Cycle 1
Health 2025-02-14 · Fire 2025-02-14
8 health deficiencies
Top issue: Resident Rights (3 deficiencies)
3 fire-safety deficiencies
Top issue: Smoke (2 deficiencies)
Austin, TX
Brookdale Westlake Hills
1-star overall rating with 2-star inspections with $300,561 in total fines with 8 recent health deficiencies with 3 fire-safety deficiencies in the latest cycle
1034 Liberty Park Dr, Austin, TX
(512) 328-3775
Overall
1 / 5
CMS overall stars
Health inspections
2 / 5
Survey and complaint cycles
Staffing
1 / 5
RN + nurse staffing
Quality measures
4 / 5
Resident outcomes and process measures
Quick facts
Facility snapshot
Beds
90
Certified beds
Average residents
51
Average occupied residents
Ownership
For-Profit
Publicly displayed owner type
Chain
Brookdale Senior Living
Operator or chain grouping
Approved since
1990-01-09
CMS approved date
Coverage
Medicare
Participation flags
Chain footprint
14 facilities
Chain averages 3 overall / 3 health / 3 staffing / 4 quality stars
Changed ownership
No
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
0.70
Registered nurse staffing · state 0.44 · national 0.68
LPN hours / resident day
1.36
Licensed practical nurse staffing · state 0.95 · national 0.87
Aide hours / resident day
2.67
Nurse aide staffing · state 2.01 · national 2.35
Total nurse hours
4.74
All reported nurse hours · state 3.40 · national 3.89
Licensed hours
2.06
RN + LPN hours · state 1.38 · national 1.54
Weekend hours
4.13
Weekend nurse staffing · state 2.99 · national 3.43
Weekend RN hours
0.18
Weekend registered nurse coverage · state 0.34 · national 0.47
Physical therapist
0.18
Reported PT staffing · state 0.07 · national 0.07
Adjusted RN hours
0.60
CMS adjusted RN staffing hours
Adjusted total hours
4.06
CMS adjusted total nurse staffing hours
Case-mix index
1.60
Higher values indicate more complex resident acuity
RN turnover
56%
Annual RN turnover · state 52% · national 45%
Total nurse turnover
35%
Annual nurse turnover · state 52% · national 46%
SNF VBP
Value-based purchasing
Program rank
2,253
Lower is better among SNFs in the FY 2026 VBP program.
Performance score
50.67
Composite VBP score used to determine payment impact.
Payment multiplier
1.0049
Above 1.000 increases Medicare payment; below 1.000 reduces it.
Program components
How the VBP score is built
Readmission
2.34
Baseline 18.25% · Performance 20.35% · Measure score 2.34 · Achievement 2.34 · Improvement 0
Healthcare-associated infections
6.60
Baseline 5.51% · Performance 5.86% · Measure score 6.60 · Achievement 6.60 · Improvement 0
Total nurse turnover
6.07
Baseline 53.95% · Performance 38.89% · Measure score 6.07 · Achievement 6.07 · Improvement 4.68
Adjusted total nurse staffing
5.26
Baseline 4.37 hours · Performance 4.58 hours · Measure score 5.26 · Achievement 5.26 · Improvement 0.95
SNF QRP
Medicare quality reporting measures
| Measure | Facility | National | Note |
|---|---|---|---|
| Potentially preventable 30-day readmission | 12.13% |
10.72%
1.4 pts worse
|
No Different than the National Rate · Eligible stays 390 · Observed rate 11.54% · Lower 95% interval 9.42% |
| Discharge to community | 60.46% |
50.57%
9.9 pts better
|
Better than the National Rate · Eligible stays 371 · Observed rate 56.6% · Lower 95% interval 55.9% |
| Medicare spending per beneficiary | 0.94 |
1.02
0.1 pts better
|
|
| Drug regimen review with follow-up | 74.6% |
95.27%
20.7 pts worse
|
Numerator 141 · Denominator 189 |
| Falls with major injury | 0% |
0.77%
0.8 pts better
|
Numerator 0 · Denominator 189 |
| Discharge self-care score | 60.74% |
53.69%
7.1 pts better
|
Numerator 82 · Denominator 135 |
| Discharge mobility score | 28.15% |
50.94%
22.8 pts worse
|
Numerator 38 · Denominator 135 |
| Pressure ulcers or injuries, new or worsened | 1.59% |
2.29%
0.7 pts better
|
Numerator 3 · Denominator 189 · Adjusted rate 1.49% |
| Healthcare-associated infections requiring hospitalization | 5.86% |
7.12%
1.3 pts better
|
No Different than the National Rate · Eligible stays 197 · Observed rate 4.06% · Lower 95% interval 3.82% |
| Staff COVID-19 vaccination coverage | 17.44% |
8.2%
9.2 pts better
|
Numerator 45 · Denominator 258 |
| Staff flu vaccination coverage | 26.18% |
42%
15.8 pts worse
|
Numerator 72 · Denominator 275 |
| Discharge function score | 51.11% |
56.45%
5.3 pts worse
|
Numerator 69 · Denominator 135 |
| Transfer of health information to provider | 92.5% |
95.95%
3.5 pts worse
|
Numerator 37 · Denominator 40 |
| Transfer of health information to patient | 83.19% |
96.28%
13.1 pts worse
|
Numerator 99 · Denominator 119 |
| Resident COVID-19 vaccinations up to date | 16.67% |
25.2%
8.5 pts worse
|
Numerator 16 · Denominator 96 |
Quality measures
Resident outcomes and process scores
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| 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 · 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 | 12.5% |
3.3%
9.2 pts worse
|
3.3%
9.2 pts worse
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 12.5% · Used in QM five-star |
| Percentage of long-stay residents who have depressive symptoms | 0.0% |
2.7%
2.7 pts better
|
11.4%
11.4 pts better
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 0.0% |
| Percentage of long-stay residents who lose too much weight | 0.0% |
3.3%
3.3 pts better
|
5.4%
5.4 pts better
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 0.0% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 5.8% |
18.9%
13.1 pts better
|
19.6%
13.8 pts better
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 5.8% |
| Percentage of long-stay residents who received an antipsychotic medication | 10.3% |
10.8%
0.5 pts better
|
16.7%
6.4 pts better
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 10.3% · 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 · 4Q avg 0.0% |
| Percentage of long-stay residents whose need for help with daily activities has increased | 15.9% |
16.1%
0.2 pts better
|
14.9%
1 pts worse
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 15.9% · 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 · 4Q avg 0.0% · Used in QM five-star |
| Percentage of long-stay residents with a urinary tract infection | 1.6% |
0.8%
0.8 pts worse
|
1.7%
0.1 pts better
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 1.6% · Used in QM five-star |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | 18.4% |
15.0%
3.4 pts worse
|
19.8%
1.4 pts better
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 18.4% |
| Percentage of long-stay residents with pressure ulcers | 9.6% |
4.2%
5.4 pts worse
|
5.1%
4.5 pts worse
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 9.6% · Used in QM five-star |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 95.0% |
89.7%
5.3 pts better
|
81.7%
13.3 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 93.4% · Q2 94.8% · Q3 94.6% · Q4 97.2% · 4Q avg 95.0% |
| Percentage of short-stay residents who had an outpatient emergency department visit | 8.3% |
12.0%
3.7 pts better
|
12.0%
3.7 pts better
|
Short Stay · 20240701-20250630 · Adjusted 8.3% · Observed 8.0% · Expected 10.8% · Used in QM five-star |
| Percentage of short-stay residents who newly received an antipsychotic medication | 0.6% |
1.5%
0.9 pts better
|
1.6%
1 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 1.0% · Q2 0.0% · Q3 0.4% · Q4 0.9% · 4Q avg 0.6% · Used in QM five-star |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 90.5% |
88.0%
2.5 pts better
|
79.7%
10.8 pts better
|
Short Stay · 2024Q3-2025Q2 · 4Q avg 90.5% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission | 21.0% |
25.9%
4.9 pts better
|
23.9%
2.9 pts better
|
Short Stay · 20240701-20250630 · Adjusted 21.0% · Observed 19.1% · Expected 21.7% · Used in QM five-star |
Survey summary
Recent inspection cycles
Cycle 2
Health 2024-01-26 · Fire 2024-01-26
13 health deficiencies
Top issue: Quality of Life and Care (6 deficiencies)
7 fire-safety deficiencies
Top issue: Egress (2 deficiencies)
Cycle 3
Health 2022-11-22 · Fire 2022-11-22
5 health deficiencies
Top issue: Quality of Life and Care (3 deficiencies)
0 fire-safety deficiencies
No concentrated fire-safety issue counts in this cycle.
Fire safety
Fire-safety citations
F · Potential for more than minimal harm
2025-02-14
K372 · Smoke Deficiencies
Fire Safety
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
Corrected 2025-03-04
E · Potential for more than minimal harm
2025-02-14
K293 · Egress Deficiencies
Fire Safety
Have properly located and lighted "Exit" signs.
Corrected 2025-03-08
E · Potential for more than minimal harm
2025-02-14
K353 · Smoke Deficiencies
Fire Safety
Inspect, test, and maintain automatic sprinkler systems.
Corrected 2025-03-04
F · Potential for more than minimal harm
2024-01-26
K131 · Construction Deficiencies
Fire Safety
Meet requirements for sections of health care facilities separated by fire resistive construction.
Corrected 2024-02-21
F · Potential for more than minimal harm
2024-01-26
K311 · Smoke Deficiencies
Fire Safety
Have an enclosure around a vertical opening shaft.
Corrected 2024-01-24
F · Potential for more than minimal harm
2024-01-26
K372 · Smoke Deficiencies
Fire Safety
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
Corrected 2024-02-21
F · Potential for more than minimal harm
2024-01-26
K918 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Have generator or other power source capable of supplying service within 10 seconds.
Corrected 2024-02-21
E · Potential for more than minimal harm
2024-01-26
K211 · Egress Deficiencies
Fire Safety
Keep aisles, corridors, and exits free of obstruction in case of emergency.
Corrected 2024-02-21
D · Potential for more than minimal harm
2024-01-26
K222 · Egress Deficiencies
Fire Safety
Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.
Corrected 2024-01-24
C · Minimal harm
2024-01-26
K923 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Have proper medical gas storage and administration areas.
Corrected 2024-02-21
Inspection history
Recent health citations
D · Potential for more than minimal harm
2025-12-03
F583 · Resident Rights Deficiencies
Health
Keep residents' personal and medical records private and confidential.
Corrected 2025-12-22
D · Potential for more than minimal harm
2025-12-03
F880 · Infection Control Deficiencies
Health
Provide and implement an infection prevention and control program.
Corrected 2025-12-22
E · Potential for more than minimal harm
2025-02-14
F755 · Pharmacy Service Deficiencies
Health
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Corrected 2025-03-10
D · Potential for more than minimal harm
2025-02-14
F552 · Resident Rights Deficiencies
Health
Ensure that residents are fully informed and understand their health status, care and treatments.
Corrected 2025-03-13
D · Potential for more than minimal harm
2025-02-14
F558 · Resident Rights Deficiencies
Health
Reasonably accommodate the needs and preferences of each resident.
Corrected 2025-03-12
D · Potential for more than minimal harm
2025-02-14
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 2025-03-10
D · Potential for more than minimal harm
2025-02-14
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 2025-03-10
D · Potential for more than minimal harm
2025-02-14
F880 · Infection Control Deficiencies
Health
Provide and implement an infection prevention and control program.
Corrected 2025-03-04
D · Potential for more than minimal harm
2024-10-14
F684 · Quality of Life and Care Deficiencies
Health
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected 2024-10-28
J · Immediate jeopardy
2024-05-01
F660 · Resident Assessment and Care Planning Deficiencies
Health
Plan the resident's discharge to meet the resident's goals and needs.
Corrected 2024-05-07
J · Immediate jeopardy
2024-01-26
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 2024-01-27
E · Potential for more than minimal harm
2024-01-26
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 2024-02-21
E · Potential for more than minimal harm
2024-01-26
F880 · Infection Control Deficiencies
Health
Provide and implement an infection prevention and control program.
Corrected 2024-02-21
E · Potential for more than minimal harm
2024-01-26
F914 · Environmental Deficiencies
Health
Provide bedrooms that don't allow residents to see each other when privacy is needed.
Corrected 2024-02-21
D · Potential for more than minimal harm
2024-01-26
F607 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Health
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
Corrected 2024-02-21
D · Potential for more than minimal harm
2024-01-26
F609 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Health
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Corrected 2024-02-21
D · Potential for more than minimal harm
2024-01-26
F655 · Resident Assessment and Care Planning Deficiencies
Health
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
Corrected 2024-02-21
D · Potential for more than minimal harm
2024-01-26
F691 · Quality of Life and Care Deficiencies
Health
Provide appropriate colostomy, urostomy, or ileostomy care/services for a resident who requires such services.
Corrected 2024-02-21
D · Potential for more than minimal harm
2024-01-26
F693 · Quality of Life and Care Deficiencies
Health
Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube.
Corrected 2024-02-21
D · Potential for more than minimal harm
2024-01-26
F694 · Quality of Life and Care Deficiencies
Health
Provide for the safe, appropriate administration of IV fluids for a resident when needed.
Corrected 2024-02-21
D · Potential for more than minimal harm
2024-01-26
F695 · Quality of Life and Care Deficiencies
Health
Provide safe and appropriate respiratory care for a resident when needed.
Corrected 2024-02-21
J · Immediate jeopardy
2023-12-29
F684 · Quality of Life and Care Deficiencies
Health
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected 2023-12-05
J · Immediate jeopardy
2023-12-29
F760 · Pharmacy Service Deficiencies
Health
Ensure that residents are free from significant medication errors.
Corrected 2023-12-05
G · Actual harm
2023-11-05
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 2023-09-02
K · Immediate jeopardy
2023-08-27
F600 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Health
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Corrected 2023-09-22
J · Immediate jeopardy
2023-08-27
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 2023-07-20
Penalties and ownership
What sits behind the stars
$7,800
2024-05-01
Fine
Fine · fine $7,800
Fine
$33,758
2024-01-26
Fine
Fine · fine $33,758
Fine
$7,446
2023-12-29
Fine
Fine · fine $7,446
Fine
$14,518
2023-12-29
Fine
Fine · fine $14,518
Fine
$9,311
2023-11-05
Fine
Fine · fine $9,311
Fine
$227,728
2023-08-27
Fine
Fine · fine $227,728
Fine
Ownership
Arc Fort Austin Properties LLC
Limited Partnership Interest · Organization
Arcpi Holdings Inc
Limited Partnership Interest · Organization
Baier, Lucinda
Corporate Director · Individual
Baier, Lucinda
Corporate Officer · Individual
Bertrand, Brandi
Operational/Managerial Control · Individual
Bowman, Kevin
Corporate Director · Individual
Bowman, Kevin
Corporate Officer · Individual
David-Rosen, Carol
Operational/Managerial Control · Individual
Fry, Liam
Operational/Managerial Control · Individual
Kussow, Dawn
Operational/Managerial Control · Individual
La Marre, Kevin
Operational/Managerial Control · Individual
La Marre, Kevin
Corporate Officer · Individual
Mackenzie, Todd
Operational/Managerial Control · Individual
Munoz, Anna
Operational/Managerial Control · Individual
Munoz, Anna
Corporate Officer · Individual
Odanga, Catherine
Operational/Managerial Control · Individual
White, Chadwick
Operational/Managerial Control · Individual
White, Chadwick
Corporate Director · Individual
White, Chadwick
Corporate Officer · Individual
Nearby options
Other facilities in reach
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Barton Valley Rehabilitation and Healthcare Center
Austin, TX
4-star overall rating with 4-star inspections with 8 recent health deficiencies with 1 fire-safety deficiencies in the latest cycle
#2
The Arbour At Westminster Manor
Austin, TX
5-star overall rating with 4-star inspections with $29,085 in total fines with 2 recent health deficiencies with 2 fire-safety deficiencies in the latest cycle
#3
Brush Country Nursing and Rehabilitation
Austin, TX
1-star overall rating with 1-star inspections with $143,157 in total fines with 24 recent health deficiencies
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