Source: CMS Provider Data - Nursing Home Provider Information, Health Deficiencies, Penalties, and Ownership. processing date 2026-09-01. Analysis by NursingHomesTexas.com.
The headline
Texas cares for more nursing-home residents than any other state. The public record shows an inspection system finding problems at enormous scale - and, in Texas's case, a striking share of those problems severe enough to involve actual harm or a threat to life.
Across the current public record:
| Measure | Count |
|---|---|
| Certified Texas nursing homes | 1,177 |
| Certified beds | 133,493 |
| Health-deficiency citations on record | 32,724 |
| Citations in the complete 2023-2026 window | 32,570 |
| Citations involving actual harm or immediate jeopardy (severity G-L) | 2,663 |
| Citations involving immediate jeopardy to resident safety (J-L) | 2,152 |
| Abuse, neglect, or exploitation citations | 2,336 |
| Homes cited at least once for abuse/neglect | 830 |
| Homes carrying CMS's abuse flag | 124 (10.5%) |
| Federal fines assessed | $51,954,195 |
That works out to about two serious citations for every Texas nursing home, and nearly two immediate-jeopardy citations for every home on the current record.
Severity: how bad is "bad"?
CMS grades every citation on a letter scale, from a potential for minimal harm (A-C) up to immediate jeopardy to resident health or safety (J, K, L). Texas's distribution of 32,724 citations:
| Severity band | Citations | Share |
|---|---|---|
| Minimal potential for harm (A-C) | 515 | 1.6% |
| Potential for more than minimal harm (D-F) | 29,546 | 90.3% |
| Actual harm (G-I) | 511 | 1.6% |
| Immediate jeopardy (J-L) | 2,152 | 6.6% |
Most citations never rise to actual harm - but 8.1% of all Texas citations reached actual harm or immediate jeopardy, and 2,152 involved immediate jeopardy. That is a notably higher severity share than most states report, and it is concentrated: a small number of facilities account for a disproportionate number of the worst findings.
What Texas homes get cited for
| Deficiency category | Citations |
|---|---|
| Quality of Life and Care | 6,999 |
| Resident Assessment & Care Planning | 5,409 |
| Resident Rights | 4,626 |
| Pharmacy Service | 4,135 |
| Nutrition & Dietary | 3,425 |
| Infection Control | 2,653 |
| Freedom from Abuse, Neglect & Exploitation | 2,336 |
| Environmental | 1,271 |
| Nursing & Physician Services | 849 |
| Administration | 843 |
The most-cited F-tags in Texas
| F-tag | Frequency | What it requires |
|---|---|---|
| F880 | 2,541 | Maintain an infection prevention and control program |
| F812 | 2,116 | Procure, store and serve food safely |
| F656 | 1,829 | Develop and implement a complete care plan |
| F689 | 1,679 | Keep the home free of accident hazards; adequate supervision |
| F761 | 1,525 | Label and store drugs correctly |
| F755 | 1,454 | Provide pharmaceutical services to meet each resident's needs |
| F695 | 1,038 | Provide safe and appropriate respiratory care |
| F842 | 958 | Safeguard resident records and privacy |
| F677 | 919 | Provide care and assistance with activities of daily living |
| F609 | 752 | Timely report suspected abuse, neglect or theft |
| F584 | 745 | Provide a safe, clean, comfortable and homelike environment |
| F641 | 709 | Ensure each resident receives an accurate assessment |
The abuse rules sit inside Texas's most frequent citations. F609 - the duty to report suspected abuse - appears 752 times, and F600 (the duty to protect residents from abuse) appears 644 times. Homes are not only failing to prevent abuse; they are frequently failing to report it.
Abuse and neglect: the signal in the data
- 2,336 abuse/neglect/exploitation citations on record.
- 830 of 1,177 Texas homes (71%) have at least one.
- 135 homes have five or more; 16 homes have ten or more.
- CMS independently flags 124 Texas homes with its public abuse icon - a federal marker that a facility has been cited for abuse.
- 36 homes are on CMS's Special Focus Facility list or the candidate list - the watchdog tier for the persistently worst performers.
The most abuse-cited single facility in the data is DFW Nursing & Rehab (Tarrant County) with 16 abuse/neglect citations, followed by Harmony Care at Beaumont (Jefferson County, 14) and Ralls Nursing Home (Crosby County, 13).
Complaints vs. routine inspections
Texas runs on two engines: scheduled standard surveys and complaint-driven investigations. A large share of all citations - 14,433 of 32,724 (44.1%) - came from complaints rather than routine inspections. That means residents, families and staff reporting problems are directly responsible for nearly half of the enforcement record.
The penalty picture
The federal government assessed $51.95 million in civil money penalties across 1,861 actions. The median fine is $14,838 - but the tail is severe: 124 fines of $100,000 or more, topping out at $284,250.
| Facility | Fine | Date |
|---|---|---|
| Legacy at Town Creek | $284,250 | 2024-06-06 |
| Park Place Nursing & Rehabilitation Center | $272,779 | 2025-05-05 |
| Beaumont Nursing and Rehabilitation | $266,879 | 2024-01-27 |
| Avir at Lindale | $261,383 | 2024-04-13 |
| Ashford Hall | $256,785 | 2024-03-22 |
| Focused Care of Center | $248,757 | 2025-04-22 |
| Colonial Nursing & Rehabilitation Center | $247,572 | 2024-12-27 |
| Sienna Nursing and Rehabilitation | $241,722 | 2025-06-24 |
Method & limitations
- Source: CMS Provider Data Catalog (public), files
NH_ProviderInfo,NH_HealthCitations,NH_Penalties,NH_Ownership, processing date 2026-09-01. - Scope: Medicare/Medicaid-certified skilled nursing facilities with a Texas address.
- Severity bands follow CMS's Scope-Severity grid: A-C minimal potential, D-F potential for more than minimal harm, G-I actual harm, J-L immediate jeopardy.
- Trend caveat: CMS retains deficiencies from recent inspection cycles. Of the 32,724 citations, 32,570 (99.5%) fall in the complete 2023-2026 window; earlier survey years are incomplete and should not be read as a time trend. A true multi-year series requires Texas Health and Human Services Commission (HHSC) data.
- Every figure here is derived directly from the public CMS datasets listed above.
About NursingHomesTexas.com
NursingHomesTexas.com publishes independent, data-driven reporting on Texas skilled nursing facilities. Our studies are built entirely from public federal data and are free to cite with attribution.
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