Cycle 1
Health 2025-12-17 · Fire 2025-12-17
5 health deficiencies
Top issue: Resident Rights (2 deficiencies)
1 fire-safety deficiencies
Top issue: Egress (1 deficiency)
La Vernia, TX
Country Care Manor
4-star overall rating with 4-star inspections with $24,376 in total fines with 5 recent health deficiencies with 1 fire-safety deficiencies in the latest cycle
2736 Farm To Market 775, La Vernia, TX
(830) 779-2355
Overall
4 / 5
CMS overall stars
Health inspections
4 / 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
91
Certified beds
Average residents
78
Average occupied residents
Ownership
Government
Publicly displayed owner type
Chain
Touchstone Communities
Operator or chain grouping
Approved since
2002-12-04
CMS approved date
Coverage
Medicare + Medicaid
Participation flags
Chain footprint
28 facilities
Chain averages 3 overall / 3 health / 2 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
0.49
Registered nurse staffing · state 0.44 · national 0.68
LPN hours / resident day
0.64
Licensed practical nurse staffing · state 0.95 · national 0.87
Aide hours / resident day
2.15
Nurse aide staffing · state 2.01 · national 2.35
Total nurse hours
3.28
All reported nurse hours · state 3.40 · national 3.89
Licensed hours
1.13
RN + LPN hours · state 1.38 · national 1.54
Weekend hours
2.61
Weekend nurse staffing · state 2.99 · national 3.43
Weekend RN hours
0.39
Weekend registered nurse coverage · state 0.34 · national 0.47
Physical therapist
0.04
Reported PT staffing · state 0.07 · national 0.07
Adjusted RN hours
0.46
CMS adjusted RN staffing hours
Adjusted total hours
3.04
CMS adjusted total nurse staffing hours
Case-mix index
1.47
Higher values indicate more complex resident acuity
RN turnover
40%
Annual RN turnover · state 52% · national 45%
Total nurse turnover
41%
Annual nurse turnover · state 52% · national 46%
SNF VBP
Value-based purchasing
Program rank
10,619
Lower is better among SNFs in the FY 2026 VBP program.
Performance score
19.75
Composite VBP score used to determine payment impact.
Payment multiplier
0.9822
Above 1.000 increases Medicare payment; below 1.000 reduces it.
Program components
How the VBP score is built
Readmission
0
Baseline 19.70% · Performance 23.16% · Measure score 0 · Achievement 0 · Improvement 0
Healthcare-associated infections
0
Baseline 7.64% · Performance 9.93% · Measure score 0 · Achievement 0 · Improvement 0
Total nurse turnover
7.81
Performance 31.75% · Measure score 7.81 · Achievement 7.81 · This facility did not have sufficient data to calculate a baseline period measure result.
Adjusted total nurse staffing
0.09
Baseline 2.73 hours · Performance 2.91 hours · Measure score 0.09 · Achievement 0 · Improvement 0.09
SNF QRP
Medicare quality reporting measures
| Measure | Facility | National | Note |
|---|---|---|---|
| Potentially preventable 30-day readmission | 10.8% |
10.72%
0.1 pts worse
|
No Different than the National Rate · Eligible stays 60 · Observed rate 10% · Lower 95% interval 7.47% |
| Discharge to community | 43.92% |
50.57%
6.6 pts worse
|
No Different than the National Rate · Eligible stays 37 · Observed rate 37.84% · Lower 95% interval 32.9% |
| Medicare spending per beneficiary | 1.67 |
1.02
0.6 pts worse
|
|
| Drug regimen review with follow-up | 98.59% |
95.27%
3.3 pts better
|
Numerator 70 · Denominator 71 |
| Falls with major injury | 0% |
0.77%
0.8 pts better
|
Numerator 0 · Denominator 71 |
| Discharge self-care score | 57.89% |
53.69%
4.2 pts better
|
Numerator 22 · Denominator 38 |
| Discharge mobility score | 50% |
50.94%
0.9 pts worse
|
Numerator 19 · Denominator 38 |
| Pressure ulcers or injuries, new or worsened | 1.41% |
2.29%
0.9 pts better
|
Numerator 1 · Denominator 71 · Adjusted rate 1.49% |
| Healthcare-associated infections requiring hospitalization | 9.93% |
7.12%
2.8 pts worse
|
No Different than the National Rate · Eligible stays 49 · Observed rate 16.33% · Lower 95% interval 5.65% |
| Staff COVID-19 vaccination coverage | 0% |
8.2%
8.2 pts worse
|
Numerator 0 · Denominator 92 |
| Staff flu vaccination coverage | 7.61% |
42%
34.4 pts worse
|
Numerator 44 · Denominator 578 |
| Discharge function score | 57.89% |
56.45%
1.4 pts better
|
Numerator 22 · Denominator 38 |
| Transfer of health information to provider | 100% |
95.95%
4 pts better
|
Numerator 35 · Denominator 35 |
| Transfer of health information to patient | Not Available |
96.28%
|
Numerator Not Available · Denominator 11 · Too few residents or stays to report publicly. |
| Resident COVID-19 vaccinations up to date | 17.65% |
25.2%
7.6 pts worse
|
Numerator 6 · Denominator 34 |
Quality measures
Resident outcomes and process scores
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| Number of hospitalizations per 1000 long-stay resident days | 1.4 |
2.1
0.7 pts better
|
1.9
0.5 pts better
|
Long Stay · 20240701-20250630 · Adjusted 1.4 · Observed 1.9 · Expected 2.6 · Used in QM five-star |
| Number of outpatient emergency department visits per 1000 long-stay resident days | 2.2 |
2.1
0.1 pts worse
|
1.8
0.4 pts worse
|
Long Stay · 20240701-20250630 · Adjusted 2.2 · Observed 2.5 · Expected 1.9 · 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 | 4.6% |
3.3%
1.3 pts worse
|
3.3%
1.3 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 3.0% · Q2 4.4% · Q3 6.3% · Q4 4.8% · 4Q avg 4.6% · Used in QM five-star |
| Percentage of long-stay residents who have depressive symptoms | 2.9% |
2.7%
0.2 pts worse
|
11.4%
8.5 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 1.6% · Q2 4.5% · Q3 3.4% · Q4 1.7% · 4Q avg 2.9% |
| 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 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 17.9% |
18.9%
1 pts better
|
19.6%
1.7 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 20.3% · Q2 20.7% · Q3 14.3% · Q4 15.2% · 4Q avg 17.9% |
| Percentage of long-stay residents who received an antipsychotic medication | 9.5% |
10.8%
1.3 pts better
|
16.7%
7.2 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 13.3% · Q2 8.3% · Q3 7.9% · Q4 7.9% · 4Q avg 9.5% · 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 | 16.4% |
15.4%
1 pts worse
|
16.3%
0.1 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q3 13.9% · 4Q avg 16.4% · Used in QM five-star |
| Percentage of long-stay residents whose need for help with daily activities has increased | 11.2% |
16.1%
4.9 pts better
|
14.9%
3.7 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 23.6% · Q2 3.7% · Q3 6.7% · Q4 9.3% · 4Q avg 11.2% · Used in QM five-star |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | 0.5% |
0.5%
About the same
|
1.0%
0.5 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 1.7% · Q3 0.0% · Q4 0.0% · 4Q avg 0.5% · Used in QM five-star |
| Percentage of long-stay residents with a urinary tract infection | 0.0% |
0.8%
0.8 pts better
|
1.7%
1.7 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 new or worsened bowel or bladder incontinence | 15.7% |
15.0%
0.7 pts worse
|
19.8%
4.1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 22.4% · Q2 10.5% · Q3 15.7% · Q4 14.4% · 4Q avg 15.7% |
| Percentage of long-stay residents with pressure ulcers | 3.4% |
4.2%
0.8 pts better
|
5.1%
1.7 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 2.6% · Q2 3.7% · Q3 4.0% · Q4 3.3% · 4Q avg 3.4% · Used in QM five-star |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 94.4% |
89.7%
4.7 pts better
|
81.7%
12.7 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 87.7% · Q2 93.2% · Q3 98.0% · Q4 97.2% · 4Q avg 94.4% |
| Percentage of short-stay residents who had an outpatient emergency department visit | 19.6% |
12.0%
7.6 pts worse
|
12.0%
7.6 pts worse
|
Short Stay · 20240701-20250630 · Adjusted 19.6% · Observed 18.4% · Expected 10.5% · Used in QM five-star |
| Percentage of short-stay residents who newly received an antipsychotic medication | 0.0% |
1.5%
1.5 pts better
|
1.6%
1.6 pts better
|
Short 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 short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 92.4% |
88.0%
4.4 pts better
|
79.7%
12.7 pts better
|
Short Stay · 2024Q3-2025Q2 · 4Q avg 92.4% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission | 27.3% |
25.9%
1.4 pts worse
|
23.9%
3.4 pts worse
|
Short Stay · 20240701-20250630 · Adjusted 27.3% · Observed 26.5% · Expected 23.2% · Used in QM five-star |
Survey summary
Recent inspection cycles
Cycle 2
Health 2024-09-18 · Fire 2024-09-18
4 health deficiencies
Top issue: Administration (1 deficiency)
0 fire-safety deficiencies
No concentrated fire-safety issue counts in this cycle.
Cycle 3
Health 2023-08-02 · Fire 2023-08-02
3 health deficiencies
Top issue: Environmental (1 deficiency)
3 fire-safety deficiencies
Top issue: Smoke (2 deficiencies)
Fire safety
Fire-safety citations
E · Potential for more than minimal harm
2025-12-17
K211 · Egress Deficiencies
Fire Safety
Keep aisles, corridors, and exits free of obstruction in case of emergency.
Corrected 2026-01-31
E · Potential for more than minimal harm
2023-08-02
K200 · Egress Deficiencies
Fire Safety
Meet other general requirements.
Corrected 2023-08-08
E · Potential for more than minimal harm
2023-08-02
K325 · Smoke Deficiencies
Fire Safety
Have properly installed hallway dispensers for alcohol-based hand rub.
Corrected 2023-08-04
E · Potential for more than minimal harm
2023-08-02
K345 · Smoke Deficiencies
Fire Safety
Have approved installation, maintenance and testing program for fire alarm systems.
Corrected 2023-08-04
Inspection history
Recent health citations
E · Potential for more than minimal harm
2025-12-17
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 2025-12-18
E · Potential for more than minimal harm
2025-12-17
F921 · Environmental Deficiencies
Health
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
Corrected 2026-01-31
D · Potential for more than minimal harm
2025-12-17
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 2025-12-18
D · Potential for more than minimal harm
2025-11-21
F555 · Resident Rights Deficiencies
Health
Honor the resident's right to choose his or her attending physician.
Corrected 2025-11-22
D · Potential for more than minimal harm
2025-11-21
F627 · Resident Rights Deficiencies
Health
Ensure the transfer/discharge meets the resident's needs/preferences and that the resident is prepared for a safe transfer/discharge.
Corrected 2025-11-22
E · Potential for more than minimal harm
2024-09-18
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 2024-09-19
E · Potential for more than minimal harm
2024-09-18
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 2024-09-19
E · Potential for more than minimal harm
2024-09-18
F921 · Environmental Deficiencies
Health
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
Corrected 2024-10-14
D · Potential for more than minimal harm
2024-09-18
F944 · Administration Deficiencies
Health
Conduct mandatory training, for all staff, on the facility’s Quality Assurance and Performance Improvement Program.
Corrected 2024-09-19
E · Potential for more than minimal harm
2023-08-02
F584 · Resident Rights Deficiencies
Health
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
Corrected 2023-08-03
E · Potential for more than minimal harm
2023-08-02
F921 · Environmental Deficiencies
Health
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
Corrected 2023-08-03
D · Potential for more than minimal harm
2023-08-02
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 2023-08-03
Penalties and ownership
What sits behind the stars
$6,380
2025-11-21
Fine
Fine · fine $6,380
Fine
$17,996
2024-11-25
Fine
Fine · fine $17,996
Fine
Ownership
Bexar County Hospital District
5% Or Greater Direct Ownership Interest · Organization
Barbosa, Mary Ann
Operational/Managerial Control · Individual
Campbell, Leslie
Operational/Managerial Control · Individual
Castillo, Lynnea
Operational/Managerial Control · Individual
Clayton, Jonathon
Operational/Managerial Control · Individual
Hurley, Christopher
Corporate Officer · Individual
Lument Real Estate Capital LLC
5% Or Greater Mortgage Interest · Organization
Sehlke, Bryon
Operational/Managerial Control · Individual
Thompson, Chase
Operational/Managerial Control · Individual
Touchstone Strategies - Lavernia LLC
Operational/Managerial Control · Organization
Zertuche, Benjamin
Operational/Managerial Control · Individual
Zurovec, Darrell
Operational/Managerial Control · Individual
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#2
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2-star overall rating with 3-star inspections with $87,066 in total fines with 10 recent health deficiencies with 6 fire-safety deficiencies in the latest cycle
#3
Frank M Tejeda Texas State Veterans Home
Floresville, TX
5-star overall rating with 4-star inspections with 7 recent health deficiencies with 2 fire-safety deficiencies in the latest cycle
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