221 Bartlett Drive, El Paso, TX 79912 · El Paso County · (915) 584-8438
58 certified beds, about 54 residents a day · For profit - Partnership · Medicare and Medicaid since 2018
CMS Care Compare ratings, data as of September 1, 2026 · CCN 676457 · See it on Medicare.gov · Compare with other homes
At its most recent standard inspection, on August 22, 2025, inspectors cited 5 health deficiencies (the Texas average is 9.4, the national average 9.2).
Of 37 health citations since June 2023, 2 were rated as actual harm or immediate jeopardy to residents.
CMS lists 2 fines totaling $34,928 in the last three years; the largest was $21,863, and the latest is dated April 11, 2026.
Nurses and nurse aides worked 3.58 hours per resident per day, against 3.39 across Texas and 3.86 nationally. Registered nurses accounted for 0.15 of those hours.
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 37 health citations on file.
Inspectors wroteBased on interview and record review, the facility failed to ensure that residents who required dialysis received such services, consistent with professional standards of practice for 1 of 5 (Resident #1) residents reviewed for quality of care, in that:The facility failed to maintain communication, coordination, and collaboration with the dialysis provider for Resident #1. This failure could place residents who received dialysis treatments at risk for complications and not receiving proper care and treatment to meet their needs.
Inspectors wroteBased on interviews and record review, the facility failed to follow written policy on permitting residents to return to the facility after they are hospitalized for one of (Resident #1) six residents reviewed for transfer and discharge. The facility failed to readmit Resident #1 to the facility after she was sent to the hospital on [DATE]. This failure could place residents at risk of being discharged and not allowed to return to the facility causing a disruption in their care and services and potential for decline.
Inspectors wroteBased on interview and record review the facility failed to ensure, in accordance with accepted professional standards and practices, medical records were maintained on each resident that were accurately documented for 2 (Resident #1 and Resident #2) of 6 residents reviewed for medical records. [...]
Inspectors wroteBased on observation, interviews and record review, the facility failed to ensure efforts were made to resolve resident grievances, for 1 (Resident #2) of 6 residents reviewed for grievance resolution. The facility failed to follow their policy and procedure on Grievance/Complaints when Resident #2 lost his cell phone. This failure could place residents at risk of feeling that their voices were not being heard or taken seriously and could cause feelings of worthlessness.
Inspectors wroteBased on interview and record review, the facility failed to develop and implement a comprehensive person-centered care plan that includes measurable objectives and timeframes to meet a resident's medical, nursing, mental and psychosocial needs for three residents, (Residents #6, #33, and #44), of six residents reviewed for care plans. The facility failed to have a comprehensive person-centered care plan for Resident #6, #33 and #44 to address residents prescribed insulin medication. These failures could affect residents prescribed insulin medication by placing them at risk for not receiving care and services to meet their needs. Findings Include:Resident# 6Record review of Resident #6's admission Record dated 08/19/2025 revealed an admission date of 07/21/2025. [...]
Inspectors wroteBased on observation, interviews, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety for 1 of 1 kitchen reviewed in that:-The facility failed, on 8/19/25, to maintain the bottom of freezer # 1 clean and free of food crumbs and ice cream drippings. -The facility failed, on 8/19/25, to maintain the bottom of refrigerator # 2 clean and free of dry meat juices. -The facility failed, on 8/19/25, to seal a bag of lettuce and to close a box containing an open stick of butter in refrigerator # 3. These failures could place residents who eat foods prepared in the kitchen at risk of cross contamination and food-borne illnesses.
Inspectors wroteBased on interview and record review, the facility failed to provide the mandatory training on standards, policies, and procedures for an infection prevention and control program for 2 of 8 staff (the MDS Nurse and the Administrator) reviewed for training, in that:The facility failed to ensure infection prevention and control training was provided to the MDS Nurse and the Administrator. This failure could place residents at risk of illness due to lack of staff training.
Inspectors wroteBased on an observation, interviews, and record review, the facility failed to treat each resident with respect and dignity and care for each resident in a manner and in an environment that promotes maintenance or enhancement of his or her quality of life for 1 (Resident #28) of 15 residents reviewed for dignity. The facility failed to ensure Resident #28 was groomed and dressed appropriately on 08/21/25. This failure could place the residents at risk of loss of dignity and self-worth.
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 to help prevent the development and transmission of communicable diseases and infections for 1 of 6 (Resident #9) residents reviewed for infection control. CNA A failed, on 8/19/25, to properly serve a meal tray to Resident #9 by touching her cheeseburger with her bare hands. This deficient practice could place residents at risk for infection due to improper care practices.
Inspectors wroteBased on interview and record review the facility failed to ensure residents were free from abuse, neglect, misappropriation of resident property, and exploitation for 2 of 5 residents reviewed for abuse. The facility failed to ensure Resident #1 was free from abuse when Resident #2 physically struck Resident #1 resulting in a bruise/hematoma to her forehead. This deficient practice placed residents at risk for further abuse.
Inspectors wroteBased on interview and record review the facility failed to develop and implement written policies and procedures that prohibit and prevent abuse, neglect, and exploitation of residents and misappropriation of resident property for 2 of 4 residents (Resident#1 and Resident #2) reviewed for abuse. The facility failed to implement their abuse policy when they failed to report abuse when Resident #2 hit Resident #1. This failure could place residents at risk for abuse by not immediately following the facility policy and procedure manual of recognizing and reporting abuse.
Inspectors wroteBased on interview and record review the facility failed ensure alleged violations involving abuse, neglect, exploitation or mistreatment, including injuries of unknown source and misappropriation of resident property, were reported immediately, but not later than 2 hours after the allegation was made, if the events that caused the allegation involved abuse or resulted in serious bodily injury, to the administrator of the facility and to other officials (including to the State Survey Agency and adult protective services where state law provides for jurisdiction in long-term care facilities) in accordance with State law through established procedures for 2 of 4 residents (Resident #1 and Resident#2) reviewed for reporting. The facility failed to report abuse when Resident #2 hit Resident #1 to State Office Agency, Law Enforcement, and Ombudsman. [...]
Inspectors wroteBased on interview and record review, the facility failed to ensure medical records were maintained on each resident that were complete and accurately documented for 1 (Resident #2) of 5 residents reviewed for resident records. -The facility failed to ensure the accuracy of Resident #2's medical records. The physician said to hold Resident #2's medication Donepezil due to an interaction and this was not in the medical records. This failure could put residents at risk of improper medication administration based on inaccurate documentation.
Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to ensure they followed professional standards of practice in accordance with physician orders and facility policy for care of PICC for 1 (Residents #1) of 2 residents reviewed for parenteral and intravenous care. The facility failed to change Resident #1's PICC line dressing as ordered. This failure placed the residents at risk of complications with their PICC needed for infusion therapy.
Inspectors wroteBased on observations, interviews, and record review, the facility failed to store all drugs and biologicals in locked compartments for 1 of 2 medication carts reviewed for medication storage and security. The facility failed to ensure LVN A secured the medication cart when it was left unattended. This failure: could place residents at risk for drug diversion or accidental ingestion.
Inspectors wroteBased on interviews and record review the facility failed to include as part of its QAPI program mandatory training that outlines and informs staff of the elements and goals of the facility's QAPI program for 16 ( the Administrator, the DON, the Infection Disease Preventionist, the Social Worker, the Activity Director, the Housekeeping Supervisor, the Maintenance Supervisor, the Director of Food Services, RN H, LVN I, LVN J, LVN K, CNA L, CNA M, CNA N, and CNA O) of 16 employees reviewed for training regarding QAPI. The facility failed to include training regarding the facility's QAPI program in its training for employees. This failure put residents at risk of receiving poor-quality services as a result of staff being unaware of quality control concerns the facility was working to address.
Inspectors wroteBased on interviews and record review, the facility failed to ensure dialysis services were provided consistently with professional standards of practice for 2 (Resident #7 and Resident #40) of 2 residents reviewed for dialysis services. The facility failed to ensure post-dialysis (treatment that filters water and waste from the blood when the kidneys are no longer able to do so) assessments were documented in Resident #7 and Resident #40's charts. These failures could place residents who received dialysis at risk for complications and not receiving proper care and treatment to meet their needs.
Inspectors wroteBased on interviews and record review the facility failed to ensure that residents who have not used psychotropic drugs were not given these drugs unless the medication was necessary to treat a specific condition as diagnosed and documented in the clinical record for 2 (Residents #3 and #7) of 8 residents reviewed for unnecessary medications, and failed to ensure PRN orders for psychotropic drugs were limited to 14 days for 1 (Resident #98) of 8 residents reviewed for unnecessary medications. The facility failed to ensure that Resident #7 and Resident #3 had appropriate diagnoses for Risperidone (an antipsychotic used to treat schizophrenia and bipolar disorder). The facility failed to ensure that Resident #98 had a 14-day limit on her order for PRN Lorazepam. [...]
Inspectors wroteBased on observations, record review, and interviews, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety in 1 of 1 kitchen reviewed for food procurement. 1. The facility failed to ensure foods were properly labeled (contents of containers, opened date, date prepared), covered, and sealed. 2. The facility failed to ensure meat was thawed properly on a tray in the refrigerator. These failures could place residents who ate food from the kitchen at risk of food borne illness and disease. Findings Included: Observation and interview on 7/9/24 at 8:18 am with [NAME] C, revealed an unsealed plastic bag labeled cilantro found in the refrigerator labeled Produce. [NAME] C stated the risk of having the bag open and not inside a sealed bag was that there was no way to know when it had been opened. [...]
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 and transmission of communicable diseases and infections for three residents (Resident #252, Resident #31, Resident #20) of eight residents observed for infection control in that: 1. Resident #252's catheter drainage collection bag was left on the floor. 2. CNA D and CNA E did not change their gloves after they became contaminated during incontinent care while assisting Resident #20 and did not practice adequate hand hygiene after. 3. [...]
Inspectors wroteBased on interviews and record review the facility failed to develop a comprehensive person-centered care plan for each resident, that included measurable objectives and timeframes to meet a resident's medical needs that wase identified in the comprehensive assessment for 1 (Resident #40) of 20 residents reviewed for comprehensive person-centered care plans. The facility failed to develop a care plan that addressed Resident #40's diagnosis of diabetes. This failure could put residents at increased risk of not having their care needs met.
Inspectors wroteBased on interviews and record review, the facility failed to ensure drug regimen irregularities reported by the Pharmacist Consultant were acted upon by the physician for 1 (Resident #3) of 6 residents reviewed for physician response to medication regimen review. The facility failed to ensure that the physician responded to Pharmacist Consultant recommendations that an appropriate diagnosis or gradual dose reduction be applied to Risperidone [Risperdal] (an antipsychotic medication) prescribed for Resident #3. This failure could place residents at risk of adverse side effects and decreased quality of life as a result of receiving unnecessary antipsychotic medications.
Inspectors wroteBased on observations, interviews, and record review the facility failed to maintain clinical records that were complete and accurate for 1 of 4 (Resident #7) residents reviewed for clinical records. The facility failed to place resident identifying information on 5 of 17 Hemodialysis Communication forms located in the 100/200 Hall Dialysis (treatment that filters water and waste from the blood when the kidneys are no longer able to do so) Communication Binder. The facility failed to ensure that Resident #7's Hemodialysis Communication forms were scanned into her electronic chart as part of her permanent record and post-dialysis monitoring. This failure could place residents at risk for inadequate monitoring and inaccurate records.
Inspectors wroteBased on observation, interview, 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 4 (Resident #4, Resident #11, Resident #23, & Resident #205) of 10 residents observed for oxygen management. 1. Residents #4, #11, #23, & #205 were not having there oxygen tubing dated. 2. Residents #4, #11, #23, & #205 did not have oxygen signs posted outside their bedrooms. These failures could place residents on oxygen therapy at risk of receiving incorrect or inadequate oxygen support and decline in health.
Inspectors wroteBased on observation, interview, and record review the facility failed to provide pharmaceutical services that assured the accurate system is in place for acquiring, dispensing and storage of medications for pharmaceutical services; failed to have an established system in place for accurate reconciliation for 3 (Hall 100, Hall 300 and Hall 500) of 5 halls that had residents with orders for controlled substances and monitoring of over-the-counter medication in one medication storage room. The facility failed to ensure Licensed Staff were signing Controlled Drugs Count Record when Controlled Drugs were reconciled at change of shift according to facility policy. The facility failed to monitor expiration dates on the over-the-counter medication in the medication storage room leaving expired medication on the shelves. [...]
Inspectors wroteBased on interview and record review the facility failed to ensure that residents who have not used psychotropic drugs are not given these drugs unless the medication is necessary to treat a specific condition as diagnosed and documented in the clinical record for one (Resident #30) of 6 resident ' s reviewed for psychotropic medication, . The facility failed to ensure that Resident #30 did not receive antipsychotics (quetiapine fumarate and aripiprazole) that were not necessary to treat a specific condition These failures could put residents at risk of side effects from unnecessary psychotropic medications.
Inspectors wroteBased on the observations, interviews, and record review the facility failed to store, prepare, distribute and serve food in accordance with professional standards for food service safety in 1 of 1 kitchen reviewed for kitchen sanitization: residents . 1. Foods in dry store, walk in, and freezer not dated or labeled properly. 2. Food containers and food bags not properly sealed in the kitchen and walk-in. 3. Stove food catchers/food traps not being cleaned regularly. 4. Staff not wearing hair nets when entering the kitchen. 5. Food Temperature Logs were not filled out correctly for May 2023 and June 2023. 6. Clean Documentation Form not filled for the week of June 07, 2023, to June 14, 2023. 7. [...]
Inspectors wroteBased on the observations, interviews, and record reviews the facility failed to dispose of garbage and refuse properly for 3 (Dumpsters #1, #2, & #3) of 3 dumpsters containers and 1 (utility tilted trash cart) of 1 utility tiled trash cart reviewed for food safety requirements. 1. Three dumpsters (#1, #2, & #3) had their dumpster lids open. 2. One utility tiled trash cart did not have a lid. 3. Three dumpsters in the back of the facility had trash on the floor outside and around the dumpsters. 4. One utility tiled trash cart in the back of the kitchen had cigarette buds on the floor outside near grease. This failure could affect residents by placing them at risk of food borne illness, illnesses, or be provided an unsafe, unsanitary and uncomfortable environment.
Inspectors wroteBased on observation, interview, and record review the facility failed to maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 1 (Resident #44) of 11 residents and treatment cart reviewed for infection prevention and control. 1. The facility failed to ensure that Resident #44 ' s nebulizer treatment mask was covered when not in use. 2. The facility failed to ensure supplies in the treatment cart were sealed properly. These failures could increase residents ' risk of respiratory infections.
Inspectors wroteBased on observation, interviews, and record review the facility failed to ensure residents had the right to reside and receive services in the facility with reasonable accommodation of resident needs and preferences for 2 (Residents #50, #204) of 14 residents observed for call light placement. The facility failed to ensure Residents #50 and #204 ' s call lights were within their reach. This failure put residents at risk of not being able to call for assistance when needed.
Inspectors wroteBased on interview and record review the facility failed to ensure that staff may attend resident group meetings only at the respective group's invitation for one of one resident group reviewed for staff attendance at group meetings by invitation. The facility failed to inform the resident council that they could hold council meetings without staff members present. This failure could put residents at risk of reduced opportunities to express their concerns.
Inspectors wroteBased on observation, interview, and record review the facility failed to ensure residents had the right to have reasonable access to the use of a telephone and a place in the facility where calls can be made without being overheard for 1 of 6 (Resident #259) residents reviewed for telephone use. The facility failed to provide a place for Resident #259 could make telephone calls without being overhead. This failure could place residents at risk of conversations being overheard and privacy rights not being respected.
Inspectors wroteBased on interviews and record review the facility failed to ensure that all alleged violations involving abuse, neglect, exploitation, or mistreatment, including injuries of unknown source and misappropriation of resident property, are reported immediately, but not later than 2 hours after the allegation is made for 2 of 6 (Resident #259 and Resident #34) residents reviewed for abuse. The facility failed to report alleged verbal abuse for Resident #259 to State Agency. The facility failed to report alleged financial exploitation for Resident #34 to State Agency. These failures could affect residents by placing them at risk of abuse if the reportable allegations are not reported in time after they are alleged. Resident #259 Record review of Resident # 259's face sheet dated 6/14/23 revealed a [AGE] year-old male admitted on [DATE]. [...]
Inspectors wroteBased on observation, interview, and record review the facility failed to develop and implement a baseline care plan for each resident that includes the instructions needed to provide effective and person-centered care of the resident that meet professional standards of quality care. The baseline care plan must be developed within 48 hours of a resident's admission for 1 of 6 residents (Resident #11) reviewed for baseline care plan. Resident #11 did not have a baseline care plan that addressed her oxygen use. This failure could have placed newly admitted residents at risk of not receiving the care and services and continuity of care.
Inspectors wroteBased on observation, interview, and record review the facility failed to develop and implement comprehensive person-centered care plan that includes measurable objectives and time frames to meet a resident medical and nursing needs to be furnished to attain or maintain the residents highest practicable physical, mental, and psychosocial well-being for 2 of 12 residents (Resident #10 & Resident #11) reviewed for comprehensive care plans in that: The facility failed to implement a comprehensive person-centered care plan for Resident #10s urinary foley catheter and Resident #11s oxygen use. This deficient practice could place residents in the facility at risk of not receiving the necessary care or services and having personalized plans developed to address their needs.
Inspectors wroteBased on observation, interview, and record review the facility failed to ensure that residents received the appropriate treatment and services to prevent urinary tract infections and to restore as much normal bladder function as possible for 1 (Resident #206) of 6 residents reviewed for indwelling catheters 1. Resident #206's indwelling catheter tubing was cloudy with solid particles in the tubing and full of urine. 2. Resident #206's catheter tubing was not anchored on resident's leg correctly. This failure place residents at risk of dislodgement of foley and of the collection tube becoming full and allowing urine to flow back into the bladder that could result in a urinary tract infection.
Inspectors wroteBased on observation, interviews, and record review the facility failed to ensure medical records on each resident were complete and accurately documented for 1 of 6 (Resident #259) residents reviewed for accuracy of clinical records. The facility failed to accurately document Resident #10 had over the counter medication in his possession via electronic and/or paper charting. This failure could have placed residents at risk of inaccurate medical records that could affect monitoring and medical services provided.
12 fire safety citations on file: 7 on August 22, 2025, 2 on July 11, 2024, 3 on June 15, 2023.
| Date | Penalty | Amount or length |
|---|---|---|
| April 11, 2026 | Fine | $13,065 |
| August 7, 2025 | Fine | $21,863 |
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) | 3.58 | 3.39 | 3.86 |
| Registered nurses | 0.15 | 0.43 | 0.69 |
| All nursing staff on weekends | 3.16 | 2.98 | 3.42 |
| Nurse aides | 1.96 | ||
| Licensed practical nurses | 1.47 | ||
| Nursing staff turnover (share who left in a year) | not reported | 55.3% | 45.8% |
| Registered nurse turnover | not reported | 54.6% | 42.9% |
| Administrators who left | not reported |
CMS expects 4.04 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 3.74 on weekdays and 3.16 on weekends, 16% 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 3.98 in April to June 2025 to 3.58 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 | 3.58 | 0.15 | 3.74 | 3.16 | 0.0% | 0 of 90 | 54 |
| Oct to Dec 2025 | 3.51 | 0.15 | 3.58 | 3.32 | 0.0% | 0 of 92 | 55 |
| Apr to Jun 2025 | 3.98 | 0.17 | 4.28 | 3.23 | 0.0% | 0 of 91 | 56 |
| 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.
| 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 | 12.0 | 15.8 | 13.9 |
| Percentage of long-stay residents with a catheter inserted and left in their bladder Long Stay residents, 2025Q2-2026Q1 | 8.9 | 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 | 0.0 | 3.3 | 3.2 |
| Percentage of short-stay residents who newly received an antipsychotic medication Short Stay residents, 2025Q2-2026Q1 | 1.9 | 1.5 | 1.6 |
| Percentage of long-stay residents with pressure ulcers Long Stay residents, 2025Q2-2026Q1 | 10.5 | 3.8 | 4.6 |
| Percentage of long-stay residents who received an antipsychotic medication Long Stay residents, 2025Q2-2026Q1 | 37.0 | 9.6 | 15.4 |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission Short Stay residents, 20250101-20251231 | 24.7 | 25.7 | 23.8 |
| Percentage of short-stay residents who had an outpatient emergency department visit Short Stay residents, 20250101-20251231 | 10.2 | 12.3 | 12.0 |
For a stay to recover after a hospital visit, these are the results CMS publishes for The Bartlett Skilled Nursing and Assisted Living's Medicare short-stay residents. On returning residents home or to the community, CMS rates it no different from the national rate (56.9% of residents, after adjusting for how sick they were). How to read these, and what Medicare pays for.
56.9% this home
No different from the national rate
US median of homes 51.5% · Texas: 116 better, 50 worse
Rate of successful return to home or community from a SNF (risk-standardized discharge to community rate). Higher is better. October 2022 to September 2024. 242 eligible stays.
9.2% this home
No different from the national rate
US median of homes 10.7% · Texas: 0 better, 9 worse
Rate of potentially preventable hospital readmissions 30 days after discharge from a SNF (risk-standardized rate). Lower is better. October 2022 to September 2024. 228 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. 165 eligible stays.
25.0% 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. 156 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. 231 residents counted.
0.0% this home
Median of homes: Texas1.3% · US 1.7%
Percentage of residents with pressure ulcers or pressure injuries that are new or worsened (adjusted rate). Lower is better. October 2024 to September 2025. 231 residents counted.
99.0% 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. 101 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: PENAN RETIREMENT CENTERS LIMITED PARTNERSHIP.
| Name | Role | Type | Share | Since |
|---|---|---|---|---|
| Douglas G Pendergras Sr Estate | 5% or greater direct ownership interest | Organization | 50% | 03/20/2018 |
| Penan Retirement Inc. | 5% or greater direct ownership interest | Organization | 01/01/2018 | |
| Pendergras, Don | 5% or greater direct ownership interest | Individual | 50% | 01/01/2018 |
| Douglas G Pendergras Sr Estate | 5% or greater security interest | Organization | 03/20/2018 | |
| Pendergras, Don | Operational/managerial control | Individual | 01/01/2018 | |
| Penan Retirement Inc. | General partnership interest | Organization | 01/01/2018 | |
| Douglas G Pendergras Sr Estate | Adp of the SNF | Organization | 01/01/2018 | |
| Annabi, Michael | Adp of the SNF | Individual | 01/01/2018 | |
| Perkins, Michael | Adp of the SNF | Individual | 01/01/2018 |
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.