Hays Nursing and Rehabilitation Center
1900 Medical Parkway, San Marcos, TX 78666 · Hays County · 116 certified beds · avg 93 residents/day · certified since Oct 1, 1991
Part of chain: THE ENSIGN GROUP (342 facilities, chain avg rating 3.2★)
What health inspectors found (on-site government inspections — the most independent evidence available)
Health inspection rating: ★★★☆☆3/5 · CMS overall rating: 3/5
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 · May 2, 2024 · 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 (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 3, 2024 (Deficient, Provider has date of correction)
▲ Immediate jeopardy, one-off · May 2, 2024 · F-0607 · triggered by a complaint
The facility did not develop and follow policies and procedures to prevent abuse, neglect, and theft. These written safeguards are the foundation of resident protection.
Why it matters: Without working prevention policies, mistreatment is more likely to happen and less likely to be caught.
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 3, 2024 (Deficient, Provider has date of correction)
All citations in the current public record (26)
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 |
|---|---|---|
| Mar 5, 2026 | E · Potential for harm, repeated | The facility did not make reasonable adjustments to fit each resident's individual needs and preferences — things like call buttons within reach, preferred wake-up times, or accessible room setups. |
| Mar 5, 2026 | E · Potential for harm, repeated | The facility did not provide a safe, clean, comfortable, and homelike environment, including safe support for residents' daily living needs. |
| Mar 5, 2026 | 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. |
| Mar 5, 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. |
| Mar 5, 2026 | 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. |
| Mar 5, 2026 | D · Potential for harm, one-off | The facility did not provide special eating equipment and utensils — like adaptive cups or easy-grip silverware — for residents who need them, along with appropriate help at meals. |
| Jan 16, 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. |
| Jan 16, 2025 | E · Potential for harm, repeated | The facility did not provide activities that meet residents' needs and interests. Nursing homes must offer meaningful activity programs, not just leave residents idle. |
| Jan 16, 2025 | E · Potential for harm, repeated | The facility did not have a licensed pharmacist review each resident's complete medication regimen and medical chart every month, or did not follow its own rules for reporting medication problems. |
| Jan 16, 2025 | E · Potential for harm, repeated | 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 16, 2025 | 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. |
| Jan 16, 2025 | 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. |
| Jul 9, 2024 | 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. · from a complaint |
| Jul 9, 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 |
| May 2, 2024 | ▲ J · Immediate jeopardy, 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 |
| May 2, 2024 | ▲ J · Immediate jeopardy, one-off | The facility did not develop and follow policies and procedures to prevent abuse, neglect, and theft. These written safeguards are the foundation of resident protection. · from a complaint |
| May 2, 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 |
| Dec 14, 2023 | 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. |
| Dec 14, 2023 | E · Potential for harm, repeated | The facility did not provide a safe, clean, comfortable, and homelike environment, including safe support for residents' daily living needs. |
| Dec 14, 2023 | E · Potential for harm, repeated | The facility did not keep the environment free of accident hazards, or did not provide enough supervision to prevent accidents like falls. |
| Dec 14, 2023 | D · Potential for harm, one-off | The facility did not provide activities that meet residents' needs and interests. Nursing homes must offer meaningful activity programs, not just leave residents idle. |
| Dec 14, 2023 | D · Potential for harm, 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. |
| Dec 14, 2023 | 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. |
| Dec 14, 2023 | D · Potential for harm, one-off | The facility did not provide enough food and fluids to keep residents healthy, such as preventing unplanned weight loss or dehydration. |
| Nov 20, 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. · from a complaint |
| Sep 23, 2023 | 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 |
Inspection trend by year
Citations from standard inspections stayed about the same across the last two inspection cycles (6 → 6).
| Year | Citations | Serious (G–L) | Worst severity that year |
|---|---|---|---|
| 2023 | 9 | 0 | F |
| 2024 | 5 | 2 | J ▲ |
| 2025 | 6 | 0 | E |
| 2026 | 6 | 0 | E |
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 $8,226.
| Date | Type | Amount / length |
|---|---|---|
| May 2, 2024 | Fine | $8,226 |
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) | 3.63 | 3.46 | 3.95 | top 28% in Texas; bottom 43% in the U.S. |
| Registered Nurse hours | 0.51 | 0.44 | 0.69 | top 25% in Texas; bottom 39% in the U.S. |
| Weekend total nurse staffing | 3.01 | 3.04 | 3.50 | top 40% in Texas; bottom 32% in the U.S. |
| Weekend RN hours (not acuity-adjusted) | 0.22 | 0.34 | 0.48 | bottom 27% in Texas; bottom 15% in the U.S. |
| Total nursing staff turnover (%) | 37.9 | 55.3 | 45.8 | top 16% in Texas; top 31% in the U.S. |
| RN turnover (%) | 22.2 | 54.6 | 42.9 | top 10% in Texas; top 17% 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 3.27, RN 0.46, weekend 2.72. Staffing rating: 3/5.
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: 4/5 · short-stay residents: 4/5
Who owns this facility
For profit - Corporation
| Owner / manager | Type | Role | Stake | Since |
|---|---|---|---|---|
| Guadalupe County Hospital Board | Organization | 5% or Greater Direct Ownership Interest | 100% | 12/01/2020 |
| Burnam, Soon | Individual | Corporate Officer | NOT APPLICABLE | 12/01/2020 |
| Chudleigh, James | Individual | Managing Control - Governing Body | NOT APPLICABLE | 02/01/2024 |
| Chudleigh, James | Individual | Operational/Managerial Control | NOT APPLICABLE | 02/01/2024 |
| Chudleigh, James | Individual | ADP of the SNF | NOT APPLICABLE | 02/01/2024 |
| Ensign Services INC | Organization | ADP of the SNF | NOT APPLICABLE | 10/13/2020 |
| Gann, Kody | Individual | Corporate Officer | NOT APPLICABLE | 04/03/2021 |
| Keetch, Chad | Individual | Corporate Officer | NOT APPLICABLE | 03/01/2011 |
| Phelps, Nelson | Individual | Managing Control - Governing Body | NOT APPLICABLE | 12/01/2020 |
| Phelps, Nelson | Individual | Operational/Managerial Control | NOT APPLICABLE | 12/01/2020 |
| Phelps, Nelson | Individual | ADP of the SNF | NOT APPLICABLE | 12/01/2020 |
| San Marcos TX Propco LLC | Organization | ADP of the SNF | NOT APPLICABLE | 12/01/2020 |
| Willow Springs Creek Healthcare, INC. | Organization | Operational/Managerial Control | NOT APPLICABLE | 12/01/2020 |
| Willow Springs Creek Healthcare, INC. | Organization | ADP of the SNF | NOT APPLICABLE | 11/25/2025 |
Questions to ask on your visit
Generated from this facility's actual citation record — bring them to a tour and ask the administrator directly.
- "Tell me about this abuse or neglect citation — what happened, and what specific changes did you make afterward?"
- "What specific steps do you take to prevent abuse and neglect, and how are staff trained on them?"
- "Can you give me examples of how you adjust daily routines and room setups to fit each resident's preferences?"
- "Can we tour the resident rooms, bathrooms, and common areas today, including areas not on the usual tour route?"
- "How many aides are on each shift, and how do you make sure every resident gets timely help with bathing, dressing, and meals?"
- "What did your most recent kitchen inspection find, and can I see how food is stored and prepared?"
- "Who leads your infection prevention program, and how do you make sure staff follow practices like hand hygiene every day?"
- "What adaptive eating equipment do you provide, and how do you decide who needs help at meals?"
- "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 |
|---|---|---|---|---|---|
| Cypress Healthcare and Rehabilitation Center | 0.6 mi | San Marcos, TX | ★☆☆☆☆ | 1/5 | |
| San Marcos Rehabilitation and Healthcare Center | 1.9 mi | San Marcos, TX | ★☆☆☆☆ | 1/5 | |
| Legend Oaks Healthcare and Rehabilitation - New Br | 11.6 mi | New Braunfels, TX | ★★★☆☆ | 3/5 | |
| Legend Oaks Healthcare and Rehabilitation-Kyle | 12.0 mi | Kyle, TX | ★★★☆☆ | 3/5 | |
| Sundance Inn Health Center | 12.2 mi | New Braunfels, TX | ★★☆☆☆ | 2/5 | abuse |
| Avir at New Braunfels | 12.3 mi | New Braunfels, TX | ★☆☆☆☆ | 1/5 | abuse |
| Deer Creek Nursing and Rehabilitation | 13.1 mi | Wimberley, TX | ★☆☆☆☆ | 1/5 | |
| Eden Home | 14.3 mi | New Braunfels, TX | ★★★☆☆ | 3/5 | |
| Chisolm Trail Nursing and Rehabilitation Center | 15.8 mi | Lockhart, TX | ★★★☆☆ | 3/5 | |
| Parkview Nursing and Rehabilitation Center | 16.6 mi | Lockhart, TX | ★★☆☆☆ | 2/5 | abuse |
| Kirkwood Manor | 16.8 mi | New Braunfels, TX | ★★☆☆☆ | 2/5 | |
| Avir at Walnut Springs | 18.6 mi | Seguin, TX | ★★★★☆ | 4/5 |
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Facility data as of CMS processing date 2026-08-01. CCN 455960.