Ten Texas nursing homes lead the state with 32–38 cited health deficiencies each — all ten remain open and Medicare/Medicaid-certified today

Summary

In Texas, the nursing home with the most cited serious quality-of-care problems on its most recent CMS standard survey is Avir at Kerrville (Kerr County), with 38 total health deficiencies, a weighted deficiency score of 216, 2 fines ($20,467), and a 1-star overall/1-star health-inspection CMS rating. It is closely followed by Avir at Schertz (37), and a group tied at 36 — Trinity Rehabilitation & Healthcare Center (Trinity), Coral Rehabilitation and Nursing of Austin (Travis County), and San Antonio West Nursing and Rehabilitation (Bexar County). All ten of the most-cited facilities are currently Medicare/Medicaid-certified and operating — each appears in CMS's live, current-quarter Nursing Home Compare provider file, from which CMS removes facilities once they close or exit the program. Nine of the ten carry the lowest possible 1-star overall CMS rating; one (Avir at Schertz) is 2-star. Note: the ranking query applied the filter total_health_deficiencies IS NOT NULL, which removed 6 of 1,177 Texas facilities (0.5%) that had no deficiency count on file; see 'Method and data' for exactly which facilities that excluded and why it does not change the top-10 list.

Method and data

Ranked all Texas rows in CMS's Nursing Home Compare "Provider Information" dataset (health.cms_nursing_home, sourced from data.cms.gov dataset 4pq5-n9py) by total_health_deficiencies — the count of health deficiencies cited on each facility's most recent standard survey. This is a point-in-time snapshot, not a multi-year trend: CMS's public file carries only the latest survey cycle's tally per facility, so 'recently' here means the facility's most recent inspection cycle, not a rolling window.

Exclusion disclosed: The query's filter total_health_deficiencies IS NOT NULL excluded 6 of 1,177 Texas facilities (0.5%) that carry a NULL deficiency count in the CMS file and so could not be ranked at all: Coon Memorial Home (Dalhart, Dallam County), Rolling Meadows (Wichita Falls, Wichita County), Tuskegee Airmen Texas State Veterans Home (Fort Worth, Tarrant County), The Heights of Magnolia (Magnolia, Montgomery County), St. Joseph's Care Center (McGregor, McLennan County), and St. Juanita Retirement and Rehab (San Angelo, Tom Green County). Because a NULL value cannot be sorted (it is absent, not low), re-running the same ranking WITHOUT the total_health_deficiencies IS NOT NULL filter produces an identical top-10 list — the headline is unchanged by this exclusion — but the reader should know these six facilities simply carry no current deficiency data in the CMS file rather than a favorable one, which is itself worth disclosing rather than silently dropping.

Fines, penalty counts, and CMS star ratings (overall and health-inspection) were pulled alongside deficiency counts as corroborating severity signals, since a raw deficiency count alone does not distinguish 'many minor tags' from 'few severe ones' — the weighted health_deficiency_score and fine/penalty counts help triangulate genuine seriousness. Notably, Coral Rehabilitation and Nursing of Austin has 36 deficiencies but the highest weighted deficiency score (960) and $294,614 in fines among the top group, and Merkel Nursing Center (29 deficiencies, ranked lower by raw count) carries a weighted score of 815 and $318,060 in fines — a reminder that raw deficiency count and true severity do not always move together.

Are they still operating?

Yes — all ten facilities listed above are present in CMS's current Nursing Home Compare snapshot, which is the operative evidence: CMS's monthly-refreshed provider file does not retain closed or deactivated facilities (per StarPRO's tracking of CMS nursing-home deactivations and McKnight's reporting on the Care Compare pipeline). A facility's continued presence in this file is CMS's own signal that it remains Medicare/Medicaid-certified. We attempted to cross-check against health.cms_pos_termination_history (CMS's hospital/facility termination-event table), but that table's provider-category scope (hospitals, psychiatric/behavioral residential, clinics, community mental health centers, and an 'other' bucket) does not include skilled nursing facilities as a category, and none of the ten CCNs returned any row there — so it neither confirms nor contradicts operating status for this facility type, and we do not rely on it. A spot web check of the top-ranked facility (Avir at Kerrville, CCN 745050) via its own facility website, ProPublica's Nursing Home Inspect database, and local business listings confirms it is an actively operating, newly built skilled-nursing/rehab facility in Kerrville, TX as of this writing.

Top 10 Texas nursing homes by cited deficiencies

Every query behind this report

5 warehouse calls ran in this session, in order. Each is reproducible against the same snapshot.

SELECT provider_name, city, state, county, ownership_type,
  CAST(total_health_deficiencies AS DOUBLE) AS deficiencies,
  CAST(health_deficiency_score AS DOUBLE) AS deficiency_score,
  CAST(number_of_fines AS DOUBLE) AS fines,
  CAST(total_fines_dollars AS DOUBLE) AS fines_dollars,
  CAST(total_number_of_penalties AS DOUBLE) AS penalties,
  overall_rating, health_inspection_rating, certified_beds
FROM health.cms_nursing_home
WHERE state = 'TX' AND total_health_deficiencies IS NOT NULL
ORDER BY deficiencies DESC
LIMIT 15

SELECT COUNT(*) AS total, SUM(CASE WHEN total_health_deficiencies IS NULL THEN 1 ELSE 0 END) AS null_deficiencies FROM health.cms_nursing_home WHERE state = 'TX'

SELECT ccn, provider_name, city, county,
  CAST(total_health_deficiencies AS DOUBLE) AS deficiencies
FROM health.cms_nursing_home
WHERE state = 'TX' AND total_health_deficiencies IS NOT NULL
ORDER BY deficiencies DESC
FETCH FIRST 10 ROWS ONLY

SELECT provider_number, facility_name, is_terminated, termination_date, termination_code
FROM health.cms_pos_termination_history
WHERE provider_number IN ('745050','676301','676439','455862','675002','455804','675509','455532','675756','455510')

SELECT provider_name, city, county FROM health.cms_nursing_home WHERE state = 'TX' AND total_health_deficiencies IS NULL