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.
Paradigm At The Oak runs 3.18 nurse hours per resident day, roughly 18% under the national average of 3.86, and weekend coverage drops another 9% below its own weekday level. That thin coverage shows up in the inspection record: 60 deficiencies, eight of them at the harm or jeopardy level and eight tied to abuse, with four fines totaling $103,606 and a one-star health inspection rating from CMS. Staff turnover sits at 39%, which is actually below the 45.8% national figure, so the problem here isn't retention so much as how few hands are on the floor. The last inspection was April 2026. For-profit corporate ownership.
The Hills runs lean on nursing care: 2.74 hours per resident day against a national average of 3.86, and weekends drop roughly 15% below its own weekday level. That thin coverage shows up in the numbers CMS tracks, a one-out-of-five staffing rating, 18 deficiencies on the current record including four at the harm or jeopardy level and one tied to abuse, plus two fines totaling $29,325. Annual turnover sits at 93.2%, more than double the national rate, meaning the aides and nurses at the bedside are constantly new. The most recent inspection is dated February 26, 2026, so the record is current, not stale. Ownership is a for-profit limited liability company. Decatur families weighing this one should ask directly how the home covers weekend shifts.
Decatur Medical Lodge runs on 3.06 nurse hours per resident day, about a fifth below the national average, and weekends dip roughly 13% under its own weekday pace. Staff turnover sits at 71.3% against a 45.8% national figure, so the people caring for residents are leaving faster than they can be replaced. Inspections have logged 29 deficiencies, including one at the harm level and two tied to abuse, with a $14,518 fine on record. The last inspection was April 2026. For-profit ownership through a limited liability company rounds out the picture. Worth asking direct questions about weekend coverage and how quickly shifts get filled.
The Atrium of Bellmead runs on 3.25 nursing hours per resident day, roughly 16% under the national average, and weekends drop about 14% below its own weekday numbers. Staff turnover is the number that should stop you: 95.3% a year against a national average of 45.8%, meaning the aides and nurses at the bedside are largely new faces. Inspections look strong on paper, a recent February 2026 survey and no deficiencies at the harm level, but six deficiencies are on record, two of them abuse-related, and the government's own staffing rating lands at the bottom. Government hospital district ownership doesn't change any of that arithmetic.
St. Teresa runs on thin staffing, and the numbers show it: 3.63 nurse hours per resident day against a national average of 3.86, with weekends dropping about 11% below its own weekday coverage. That's roughly 97% of staff turning over each year, more than double the national rate, which means caregivers are constantly new to residents who need consistency. The inspection record carries 75 deficiencies, including two at the harm level and seven tied to abuse, with $20,730 in fines. Federal inspectors last visited in September 2025. For-profit individual ownership, 124 beds, and a staffing star rating of 1 out of 5 round out a picture worth weighing carefully against other El Paso options.
Ignite Medical Resort Sugar Land runs 90 certified beds and reports 13 deficiencies on its current record, three of them serious enough to involve actual harm or jeopardy. Fines total $155,401 across eight separate penalties, which tells you the problems aren't isolated incidents. Staffing sits slightly under the national average at 3.82 hours per resident day, but the bigger issue is turnover: 62.2% of staff leave each year, well above the 45.8% national rate, and weekend coverage dips below what the home manages on weekdays. The most recent inspection came in December 2025. High turnover with thin weekend staffing is where quality problems tend to surface.
La Hacienda De Paz is a 104-bed hospital-district home in Eagle Pass, and the numbers that stand out most are about who's there to care for residents. Nurse staffing runs 3.12 hours per resident day, roughly 19 percent under the national average, and weekends drop about 12 percent below the home's own weekday levels, so the thinnest coverage lands when families tend to visit. Staff turnover sits at 95.1 percent against a national 45.8 percent, meaning the aides and nurses you meet may not be there in six months. The inspection record shows 24 deficiencies, one at harm or jeopardy level and four tied to abuse, with a $14,069 fine. Ownership is government, through a hospital district.
Avir At Lindale runs on thinner nursing coverage than most homes nationally, 3.60 nurse hours per resident day against a 3.86 average, and weekends dip about 8% below its own weekday level, so the thinnest shifts come when families often visit. Staff turnover sits at 60%, well above the 45.8% national figure, meaning many of the people caring for residents are still new to the building. The inspection record is the sharper concern: 34 deficiencies, 8 of them at harm or jeopardy level and 3 abuse-related, with five fines totaling $754,374 and a February 2026 inspection. Government hospital-district ownership hasn't shielded it from any of that.
Gilmer Nursing And Rehabilitation runs on thin staffing: 2.99 nurse hours per resident day, roughly a quarter below the national average, and weekends drop further, about 12 percent under its own weekday level, when backup is scarcest. The inspection record is heavier than that number alone suggests: 62 deficiencies on file, nine serious enough to reach harm or jeopardy, four tied to abuse, and three fines totaling $218,053. A for-profit limited liability company operates the 93-bed home, and its last inspection was March 2026. Quality measures score mid-range, but the health inspection and staffing ratings both sit at the bottom of the scale.
Avir At Longview runs on a hospital district's license with 115 certified beds, and the staffing numbers are the first thing to notice: 3.56 nurse hours per resident day, roughly 8% under the national average, with weekends dropping about 9% below its own weekday level. Staff turnover sits at 73.3% against a national 45.8%, which means the people caring for residents are, more often than not, new to the building. The inspection record backs that up, 55 deficiencies, 8 of them at harm or jeopardy level, 5 tied to abuse, and two fines totaling $262,731. The most recent inspection was May 2025. If you're considering this one, ask hard questions about who's actually on the floor on a Sunday.
Afton Oaks is a 169-bed for-profit home in Houston that CMS has placed in its Special Focus Facility program, a designation reserved for homes with a persistent record of serious problems. The numbers back that up: 37 deficiencies on the current record, 16 of them at the harm or jeopardy level and 5 tied to abuse, plus four fines totaling $115,512. Nurse staffing runs about 7% below the national average, and weekends drop roughly 8% below the home's own weekday levels, when residents still need care. Its last inspection was in April 2025. If you're considering this one, ask directly what's changed since CMS flagged it.
Town And Country runs on thinner nursing coverage than most homes, 3.33 hours per resident day against a national average of 3.86, with weekends dipping about 10% below its own weekday levels. That shortfall shows up in the federal staffing rating, which sits at the bottom of the scale, and in an annual turnover rate of 65.9% compared with 45.8% nationally: roughly two of every three caregivers left within the year.
The inspection record carries 57 deficiencies, including three at the harm or jeopardy level and five tied to abuse, with $150,922 in fines. A 4/5 quality measure score and a May 2025 inspection are the brighter spots, but they sit alongside a 2/5 inspection rating and government hospital-district ownership.
Kennedy Health & Rehab has been flagged for CMS's Special Focus Facility program, which is reserved for homes with a persistent record of serious problems. The inspection history backs that up: 49 deficiencies on the current record, including 10 at the harm or jeopardy level and 8 tied to abuse. Federal fines total $268,507 across four penalties.
Staffing sits at one star, and so do the health inspection and quality measure ratings, all three below what you'd want to see. This is a 145-bed for-profit home owned by an individual, most recently inspected in June 2025. If you're considering it for someone you love, the pattern here is consistent and serious, not a one-time slip.
Arlington Residence and Rehabilitation Center runs 118 certified beds under corporate ownership, and the staffing numbers tell you a lot before you even get to inspections. At 3.12 nurse hours per resident day, it sits about 19 percent under the national average of 3.86, and weekends dip another 8 percent below its own weekday levels, so coverage thins out exactly when families tend to visit. Turnover is 46 percent, roughly in line with the national 45.8. The inspection record is where it gets heavier: 57 deficiencies, including 4 at harm or jeopardy level and 6 tied to abuse, plus six fines totaling $111,622. Its most recent inspection was February 2025.
Deer Creek runs about 30% below the national average on nurse staffing, 2.69 hours per resident day against 3.86, and weekends dip another 13% below its own weekday level. That thin coverage shows up on the inspection side too: 35 deficiencies on the current record, 6 of them at the harm or jeopardy level, plus 2 abuse-related findings and $75,581 in fines across 4 citations. Staff turnover sits at 56.1%, well above the 45.8% national figure, which matters most when residents need consistent hands on deck. The last inspection was recent, so the picture is current, and the ownership is a for-profit corporation.
Avir At Lubbock runs on 3.39 nursing hours per resident per day, about 12% under the national average, and weekends dip another 6% below its own weekdays, so the thinnest coverage lands when families visit most. Annual turnover sits at 70% against a national 45.8%, meaning most of the people caring for residents this year likely won't be there next year. The inspection record is where it gets serious: 63 deficiencies, 7 at harm or jeopardy level, 10 abuse-related, four fines totaling $69,307, and CMS has placed the home in its Special Focus Facility program. A 4/5 quality measure score can't offset a 1/5 inspection rating and staffing this thin.
Cottonwood runs about 3.24 nurse hours per resident per day, roughly 16% under the national average, and weekends dip a bit further below its own weekday numbers. The bigger issue is turnover: 98% annually, more than double the national rate, which means the aides and nurses caring for your relative are constantly new. Twenty-eight deficiencies sit on the current record, though none rose to harm or jeopardy and none involved abuse. A recent inspection in August 2025 is a point in its favor, as is the three-star health inspection rating. But for-profit corporate ownership, a one-star staffing rating, and a two-star quality measure rating all point the same direction: check actual caregiver presence on the shifts you'd visit.
Harmony Care At Giddings holds a federal Special Focus Facility designation, and the inspection record shows why: 48 deficiencies on file, including 9 at the harm or jeopardy level and 7 tied to abuse. Five fines total $237,415. Its health inspection rating sits at 1 out of 5 stars, and the most recent inspection was July 17, 2025. Ownership is a for-profit partnership. The one bright spot is quality measures at 4 stars, but that stands apart from how the home is actually run day to day. Nurse staffing averages 3.99 hours per resident day, only slightly above the national 3.86, and weekends run about 8% thinner than weekdays, worth asking about directly, since that's when families often visit.
Harmony Care At Beaumont is run by a hospital district, and it has 98 certified beds. The nurse staffing number looks strong on paper, 4.72 hours per resident day, roughly 22% above the national average, but weekends drop about 14% below the home's own weekday level, so coverage isn't steady across the week. The bigger issue sits in the inspection record: 77 deficiencies, 15 of them at harm or jeopardy level, 14 tied to abuse, plus 10 fines totaling $380,812. CMS has placed it in the Special Focus Facility program, which is reserved for homes with a persistent pattern of serious problems. The most recent inspection was April 15, 2026.
The numbers at Williamsburg Village in Desoto tell a split story: residents get good clinical outcomes on paper, but the day-to-day care and oversight don't hold up. Nurse staffing runs 2.81 hours per resident day, about 27% under the national average, and weekend coverage drops roughly 13% below its own weekday level, thinner help exactly when families can't be there. Behind that sit 79 deficiencies, nine serious enough to put residents in harm's way and ten tied to abuse, plus $195,541 in fines and a spot in CMS's Special Focus Facility program. Ownership is for-profit corporate, and turnover sits slightly better than average.
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?