McGregor Wellness & Rehabilitation
414 Johnson Dr, Mc Gregor, TX 76657 · Mc Lennan County · 186 certified beds · avg 57 residents/day · certified since Jun 17, 1985
Part of chain: OPCO SKILLED MANAGEMENT (66 facilities, chain avg rating 2.3★)
What health inspectors found (on-site government inspections — the most independent evidence available)
Health inspection rating: ★☆☆☆☆1/5 · CMS overall rating: 2/5
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 · Jun 25, 2025 · F-0580 · triggered by a complaint
The facility did not immediately notify the resident, their doctor, and a family member when something significant happened — such as an injury, a decline in health, or a room change. Families and doctors are entitled to know right away.
Why it matters: A family could learn about a serious injury or decline days later, after the chance to act has passed.
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: Jul 25, 2025 (Deficient, Provider has date of correction)
▲ Immediate jeopardy, one-off · Jun 25, 2025 · F-0690 · triggered by a complaint
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.
Why it matters: Poor continence and catheter care leads to infections, skin breakdown, and loss of dignity.
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: Jul 25, 2025 (Deficient, Provider has date of correction)
▲ Immediate jeopardy, one-off · Jun 25, 2025 · 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: Jul 25, 2025 (Deficient, Provider has date of correction)
▲ Immediate jeopardy, repeated · Apr 15, 2024 · 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 (K): A life-threatening or extremely dangerous situation affected several residents. Among the most serious findings an inspection can produce.
Corrected: Apr 16, 2024 (Deficient, Provider has date of correction)
▲ Immediate jeopardy, repeated · Dec 4, 2023 · F-0755 · triggered by a complaint
The facility did not provide pharmacy services that meet each resident's needs, or did not employ or contract with a licensed pharmacist.
Why it matters: Weak pharmacy services lead to medication mistakes, delays, and missed drug interactions that can seriously harm residents.
Severity (K): A life-threatening or extremely dangerous situation affected several residents. Among the most serious findings an inspection can produce.
Corrected: Dec 8, 2023 (Deficient, Provider has date of correction)
▲ Immediate jeopardy, repeated · Dec 4, 2023 · F-0760 · triggered by a complaint
The facility did not keep residents free from significant medication errors — such as giving the wrong drug, the wrong dose, or missing a critical medication.
Why it matters: A serious medication error can cause real harm, hospitalization, or worse.
Severity (K): A life-threatening or extremely dangerous situation affected several residents. Among the most serious findings an inspection can produce.
Corrected: Dec 8, 2023 (Deficient, Provider has date of correction)
All citations in the current public record (19)
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 12, 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 12, 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. |
| Jan 6, 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. · from a complaint |
| Aug 7, 2025 | D · Potential for harm, one-off | 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. · from a complaint |
| Aug 7, 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 |
| Jun 25, 2025 | ▲ J · Immediate jeopardy, one-off | The facility did not immediately notify the resident, their doctor, and a family member when something significant happened — such as an injury, a decline in health, or a room change. Families and doctors are entitled to know right away. · from a complaint |
| Jun 25, 2025 | ▲ J · Immediate jeopardy, 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. · from a complaint |
| Jun 25, 2025 | ▲ J · Immediate jeopardy, one-off | The facility did not provide safe and appropriate pain management for a resident who needed it. · from a complaint |
| Dec 11, 2024 | E · Potential for harm, repeated | The facility did not update each resident's care assessment at least once every 3 months. These regular check-ins keep the resident's care plan matched to their current condition. |
| Dec 11, 2024 | 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. |
| Aug 24, 2024 | 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. · from a complaint |
| Jul 31, 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. · from a complaint |
| Apr 15, 2024 | ▲ K · Immediate jeopardy, repeated | 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 |
| Dec 4, 2023 | ▲ K · Immediate jeopardy, repeated | The facility did not provide pharmacy services that meet each resident's needs, or did not employ or contract with a licensed pharmacist. · from a complaint |
| Dec 4, 2023 | ▲ K · Immediate jeopardy, repeated | The facility did not keep residents free from significant medication errors — such as giving the wrong drug, the wrong dose, or missing a critical medication. · from a complaint |
| Nov 1, 2023 | 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. |
| Nov 1, 2023 | D · Potential for harm, one-off | The facility did not properly complete the required screening (called PASARR) that identifies whether a person entering a nursing home has a mental illness or intellectual disability and needs specialized services. |
| Nov 1, 2023 | 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. |
| Nov 1, 2023 | 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. |
Inspection trend by year
Citations from standard inspections stayed about the same across the last two inspection cycles (2 → 2).
| Year | Citations | Serious (G–L) | Worst severity that year |
|---|---|---|---|
| 2023 | 6 | 2 | K ▲ |
| 2024 | 5 | 1 | K ▲ |
| 2025 | 5 | 3 | J ▲ |
| 2026 | 3 | 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)
2 fines totaling $49,443.
| Date | Type | Amount / length |
|---|---|---|
| Apr 15, 2024 | Fine | $22,466 |
| Dec 4, 2023 | Fine | $26,977 |
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) | 4.36 | 3.46 | 3.95 | top 9% in Texas; top 27% in the U.S. |
| Registered Nurse hours | 0.90 | 0.44 | 0.69 | top 4% in Texas; top 20% in the U.S. |
| Weekend total nurse staffing | 3.98 | 3.04 | 3.50 | top 7% in Texas; top 23% in the U.S. |
| Weekend RN hours (not acuity-adjusted) | 0.56 | 0.34 | 0.48 | top 10% in Texas; top 27% in the U.S. |
| Total nursing staff turnover (%) | 100.0 | 55.3 | 45.8 | bottom 1% in Texas; bottom 1% in the U.S. |
| RN turnover (%) | 100.0 | 54.6 | 42.9 | bottom 8% in Texas; bottom 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 3.72, RN 0.77, weekend 3.39. 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: 5/5 · long-stay residents: 5/5 · short-stay residents: —/5
Who owns this facility
Government - Hospital district
| Owner / manager | Type | Role | Stake | Since |
|---|---|---|---|---|
| TX2 Propco Holdco, LLC | Organization | Direct Ownership Interest | NOT APPLICABLE | 06/01/2024 |
| David M Fistel TX LLC | Organization | 5% or Greater Mortgage Interest | NOT APPLICABLE | 06/01/2024 |
| DFJL, LLC | Organization | 5% or Greater Mortgage Interest | NOT APPLICABLE | 06/01/2024 |
| DZ Arlington, LLC | Organization | 5% or Greater Mortgage Interest | NOT APPLICABLE | 06/01/2024 |
| Efroymson, David | Individual | 5% or Greater Mortgage Interest | NOT APPLICABLE | 06/01/2024 |
| Efroymson, David | Individual | Operational/Managerial Control | NOT APPLICABLE | 06/01/2024 |
| Fistel, David | Individual | 5% or Greater Mortgage Interest | NOT APPLICABLE | 06/01/2024 |
| Greenfield, Mordechai | Individual | 5% or Greater Mortgage Interest | NOT APPLICABLE | 06/01/2024 |
| Heath, Michael | Individual | ADP of the SNF | NOT APPLICABLE | 06/01/2024 |
| House, Janelle | Individual | ADP of the SNF | NOT APPLICABLE | 06/01/2024 |
| McGregor Management LLC | Organization | Operational/Managerial Control | NOT APPLICABLE | 06/01/2024 |
| Newton, Elizabeth | Individual | Corporate Director | NOT APPLICABLE | 06/01/2024 |
| Zemel, Daniel | Individual | 5% or Greater Mortgage Interest | NOT APPLICABLE | 06/01/2024 |
Questions to ask on your visit
Generated from this facility's actual citation record — bring them to a tour and ask the administrator directly.
- "If my family member falls or their condition changes, exactly when and how will I be notified?"
- "How do you care for residents with incontinence or catheters, and what do you do to prevent urinary tract infections?"
- "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?"
- "How does your pharmacist review residents' medications, and how quickly can you fill new or urgent prescriptions?"
- "What systems do you use to prevent medication errors, and what happens when one occurs?"
- "What did your most recent kitchen inspection find, and can I see how food is stored and prepared?"
- "Who completes resident assessments here, and how do you check them for accuracy?"
- "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 |
|---|---|---|---|---|---|
| St. Joseph's Care Center | 0.2 mi | McGregor, TX | —/5 | ||
| Wesley Woods Health & Rehabilitation | 12.4 mi | Waco, TX | ★★☆☆☆ | 2/5 | |
| St. Catherine Center | 12.5 mi | Waco, TX | ★★★★★ | 4/5 | |
| Avir at Waco | 12.8 mi | Waco, TX | ★★★★☆ | 4/5 | |
| Ridgecrest Retirement and Healthcare Community | 13.0 mi | Waco, TX | ★☆☆☆☆ | 2/5 | |
| Hewitt Nursing and Rehabilitation | 13.3 mi | Hewitt, TX | ★★★☆☆ | 2/5 | |
| Woodway Rehabilitation and Healthcare Center | 13.5 mi | Waco, TX | ★★☆☆☆ | 2/5 | |
| St. Anthony's Care Center | 14.3 mi | Waco, TX | ★★★★☆ | 4/5 | |
| Greenview Nursing and Rehabilitation | 14.5 mi | Waco, TX | ★☆☆☆☆ | 1/5 | |
| Avir at Jeffrey Place | 15.2 mi | Waco, TX | ★★★☆☆ | 3/5 | |
| The Chateau Waco | 15.9 mi | Waco, TX | ★☆☆☆☆ | 1/5 | |
| Ivy Creek Wellness & Rehabilitation | 17.2 mi | Waco, TX | ★☆☆☆☆ | 2/5 |
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Facility data as of CMS processing date 2026-08-01. CCN 455554.