2875 Shiloh Road, Tyler, TX 75703 · Smith County · (903) 561-1300
92 certified beds, about 67 residents a day · Government - Hospital district · Medicare and Medicaid since 2008
CMS Care Compare ratings, data as of September 1, 2026 · CCN 676193 · See it on Medicare.gov · Compare with other homes
At its most recent standard inspection, on May 6, 2026, inspectors cited 4 health deficiencies (the Texas average is 9.4, the national average 9.2).
Of 10 health citations since January 2024, 2 were rated as actual harm or immediate jeopardy to residents (1 immediate jeopardy).
CMS lists 2 fines totaling $23,389 in the last three years; the largest was $14,380, and the latest is dated April 23, 2026.
Nurses and nurse aides worked 3.38 hours per resident per day, against 3.39 across Texas and 3.86 nationally. Registered nurses accounted for 0.51 of those hours.
50.7% of nursing staff left within the year CMS measured (Texas average 55.3%).
CMS links it to The Ensign Group, an affiliated group of 344 nursing homes.
Federal rules call for a standard inspection at least every 15 months, plus a visit whenever a complaint is filed. Each mark below is one citation, colored by how serious inspectors rated it. How to read a citation.
Under each citation, the quoted text is the inspector's own summary from the federal statement of deficiencies (CMS form 2567), word for word apart from a privacy scrub; CMS removes residents' and staff names before it publishes the text. The full notes are on Medicare.gov.
CMS rates every citation by how much harm it caused (rows) and how many residents it touched (columns). The count in each box is this home's, across all 10 health citations on file.
Inspectors wroteBased on observations, interviews, and record reviews, the facility failed to provide housekeeping and maintenance services necessary to maintain a sanitary, orderly, and comfortable interior for 1 of 3 resident bathrooms (the shared bathroom of Resident #55 and Resident #62) reviewed for environment. The facility failed to ensure Resident #55 and Resident #62's shared bathroom was free of water on the floor, wet towels, and flying insects. This failure could place residents at risk of an unsanitary environment which could lead to a decrease in quality of life.
Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the PICC line site was maintained consistent with professional standards of practice for 1 of 1 resident reviewed for PICC line care (Resident #69). The facility failed to ensure the Peripherally Inserted Central Catheter (PICC) line dressing change for Resident #69 were performed according to physician orders, infection prevention principles, and accepted standards of nursing practice. This failure could place the residents at risk for contamination, infection, interruption of therapy and adverse outcomes.
Inspectors wroteBased on interview and record review, the facility failed to ensure medical records, in accordance with accepted professional standards and practices, were complete and accurately documented for 2 of 2 residents (Resident #3 and Resident #6) reviewed for medical records accuracy. The facility failed to ensure Resident #3's and Resident #6's OOH DNR records were complete and accurately signed and dated. This failure could place residents at risk for receiving resuscitation actions against their declared instructions.
Inspectors wroteBased on observations, interviews, 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 2 of 3 resident bathrooms (the shared bathroom of Resident #36 and Resident #40 and the shared bathroom of Resident #55 and Resident #62) reviewed for infection control. The facility failed to ensure antibacterial soap was provided in the shared bathroom of Resident #36 and Resident #40 and the shared bathroom of Resident #55 and Resident #62. This failure could place residents at risk for ineffective hand hygiene practices, which may contribute to the transmission of communicable diseases and cross-contamination among residents, staff, and visitors.
Inspectors wroteBased on observation, interview, and record review the facility failed to ensure that residents receive treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the residents' choices for 1 of 2 residents (Resident #1) reviewed for quality of care. The facility did not obtain physician order's for wound care to her post-surgical incision sites during her stay at the facility from 3/28/26 to 4/8/26. LVN A did not obtain physician order's for the betadine (a widely used, non-stinging antiseptic that kills germs) she applied to Resident #1's post-surgical incision sights. The facility did not thoroughly assess and document Resident #1's post-surgical incision sites on 3/29/26 and 3/31/26. The facility did not assess and document Resident #1's post-surgical incision sites on 3/30/26and 4/1/26 through 4/8/26. [...]
Inspectors wroteBased on interview and record review the facility failed to ensure accurate assessments were completed for 7 of 15 residents (Residents #9, #15, #20, #24, #25, #38, and #112) reviewed for accuracy of assessments. The facility failed to ensure (Residents #9, #15, #20, #24, #25, #38, and #112's MDS assessment was accurately coded for Preadmission Screening and Resident Review (PASRR). These failures could place residents at risk for not receiving the appropriate care and services to maintain the highest level of well-being.
Inspectors wroteBased on observation, interview and record review, the facility failed to maintain acceptable parameters of nutritional status, such as usual body weight or desirable body weight range and electrolyte balance and offered a therapeutic diet when there is a nutritional problem, and the health care provider orders a therapeutic diet for 1 of 4 residents (Resident #21) reviewed for nutrition. The facility failed to ensure Resident #21 received a health shake (nutritional supplement) on 03/24/25, 03/25/25, 03/26/25 and 2 desserts on 03/24/25, 03/25/25 with her meals as prescribed by the physician. These failures placed the resident at risk for weight loss, malnutrition, loss of energy, and decreased quality of life.
Inspectors wroteBased on interview and observation, the facility failed to ensure the residents received mail for 2 of 7 confidential residents reviewed for right to forms of communication. The facility did not implement a system for delivering mail on Saturdays. This failure could place the residents at risk of not receiving mail in a timely manner and a diminished quality of life.
Inspectors wroteBased on observations and interviews, the facility failed to provide a safe, functional, sanitary, and comfortable environment for residents, staff, and visitors for 1 of 3 sections (north side of the facility which is referred to as the Nile) of the facility reviewed for environmental conditions. The facility failed to provide an area for specialized therapy services that was conducive to the well-being of its residents by providing diathermy (a specialized therapy treatment that uses electric currents to generate heat) to a resident in a room used for storage. [...]
Inspectors wroteBased on observation, interviews, and record review the facility failed to ensure that the resident environment remained as free of accident hazards as was possible and that each resident received adequate supervision and assistance devices to prevent accidents for 1 of 6 (Residents #1) residents reviewed for accidents. The facility failed to ensure adequate supervision for Resident #1 who was at risk for elopement. The facility staff were not aware Resident #1 was missing when he eloped on 09/18/23. The facility failed to ensure the function of Resident #1's Wander Guard Monitoring Bracelet was documented each shift for the month of July 2023, August 2023, and September 2023. The facility failed to ensure staff were trained on the facility's Wander System Policy/Procedure and Elopement Policy/Procedure. The facility staff were not aware which residents used a wander guard. [...]
| Date | Penalty | Amount or length |
|---|---|---|
| April 23, 2026 | Fine | $14,380 |
| January 8, 2024 | Fine | $9,009 |
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) | 3.38 | 3.39 | 3.86 |
| Registered nurses | 0.51 | 0.43 | 0.69 |
| All nursing staff on weekends | 3.00 | 2.98 | 3.42 |
| Nurse aides | 2.09 | ||
| Licensed practical nurses | 0.78 | ||
| Nursing staff turnover (share who left in a year) | 50.7% | 55.3% | 45.8% |
| Registered nurse turnover | 44.4% | 54.6% | 42.9% |
| Administrators who left | 0 |
CMS expects 3.83 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 3.53 on weekdays and 3.00 on weekends, 15% lower on weekends (nationally, weekends ran 15% lower). Contract or agency staff worked 0.0% of nursing hours, against 5.3% nationally. Total nursing hours per resident went from 3.51 in April to June 2025 to 3.38 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 | 3.38 | 0.51 | 3.53 | 3.00 | 0.0% | 0 of 90 | 67 |
| Oct to Dec 2025 | 3.49 | 0.51 | 3.58 | 3.25 | 0.0% | 0 of 92 | 67 |
| Jul to Sep 2025 | 3.42 | 0.54 | 3.54 | 3.11 | 0.0% | 0 of 92 | 69 |
| Apr to Jun 2025 | 3.51 | 0.54 | 3.70 | 3.02 | 0.0% | 0 of 91 | 65 |
| 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.
Trains nurse aides: this home runs a state-approved CNA program (state list: HHSC Approved NATCEP Providers, as of October 6, 2026). A nursing home cannot charge aides it employs, or has offered a job, for state-approved training (42 CFR 483.152(c)). See Waterton Healthcare Nurse Aide Training Program on CareerFunded, our sister site for career training.
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 | 17.4 | 15.8 | 13.9 |
| Percentage of long-stay residents with a catheter inserted and left in their bladder Long Stay residents, 2025Q2-2026Q1 | 0.0 | 0.3 | 0.8 |
| Percentage of long-stay residents with a urinary tract infection Long Stay residents, 2025Q2-2026Q1 | 0.5 | 0.8 | 1.6 |
| Percentage of long-stay residents experiencing one or more falls with major injury Long Stay residents, 2025Q2-2026Q1 | 6.8 | 3.3 | 3.2 |
| Percentage of short-stay residents who newly received an antipsychotic medication Short Stay residents, 2025Q2-2026Q1 | 0.0 | 1.5 | 1.6 |
| Percentage of long-stay residents whose ability to walk independently worsened Long Stay residents, 2025Q2-2026Q1 | 11.7 | 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 | 6.8 | 9.6 | 15.4 |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission Short Stay residents, 20250101-20251231 | 24.4 | 25.7 | 23.8 |
| Percentage of short-stay residents who had an outpatient emergency department visit Short Stay residents, 20250101-20251231 | 12.8 | 12.3 | 12.0 |
| Number of hospitalizations per 1000 long-stay resident days Long Stay residents, 20250101-20251231 | 2.3 | 2.2 | 1.9 |
| Number of outpatient emergency department visits per 1000 long-stay resident days Long Stay residents, 20250101-20251231 | 3.2 | 2.1 | 1.8 |
For a stay to recover after a hospital visit, these are the results CMS publishes for The Waterton Healthcare & Rehabilitation's Medicare short-stay residents. On returning residents home or to the community, CMS rates it no different from the national rate (46.2% of residents, after adjusting for how sick they were). How to read these, and what Medicare pays for.
46.2% 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. 68 eligible stays.
10.9% 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. 89 eligible stays.
6.9% 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. 65 eligible stays.
73.2% this home
Median of homes: Texas57.3% · US 56.6%
Percentage of residents who are at or above an expected ability to care for themselves and move around at discharge. Higher is better. October 2024 to September 2025. 41 residents counted.
1.5% 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. 66 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. 66 residents counted.
Not reported
CMS note: The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure.
Median of homes: Texas98.5% · US 98.7%
Percentage of residents where the SNF provided a current medication list to the resident, family, and/or caregiver at final discharge. Higher is better. October 2024 to September 2025. 14 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: FANNIN COUNTY HOSPITAL AUTHORITY. CMS links this home to The Ensign Group, a group of 344 nursing homes averaging 3.2 stars overall.
| Name | Role | Type | Share | Since |
|---|---|---|---|---|
| Fannin County Hospital Authority | 5% or greater direct ownership interest | Organization | 100% | 03/01/2022 |
| Costa, Charlie | Managing control - governing body | Individual | 03/01/2022 | |
| Wilson, Jennifer | Managing control - governing body | Individual | 03/01/2022 | |
| Burnam, Soon | Corporate officer | Individual | 03/01/2022 | |
| Sanderson, Clark | Corporate officer | Individual | 10/29/2012 | |
| Chickadee Healthcare LLC | Operational/managerial control | Organization | 03/01/2022 | |
| Costa, Charlie | Operational/managerial control | Individual | 03/01/2022 | |
| Chickadee Healthcare LLC | Adp of the SNF | Organization | 05/14/2025 | |
| Ensign Services Inc | Adp of the SNF | Organization | 03/01/2022 | |
| Rose Health Holdings LLC | Adp of the SNF | Organization | 03/01/2022 | |
| Standard Bearer Healthcare Op, LP | Adp of the SNF | Organization | 03/01/2022 | |
| The Ensign Group Inc | Adp of the SNF | Organization | 03/01/2022 | |
| Costa, Charlie | Adp of the SNF | Individual | 05/14/2025 | |
| Wilson, Jennifer | Adp of the SNF | Individual | 04/27/2025 |
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.