Arbor Grace Guest Care Center
2700 S. Henderson Blvd., Kilgore, TX 75662 · Rusk County · 127 certified beds · avg 84 residents/day · certified since Dec 14, 1999
What health inspectors found (on-site government inspections — the most independent evidence available)
Health inspection rating: ★★☆☆☆2/5 · CMS overall rating: 1/5
The health inspection star above is graded on a curve within each state — a set share of each state's facilities gets each star level — so a facility can have few citations and still rate 2–3 stars if others in its state did even better. The overall rating combines that inspection score with staffing and self-reported quality measures.
Most serious findings (actual harm or immediate jeopardy)
▲ Immediate jeopardy, one-off · Apr 29, 2026 · F-0684 · triggered by a complaint
The facility did not provide treatment and care that follows the doctor's orders and matches the resident's own preferences and goals.
Why it matters: Care that strays from doctor's orders or ignores the resident's wishes can lead to declining health and avoidable harm.
Severity (J): Inspectors found a situation that put a resident's life or safety in immediate danger, affecting one or a few residents. The facility must fix it immediately — these citations often come with large fines.
Corrected: May 1, 2026 (Deficient, Provider has date of correction)
All citations in the current public record (23)
CMS publishes roughly the last three inspection cycles plus recent complaint investigations. Older surveys drop out of the record as new ones are completed.
| Date | Severity | What the facility was cited for |
|---|---|---|
| Jun 17, 2026 | E · Potential for harm, repeated | The facility gave residents unnecessary mind-altering (psychotropic) medications, or used drugs in a way that restrained residents by dulling their ability to think, move, or function. |
| Jun 17, 2026 | E · Potential for harm, repeated | The facility did not get its food from approved, safe sources, or did not store, prepare, and serve food according to professional food safety standards. |
| Jun 17, 2026 | D · Potential for harm, one-off | The facility did not protect residents from misuse of their belongings or money — this is called misappropriation, and it includes theft or improper use of a resident's property or funds. · from a complaint |
| Jun 17, 2026 | D · Potential for harm, one-off | The facility did not fully assess residents on time — a complete assessment of health, abilities, and needs is required when a resident is first admitted and at least once every 12 months after that. |
| Jun 17, 2026 | D · Potential for harm, one-off | The facility did not accurately assess a resident's health and needs. Assessments are the foundation for all the care a resident receives. |
| Jun 17, 2026 | D · Potential for harm, one-off | The facility did not provide the care needed to maintain or improve residents' movement and flexibility — such as range-of-motion exercises — leading to avoidable decline. |
| Jun 17, 2026 | D · Potential for harm, one-off | The facility did not have or follow an effective program to prevent and control infections — such as proper hand washing, cleaning, and isolation practices. This is the most commonly cited deficiency nationwide. |
| Jun 17, 2026 | D · Potential for harm, one-off | The facility did not have a working program to monitor how antibiotics are used. Tracking antibiotic use helps make sure these drugs are given only when needed and remain effective. |
| Apr 29, 2026 | ▲ J · Immediate jeopardy, one-off | The facility did not provide treatment and care that follows the doctor's orders and matches the resident's own preferences and goals. · from a complaint |
| Apr 2, 2025 | E · Potential for harm, repeated | The facility did not have or follow an effective program to prevent and control infections — such as proper hand washing, cleaning, and isolation practices. This is the most commonly cited deficiency nationwide. |
| Apr 2, 2025 | D · Potential for harm, one-off | The facility did not keep the environment free of accident hazards, or did not provide enough supervision to prevent accidents like falls. |
| Apr 2, 2025 | D · Potential for harm, one-off | The facility did not provide appropriate care related to bladder and bowel needs — including care for residents who use catheters and steps to prevent urinary tract infections. |
| Apr 2, 2025 | D · Potential for harm, one-off | The facility did not label drugs according to professional standards or did not store them in locked compartments, with controlled drugs (medications with a high risk of misuse) kept under a separate lock. · from a complaint |
| Mar 20, 2024 | F · Potential for harm, facility-wide | The facility did not get its food from approved, safe sources, or did not store, prepare, and serve food according to professional food safety standards. |
| Mar 20, 2024 | F · Potential for harm, facility-wide | The facility did not keep all essential equipment working safely — things like heating and cooling systems, kitchen equipment, and medical devices. |
| Mar 20, 2024 | D · Potential for harm, one-off | The facility did not report suspected abuse, neglect, or theft to the proper authorities quickly enough, or did not report the results of its investigation. · from a complaint |
| Mar 20, 2024 | D · Potential for harm, one-off | The facility did not provide the help residents need with basic daily activities — like bathing, dressing, eating, and using the bathroom — for residents who cannot do these things on their own. |
| Mar 20, 2024 | D · Potential for harm, one-off | The facility did not provide safe and appropriate respiratory care — such as oxygen, breathing treatments, or care for residents on breathing equipment — for residents who needed it. |
| Feb 29, 2024 | D · Potential for harm, one-off | The facility did not develop or follow a complete care plan for each resident — the written roadmap covering all of a resident's needs, with measurable goals and timelines. · from a complaint |
| Feb 23, 2024 | D · Potential for harm, one-off | The facility did not honor residents' right to voice complaints without discrimination or retaliation, or did not have a working complaint process that resolves issues promptly. · from a complaint |
| Nov 20, 2023 | D · Potential for harm, one-off | The facility did not treat residents with dignity and respect, or did not honor their rights to make their own decisions and communicate freely. This is one of the most fundamental resident rights. · from a complaint |
| Nov 20, 2023 | D · Potential for harm, one-off | The facility did not provide proper care for pressure ulcers (bedsores) or did not do enough to prevent new ones from forming. Bedsores develop when residents stay in one position too long without help moving. · from a complaint |
| Nov 20, 2023 | D · Potential for harm, one-off | The facility did not serve meals and snacks at times that fit residents' needs, preferences, and requests, or did not offer nourishing alternatives for residents who want to eat outside scheduled meal times. · from a complaint |
Inspection trend by year
Citations from standard inspections increased between the last two inspection cycles (4 → 8).
| Year | Citations | Serious (G–L) | Worst severity that year |
|---|---|---|---|
| 2023 | 3 | 0 | D |
| 2024 | 7 | 0 | F |
| 2025 | 4 | 0 | E |
| 2026 | 9 | 1 | J ▲ |
Counts reflect the current CMS public record (~3 inspection cycles plus complaint investigations); years with no surveys show no row. Inspection frequency varies, so compare severity as well as counts.
Fines and enforcement (last 3 years)
1 fine totaling $187,096.
| Date | Type | Amount / length |
|---|---|---|
| Apr 29, 2026 | Fine | $187,096 |
Nurse staffing (from payroll records, adjusted for how much care residents need)
| Measure | This facility | Texas avg | U.S. avg | Where it stands |
|---|---|---|---|---|
| Total nurse staffing (hours per resident per day) | 3.38 | 3.46 | 3.95 | top 44% in Texas; bottom 30% in the U.S. |
| Registered Nurse hours | 0.39 | 0.44 | 0.69 | bottom 49% in Texas; bottom 20% in the U.S. |
| Weekend total nurse staffing | 2.95 | 3.04 | 3.50 | top 46% in Texas; bottom 28% in the U.S. |
| Weekend RN hours (not acuity-adjusted) | 0.31 | 0.34 | 0.48 | top 44% in Texas; bottom 35% in the U.S. |
| Total nursing staff turnover (%) | 75.3 | 55.3 | 45.8 | bottom 15% in Texas; bottom 3% in the U.S. |
| RN turnover (%) | 69.2 | 54.6 | 42.9 | bottom 30% in Texas; bottom 12% in the U.S. |
Hours are per resident per day, case-mix adjusted by CMS so facilities caring for sicker residents can be compared fairly (same basis as the CMS staffing star). "Top X%" means better than most facilities: more staffing hours, or lower turnover. Raw (unadjusted) reported hours: total 3.58, RN 0.41, weekend 3.13. Staffing rating: 1/5.
Self-reported quality measures
Note: these ratings are based on data the facility reports about itself to CMS. They are not independently verified by inspectors, and can look better than inspection findings. Give more weight to the inspection results above.
Quality measures rating: 3/5 · long-stay residents: 4/5 · short-stay residents: 1/5
Who owns this facility
For profit - Corporation
| Owner / manager | Type | Role | Stake | Since |
|---|---|---|---|---|
| Gamble, Denny | Individual | Operational/Managerial Control | NOT APPLICABLE | 06/01/2023 |
| Gamvest Texas LLC | Organization | ADP of the SNF | NOT APPLICABLE | 06/01/2023 |
| Hooper, Grady | Individual | Corporate Officer | NOT APPLICABLE | 06/01/2023 |
| K-J-K Venture, LLC | Organization | ADP of the SNF | NOT APPLICABLE | 06/01/2023 |
| Kegarise, Brandon | Individual | Operational/Managerial Control | NOT APPLICABLE | 02/27/2023 |
| Kegarise, Brandon | Individual | ADP of the SNF | NOT APPLICABLE | 02/27/2023 |
| Machen Health Management LLC | Organization | ADP of the SNF | NOT APPLICABLE | 06/01/2023 |
| Machen, Matt | Individual | Operational/Managerial Control | NOT APPLICABLE | 06/01/2023 |
| MPD Acquisition of Kilgore, LLC | Organization | 5% or Greater Mortgage Interest | NOT APPLICABLE | 06/01/2023 |
| MPD Acquisition of Kilgore, LLC | Organization | ADP of the SNF | NOT APPLICABLE | 06/01/2023 |
| MPD Texas Resources of Kilgore LLC | Organization | Operational/Managerial Control | NOT APPLICABLE | 06/01/2023 |
| MPD Texas Resources of Kilgore LLC | Organization | ADP of the SNF | NOT APPLICABLE | 04/29/2025 |
| Shen, Hong-I | Individual | Operational/Managerial Control | NOT APPLICABLE | 06/01/2023 |
| Shen, Hong-I | Individual | ADP of the SNF | NOT APPLICABLE | 06/01/2023 |
Questions to ask on your visit
Generated from this facility's actual citation record — bring them to a tour and ask the administrator directly.
- "How do you make sure each resident's care follows the doctor's orders, and what changed after this citation?"
- "What percentage of your residents are on antipsychotic or sedating medications, and how do you work to reduce that?"
- "What did your most recent kitchen inspection find, and can I see how food is stored and prepared?"
- "What safeguards do you have to protect residents' money and belongings, and what happens when something goes missing?"
- "How soon after admission is a full assessment completed, and how are the findings shared with the family?"
- "Who completes resident assessments here, and how do you check them for accuracy?"
- "What do you do daily to keep residents moving, and how do you help residents at risk of losing mobility?"
- "Who leads your infection prevention program, and how do you make sure staff follow practices like hand hygiene every day?"
- "What is your current ratio of nursing staff to residents on day, evening, and weekend shifts?"
- "Can I see the results and plan of correction from your most recent state inspection?"
Nearby facilities (within 20 miles)
| Facility | Distance | City | Overall | Inspection | Flags |
|---|---|---|---|---|---|
| Willow Rehab & Nursing | 0.7 mi | Kilgore, TX | ★★★☆☆ | 2/5 | |
| Avir at Overton | 8.2 mi | Overton, TX | ★★☆☆☆ | 1/5 | abuseSFF |
| Pine Tree Lodge Nursing Center | 12.4 mi | Longview, TX | ★☆☆☆☆ | 1/5 | |
| Highland Pines Nursing Home | 12.8 mi | Longview, TX | ★☆☆☆☆ | 2/5 | |
| Truman W Smith Children's Care Center | 13.6 mi | Gladewater, TX | ★★★★★ | 5/5 | |
| Heritage at Longview Healthcare Center | 13.6 mi | Longview, TX | ★☆☆☆☆ | 2/5 | |
| The Oaks at Longview | 13.6 mi | Longview, TX | ★★★☆☆ | 4/5 | |
| Buckner Westminster Place | 13.7 mi | Longview, TX | ★★★★☆ | 3/5 | |
| Avir at Longview | 13.8 mi | Longview, TX | ★☆☆☆☆ | 1/5 | abuse |
| Autumn Leaves Nursing and Rehab INC | 14.0 mi | Henderson, TX | ★★☆☆☆ | 2/5 | |
| Whispering Pines Lodge | 14.2 mi | Longview, TX | ★☆☆☆☆ | 1/5 | abuseSFF |
| Longview Hill Nursing and Rehabilitation Center | 14.4 mi | Longview, TX | ★☆☆☆☆ | 1/5 |
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Facility data as of CMS processing date 2026-08-01. CCN 675814.