San Marcos Rehabilitation and Healthcare Center
1600 N I H 35, San Marcos, TX 78666 · Hays County · 129 certified beds · avg 105 residents/day · certified since Feb 1, 1997
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: ★☆☆☆☆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, repeated · Aug 1, 2025 · 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 (K): A life-threatening or extremely dangerous situation affected several residents. Among the most serious findings an inspection can produce.
Corrected: Aug 2, 2025 (Deficient, Provider has date of correction)
▲ Immediate jeopardy, repeated · Aug 1, 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 (K): A life-threatening or extremely dangerous situation affected several residents. Among the most serious findings an inspection can produce.
Corrected: Aug 2, 2025 (Deficient, Provider has date of correction)
▲ Actual harm, one-off · 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 (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 3, 2024 (Deficient, Provider has date of correction)
All citations in the current public record (17)
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 |
|---|---|---|
| Dec 30, 2025 | F · Potential for harm, facility-wide | The facility did not post its nurse staffing information every day. Nursing homes must publicly display how many nurses and aides are on duty each day. · from a complaint |
| Aug 1, 2025 | ▲ K · Immediate jeopardy, repeated | 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 |
| Aug 1, 2025 | ▲ K · Immediate jeopardy, repeated | The facility did not provide safe and appropriate pain management for a resident who needed it. · from a complaint |
| Nov 4, 2024 | 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. · from a complaint |
| Nov 4, 2024 | E · Potential for harm, 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 4, 2024 | D · Potential for harm, 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 |
| Aug 15, 2024 | E · Potential for harm, repeated | The facility did not keep residents' personal and medical information private and confidential. |
| Aug 15, 2024 | 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. |
| Aug 15, 2024 | 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. |
| Aug 15, 2024 | 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. |
| Aug 15, 2024 | 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. |
| Aug 15, 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 15, 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. |
| Aug 15, 2024 | D · Potential for harm, one-off | The facility did not provide routine dental care and 24-hour emergency dental care for residents. |
| Apr 15, 2024 | ▲ G · Actual 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. · from a complaint |
| Jun 16, 2023 | 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. |
| Jun 16, 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. |
Inspection trend by year
| Year | Citations | Serious (G–L) | Worst severity that year |
|---|---|---|---|
| 2023 | 2 | 0 | D |
| 2024 | 12 | 1 | G ▲ |
| 2025 | 3 | 2 | K ▲ |
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 $33,891.
| Date | Type | Amount / length |
|---|---|---|
| Aug 1, 2025 | Fine | $33,891 |
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) | 3.24 | 3.46 | 3.95 | bottom 44% in Texas; bottom 24% in the U.S. |
| Registered Nurse hours | 0.70 | 0.44 | 0.69 | top 10% in Texas; top 36% in the U.S. |
| Weekend total nurse staffing | 2.77 | 3.04 | 3.50 | bottom 36% in Texas; bottom 19% in the U.S. |
| Weekend RN hours (not acuity-adjusted) | 0.60 | 0.34 | 0.48 | top 8% in Texas; top 23% in the U.S. |
| Total nursing staff turnover (%) | 48.8 | 55.3 | 45.8 | top 42% in Texas; bottom 40% in the U.S. |
| RN turnover (%) | 53.3 | 54.6 | 42.9 | top 50% in Texas; bottom 31% 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 2.98, RN 0.64, weekend 2.54. 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 - Corporation
| Owner / manager | Type | Role | Stake | Since |
|---|---|---|---|---|
| Guadalupe County Hospital Board | Organization | 5% or Greater Direct Ownership Interest | 100% | 04/01/2017 |
| Burnam, Soon | Individual | Corporate Officer | NOT APPLICABLE | 04/01/2017 |
| Caretrust GP LLC | Organization | ADP of the SNF | NOT APPLICABLE | 04/01/2017 |
| Caretrust Reit INC | Organization | ADP of the SNF | NOT APPLICABLE | 04/01/2017 |
| Castro Pou, Graciela | Individual | Managing Control - Governing Body | NOT APPLICABLE | 12/27/2024 |
| Castro Pou, Graciela | Individual | Operational/Managerial Control | NOT APPLICABLE | 12/27/2024 |
| Castro Pou, Graciela | Individual | ADP of the SNF | NOT APPLICABLE | 12/27/2024 |
| Ctr Partnership LP | Organization | ADP of the SNF | NOT APPLICABLE | 04/01/2017 |
| Ensign Services INC | Organization | ADP of the SNF | NOT APPLICABLE | 02/05/2010 |
| Gann, Kody | Individual | Corporate Officer | NOT APPLICABLE | 04/01/2017 |
| Ives Health Holdings LLC | Organization | ADP of the SNF | NOT APPLICABLE | 04/01/2017 |
| Keetch, Chad | Individual | Corporate Officer | NOT APPLICABLE | 03/01/2011 |
| Tochterman, Jerry | Individual | Managing Control - Governing Body | NOT APPLICABLE | 08/21/2017 |
| Tochterman, Jerry | Individual | Operational/Managerial Control | NOT APPLICABLE | 08/21/2017 |
| Tochterman, Jerry | Individual | ADP of the SNF | NOT APPLICABLE | 08/21/2017 |
| Wood Bayou Healthcare, INC. | Organization | Operational/Managerial Control | NOT APPLICABLE | 04/01/2017 |
| Wood Bayou Healthcare, INC. | Organization | ADP of the SNF | NOT APPLICABLE | 09/30/2025 |
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?"
- "Where do you post your daily staffing numbers, and can I see today's?"
- "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?"
- "If my family member falls or their condition changes, exactly when and how will I be notified?"
- "How do you protect residents' privacy, both in their medical records and in day-to-day care?"
- "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 |
|---|---|---|---|---|---|
| Hays Nursing and Rehabilitation Center | 1.9 mi | San Marcos, TX | ★★★☆☆ | 3/5 | |
| Cypress Healthcare and Rehabilitation Center | 2.4 mi | San Marcos, TX | ★☆☆☆☆ | 1/5 | |
| Legend Oaks Healthcare and Rehabilitation-Kyle | 10.1 mi | Kyle, TX | ★★★☆☆ | 3/5 | |
| Deer Creek Nursing and Rehabilitation | 11.8 mi | Wimberley, TX | ★☆☆☆☆ | 1/5 | |
| Legend Oaks Healthcare and Rehabilitation - New Br | 13.2 mi | New Braunfels, TX | ★★★☆☆ | 3/5 | |
| Sundance Inn Health Center | 13.7 mi | New Braunfels, TX | ★★☆☆☆ | 2/5 | abuse |
| Avir at New Braunfels | 13.9 mi | New Braunfels, TX | ★☆☆☆☆ | 1/5 | abuse |
| Eden Home | 15.6 mi | New Braunfels, TX | ★★★☆☆ | 3/5 | |
| Chisolm Trail Nursing and Rehabilitation Center | 15.6 mi | Lockhart, TX | ★★★☆☆ | 3/5 | |
| Parkview Nursing and Rehabilitation Center | 16.6 mi | Lockhart, TX | ★★☆☆☆ | 2/5 | abuse |
| Kirkwood Manor | 18.1 mi | New Braunfels, TX | ★★☆☆☆ | 2/5 | |
| Marbridge Villa | 18.4 mi | Manchaca, TX | ★★★★☆ | 4/5 |
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Facility data as of CMS processing date 2026-08-01. CCN 675651.