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.
Kemp Care Center runs on 2.88 nurse hours per resident day, about a quarter below the national average, and weekends dip roughly 16% below what the home staffs on weekdays. That thin coverage sits behind a 95.4% annual turnover rate, more than double the national figure, so the aides and nurses at the bedside are, statistically, mostly new. Inspectors have cited 41 deficiencies, three of them at harm or jeopardy level and seven tied to abuse, with $256,260 in fines on record. A 5/5 quality measure score and a recent July 2025 inspection don't offset a 1/5 staffing rating from CMS. For-profit corporate ownership; ask specifically how weekends and evenings are covered before you decide.
Paradigm At The Prairies runs on 2.42 nurse hours per resident day, roughly 37 percent under the national average, and weekends drop about another 15 percent below what the home itself staffs on weekdays. That thin coverage sits alongside 25 deficiencies on the current record, four of them serious enough to involve harm or jeopardy and three tied to abuse. Staff turnover lands at 51.4 percent, above the national figure. The most recent inspection was April 2025, and three fines totaling $62,430 have accumulated. For-profit individual ownership, 150 certified beds, and one out of five stars from CMS on both staffing and health inspections.
If you're weighing Lakeside for someone you love, the staffing numbers are the place to start. At 3.13 nurse hours per resident day, this for-profit home runs roughly 19% below the national average, and weekends drop about 12% below its own weekday level. Annual turnover sits at 82.2% against a national average of 45.8%, which means the people caring for your family member are likely to change often. The record shows 44 deficiencies, three at harm or jeopardy level and six tied to abuse, with the most recent inspection in April 2025. That's a lot of history for a 93-bed building.
Normandy Terrace is a 320-bed for-profit home in San Antonio, and the numbers that stand out are about people. Nurse staffing sits at 3.01 hours per resident day, roughly 22 percent under the national average, and weekends run about 18 percent thinner than weekdays. Staff turnover is 95.8 percent, more than double the national figure, meaning the aides and nurses caring for residents are, in large part, new or on their way out. The inspection record shows 49 deficiencies, six at the harm or jeopardy level and four abuse-related, with five fines totaling $287,359. A 1-out-of-5 inspection rating and a 1-out-of-5 staffing rating back that up. If you're considering this home, ask hard questions about who's on the floor at night and on weekends.
Rock Creek runs on 2.84 nursing hours per resident per day, roughly 27% under the national average of 3.86, and weekends dip about 15% below its own weekday staffing. That thin coverage shows up in turnover: 90.3% of staff left over the past year, double the national rate of 45.8%. The current record carries 36 deficiencies, two serious enough to involve harm or jeopardy, plus $82,579 in fines across two events. Inspectors last visited in August 2025. Corporate-owned and Medicare-certified for 120 beds, the home scores 1 out of 5 on CMS staffing and 2 on health inspections, while its quality measure rating sits at 3.
The Rio at Mission Trails runs 124 beds under hospital district ownership in San Antonio, and its nurse staffing sits just under the national average, 3.71 hours per resident day against 3.86. That small gap is not the real story. Weekend staffing drops roughly 16% below its own weekday level, and annual turnover hits 97.2%, more than double the national rate of 45.8%, meaning the aides and nurses at your mother's bedside are, statistically, almost certain to be new within the year. On inspections, the home carries 32 deficiencies, three at harm or jeopardy level and four abuse-related, with two fines totaling $153,825.
Castle Hills Rehabilitation and Care Center is a for-profit, limited liability operation with 143 certified beds in San Antonio. Nurse staffing runs about 2.96 hours per resident per day, roughly 23 percent below the national average, and weekends fall about 15 percent under its own weekday levels. Every CMS star category here lands at 1 out of 5: health inspections, quality measures, and staffing. The deficiency record shows 72 citations, eight of them at harm or jeopardy level and two tied to abuse, with four fines totaling $112,386 and a recent inspection on September 12, 2025. That combination of thin staffing, low inspection scores, and serious deficiencies is what any family should weigh before choosing this home.
Avir At San Antonio runs on 2.63 nurse staffing hours per resident per day, roughly a third below the national average, and weekends drop about 9% below its own weekday level, so coverage is thinnest when families tend to visit. Staff turnover sits at 60.7%, well above the 45.8% national figure, which means the people caring for your relative are often new to the building. The inspection record shows 43 deficiencies, including three at the harm or jeopardy level and four tied to abuse, with $29,494 in fines across three penalties. Its most recent inspection was August 30, 2025, and the corporation that owns it holds a for-profit license.
Austin Wellness & Rehabilitation runs on 2.63 nurse hours per resident each day, roughly a third below the national average of 3.86, and weekend staffing drops another 9% below its own weekday level. That thin coverage sits behind a 1-out-of-5 inspection rating and 62 deficiencies on the current record, four of them at harm or jeopardy level and two tied to abuse. Staff turnover is 61.3% against a national 45.8%, meaning the aides and nurses your family member sees may keep changing. Three fines total $166,205, and the last inspection was March 2025. For-profit, individually owned, 120 beds.
Greenhill Villas runs on thin staffing even before the weekend squeeze: 3.10 nurse hours per resident day against a national average of 3.86, and weekends drop about 15% below its own weekday level. That's the kind of gap families notice as slower call-button response. Staff turnover sits at 95.2%, more than double the national 45.8%, so the aide who knows your mother's routine this month may be gone the next. The current record carries 47 deficiencies, including three at harm or jeopardy level and five tied to abuse, plus $154,116 in fines across three penalties. The last inspection was June 2025. Corporate-owned, 150 beds.
Forest Park runs on 2.92 nurse hours per resident day, roughly a quarter below the national average, and weekend coverage dips about 8% below its own weekday level. That thin staffing shows up in a 67.8% annual turnover rate, well above the 45.8% national figure. Its inspection record carries 53 deficiencies, eight at the harm or jeopardy level and four tied to abuse, along with four fines totaling $193,834. The most recent inspection was February 2026. A 4/5 quality measure score sits alongside 1/5 ratings for both staffing and health inspections, worth knowing what that quality number actually measures before weighing it against the rest.
Buena Vida Nursing and Rehab in San Antonio runs 222 certified beds under hospital district ownership, and federal data shows it struggling on every measure CMS tracks. Nurse staffing sits at 2.93 hours per resident day, roughly a quarter below the national average of 3.86, and weekends drop about 9% below its own weekday level, so coverage thins out exactly when families tend to visit. The inspection record is the bigger concern: 49 deficiencies, five serious enough to put residents in harm's way, three tied to abuse, and $187,608 in fines. That combination landed it in CMS's Special Focus Facility program, a designation reserved for the country's most persistently troubled homes.
Focused Care At Sherman runs on 3.17 nurse hours per resident day, roughly 18% under the national average, and weekends drop about 13% below its own weekday staffing. That thin coverage sits behind a 75% annual turnover rate, well above the national 45.8%, so the people caring for residents are often new to the building. Its current record carries 45 deficiencies, including 7 at harm or jeopardy level and 6 tied to abuse, plus one fine of $82,570, with the most recent inspection in May 2025. The quality measure rating of 3/5 is the one area that looks closer to average, but staffing and inspection ratings both sit at 1/5.
Avir At Weston runs 120 certified beds in Temple under individual for-profit ownership, and the staffing numbers are where the trouble starts. At 3.03 nurse hours per resident day, it sits roughly 21% below the national average of 3.86, and weekend coverage drops about 12% below its own weekday level, so the thinnest shifts get even thinner. Staff turnover hits 83.3% against a national average of 45.8%, meaning most of the people caring for residents are new to the building. The inspection record backs that up: 29 deficiencies, six at harm or jeopardy level, one abuse-related, and four fines totaling $154,589. The most recent inspection was June 13, 2025.
Peach Tree Place runs on 2.65 nurse hours per resident day, about a third less than the national average, and weekend coverage drops roughly 14% below what it manages on weekdays. Staff turnover hits 92% a year, double the national rate, so the people caring for residents are, more often than not, new to the building. The inspection record shows 29 deficiencies, five involving actual harm or jeopardy to residents and five tied to abuse. One fine on file totals $229,570. Ownership is a for-profit corporation, and the most recent state inspection dates to March 2024.
Avir At Rose Trail carries a record that should give any family pause. The Tyler home runs 3.04 nurse staffing hours per resident day against a national average of 3.86, and weekends drop about 16% below its own weekday level, so the thinnest coverage lands exactly when families tend to visit. Staff turnover sits at 69.6% against a national 45.8%, meaning most of the people caring for your relative will likely be gone within the year.
The inspection record is worse: 59 deficiencies, 10 of them at the harm or jeopardy level and 10 tied to abuse, with $442,321 in federal fines. CMS has placed it in the Special Focus Facility program, reserved for the country's most troubled homes.
Estates Healthcare and Rehabilitation Center runs 141 beds in Fort Worth under corporate for-profit ownership, and the numbers that stand out most are its inspection record and its staffing. Nurses provide about 3.08 hours of care per resident per day, roughly 20% below the national average, and weekend coverage drops about 16% below what the home staffs on weekdays. Staff turnover sits at 86.7%, nearly double the national rate of 45.8%.
That instability shows up in the record: 53 deficiencies, 11 of them serious enough to involve harm or jeopardy to residents, and 8 tied to abuse. Eight fines total $159,833. One bright spot is the quality measure rating at 4/5, but with a 1/5 inspection rating and a 1/5 staffing rating, families should ask hard questions before choosing this home.
Paradigm At Woodwind Lakes runs 3.21 nursing hours per resident per day, roughly 17% under the national average, and weekend coverage drops about 12% below its own weekday level. Staff turnover sits at 58.3% against a national 45.8%, so the people providing that thin coverage are also leaving fast. The inspection record shows 44 deficiencies, 12 of them at harm or jeopardy level and 3 abuse-related, with two CMS fines totaling $89,541. This for-profit LLC is in the Special Focus Facility program, meaning federal regulators watch it more closely than most. The most recent inspection was January 9, 2026.
Bluebonnet Nursing and Rehabilitation runs 120 beds in Karnes County under corporate ownership, and the staffing numbers are the first thing to notice. At 3.40 nurse hours per resident day, it sits about 12% under the national average, and weekends drop roughly 23% below its own weekday level, which matters if your family visits on a Saturday. Turnover is the harder number: 91.4% of staff leave each year against a national average of 45.8%, so the people caring for your relative are likely new to the building and still learning it. The current inspection record shows 39 deficiencies, five of them at the harm or jeopardy level, with $125,523 in fines across five penalties. The last inspection was August 2025.
Nurse staffing at Marine Creek works out to 3.47 hours per resident per day, roughly 10 percent under the national average, and weekends drop about 18 percent below the home's own weekday levels, so the thinnest coverage lands when families tend to visit. Staff turnover is 94.1 percent a year against a national average near 46 percent, meaning most of the people caring for residents are new to the building and still learning it. The current inspection record carries 44 deficiencies, including 6 at the harm or jeopardy level and 5 tied to abuse. Three fines totaling $23,621 are on file, and the most recent inspection was September 18, 2025.
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?