Greenville, TX

Briarcliff Health Center Of Greenville

2-star overall rating with 2-star inspections with $25,175 in total fines with 13 recent health deficiencies

4400 Walnut St, Greenville, TX

(903) 455-8729

Compare this facility

Overall

2 / 5

CMS overall stars

Health inspections

2 / 5

Survey and complaint cycles

Staffing

2 / 5

RN + nurse staffing

Quality measures

4 / 5

Resident outcomes and process measures

Quick facts

Facility snapshot

Beds

120

Certified beds

Average residents

Average occupied residents

Ownership

For-Profit

Publicly displayed owner type

Chain

No chain reported

Operator or chain grouping

Approved since

1997-03-10

CMS approved date

Coverage

Medicare + Medicaid

Participation flags

Changed ownership

Within the last 12 months

Family council

Yes

Resident and family council reported

Sprinklers

Yes

Automatic sprinklers in all required areas

Staffing

Hours and turnover

RN hours / resident day

0.23

Registered nurse staffing · state 0.44 · national 0.68

LPN hours / resident day

1.06

Licensed practical nurse staffing · state 0.95 · national 0.87

Aide hours / resident day

2.09

Nurse aide staffing · state 2.01 · national 2.35

Total nurse hours

3.37

All reported nurse hours · state 3.40 · national 3.89

Licensed hours

1.28

RN + LPN hours · state 1.38 · national 1.54

Weekend hours

2.97

Weekend nurse staffing · state 2.99 · national 3.43

Weekend RN hours

0.35

Weekend registered nurse coverage · state 0.34 · national 0.47

Physical therapist

0.13

Reported PT staffing · state 0.07 · national 0.07

Adjusted RN hours

0.22

CMS adjusted RN staffing hours

Adjusted total hours

3.33

CMS adjusted total nurse staffing hours

Case-mix index

1.38

Higher values indicate more complex resident acuity

RN turnover

Annual RN turnover

Total nurse turnover

24%

Annual nurse turnover · state 52% · national 46%

SNF VBP

Value-based purchasing

Program rank

12,695

Lower is better among SNFs in the FY 2026 VBP program.

Performance score

Composite VBP score used to determine payment impact.

Payment multiplier

0.9810

Above 1.000 increases Medicare payment; below 1.000 reduces it.

Program components

How the VBP score is built

Readmission

Baseline 19.64% · Performance 23.40% · Measure score 0 · Achievement 0 · Improvement 0

Healthcare-associated infections

1.92

Baseline 9.54% · Performance 8.44% · Measure score 1.92 · Achievement 0 · Improvement 1.92

Total nurse turnover

2.48

Baseline 50.00% · Performance 53.53% · Measure score 2.48 · Achievement 2.48 · Improvement 0

Adjusted total nurse staffing

Baseline 3.98 hours · Performance 2.95 hours · Measure score 0 · Achievement 0 · Improvement 0

SNF QRP

Medicare quality reporting measures

Measure	Facility	National	Note
Potentially preventable 30-day readmission	10.31%	10.72% 0.4 pts better	No Different than the National Rate · Eligible stays 235 · Observed rate 10.21% · Lower 95% interval 7.43%
Discharge to community	49.22%	50.57% 1.4 pts worse	No Different than the National Rate · Eligible stays 238 · Observed rate 44.12% · Lower 95% interval 43.01%
Medicare spending per beneficiary	1.26	1.02 0.2 pts worse
Drug regimen review with follow-up	100%	95.27% 4.7 pts better	Numerator 155 · Denominator 155
Falls with major injury	1.29%	0.77% 0.5 pts worse	Numerator 2 · Denominator 155
Discharge self-care score	70.24%	53.69% 16.5 pts better	Numerator 59 · Denominator 84
Discharge mobility score	58.33%	50.94% 7.4 pts better	Numerator 49 · Denominator 84
Pressure ulcers or injuries, new or worsened	0.65%	2.29% 1.6 pts better	Numerator 1 · Denominator 155 · Adjusted rate 0.44%
Healthcare-associated infections requiring hospitalization	8.44%	7.12% 1.3 pts worse	No Different than the National Rate · Eligible stays 167 · Observed rate 9.58% · Lower 95% interval 5.46%
Staff COVID-19 vaccination coverage	8.26%	8.2% 0.1 pts better	Numerator 9 · Denominator 109
Staff flu vaccination coverage	47.27%	42% 5.3 pts better	Numerator 52 · Denominator 110
Discharge function score	73.81%	56.45% 17.4 pts better	Numerator 62 · Denominator 84
Transfer of health information to provider	100%	95.95% 4 pts better	Numerator 83 · Denominator 83
Transfer of health information to patient	100%	96.28% 3.7 pts better	Numerator 40 · Denominator 40
Resident COVID-19 vaccinations up to date	22.58%	25.2% 2.6 pts worse	Numerator 21 · Denominator 93

Quality measures

Resident outcomes and process scores

Measure	Facility	State	National	Note
Number of hospitalizations per 1000 long-stay resident days	2.3	2.1 0.2 pts worse	1.9 0.4 pts worse	Long Stay · 20240701-20250630 · Adjusted 2.3 · Observed 2.2 · Expected 1.8 · Used in QM five-star
Number of outpatient emergency department visits per 1000 long-stay resident days	0.8	2.1 1.3 pts better	1.8 1 pts better	Long Stay · 20240701-20250630 · Adjusted 0.8 · Observed 0.7 · Expected 1.6 · Used in QM five-star
Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine	100.0%	97.1% 2.9 pts better	93.4% 6.6 pts better	Long Stay · 2024Q4-2025Q3 · Q1 100.0% · Q2 100.0% · Q3 100.0% · Q4 100.0% · 4Q avg 100.0%
Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine	100.0%	97.9% 2.1 pts better	95.5% 4.5 pts better	Long Stay · 2024Q3-2025Q2 · 4Q avg 100.0%
Percentage of long-stay residents experiencing one or more falls with major injury	3.2%	3.3% 0.1 pts better	3.3% 0.1 pts better	Long Stay · 2024Q4-2025Q3 · Q1 5.2% · Q2 3.8% · Q3 2.6% · Q4 1.2% · 4Q avg 3.2% · Used in QM five-star
Percentage of long-stay residents who have depressive symptoms	4.6%	2.7% 1.9 pts worse	11.4% 6.8 pts better	Long Stay · 2024Q4-2025Q3 · Q1 2.7% · Q2 2.7% · Q3 5.4% · Q4 7.6% · 4Q avg 4.6%
Percentage of long-stay residents who lose too much weight	2.4%	3.3% 0.9 pts better	5.4% 3 pts better	Long Stay · 2024Q4-2025Q3 · Q1 4.8% · Q2 1.6% · Q3 3.2% · Q4 0.0% · 4Q avg 2.4%
Percentage of long-stay residents who received an antianxiety or hypnotic medication	15.7%	18.9% 3.2 pts better	19.6% 3.9 pts better	Long Stay · 2024Q4-2025Q3 · Q1 18.5% · Q2 16.2% · Q3 14.5% · Q4 13.6% · 4Q avg 15.7%
Percentage of long-stay residents who received an antipsychotic medication	2.0%	10.8% 8.8 pts better	16.7% 14.7 pts better	Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 4.5% · Q3 2.0% · Q4 2.0% · 4Q avg 2.0% · Used in QM five-star
Percentage of long-stay residents who were physically restrained	0.0%	0.0% About the same	0.1% 0.1 pts better	Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0%
Percentage of long-stay residents whose ability to walk independently worsened	23.9%	15.4% 8.5 pts worse	16.3% 7.6 pts worse	Long Stay · 2024Q4-2025Q3 · 4Q avg 23.9% · Used in QM five-star
Percentage of long-stay residents whose need for help with daily activities has increased	12.4%	16.1% 3.7 pts better	14.9% 2.5 pts better	Long Stay · 2024Q4-2025Q3 · Q1 18.3% · Q2 17.2% · Q3 8.9% · Q4 4.9% · 4Q avg 12.4% · Used in QM five-star
Percentage of long-stay residents with a catheter inserted and left in their bladder	0.0%	0.5% 0.5 pts better	1.0% 1 pts better	Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0% · Used in QM five-star
Percentage of long-stay residents with a urinary tract infection	1.3%	0.8% 0.5 pts worse	1.7% 0.4 pts better	Long Stay · 2024Q4-2025Q3 · Q1 2.7% · Q2 1.4% · Q3 0.0% · Q4 1.2% · 4Q avg 1.3% · Used in QM five-star
Percentage of long-stay residents with new or worsened bowel or bladder incontinence	16.0%	15.0% 1 pts worse	19.8% 3.8 pts better	Long Stay · 2024Q4-2025Q3 · Q1 28.3% · Q2 17.5% · Q3 5.6% · Q4 13.3% · 4Q avg 16.0%
Percentage of long-stay residents with pressure ulcers	2.9%	4.2% 1.3 pts better	5.1% 2.2 pts better	Long Stay · 2024Q4-2025Q3 · Q1 2.5% · Q2 4.8% · Q3 3.1% · Q4 1.5% · 4Q avg 2.9% · Used in QM five-star
Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine	100.0%	89.7% 10.3 pts better	81.7% 18.3 pts better	Short Stay · 2024Q4-2025Q3 · Q1 100.0% · Q2 100.0% · Q3 100.0% · Q4 100.0% · 4Q avg 100.0%
Percentage of short-stay residents who had an outpatient emergency department visit	10.7%	12.0% 1.3 pts better	12.0% 1.3 pts better	Short Stay · 20240701-20250630 · Adjusted 10.7% · Observed 10.8% · Expected 11.2% · Used in QM five-star
Percentage of short-stay residents who newly received an antipsychotic medication	0.4%	1.5% 1.1 pts better	1.6% 1.2 pts better	Short Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 1.5% · 4Q avg 0.4% · Used in QM five-star
Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine	100.0%	88.0% 12 pts better	79.7% 20.3 pts better	Short Stay · 2024Q3-2025Q2 · 4Q avg 100.0%
Percentage of short-stay residents who were rehospitalized after a nursing home admission	29.2%	25.9% 3.3 pts worse	23.9% 5.3 pts worse	Short Stay · 20240701-20250630 · Adjusted 29.2% · Observed 30.9% · Expected 25.2% · Used in QM five-star

Survey summary

Recent inspection cycles

Cycle 1 Health 2024-11-20 · Fire 2024-11-20

13 health deficiencies

Top issue: Quality of Life and Care (3 deficiencies)

0 fire-safety deficiencies

No concentrated fire-safety issue counts in this cycle.

Cycle 2 Health 2023-09-21 · Fire 2023-09-21

15 health deficiencies

Top issue: Quality of Life and Care (4 deficiencies)

0 fire-safety deficiencies

No concentrated fire-safety issue counts in this cycle.

Cycle 3 Health 2022-07-13 · Fire 2022-07-13

2 health deficiencies

Top issue: Quality of Life and Care (1 deficiency)

3 fire-safety deficiencies

Top issue: Smoke (3 deficiencies)

Fire safety

Fire-safety citations

F · Potential for more than minimal harm 2022-07-13

K321 · Smoke Deficiencies

Fire Safety

Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.

Corrected 2022-08-19

F · Potential for more than minimal harm 2022-07-13

K372 · Smoke Deficiencies

Fire Safety

Ensure smoke barriers are constructed to a 1 hour fire resistance rating.

Corrected 2022-08-26

E · Potential for more than minimal harm 2022-07-13

K353 · Smoke Deficiencies

Fire Safety

Inspect, test, and maintain automatic sprinkler systems.

Corrected 2022-08-26

Inspection history

Recent health citations

D · Potential for more than minimal harm 2025-11-21

F842 · Resident Assessment and Care Planning Deficiencies

Health

Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.

Corrected 2025-11-22

D · Potential for more than minimal harm 2025-11-21

F880 · Infection Control Deficiencies

Health

Provide and implement an infection prevention and control program.

Corrected 2025-11-22

D · Potential for more than minimal harm 2025-07-28

F925 · Environmental Deficiencies

Health

Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.

Corrected 2025-07-29

E · Potential for more than minimal harm 2024-11-20

F656 · Resident Assessment and Care Planning Deficiencies

Health

Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

Corrected 2024-12-13

E · Potential for more than minimal harm 2024-11-20

F657 · Resident Assessment and Care Planning Deficiencies

Health

Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.

Corrected 2024-12-13

E · Potential for more than minimal harm 2024-11-20

F880 · Infection Control Deficiencies

Health

Provide and implement an infection prevention and control program.

Corrected 2024-12-13

D · Potential for more than minimal harm 2024-11-20

F550 · Resident Rights Deficiencies

Health

Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

Corrected 2024-12-13

D · Potential for more than minimal harm 2024-11-20

F558 · Resident Rights Deficiencies

Health

Reasonably accommodate the needs and preferences of each resident.

Corrected 2024-12-13

D · Potential for more than minimal harm 2024-11-20

F677 · Quality of Life and Care Deficiencies

Health

Provide care and assistance to perform activities of daily living for any resident who is unable.

Corrected 2024-12-13

D · Potential for more than minimal harm 2024-11-20

F689 · Quality of Life and Care Deficiencies

Health

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Corrected 2024-12-13

D · Potential for more than minimal harm 2024-11-20

F695 · Quality of Life and Care Deficiencies

Health

Provide safe and appropriate respiratory care for a resident when needed.

Corrected 2024-12-13

D · Potential for more than minimal harm 2024-11-20

F761 · Pharmacy Service Deficiencies

Health

Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.

Corrected 2024-12-13

D · Potential for more than minimal harm 2024-11-20

F812 · Nutrition and Dietary Deficiencies

Health

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

Corrected 2024-12-13

D · Potential for more than minimal harm 2024-04-23

F880 · Infection Control Deficiencies

Health

Provide and implement an infection prevention and control program.

Corrected 2024-05-04

K · Immediate jeopardy 2023-09-21

F690 · Quality of Life and Care Deficiencies

Health

Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.

Corrected 2023-09-22

K · Immediate jeopardy 2023-09-21

F880 · Infection Control Deficiencies

Health

Provide and implement an infection prevention and control program.

Corrected 2023-09-22

F · Potential for more than minimal harm 2023-09-21

F812 · Nutrition and Dietary Deficiencies

Health

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

Corrected 2023-09-22

E · Potential for more than minimal harm 2023-09-21

F576 · Resident Rights Deficiencies

Health

Ensure residents have reasonable access to and privacy in their use of communication methods.

Corrected 2023-09-22

E · Potential for more than minimal harm 2023-09-21

F607 · Freedom from Abuse, Neglect, and Exploitation Deficiencies

Health

Develop and implement policies and procedures to prevent abuse, neglect, and theft.

Corrected 2023-10-12

E · Potential for more than minimal harm 2023-09-21

F700 · Quality of Life and Care Deficiencies

Health

Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail.

Corrected 2023-10-13