Avir at Veterans Memorial
1424 Fallbrook Drive, Houston, TX 77038 · Harris County · 120 certified beds · avg 98 residents/day · certified since Jun 25, 2010
Abuse citation flag (CMS)
Part of chain: AVIR HEALTH GROUP (116 facilities, chain avg rating 2.3★)
The abuse flag means inspectors cited this facility for abuse that caused harm to a resident within the past year, or potential for harm in each of the last two years. Source: CMS.
What health inspectors found (on-site government inspections — the most independent evidence available)
Health inspection rating: ★☆☆☆☆1/5 · 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 18, 2026 · F-0684
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: Apr 19, 2026 (Deficient, Provider has date of correction)
▲ Immediate jeopardy, one-off · Apr 18, 2026 · F-0697 · triggered by a complaint
The facility did not provide safe and appropriate pain management for a resident who needed it.
Why it matters: Untreated pain causes needless suffering and can lead to depression, poor sleep, and declining health.
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: Apr 19, 2026 (Deficient, Provider has date of correction)
▲ Immediate jeopardy, one-off · Oct 31, 2025 · F-0689 · triggered by a complaint
The facility did not keep the environment free of accident hazards, or did not provide enough supervision to prevent accidents like falls.
Why it matters: This is one of the most common citations and directly relates to falls and injuries, which can be devastating for older adults.
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: Oct 8, 2025 (Past Non-Compliance)
▲ Actual harm, one-off · May 7, 2026 · F-0600 · triggered by a complaint
The facility did not protect residents from abuse or neglect. This covers physical, mental, and sexual abuse, physical punishment, and neglect, by anyone — staff, other residents, or visitors.
Why it matters: Abuse and neglect cause direct physical and emotional harm and are among the most serious failures a nursing home can have.
Severity (G): One or a few residents were actually harmed — physically or emotionally — though not put in immediate danger of serious injury or death.
Corrected: May 12, 2026 (Deficient, Provider has date of correction)
▲ Actual harm, one-off · Oct 31, 2025 · F-0694 · triggered by a complaint
The facility did not safely and appropriately administer IV fluids (fluids given through a vein) for residents who needed them.
Why it matters: Improper IV care can cause infections, dehydration, or dangerous fluid imbalances.
Severity (G): One or a few residents were actually harmed — physically or emotionally — though not put in immediate danger of serious injury or death.
Corrected: Nov 3, 2025 (Deficient, Provider has date of correction)
All citations in the current public record (27)
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 |
|---|---|---|
| May 21, 2026 | D · Potential for harm, one-off | The facility did not maintain an effective pest control program to prevent or deal with mice, insects, or other pests. · from a complaint |
| May 7, 2026 | ▲ G · Actual harm, one-off | The facility did not protect residents from abuse or neglect. This covers physical, mental, and sexual abuse, physical punishment, and neglect, by anyone — staff, other residents, or visitors. · from a complaint |
| Apr 18, 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. |
| Apr 18, 2026 | ▲ J · Immediate jeopardy, one-off | The facility did not provide safe and appropriate pain management for a resident who needed it. · from a complaint |
| Apr 18, 2026 | E · Potential for harm, repeated | 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. |
| Apr 18, 2026 | E · Potential for harm, repeated | 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. |
| Apr 18, 2026 | E · Potential for harm, repeated | The facility did not safely and appropriately administer IV fluids (fluids given through a vein) for residents who needed them. |
| Apr 18, 2026 | E · Potential for harm, repeated | The facility did not provide pharmacy services that meet each resident's needs, or did not employ or contract with a licensed pharmacist. |
| Apr 18, 2026 | D · Potential for harm, one-off | The facility did not honor residents' rights to request, refuse, or stop treatment, to decline participation in medical research, or to make an advance directive — a written statement of their wishes for future medical care. |
| Apr 18, 2026 | D · Potential for harm, one-off | The facility did not provide a safe, clean, comfortable, and homelike environment, including safe support for residents' daily living needs. |
| Apr 18, 2026 | D · Potential for harm, one-off | The facility did not coordinate resident assessments with the state's pre-admission screening program for mental illness and intellectual disabilities, or failed to refer residents for the special services they need. |
| Apr 18, 2026 | 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. |
| Apr 18, 2026 | D · Potential for harm, one-off | The facility did not provide timely, approved x-ray services or have an agreement with an approved provider to supply them. |
| Apr 18, 2026 | D · Potential for harm, one-off | 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. |
| Apr 18, 2026 | D · Potential for harm, one-off | The facility did not have a working call system — the button or cord residents use to summon help — in each resident's bathroom and bathing area. |
| Oct 31, 2025 | ▲ J · Immediate jeopardy, one-off | The facility did not keep the environment free of accident hazards, or did not provide enough supervision to prevent accidents like falls. · from a complaint |
| Oct 31, 2025 | ▲ G · Actual harm, one-off | The facility did not safely and appropriately administer IV fluids (fluids given through a vein) for residents who needed them. · from a complaint |
| Oct 31, 2025 | E · Potential for harm, repeated | 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 |
| Apr 15, 2025 | 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 |
| Jan 31, 2025 | 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. |
| Jan 31, 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. |
| Jan 3, 2025 | D · Potential for harm, one-off | The facility did not protect residents' personal information or did not keep complete, accurate medical records that meet professional standards. · from a complaint |
| Dec 8, 2023 | E · Potential for harm, repeated | 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. |
| Dec 8, 2023 | E · Potential for harm, repeated | 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. |
| Dec 8, 2023 | E · Potential for harm, repeated | The facility's bedrooms did not give residents visual privacy — such as curtains or dividers — when privacy is needed. · from a complaint |
| Dec 8, 2023 | 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. |
| Sep 27, 2023 | 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 |
Inspection trend by year
Citations from standard inspections increased between the last two inspection cycles (2 → 13).
| Year | Citations | Serious (G–L) | Worst severity that year |
|---|---|---|---|
| 2023 | 5 | 0 | E |
| 2025 | 7 | 2 | J ▲ |
| 2026 | 15 | 3 | 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)
2 fines totaling $37,961, plus 1 Medicare payment denial period.
| Date | Type | Amount / length |
|---|---|---|
| Apr 18, 2026 | Fine | $23,611 |
| Apr 18, 2026 | Payment Denial | 2 days from May 20, 2026 |
| Oct 31, 2025 | Fine | $14,350 |
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) | 3.03 | 3.46 | 3.95 | bottom 25% in Texas; bottom 15% in the U.S. |
| Registered Nurse hours | 0.38 | 0.44 | 0.69 | bottom 48% in Texas; bottom 19% in the U.S. |
| Weekend total nurse staffing | 2.71 | 3.04 | 3.50 | bottom 31% in Texas; bottom 17% in the U.S. |
| Weekend RN hours (not acuity-adjusted) | 0.27 | 0.34 | 0.48 | bottom 44% in Texas; bottom 26% in the U.S. |
| Total nursing staff turnover (%) | 52.8 | 55.3 | 45.8 | bottom 48% in Texas; bottom 30% in the U.S. |
| RN turnover (%) | 0.0 | 54.6 | 42.9 | top 1% in Texas; top 1% 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 3.12, RN 0.39, weekend 2.79. Staffing rating: 2/5.
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: 4/5 · long-stay residents: 5/5 · short-stay residents: 3/5
Who owns this facility
For profit - Limited Liability company
| Owner / manager | Type | Role | Stake | Since |
|---|---|---|---|---|
| 1424 Fallbrook Dr Holdings LLC | Organization | Direct Ownership Interest | NOT APPLICABLE | 08/01/2025 |
| Ana TX Holdings, LLC | Organization | Indirect Ownership Interest | NOT APPLICABLE | 08/01/2025 |
| Graf Holdings LLC | Organization | Indirect Ownership Interest | NOT APPLICABLE | 08/01/2025 |
| TX SNF Holdings II LLC | Organization | Indirect Ownership Interest | NOT APPLICABLE | 08/01/2025 |
| TX SNF Holdings Member, LLC | Organization | Indirect Ownership Interest | NOT APPLICABLE | 08/01/2025 |
| 1424 Fallbrook Dr Property Owner LLC | Organization | ADP of the SNF | NOT APPLICABLE | 08/01/2025 |
| Freund, Nochum | Individual | Corporate Officer | NOT APPLICABLE | 08/01/2025 |
| Suter, Rachel | Individual | ADP of the SNF | NOT APPLICABLE | 08/01/2025 |
| Travitsky, Aaron | Individual | Operational/Managerial Control | NOT APPLICABLE | 08/01/2025 |
| Welltower INC | Organization | ADP of the SNF | NOT APPLICABLE | 08/01/2025 |
| Welltower NNN Group, LLC | Organization | ADP of the SNF | NOT APPLICABLE | 08/01/2025 |
| Welltower Op, LLC | Organization | ADP of the SNF | NOT APPLICABLE | 08/01/2025 |
| Wilbert, Shanae | Individual | ADP of the SNF | NOT APPLICABLE | 08/01/2025 |
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?"
- "How do you assess and manage residents' pain, especially for those who have trouble communicating?"
- "What is your falls rate, and what specific steps do you take to prevent falls and supervise residents at risk?"
- "Tell me about this abuse or neglect citation — what happened, and what specific changes did you make afterward?"
- "Who on your staff manages IV therapy, and what training and monitoring is in place?"
- "How is pest control handled here, and when was the last treatment or inspection?"
- "Can you give me examples of how your staff protect residents' dignity in everyday care, like bathing and dressing?"
- "Can you show me an example care plan, and how are families included when it's created and updated?"
- "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 |
|---|---|---|---|---|---|
| Houston Heights Nursing and Rehabilitation Center | 4.1 mi | Houston, TX | ★☆☆☆☆ | 2/5 | |
| Ashford Gardens | 4.7 mi | Houston, TX | ★★☆☆☆ | 2/5 | |
| Caraday of Houston | 4.7 mi | Houston, TX | ★☆☆☆☆ | 1/5 | |
| Villa Toscana at Cypress Woods | 5.5 mi | Houston, TX | ★☆☆☆☆ | 2/5 | |
| Legend Oaks Healthcare and Rehabilitation Center - | 6.1 mi | Houston, TX | ★★☆☆☆ | 2/5 | |
| West Janisch Health Care Center | 6.2 mi | Houston, TX | ★☆☆☆☆ | 1/5 | abuse |
| Paradigm at Woodwind Lakes | 6.3 mi | Houston, TX | —/5 | SFF | |
| Champions Healthcare at Willowbrook | 6.8 mi | Houston, TX | ★★☆☆☆ | 2/5 | abuse |
| Highland Park Care Center | 6.9 mi | Houston, TX | ★★☆☆☆ | 1/5 | |
| Paradigm Northwest | 7.1 mi | Houston, TX | ★☆☆☆☆ | 1/5 | |
| Park Manor of Cypress Station | 7.1 mi | Houston, TX | ★☆☆☆☆ | 1/5 | abuse |
| The Heights of North Houston | 7.4 mi | Houston, TX | ★★☆☆☆ | 2/5 |
Compare this facility with the 3 closest →
Facility data as of CMS processing date 2026-08-01. CCN 676252.