Texas Nursing Home Ratings 2026: CMS Stars, Violations and Fines

Texas Nursing Home come from the federal government, not from us. Medicare scores every Medicare-certified nursing home in Texas on a five-star scale built from health inspections, staffing levels and quality measures. This page organises that public data for all 1,177 facilities in the state so you can see the range before you tour anywhere.

What Texas Nursing Home Actually Measure

Every Texas nursing home carries an overall star rating that is a composite of three separate ratings, and the three do not carry equal weight. The health inspection rating is the backbone: it reflects what state surveyors found on their most recent standard inspections and any complaint investigations. The staffing rating reflects nursing hours per resident per day, adjusted for how sick the residents are. The quality measure rating comes from clinical data the facility reports itself.

That last distinction matters. Inspection results are gathered by outside surveyors, while quality measures are self-reported by the facility, so a Texas nursing home can score better on the measures it reports than on the inspections it undergoes. When those two disagree, the inspection rating is the more independent signal.

A one-star rating means CMS placed the facility in the bottom fifth of its state on health inspections. It is a comparative ranking within Texas, not an absolute safety verdict, and it does not by itself establish that any resident was harmed.

How Texas Nursing Homes Are Distributed by Rating

12 facilities in Texas carry no overall rating. CMS leaves a facility unrated when it is too new or has too little inspection history to score, which is not the same as a poor rating.

The Lowest-Rated Nursing Homes in Texas

These are the Texas facilities carrying the lowest CMS overall ratings in the dataset processed 2026-07-01. The table is ranked from the lowest rating upward, using the CMS overall star rating, then the number of health deficiencies recorded at the most recent standard inspection.

A low rating on a Texas nursing home is a reason to look closer, not a conclusion. Ratings move as new inspections are completed, ownership changes and staffing shifts, so confirm any facility’s current standing on Medicare Care Compare before drawing a conclusion from this table.

The Highest-Rated Nursing Homes in Texas

At the other end of the Texas range, these facilities carry the highest CMS overall ratings in the same dataset. The table is ranked from the highest rating downward, using the CMS overall star rating, then the number of health deficiencies recorded at the most recent standard inspection.

Fines, Penalties and Enforcement in Texas

CMS can fine a facility, deny payment for new admissions, or in the most serious cases end its Medicare agreement. In Texas, 822 facilities carry fines on record totalling $57,015,899, and 136 have had a payment denial imposed.

Across the state, facilities averaged 9.12 health deficiencies at their most recent standard inspection, and 207 infection-control citations have been recorded in total. A deficiency is a finding that a facility failed to meet a federal requirement; they range from paperwork problems to findings that placed residents in immediate jeopardy.

The Special Focus Facility program is the most serious ongoing designation short of termination. CMS inspects these homes twice as often as normal. Texas currently has 6 facilities in the program and 30 listed as candidates. CMS treats those two categories differently and so should you: a candidate has been identified as having a persistent pattern, not selected into the program.

Staffing Levels and Turnover

Staffing is the factor families ask about least and researchers point to most. The average Texas nursing home reports 3.39 total nursing hours per resident per day.

Turnover tells you something the star rating does not. Nursing staff turnover at the typical Texas nursing home averages 55.34%, and registered nurse turnover averages 54.64%. A facility where most of the nursing staff changes within a year struggles to maintain consistent care regardless of its current star rating, and turnover is worth asking about directly on a tour.

Facilities Without a Recent Inspection

14 of the 1,177 nursing homes in Texas have not had a standard health inspection in more than two years, according to the CMS flag on each record. That is 1% of the state’s facilities.

This matters when you read any Texas nursing home rating. A star rating built on an inspection from three years ago describes the facility as it was then, under whatever management and staffing it had at the time. When you are comparing two homes, the date of the last inspection is worth as much attention as the rating itself.

Who Owns Texas Nursing Homes

Of the 1,177 Texas nursing home locations in the dataset, 827 are for-profit, 111 are non-profit and 239 are government-operated. Ownership type is recorded by CMS on every facility record and is one of the fields worth checking, alongside whether the home changed hands recently.

Where Texas Nursing Homes Are Concentrated

Texas has Medicare-certified nursing homes across 216 counties. The counties below hold the most facilities, which is usually a reflection of population rather than of quality.

A county average hides a wide spread. A county with a middling average can contain both a five-star facility and a one-star facility, which is why the individual record matters more than the county figure.

How to Check a Texas Nursing Home Yourself

Everything on this page comes from a public federal source you can search directly. Medicare’s Care Compare tool holds the current record for every certified facility, including the full inspection report behind the rating.

Three things in a Texas nursing home record are worth reading rather than skimming. The inspection report lists each deficiency with its scope and severity code, which tells you whether a finding affected one resident or many, and whether it caused harm. The staffing detail shows hours per resident rather than headcount. The penalty history shows whether problems recurred.

Then visit. Federal data describes what surveyors found on specific dates; it cannot tell you how a hallway smells at seven in the evening, whether call lights get answered, or how staff speak to residents when they think nobody is watching.

How to Report a Problem in Texas

Every state has a Long-Term Care Ombudsman program that advocates for residents and takes complaints confidentially, and every state has a survey agency that investigates formal complaints against facilities. You can reach the Texas ombudsman through the National Consumer Voice directory or the federal Eldercare Locator.

Complaints matter to more than your own case. A complaint against a Texas nursing home feeds the health inspection rating, which is why a facility’s complaint-driven deficiencies are tracked separately from its routine ones.

If you believe a resident has been harmed rather than inconvenienced, the ombudsman and the state survey agency are the right first calls. They can investigate, which a website cannot.

Frequently Asked Questions

Which are the worst nursing homes in Texas?

CMS does not publish a list of worst facilities. What it publishes is a five-star rating, and the table above shows the Texas facilities carrying the lowest overall ratings in the current dataset. A one-star rating means the facility ranks in the bottom fifth of its state on health inspections; it is a comparative measure, and it can change with the next inspection.

How reliable are texas nursing home?

The health inspection portion is gathered by outside surveyors and is the most independent part of any Texas nursing home score. The quality measure portion is self-reported by facilities. Ratings are also a snapshot: if the last inspection is years old, the rating describes the facility as it was then.

What is a Special Focus Facility?

It is a CMS designation for facilities with a persistent pattern of serious problems. They are inspected roughly twice as often as other homes and must improve or face termination from Medicare and Medicaid. CMS also maintains a separate candidate list, which is not the same thing as being in the program.

What does the abuse icon mean?

CMS flags facilities cited for abuse on its Care Compare listings. The flag reflects a specific citation on a specific inspection, and CMS removes it when the facility goes a defined period without a further citation. Read the underlying inspection report rather than treating the icon alone as the whole story.

How often are Texas nursing homes inspected?

Every Texas nursing home is meant to have a standard health inspection roughly annually, though the interval varies and complaint investigations happen as needed. In practice 14 Texas facilities are flagged as not having had a standard inspection in over two years.

Does a low rating mean a resident was harmed?

No. A rating summarises inspection findings, staffing and reported quality measures. Individual deficiencies carry scope and severity codes that indicate whether harm occurred, and those are in the full inspection report rather than in the star rating.

Sources

• CMS Provider Data Catalog – nursing home provider information — the dataset behind every figure on this page, processed 2026-07-01
• Medicare Care Compare — current ratings, full inspection reports and penalty history by facility
• National Consumer Voice – Long-Term Care Ombudsman directory — state advocates and complaint routes

Related Guides

• Nursing Home Ratings in Every State
• Guides for Older Adults and Families
• State Tort Reform Guides
• Mass Tort Explainers

About this data. Every figure above is reproduced from the federal CMS Provider Data Catalog dataset processed 2026-07-01, without adjustment. CMS star ratings are comparative measures within each state and are updated periodically; a rating here may differ from the one currently shown on Medicare Care Compare.

Nothing on this page establishes that any facility caused harm to any resident, and nothing here is legal or medical advice. Confirm any facility’s current standing directly with CMS before making a decision, and contact your state ombudsman or survey agency with concerns about a specific resident.