Stratford, TX

Coldwater Manor

5-star overall rating with 4-star inspections with 6 recent health deficiencies

1111 Beaver Rd, Stratford, TX

(806) 396-5568

Compare this facility

Overall

5 / 5

CMS overall stars

Health inspections

4 / 5

Survey and complaint cycles

Staffing

2 / 5

RN + nurse staffing

Quality measures

5 / 5

Resident outcomes and process measures

Quick facts

Facility snapshot

Beds

26

Certified beds

Average residents

22

Average occupied residents

Ownership

Government

Publicly displayed owner type

Chain

No chain reported

Operator or chain grouping

Approved since

1977-01-31

CMS approved date

Coverage

Medicaid

Participation flags

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

1.41

Registered nurse staffing · state 0.44 · national 0.68

LPN hours / resident day

0.69

Licensed practical nurse staffing · state 0.95 · national 0.87

Aide hours / resident day

0.29

Nurse aide staffing · state 2.01 · national 2.35

Total nurse hours

2.38

All reported nurse hours · state 3.40 · national 3.89

Licensed hours

2.10

RN + LPN hours · state 1.38 · national 1.54

Weekend hours

1.92

Weekend nurse staffing · state 2.99 · national 3.43

Weekend RN hours

1.04

Weekend registered nurse coverage · state 0.34 · national 0.47

Physical therapist

0.00

Reported PT staffing

Adjusted RN hours

1.72

CMS adjusted RN staffing hours

Adjusted total hours

2.90

CMS adjusted total nurse staffing hours

Case-mix index

1.12

Higher values indicate more complex resident acuity

RN turnover

0%

Annual RN turnover

Total nurse turnover

78%

Annual nurse turnover · state 52% · national 46%

SNF QRP

Medicare quality reporting measures

Measure	Facility	National	Note
Potentially preventable 30-day readmission	Not Available	10.72%	Not Available · Eligible stays Not Available · Observed rate Not Available · Lower 95% interval Not Available · This provider is not required to submit SNF QRP data.
Discharge to community	Not Available	50.57%	Not Available · Eligible stays Not Available · Observed rate Not Available · Lower 95% interval Not Available · This provider is not required to submit SNF QRP data.
Medicare spending per beneficiary	Not Available	1.02	This provider is not required to submit SNF QRP data.
Drug regimen review with follow-up	Not Available	95.27%	Numerator Not Available · Denominator Not Available · This provider is not required to submit SNF QRP data.
Falls with major injury	Not Available	0.77%	Numerator Not Available · Denominator Not Available · This provider is not required to submit SNF QRP data.
Discharge self-care score	Not Available	53.69%	Numerator Not Available · Denominator Not Available · This provider is not required to submit SNF QRP data.
Discharge mobility score	Not Available	50.94%	Numerator Not Available · Denominator Not Available · This provider is not required to submit SNF QRP data.
Pressure ulcers or injuries, new or worsened	Not Available	2.29%	Numerator Not Available · Denominator Not Available · Adjusted rate Not Available · This provider is not required to submit SNF QRP data.
Healthcare-associated infections requiring hospitalization	Not Available	7.12%	Not Available · Eligible stays Not Available · Observed rate Not Available · Lower 95% interval Not Available · This provider is not required to submit SNF QRP data.
Staff COVID-19 vaccination coverage	Not Available	8.2%	Numerator Not Available · Denominator Not Available · This provider is not required to submit SNF QRP data.
Staff flu vaccination coverage	Not Available	42%	Numerator Not Available · Denominator Not Available · This provider is not required to submit SNF QRP data.
Discharge function score	Not Available	56.45%	Numerator Not Available · Denominator Not Available · This provider is not required to submit SNF QRP data.
Transfer of health information to provider	Not Available	95.95%	Numerator Not Available · Denominator Not Available · This provider is not required to submit SNF QRP data.
Transfer of health information to patient	Not Available	96.28%	Numerator Not Available · Denominator Not Available · This provider is not required to submit SNF QRP data.
Resident COVID-19 vaccinations up to date	Not Available	25.2%	Numerator Not Available · Denominator Not Available · This provider is not required to submit SNF QRP data.

Quality measures

Resident outcomes and process scores

Measure	Facility	State	National	Note
Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine	98.6%	97.1% 1.5 pts better	93.4% 5.2 pts better	Long Stay · 2024Q4-2025Q3 · Q4 95.2% · 4Q avg 98.6%
Percentage of long-stay residents experiencing one or more falls with major injury	2.9%	3.3% 0.4 pts better	3.3% 0.4 pts better	Long Stay · 2024Q4-2025Q3 · Q4 9.5% · 4Q avg 2.9% · 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 · Q4 0.0% · 4Q avg 0.0%
Percentage of long-stay residents who lose too much weight	13.0%	3.3% 9.7 pts worse	5.4% 7.6 pts worse	Long Stay · 2024Q4-2025Q3 · Q4 19.0% · 4Q avg 13.0%
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 · Q4 9.5% · 4Q avg 5.8%
Percentage of long-stay residents who received an antipsychotic medication	6.3%	10.8% 4.5 pts better	16.7% 10.4 pts better	Long Stay · 2024Q4-2025Q3 · 4Q avg 6.3% · 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 · Q4 0.0% · 4Q avg 0.0%
Percentage of long-stay residents whose ability to walk independently worsened	7.5%	15.4% 7.9 pts better	16.3% 8.8 pts better	Long Stay · 2024Q4-2025Q3 · 4Q avg 7.5% · Used in QM five-star
Percentage of long-stay residents whose need for help with daily activities has increased	9.5%	16.1% 6.6 pts better	14.9% 5.4 pts better	Long Stay · 2024Q4-2025Q3 · Q4 10.0% · 4Q avg 9.5% · Used in QM five-star
Percentage of long-stay residents with a catheter inserted and left in their bladder	2.6%	0.5% 2.1 pts worse	1.0% 1.6 pts worse	Long Stay · 2024Q4-2025Q3 · Q4 4.9% · 4Q avg 2.6% · Used in QM five-star
Percentage of long-stay residents with a urinary tract infection	1.4%	0.8% 0.6 pts worse	1.7% 0.3 pts better	Long Stay · 2024Q4-2025Q3 · Q4 0.0% · 4Q avg 1.4% · Used in QM five-star
Percentage of long-stay residents with new or worsened bowel or bladder incontinence	22.2%	15.0% 7.2 pts worse	19.8% 2.4 pts worse	Long Stay · 2024Q4-2025Q3 · Q4 17.9% · 4Q avg 22.2%
Percentage of long-stay residents with pressure ulcers	3.6%	4.2% 0.6 pts better	5.1% 1.5 pts better	Long Stay · 2024Q4-2025Q3 · Q4 6.1% · 4Q avg 3.6% · Used in QM five-star

Survey summary

Recent inspection cycles

Cycle 1 Health 2025-06-18 · Fire 2025-06-18

6 health deficiencies

Top issue: Resident Rights (2 deficiencies)

0 fire-safety deficiencies

No concentrated fire-safety issue counts in this cycle.

Cycle 2 Health 2024-05-15 · Fire 2024-05-15

2 health deficiencies

Top issue: Nutrition and Dietary (1 deficiency)

1 fire-safety deficiencies

Top issue: Smoke (1 deficiency)

Cycle 3 Health 2023-03-17 · Fire 2023-03-17

1 health deficiencies

Top issue: Nutrition and Dietary (1 deficiency)

0 fire-safety deficiencies

No concentrated fire-safety issue counts in this cycle.

Fire safety

Fire-safety citations

D · Potential for more than minimal harm 2024-05-15

K324 · Smoke Deficiencies

Fire Safety

Provide properly protected cooking facilities.

Corrected 2024-06-06

Inspection history

Recent health citations

F · Potential for more than minimal harm 2025-06-18

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 2025-07-18

E · Potential for more than minimal harm 2025-06-18

F578 · Resident Rights Deficiencies

Health

Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.

Corrected 2025-07-18

D · Potential for more than minimal harm 2025-06-18

F583 · Resident Rights Deficiencies

Health

Keep residents' personal and medical records private and confidential.

Corrected 2025-07-18

D · Potential for more than minimal harm 2025-06-18

F641 · Resident Assessment and Care Planning Deficiencies

Health

Ensure each resident receives an accurate assessment.

Corrected 2025-07-18

D · Potential for more than minimal harm 2025-06-18

F727 · Nursing and Physician Services Deficiencies

Health

Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis.

Corrected 2025-07-18

D · Potential for more than minimal harm 2025-06-18

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 2025-07-18

F · Potential for more than minimal harm 2024-05-15

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 2024-06-07

D · Potential for more than minimal harm 2024-05-15

F578 · Resident Rights Deficiencies

Health

Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.

Corrected 2024-06-07

F · Potential for more than minimal harm 2023-03-17

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 2023-03-31

Penalties and ownership