942 of the 1,179 Medicare-certified nursing homes in Texas (80%) are chain-owned, and all are listed below. 22 of the 940 graded homes earn an A and 92 earn a D or F. They average 3.29 nursing hours per resident per day, 0.1 hours below the 3.39 for every home in Texas. Trinity Terrace in Fort Worth grades highest at A (94 out of 100).
How chain-owned homes in Texas compare
This group set against every nursing home in Texas, from the current CMS release.
Nursing hours per resident per day
3.29
All homes in Texas: 3.39
Worse than the local average
Nurse staff turnover
56.3%
All homes in Texas: 55.3%
Worse than the local average
Average ElderGrade score
65.9/100
All homes in Texas: 66.9/100
Worse than the local average
Grade spread
B
C
D
22 grade A, 316 grade B, 510 grade C, 92 grade D,
The best-graded chain-owned home in Texas is
Trinity Terrace
in Fort Worth, TX — grade A,
94/100.
Harbor Valley runs leaner on nursing hours than most homes in the country, 3.58 per resident day against a national average of 3.86, and weekends get thinner still, with about 12% less coverage than weekdays. That matters, because 40 deficiencies sit on the current record, including two at the harm level and three tied to abuse, and the last inspection was in December 2025. Staff turnover at 43.8% is actually slightly better than the typical home, which suggests the problem isn't retention so much as how many hands are scheduled. For-profit, individually owned, 120 beds. Ask about weekend staffing and how the abuse citations were resolved.
Lavaca Bay runs on 2.99 nursing hours per resident per day, roughly a fifth below the national average, and weekends drop another 14% below its own weekday staffing. That thin coverage shows up in the record: 37 deficiencies, including two at harm or jeopardy level and four tied to abuse, plus $21,720 in fines across two penalties. Turnover sits at 51.4%, higher than the 45.8% national figure, so residents see a rotating cast of caregivers. The hospital district ownership doesn't change the math here, the staffing rating reflects the hours actually worked, not who signs the paycheck.
The Brixton at Horseshoe Bay runs 3.69 nurse hours per resident day, about 4% under the national average, and weekend coverage drops roughly 13% below its own weekday level, so the thinnest staffing tends to land when families visit. Annual turnover sits at 57.8%, well above the 45.8% national figure, which at 120 beds means a lot of unfamiliar faces. Inspectors cited 10 deficiencies on the current record, one serious enough to involve harm or jeopardy, and a single fine of $85,007. The most recent inspection was June 26, 2025. A for-profit LLC operates the home.
Lampasas Nursing And Rehabilitation Center runs on 3.43 nurse hours per resident day, about 11% under the national average, and weekend coverage drops roughly 13% below what it manages on weekdays. The current inspection record carries 15 deficiencies, two of them serious enough to put residents in harm's way, along with two fines totaling $33,198. It's a hospital-district-owned home with 68 beds, inspected recently in January 2026, and its federal ratings sit at two stars for health inspections, two for quality measures, and one for staffing. The pattern worth noticing is the staffing number: when a building runs lean every day and leaner on weekends, the inspection findings tend to follow.
Falcon Point Post Acute runs 130 beds in Katy under for-profit limited liability ownership, and the numbers tell you where the strain sits: 3.22 nurse hours per resident day against a national average of 3.86, with weekends running about 15% thinner than weekdays. Annual turnover hits 58.8%, well above the 45.8% national figure, which matters because 31 deficiencies sit on the current record, including one abuse-related citation, though none reached harm or jeopardy level. A single fine of $19,684 has been levied, and the last inspection was January 10, 2025. The staffing star comes in at 1 out of 5, and that's the piece to weigh hardest when you visit.
The Heights of Bulverde runs on thinner nursing coverage than most homes nationally, 3.13 hours per resident day against a 3.86 average, and weekends drop about 17% below its own weekday staffing, so the days families visit most are often the leanest. Turnover sits at 55.9% against a national 45.8%, which means many of the aides and nurses on the floor are still learning the building. That inspection record carries 47 deficiencies, including one at the harm level and four tied to abuse, though the most recent visit was in June 2025 and quality measures scored well.
Caraday Of Lampasas runs on 2.87 nurse hours per resident day, roughly a quarter below the national average of 3.86, and weekends drop about 6% below its own weekday level, so the thinnest coverage lands when families tend to visit. The health inspection record looks solid, but staffing sits at the bottom of CMS's scale, and 13 deficiencies include three at the harm level and one tied to abuse. Three fines totaling $16,426 are on file, with the last inspection dated February 2026. It's a hospital-district home with 76 beds, and the gap between its inspection results and its day-to-day staffing is the tension worth weighing.
The Lakes at Texas City runs on 2.86 nurse hours per resident per day, roughly a quarter below the national average of 3.86, and weekends drop about 12% below its own weekday levels. That thin coverage sits alongside a 62% annual turnover rate, well above the 45.8% norm, so the aides and nurses in the building are often new to the job. Inspectors have logged 29 deficiencies, one serious enough to reach harm or jeopardy, though none abuse-related, with the most recent visit in December 2025 and $8,410 in fines. The quality measure score looks strong on paper, but it's built on top of staffing that CMS itself rates at the bottom.
Glenview Wellness & Rehabilitation runs on a leaner nurse staffing budget than most homes in the country, 2.40 hours per resident day against a national average of 3.86, and weekends dip even further below its own weekday coverage. That gap shows up in the federal staffing rating, which sits at the lowest tier, while annual turnover of 57.3% means the aides and nurses who are there keep changing.
The inspection record is where things get more concerning: 26 deficiencies on file, four of them at the level where a resident was actually harmed or put in jeopardy, and six tied to abuse. Two fines totaling $23,970 have been levied. The quality measure rating is strong at 4 out of 5, but that's a paper score next to the hands-on reality of who's available to answer a call light.
Richland Hills runs about 22% leaner on nursing hours than the typical American nursing home, and weekends drop roughly another 15% below its own weekday pace. That staffing math matters most when you consider the 72% annual turnover, nearly three-quarters of the nursing staff cycling out each year against a national average of 45.8%, on a corporate-owned, 92-bed building. The health inspection history shows 37 deficiencies, including two at the harm level and one abuse-related, with $8,190 in fines. CMS quality scores look strong, but those rely heavily on self-reported measures, while the staffing and inspection numbers reflect what surveys actually found.
Focused Care Of Waxahachie runs on 2.68 nurse hours per resident day, roughly 31% under the national average, and weekends drop another 10% below its own weekday levels. That thin coverage shows up in the staffing picture, where turnover hits 58.9% against a national 45.8%, more than half the nursing staff leaving in a year. The inspection record is the harder problem: 40 deficiencies, five serious enough to involve harm or jeopardy, three tied to abuse, and $172,367 in fines across three penalties. A government hospital district owns the 152-bed building, and its most recent inspection was April 28, 2026. Quality measures score well; the hands-on care and oversight numbers do not.
Westward Trails runs lean on nursing hours, 3.27 per resident day against a national average of 3.86, and weekends drop roughly 21% below its own weekday coverage. That's the kind of gap that shows up when a resident needs help on a Saturday afternoon. Inspectors gave the place solid marks in June 2025, but the record still carries 24 deficiencies, including two tied to abuse and two serious enough to put residents in harm's way, plus $25,036 in fines across three penalties. Corporate ownership means decisions about staffing levels get made somewhere other than Nacogdoches. Ask about weekend coverage and how those abuse deficiencies were resolved before you decide.
Cedar Hill Healthcare Center runs on 2.95 nursing hours per resident per day, roughly a quarter below the national average of 3.86, and weekend coverage dips about 6% below its own weekday numbers. The inspection record shows 27 deficiencies, including two at the harm or jeopardy level and one tied to abuse, plus $22,503 in fines across two penalties; the last inspection was July 2, 2025. Staff turnover sits at 44.3%, slightly under the national 45.8%, so retention isn't the outlier here, thin daily staffing and the harm-level findings are. Corporate for-profit ownership, 110 certified beds in Dallas County.
Balch Springs Nursing Home runs on 2.72 nurse hours per resident day, roughly 29% under the national average, and weekend coverage drops about 15% below its own weekday level. That thin margin shows up in the numbers: a 1-out-of-5 staffing rating, 56.5% annual turnover against a national 45.8%, and 21 deficiencies on the current record, two of them serious enough to reach harm or jeopardy. Ownership is for-profit corporate, and there's one fine totaling $43,095. The last inspection was May 2026. Resident outcome measures look strong at 5 out of 5, which suggests the clinical care itself isn't the problem, the question is whether the staffing can hold that up.
The Homestead of Denison runs 140 certified beds under for-profit LLC ownership, and its nurse staffing sits at 3.31 hours per resident day, roughly 14% under the national average of 3.86. Weekend coverage drops about 11% below its own weekday level, and annual turnover hits 58.3% against a national 45.8%, meaning the aides and nurses your family member sees are likelier than average to be new or on their way out. The inspection record backs that up: 29 deficiencies, two at harm or jeopardy level and three abuse-related, with $29,991 in fines and a 2-out-of-5 inspection rating. Strong quality-measure scores don't offset thin, churning staffing.
Seven Oaks runs on 2.81 nurse hours per resident per day, roughly 27% under the national average of 3.86, and weekends dip about 10% below its own weekday staffing. That thin coverage lines up with a 100% annual turnover rate, more than double the national 45.8%, so the aide or nurse your family meets in January may be gone by summer. Inspections tell a different story: a 4/5 health inspection rating, a clean record on harm and abuse, and a visit as recent as July 2025, though 30 deficiencies sit on file. Ownership is corporate, for-profit. Strong clinical quality marks and weak staffing don't cancel each other out; they describe two different parts of the same building.
Homestead Nursing and Rehabilitation of Baird runs on thin staffing. At 2.88 nurse hours per resident per day, it sits about a quarter below the national average of 3.86, and weekends drop roughly another 13 percent below its own weekday levels, so the thinnest coverage lands when families tend to visit. Staff turnover is the bigger tell: 85.7 percent annually, nearly double the national rate, meaning most of the people caring for your relative will likely be gone within a year. The good news is real: a four-star health inspection with 14 deficiencies, none causing harm or involving abuse, five stars on quality measures, and a recent May 2025 inspection. Ask how the home holds those quality numbers with so much churn.
Paradigm At The Pines runs on 2.90 nurse hours per resident per day, about a quarter below the national average, and weekends drop roughly another 11% beneath its own weekday level. Turnover sits at 67.4% against a national 45.8%, and the staffing star rating reflects that: 1 out of 5. The inspection record shows 34 deficiencies, including one at the harm level and six tied to abuse, with a $8,281 fine. It's a hospital-district home, and the last inspection was recent. The quality measure score is strong, but that's largely self-reported data, the hands-on staffing and inspection findings tell a harder story.
Harmony Care At Floresville runs 2.90 nursing hours per resident day, roughly a quarter below the national figure of 3.86, and weekends dip about 12% below what the home staffs on weekdays. Turnover sits at 50.8%, above the 45.8% national average. The inspection record shows 39 deficiencies, two of them serious enough to reach harm or jeopardy level, plus one tied to abuse, and $87,066 in fines across three penalties. This is a for-profit corporate home with 144 beds; its most recent inspection was May 8, 2026. Low staffing and a heavy deficiency history are the two things worth weighing hardest if you're deciding.
Highland Park Care Center is a 120-bed nonprofit home in Houston where the direct-care numbers are thin. Nurses and aides give residents 3.65 hours of care per resident day, under the national average, and weekends drop about 15% below the home's own weekday staffing, so the coverage your family sees on a Tuesday isn't what shows up on a Saturday. Staff turnover sits at 56.9% against a national 45.8%, meaning more than half the workforce leaves each year. Eighteen deficiencies sit on the current record, two serious enough to involve harm or jeopardy, with one fine of $40,186. The quality measure score looks strong, but quality measures reflect resident health outcomes, not whether enough hands are present.
Frequently asked questions
How many chain-owned nursing homes are there in Texas?
There are 942 chain-owned Medicare-certified nursing homes in Texas, 80% of the 1,179 nursing homes there.
Are chain-owned nursing homes better staffed?
In Texas they average 3.29 total nursing hours per resident per day, against 3.39 for all nursing homes in Texas, a difference of -0.1 hours. Staff turnover averages 56.3% against 55.3%.
Which chain-owned nursing home grades best in Texas?