The Waterton Healthcare & Rehabilitation
2875 Shiloh Road, Tyler, TX 75703 · Smith County · 92 certified beds · avg 67 residents/day · certified since Sep 3, 2008
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: ★★★★☆4/5 · CMS overall rating: 4/5
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 · Jan 8, 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 (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: Jan 9, 2024 (Deficient, Provider has date of correction)
▲ Actual harm, one-off · Apr 23, 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 (G): One or a few residents were actually harmed — physically or emotionally — though not put in immediate danger of serious injury or death.
Corrected: Apr 27, 2026 (Deficient, Provider has date of correction)
All citations in the current public record (10)
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 6, 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. |
| May 6, 2026 | D · Potential for harm, one-off | The facility did not safely and appropriately administer IV fluids (fluids given through a vein) for residents who needed them. |
| May 6, 2026 | 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. |
| May 6, 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. |
| Apr 23, 2026 | ▲ G · Actual 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. · from a complaint |
| Mar 26, 2025 | E · Potential for harm, repeated | The facility did not accurately assess a resident's health and needs. Assessments are the foundation for all the care a resident receives. |
| Mar 26, 2025 | E · Potential for harm, repeated | The facility did not provide enough food and fluids to keep residents healthy, such as preventing unplanned weight loss or dehydration. |
| Jan 31, 2024 | D · Potential for harm, one-off | The facility did not give residents reasonable access to and privacy in using ways to communicate, such as phones, mail, and email. Residents have the right to stay in touch with the outside world privately. |
| Jan 31, 2024 | D · Potential for harm, one-off | The facility did not keep its building and grounds safe, functional, clean, and comfortable for residents, staff, and visitors. |
| Jan 8, 2024 | ▲ 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 |
Inspection trend by year
Citations from standard inspections increased between the last two inspection cycles (2 → 4).
| Year | Citations | Serious (G–L) | Worst severity that year |
|---|---|---|---|
| 2024 | 3 | 1 | J ▲ |
| 2025 | 2 | 0 | E |
| 2026 | 5 | 1 | G ▲ |
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 $23,389.
| Date | Type | Amount / length |
|---|---|---|
| Apr 23, 2026 | Fine | $14,380 |
| Jan 8, 2024 | Fine | $9,009 |
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 | 0.51 | 0.44 | 0.69 | top 25% in Texas; bottom 39% in the U.S. |
| Weekend total nurse staffing | 3.00 | 3.04 | 3.50 | top 41% in Texas; bottom 31% in the U.S. |
| Weekend RN hours (not acuity-adjusted) | 0.31 | 0.34 | 0.48 | top 45% in Texas; bottom 34% in the U.S. |
| Total nursing staff turnover (%) | 50.7 | 55.3 | 45.8 | top 46% in Texas; bottom 35% in the U.S. |
| RN turnover (%) | 44.4 | 54.6 | 42.9 | top 37% in Texas; bottom 45% 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 3.38, RN 0.51, weekend 3.00. 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: 4/5 · short-stay residents: 4/5
Who owns this facility
Government - Hospital district
| Owner / manager | Type | Role | Stake | Since |
|---|---|---|---|---|
| Fannin County Hospital Authority | Organization | 5% or Greater Direct Ownership Interest | 100% | 03/01/2022 |
| Burnam, Soon | Individual | Corporate Officer | NOT APPLICABLE | 03/01/2022 |
| Chickadee Healthcare LLC | Organization | Operational/Managerial Control | NOT APPLICABLE | 03/01/2022 |
| Chickadee Healthcare LLC | Organization | ADP of the SNF | NOT APPLICABLE | 05/14/2025 |
| Costa, Charlie | Individual | Managing Control - Governing Body | NOT APPLICABLE | 03/01/2022 |
| Costa, Charlie | Individual | Operational/Managerial Control | NOT APPLICABLE | 03/01/2022 |
| Costa, Charlie | Individual | ADP of the SNF | NOT APPLICABLE | 05/14/2025 |
| Ensign Services INC | Organization | ADP of the SNF | NOT APPLICABLE | 03/01/2022 |
| Rose Health Holdings LLC | Organization | ADP of the SNF | NOT APPLICABLE | 03/01/2022 |
| Sanderson, Clark | Individual | Corporate Officer | NOT APPLICABLE | 10/29/2012 |
| Standard Bearer Healthcare Op, LP | Organization | ADP of the SNF | NOT APPLICABLE | 03/01/2022 |
| The Ensign Group INC | Organization | ADP of the SNF | NOT APPLICABLE | 03/01/2022 |
| Wilson, Jennifer | Individual | Managing Control - Governing Body | NOT APPLICABLE | 03/01/2022 |
| Wilson, Jennifer | Individual | ADP of the SNF | NOT APPLICABLE | 04/27/2025 |
Questions to ask on your visit
Generated from this facility's actual citation record — bring them to a tour and ask the administrator directly.
- "What is your falls rate, and what specific steps do you take to prevent falls and supervise residents at risk?"
- "How do you make sure each resident's care follows the doctor's orders, and what changed after this citation?"
- "Can we tour the resident rooms, bathrooms, and common areas today, including areas not on the usual tour route?"
- "Who on your staff manages IV therapy, and what training and monitoring is in place?"
- "How do you keep residents' medical records accurate, complete, and secure?"
- "Who leads your infection prevention program, and how do you make sure staff follow practices like hand hygiene every day?"
- "Who completes resident assessments here, and how do you check them for accuracy?"
- "How do you monitor residents' weight and eating, and what happens when someone starts losing weight?"
- "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 |
|---|---|---|---|---|---|
| The Center at Grande | 1.3 mi | Tyler, TX | ★★★★★ | 5/5 | |
| Providence Park Rehabilitation and Skilled Nursing | 1.6 mi | Tyler, TX | ★★☆☆☆ | 2/5 | |
| Park Place Nursing & Rehabilitation Center | 2.6 mi | Tyler, TX | ★☆☆☆☆ | 1/5 | abuse |
| Meadow Lake Health Center | 2.6 mi | Tyler, TX | ★★★★★ | 5/5 | |
| Avir at Rose Trail | 3.2 mi | Tyler, TX | ★☆☆☆☆ | 1/5 | SFF |
| Avir at Petal Hill | 3.3 mi | Tyler, TX | ★★☆☆☆ | 2/5 | abuse |
| Reunion Plaza Healthcare & Rehabilitation | 3.3 mi | Tyler, TX | ★★★★☆ | 5/5 | |
| Avir at Azalea Heights | 3.4 mi | Tyler, TX | ★★☆☆☆ | 3/5 | |
| Briarcliff Health Center | 3.5 mi | Tyler, TX | ★★☆☆☆ | 3/5 | |
| The Heights of Tyler | 4.6 mi | Tyler, TX | ★★★☆☆ | 4/5 |
Compare this facility with the 3 closest →
Facility data as of CMS processing date 2026-08-01. CCN 676193.