The Woodlands Nursing and Rehabilitation Center
4650 S Panther Creek Dr, The Woodlands, TX 77381 · Montgomery County · 214 certified beds · avg 159 residents/day · certified since Apr 23, 1990
Part of chain: WELLSENTIAL HEALTH (67 facilities, chain avg rating 2.7★)
What health inspectors found (on-site government inspections — the most independent evidence available)
Health inspection rating: ★★☆☆☆2/5 · 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, repeated · Jun 17, 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: Jun 18, 2025 (Deficient, Provider has date of correction)
▲ Actual harm, one-off · Apr 13, 2026 · F-0550 · triggered by a complaint
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.
Why it matters: Being treated without dignity harms a resident's self-worth, mental health, and overall quality of life.
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 29, 2026 (Deficient, Provider has date of correction)
▲ Actual harm, one-off · Apr 13, 2026 · 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 (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 29, 2026 (Deficient, Provider has date of correction)
▲ Actual harm, one-off · Apr 13, 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 29, 2026 (Deficient, Provider has date of correction)
All citations in the current public record (30)
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 |
|---|---|---|
| Jun 4, 2026 | D · Potential for harm, one-off | The facility did not provide safe and appropriate pain management for a resident who needed it. · from a complaint |
| Apr 25, 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. · from a complaint |
| Apr 13, 2026 | ▲ G · Actual harm, one-off | 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 13, 2026 | ▲ G · Actual 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 |
| Apr 13, 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 |
| Apr 13, 2026 | E · Potential for harm, repeated | The facility did not keep its building and grounds safe, functional, clean, and comfortable for residents, staff, and visitors. · from a complaint |
| Dec 19, 2025 | 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 19, 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. |
| Dec 19, 2025 | 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. |
| Dec 19, 2025 | 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. |
| Dec 19, 2025 | D · Potential for harm, one-off | 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. |
| Dec 19, 2025 | 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. |
| Dec 19, 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. |
| Dec 19, 2025 | 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 19, 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. |
| Sep 4, 2025 | 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 |
| Aug 19, 2025 | 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. · from a complaint |
| Jun 17, 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 |
| Jun 5, 2025 | 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 |
| Apr 3, 2025 | D · Potential for harm, one-off | 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 |
| Aug 1, 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. |
| Aug 1, 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 1, 2024 | D · Potential for harm, one-off | 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 |
| Aug 1, 2024 | 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. |
| May 18, 2023 | F · Potential for harm, facility-wide | The facility did not dispose of garbage and refuse properly. |
| May 18, 2023 | 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. |
| May 18, 2023 | E · Potential for harm, repeated | The facility's medication error rate was 5 percent or higher — meaning too many doses were given incorrectly, such as the wrong drug, dose, or time. |
| May 18, 2023 | 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. |
| May 18, 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. |
| May 18, 2023 | D · Potential for harm, one-off | 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. |
Inspection trend by year
Citations from standard inspections increased between the last two inspection cycles (4 → 9).
| Year | Citations | Serious (G–L) | Worst severity that year |
|---|---|---|---|
| 2023 | 6 | 0 | F |
| 2024 | 4 | 0 | F |
| 2025 | 14 | 1 | K ▲ |
| 2026 | 6 | 3 | 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 $23,977.
| Date | Type | Amount / length |
|---|---|---|
| Apr 13, 2026 | Fine | $14,380 |
| Jun 5, 2025 | Fine | $9,597 |
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) | 3.36 | 3.46 | 3.95 | top 46% in Texas; bottom 29% in the U.S. |
| Registered Nurse hours | 0.36 | 0.44 | 0.69 | bottom 43% in Texas; bottom 17% in the U.S. |
| Weekend total nurse staffing | 3.12 | 3.04 | 3.50 | top 33% in Texas; bottom 37% in the U.S. |
| Weekend RN hours (not acuity-adjusted) | 0.32 | 0.34 | 0.48 | top 43% in Texas; bottom 35% in the U.S. |
| Total nursing staff turnover (%) | 49.6 | 55.3 | 45.8 | top 44% in Texas; bottom 38% in the U.S. |
| RN turnover (%) | 62.5 | 54.6 | 42.9 | bottom 38% in Texas; bottom 19% 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 3.45, RN 0.37, weekend 3.20. 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: 5/5 · long-stay residents: 5/5 · short-stay residents: 4/5
Who owns this facility
Government - Hospital district
| Owner / manager | Type | Role | Stake | Since |
|---|---|---|---|---|
| 4650 S Panther Creek Drive LLC | Organization | ADP of the SNF | NOT APPLICABLE | 10/01/2018 |
| Auippa, Mistee | Individual | ADP of the SNF | NOT APPLICABLE | 01/01/2025 |
| Baird, Daniel | Individual | Corporate Officer | NOT APPLICABLE | 04/13/2021 |
| Bilboa, John | Individual | Operational/Managerial Control | NOT APPLICABLE | 10/10/2022 |
| Bilboa, John | Individual | ADP of the SNF | NOT APPLICABLE | 10/10/2022 |
| Clapp, Barbara | Individual | Corporate Officer | NOT APPLICABLE | 06/01/2021 |
| Cole, Antonia | Individual | ADP of the SNF | NOT APPLICABLE | 01/01/2025 |
| Cortese, Daren | Individual | Corporate Officer | NOT APPLICABLE | 08/10/2021 |
| CSV Rhea Management Holdco, LLC | Organization | ADP of the SNF | NOT APPLICABLE | 10/01/2018 |
| Dekowski, Donovan | Individual | ADP of the SNF | NOT APPLICABLE | 10/01/2018 |
| DWD TX Holdings LLC | Organization | ADP of the SNF | NOT APPLICABLE | 10/01/2018 |
| Gibson, Patricia | Individual | Corporate Officer | NOT APPLICABLE | 08/01/2021 |
| Guerrero, Teresa | Individual | Operational/Managerial Control | NOT APPLICABLE | 01/01/2025 |
| Guerrero, Teresa | Individual | ADP of the SNF | NOT APPLICABLE | 01/01/2025 |
| Jack and Nancy Dwyer Workforce Development Center INC | Organization | ADP of the SNF | NOT APPLICABLE | 10/01/2018 |
| Mandelbaum, Elliot | Individual | ADP of the SNF | NOT APPLICABLE | 01/01/2025 |
| Murrell, Edward | Individual | Corporate Officer | NOT APPLICABLE | 11/22/2016 |
| Reg Bridge Opco LLC | Organization | ADP of the SNF | NOT APPLICABLE | 10/01/2018 |
| Reg HG Opco LLC | Organization | ADP of the SNF | NOT APPLICABLE | 10/01/2018 |
| Reg Operator Holdco LLC | Organization | ADP of the SNF | NOT APPLICABLE | 10/01/2018 |
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?"
- "Can you give me examples of how your staff protect residents' dignity in everyday care, like bathing and dressing?"
- "If my family member falls or their condition changes, exactly when and how will I be notified?"
- "How do you assess and manage residents' pain, especially for those who have trouble communicating?"
- "Can we tour the resident rooms, bathrooms, and common areas today, including areas not on the usual tour route?"
- "Can we tour the whole building today, including resident bathrooms and common areas, not just the lobby?"
- "How many residents here use oxygen or breathing equipment, and who checks that equipment each shift?"
- "Can you show me how medications are stored and secured on the units, including controlled drugs?"
- "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 |
|---|---|---|---|---|---|
| Ridgewood at the Woodlands | 0.6 mi | The Woodlands, TX | ★☆☆☆☆ | 2/5 | |
| The Broadmoor at Creekside Park | 1.6 mi | The Woodlands, TX | ★★★☆☆ | 2/5 | |
| Park Manor of the Woodlands | 4.2 mi | The Woodlands, TX | ★★★★☆ | 4/5 | |
| The Village at Gleannloch Farms | 5.9 mi | Spring, TX | ★★★★★ | 5/5 | |
| Tomball Rehab & Nursing | 7.7 mi | Tomball, TX | ★☆☆☆☆ | 2/5 | |
| The Brightpointe | 8.4 mi | Conroe, TX | ★★★☆☆ | 3/5 | |
| Park Manor of Conroe | 8.4 mi | Conroe, TX | ★★★★★ | 5/5 | |
| Park Manor of Tomball | 8.7 mi | Tomball, TX | ★★☆☆☆ | 2/5 | |
| Lawrence Street Health Care Center | 8.9 mi | Tomball, TX | ★★★★☆ | 4/5 | |
| The Heights of Tomball | 9.3 mi | Tomball, TX | ★★★★☆ | 4/5 | |
| The Heights of North Houston | 10.4 mi | Houston, TX | ★★☆☆☆ | 2/5 | |
| Paradigm Northwest | 10.4 mi | Houston, TX | ★☆☆☆☆ | 1/5 |
Compare this facility with the 3 closest →
All facilities in The Woodlands →
Facility data as of CMS processing date 2026-08-01. CCN 455876.