4 liter per minutes via nasal cannular without a physician order. These failures could affect residents with oxygen therapy and could lead them to lack of care including possible infection by not following infection control.
Inspectors wroteBased on interview and record review, the facility failed to provide communications training for 2 of 27 employees (CNA G and MA J) reviewed for training, in that: The facility failed to ensure effective communication training was provided to CNA G and MA J annually. This failure could affect residents and place them at risk of being uninformed due to lack of staff training.
Inspectors wroteBased on interview and record review, the facility failed to provide mandatory effective training on rights of the resident training for 1 of 27 employees (Dietary Manager) reviewed for training, in that: The facility failed to ensure effective rights of the resident training was provided to Dietary Manager annually. This failure could affect residents and place them at risk of being uninformed due to lack of staff training.
Inspectors wroteBased on interview and record review, the facility failed to ensure CNA received the required minimum 12 hours annual in-service for 1 of 4 CNAs (CNA G) reviewed for training. The facility failed to provide the required 12 hours of annual training to CNA G. This failure could affect residents and place them at risk of being uninformed due to lack of staff training.
Inspectors wroteBased on interview and record review, the facility failed to provide behavioral health training consistent with the requirements at §483.40 and as determined by the facility assessment at §483.71 for 1 of 27 (Dietary Manager) employees reviewed for training, in that: The facility failed to ensure behavioral health training was provided to Dietary Manager annually. This failure could affect residents and place them at risk of being uninformed due to lack of staff training.
Inspectors wroteBased on interview and record review the facility failed to ensure the notice to residents was provided when changes in coverage were made to items and services covered by Medicare as soon as reasonable possible was provided to 2 of 2 residents (Resident #189, and Resident #190) reviewed for Medicare/Medicaid. The facility failed to give Resident #189 and Resident #190 a Skilled Nursing Facility Advance Beneficiary Notice (SNF ABN) CMS form 10055 when discharged from skilled services at the facility prior to covered days being exhausted. This failure 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 observations, interviews, and record review, the facility failed to ensure residents had the right to be free from abuse, neglect, misappropriation of resident property, and exploitation for 1 of 6 residents (Resident #6) reviewed for abuse. The facility failed to ensure residents were free from verbal abuse on 01/17/2024 when CNA L spoke in a negative manner about a resident at a high volume while in a resident hallway outside of a resident room. This failure could place residents at risk for abuse, trauma, and psychosocial harm.
Inspectors wroteBased on interviews and record review, the facility failed to ensure residents had the right to be free of misappropriation of resident property and exploitation for 1 of 4 residents (Resident #7) reviewed for misappropriation and exploitation. The facility did not prevent misappropriation when CNA M and/or CNA N stole Resident #7's bank card and began using it at the facility vending machine, as well as various grocery stores, convenience stores, and restaurants around the facility. This failure could place residents at risk of misappropriation of money, possessions, and feelings of loss.
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 2 nursing carts (400-hall nursing cart) reviewed for storage. The facility failed to ensure the 400-hall nursing cart was locked when left unattended. This failure could place residents at risk of misappropriation of medications or harm due to accidental ingestion of unprescribed mediations.
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 1 Residents (Residents #1) of 3 residents reviewed for infection control. The wound care nurse LVN-B entered Resident #1's room, who was on EBP, on 01/15/2025 at 9:00 a.m., and failed to put on a gown when the nurse performed wound treatment for Resident 1. These deficient practices affect residents who require direct care and could place residents at risk for cross contamination and infections.
Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain medical records, in accordance with accepted professional standards and practices, which are complete; and accurately documented for 1 of 4 residents (Resident #1) reviewed for documentation. Resident #'1's electronic medical record did not contain complete and accurate documentation that resident received the scheduled administration of oxycodone (a medication use to treat pain) on 6/10/24. This failure could result in residents' records not accurately documenting the administration of medications and could result in a decline in heath.
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. The facility failed to ensure dietary staff were wearing beard restraints who had facial hair. The facility failed to ensure dietary staff used proper hand hygiene during meal service. The facility failed to ensure dietary staff properly handled soup bowls while serving soup. These failures could place resident who received meals and/or snacks from the kitchen at risk for food borne illness.
Inspectors wroteBased on observation, interviews, and record reviews, the facility failed to develop and implement a comprehensive person-centered care plan for each resident, consistent with the resident rights, that includes measurable objective and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment for 3 Residents (Residents #24, #43, and #63) of 16 residents reviewed for care plans, in that: 1. Resident #24's comprehensive care plan revised dated 01/24/2024 did not reflect she was incontinent of bowel. 2. Resident #43's comprehensive care plan revised dated 05/25/2021 did not reflect she was incontinent of bowel. 3. Resident #63's comprehensive care plan did not reflect that her diet was regular, mechanical soft texture, limit oranges, bananas, potatoes, and tomatoes which was ordered on 02/16/2024. [...]
Inspectors wroteBased on observation, interview and record review, the facility failed to provide reasonable accommodation of resident needs for 2 of 8 resident rooms (Resident #49 and #68) reviewed for call lights. The facility failed to ensure Residents #49 on 03/05/2024 and #68's on 03/04/2024 call lights were within reach and placed for easy access. The deficient practice could place residents at risk of not receiving care or attention needed.
Inspectors wroteBased on record review and interview, the facility failed to assess each resident quarterly using the Minimum Data Set form specified by the state and approved by CMS for 1 of 8 residents (Resident 58) reviewed for quarterly assessments. Resident #58's quarterly MDS Assessment was not completed within 92 days of the previous MDS assessment. This failure could place residents at-risk of not having their assessments completed timely.
Inspectors wroteBased on observations, interviews and record reviews, the facility failed to ensure the assessment accurately reflected the resident's status for 2 residents of 24 (Residents #43 and #63) residents reviewed for MDS assessments, in that: 1. Facility failed to ensure Resident #43's quarterly MDS assessment with an ARD of 01/23/2024, assessment accurately reflected her bladder status. 2. Facility failed to ensure Resident #63's annual MDS assessment with an ARD of 02/20/2024, accurately reflected her oxygen therapy and her mechanical soft diet. These deficient practices could place residents at risk of inadequate care.
Inspectors wroteBased on observations, interviews and record reviews, 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 for 2 residents (Residents #45 and #57) of 24 residents reviewed for comprehensive care plans, in that: 1. Resident #45's comprehensive care plan revised date 02/11/2024 was not updated to reflect he no longer had an indwelling urinary catheter which was removed on October of 2023. 2. Resident #57's comprehensive care plan revised date 04/05/2023 was not updated to reflect his MASD which was noted in his quarterly MDS assessment with an ARD of 12/24/2023. These deficient practices place residents at risk of missed or miscommunicated care.
Inspectors wroteBased on observation, interviews and record reviews, the facility failed to ensure a resident who is fed by enteral means receives the appropriate treatment and services to restore, if possible, oral eating skills and to prevent complications of enteral feeding including but not limited to aspiration pneumonia, diarrhea, vomiting, dehydration, metabolic abnormalities, and nasal-pharyngeal ulcers for 1 resident (#78) of 1 reviewed for enteral care. LVN K failed to check the placement of Resident #78's placement of the tube by aspiration of contents, did not flush with 5-10 ml of water between the two medications he administered and did not stop the continuous feeding for 30 minutes prior to medications being administered on 03/05/2024 These deficient practices could place residents at risk for aspiration pneumonia, bloating discomfort and malabsorption of medications administered.
Inspectors wroteBased on observation, interview and record review the facility failed to ensure residents who need respiratory care were provided such care, consistent with professional standards of practice for 2 of residents (Resident #63 and #190) reviewed for respiratory care. 1. Facility failed to ensure Resident #63's oxygen was administered at the prescribed rate on 03/04/2024 and 03/05/2024. 2. Facility failed to ensure Resident #190 who used oxygen had physician orders for oxygen administration. This facility failure could result in residents receiving inadequate treatment.
Inspectors wroteBased on observation, interviews, and record reviews the facility failed to ensure the safe and secure storage of drugs and biologicals for 1 of 8 medication carts observed for mediation storage in that: On 03/06/2024 a medication cart was left unlocked and unattended beside the nurse's station at the end of 800 hall. This deficient practice could affect residents with medications and could result in missing or misuse of drugs by unauthorized personnel.
Inspectors wroteBased on observation, interviews and record reviews, the facility failed to prepare food in a form to meet individual needs for 1 of 24 residents (Resident #63) observed for dietary needs. Facility failed to serve Resident #63 on 03/06/2024 the prescribed diet of regular, mechanical soft texture and served her regular with regular texture. This deficient practice places residents at risk for choking or malnutrition.
Inspectors wroteBased on observations, interviews and record reviews , the facility failed to maintain medical records on each resident that were accurately documented for 2 of 24 residents (Residents #63 and #71) reviewed for accurate medical records in that: 1. RN L initialed off that Resident #63's oxygen was infused at 1-2 l/min, when it was at 3L/min , and she had not checked the rate on 03/04/2024 and 03/05/2024. 2. LVN M did not initial off for treatments for Resident #71 on his TAR for wound care on 03/01/2024, 03/02/2024 and for both treatments on 03/04/2024. This deficient practice could affect residents who have medical records and could result in misinformation about professional care provided.
Inspectors wroteBased on observation, interviews, and record reviews, the facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 1 Resident (#43) of 5 residents reviewed for infection control in that: CNA I failed to sanitize his hands after he changed gloves when he emptied Resident #1's urine container, wiped with the same wipe, same area several times, placed a clean brief onto Resident #1's bed with soiled gloves on and did not sanitize his hands or change gloves throughout the whole procedure of incontinent care to include after wiping feces from the residents anal area on 03/06/2024. [...]
Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable disease and infection for 1 of 3 residents (Resident #1) reviewed for infection control. While providing incontinent care for Resident #1, CNA A did not sanitize her hands between glove changes, and picked up a clean incontinent brief with soiled gloves and placed it under Resident #1. These failures could place residents at-risk for infection due to improper care practices.
Inspectors wroteBased on o interviews and record reviews, 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 demonstrated that they were unavoidable; and a resident with pressure ulcers receives necessary treatment and services, consistent with professional standards of practice, to promote healing, prevent infection and prevent new ulcers from developing for 1 (Resident #1) of 3 residents reviewed for pressure ulcers in that: [...]
Inspectors wroteBased on interviews and record reviews, the facility failed to maintain medical records on each resident that are complete and accurately documented for 2 (Resident #1 and Resident #3) out of 8 residents reviewed for clinical documentation in that: 1. Resident #1's pressure sore documentation by NP C was inaccurate. 2. Resident #3's treatments were not documented on the TAR by LVN F for September 16th, 2023. These facility failures could affect residents by receiving inaccurate care provided or ordered.
Inspectors wroteBased on observations, interviews and record reviews, 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(Resident #4) of 3 residents reviewed for oxygen therapy in that: The facility failed to acquire oxygen orders for Resident #4 until 5 days after she was readmitted on oxygen. This facility failure could result in residents missing or receiving inadequate treatment.
Inspectors wroteBased on observation, interviews, and record reviews, the facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 1 (Resident #2) of 5 residents reviewed for infection control in that: CNA A failed to sanitize her hands after removing soiled gloves and putting on clean gloves during incontinent care performed for Resident #1. This facility failure could result in cross contamination and spread of infections.
16 fire safety citations on file: 8 on June 12, 2026, 7 on April 18, 2025, 1 on March 7, 2024.
| Date | Penalty | Amount or length |
|---|---|---|
| October 10, 2025 | Fine | $16,471 |
| April 27, 2025 | Fine | $15,156 |
| December 22, 2023 | Fine | $82,676 |
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) | 3.26 | 3.39 | 3.86 |
| Registered nurses | 0.53 | 0.43 | 0.69 |
| All nursing staff on weekends | 3.02 | 2.98 | 3.42 |
| Nurse aides | 1.80 | ||
| Licensed practical nurses | 0.93 | ||
| Nursing staff turnover (share who left in a year) | 93.3% | 55.3% | 45.8% |
| Registered nurse turnover | 80.0% | 54.6% | 42.9% |
| Administrators who left | 1 |
CMS expects 3.56 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 3.35 on weekdays and 3.02 on weekends, 10% 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 3.59 in April to June 2025 to 3.26 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 | 3.26 | 0.53 | 3.35 | 3.02 | 0.0% | 0 of 90 | 97 |
| Oct to Dec 2025 | 3.38 | 0.59 | 3.50 | 3.08 | 0.0% | 0 of 92 | 94 |
| Jul to Sep 2025 | 3.59 | 0.67 | 3.70 | 3.31 | 0.0% | 0 of 92 | 88 |
| Apr to Jun 2025 | 3.59 | 0.64 | 3.78 | 3.13 | 0.0% | 0 of 91 | 89 |
| 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 | 10.3 | 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 | 2.9 | 3.3 | 3.2 |
| Percentage of short-stay residents who newly received an antipsychotic medication Short Stay residents, 2025Q2-2026Q1 | 1.6 | 1.5 | 1.6 |
| Percentage of long-stay residents whose ability to walk independently worsened Long Stay residents, 2025Q2-2026Q1 | 3.6 | 14.0 | 14.1 |
| Percentage of long-stay residents with pressure ulcers Long Stay residents, 2025Q2-2026Q1 | 2.7 | 3.8 | 4.6 |
| Percentage of long-stay residents who received an antipsychotic medication Long Stay residents, 2025Q2-2026Q1 | 6.1 | 9.6 | 15.4 |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission Short Stay residents, 20250101-20251231 | 33.9 | 25.7 | 23.8 |
| Percentage of short-stay residents who had an outpatient emergency department visit Short Stay residents, 20250101-20251231 | 15.5 | 12.3 | 12.0 |
| Number of hospitalizations per 1000 long-stay resident days Long Stay residents, 20250101-20251231 | 3.0 | 2.2 | 1.9 |
| Number of outpatient emergency department visits per 1000 long-stay resident days Long Stay residents, 20250101-20251231 | 1.5 | 2.1 | 1.8 |
For a stay to recover after a hospital visit, these are the results CMS publishes for Silver Tree 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 (52.8% of residents, after adjusting for how sick they were). How to read these, and what Medicare pays for.
52.8% this home
No different from the national rate
US median of homes 51.5% · Texas: 116 better, 50 worse
Rate of successful return to home or community from a SNF (risk-standardized discharge to community rate). Higher is better. October 2022 to September 2024. 170 eligible stays.
8.7% 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. 172 eligible stays.
7.0% 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. 108 eligible stays.
64.4% 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. 104 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. 147 residents counted.
1.2% 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. 147 residents counted.
98.9% 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. 92 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: WEST WHARTON COUNTY HOSPITAL DISTRICT. CMS links this home to Creative Solutions in Healthcare, a group of 149 nursing homes averaging 2.1 stars overall.
| Name | Role | Type | Share | Since |
|---|---|---|---|---|
| Bowers, Sean | Managing control - governing body | Individual | 07/01/2024 | |
| Cisneros, Alfred | Managing control - governing body | Individual | 02/18/2008 | |
| Cobb, Travis | Managing control - governing body | Individual | 10/05/2022 | |
| Cooper, Stephen | Managing control - governing body | Individual | 11/11/2022 | |
| Hardin, Sherrie | Managing control - governing body | Individual | 09/04/2024 | |
| Kerzee, Richard | Managing control - governing body | Individual | 09/24/2007 | |
| Korenek, Patricia | Managing control - governing body | Individual | 05/05/2018 | |
| Soechting, Paul | Managing control - governing body | Individual | 11/22/2024 | |
| Strack, Joe | Managing control - governing body | Individual | 02/11/2022 | |
| Huggins, Linda | Corporate director | Individual | 06/01/2022 | |
| Willig, Zachary | Corporate director | Individual | 01/01/2025 | |
| Thompson, Johnny | Corporate officer | Individual | 01/01/2024 | |
| Schertz I Enterprises, LLC | Operational/managerial control | Organization | 09/01/2022 | |
| Blake, Gary | Operational/managerial control | Individual | 09/01/2022 | |
| Blake, Malisa | Operational/managerial control | Individual | 09/01/2022 | |
| Schertz I Enterprises, LLC | Adp of the SNF | Organization | 05/20/2025 | |
| Blake, Gary | Adp of the SNF | Individual | 09/01/2022 | |
| Kasperkhan, Jibrail | Adp of the SNF | Individual | 01/01/2025 | |
| Linahan, Kori | Adp of the SNF | Individual | 05/20/2025 |
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.