El Paso, TX

El Paso Health & Rehabilitation Center

2-star overall rating with 2-star inspections with $20,312 in total fines with 5 recent health deficiencies with 11 fire-safety deficiencies in the latest cycle

11525 Vista Del Sol Dr, El Paso, TX

(915) 855-3636

Compare this facility

Overall

2 / 5

CMS overall stars

Health inspections

2 / 5

Survey and complaint cycles

Staffing

3 / 5

RN + nurse staffing

Quality measures

2 / 5

Resident outcomes and process measures

Quick facts

Facility snapshot

Beds

150

Certified beds

Average residents

Average occupied residents

Ownership

Government

Publicly displayed owner type

Chain

Advanced Healthcare Solutions

Operator or chain grouping

Approved since

1991-08-07

CMS approved date

Coverage

Medicare + Medicaid

Participation flags

Chain footprint

30 facilities

Chain averages 3 overall / 3 health / 2 staffing / 4 quality stars

Changed ownership

Within the last 12 months

Family council

Yes

Resident and family council reported

Sprinklers

Yes

Automatic sprinklers in all required areas

Hospital-based

Yes

CMS reports the provider resides in a hospital

Staffing

Hours and turnover

RN hours / resident day

0.25

Registered nurse staffing · state 0.44 · national 0.68

LPN hours / resident day

1.12

Licensed practical nurse staffing · state 0.95 · national 0.87

Aide hours / resident day

2.06

Nurse aide staffing · state 2.01 · national 2.35

Total nurse hours

3.43

All reported nurse hours · state 3.40 · national 3.89

Licensed hours

1.37

RN + LPN hours · state 1.38 · national 1.54

Weekend hours

2.95

Weekend nurse staffing · state 2.99 · national 3.43

Weekend RN hours

0.24

Weekend registered nurse coverage · state 0.34 · national 0.47

Physical therapist

0.03

Reported PT staffing · state 0.07 · national 0.07

Adjusted RN hours

0.29

CMS adjusted RN staffing hours

Adjusted total hours

3.98

CMS adjusted total nurse staffing hours

Case-mix index

1.18

Higher values indicate more complex resident acuity

RN turnover

75%

Annual RN turnover · state 52% · national 45%

Total nurse turnover

32%

Annual nurse turnover · state 52% · national 46%

SNF QRP

Medicare quality reporting measures

Measure	Facility	National	Note
Potentially preventable 30-day readmission	10.14%	10.72% 0.6 pts better	No Different than the National Rate · Eligible stays 28 · Observed rate 7.14% · Lower 95% interval 6.42%
Discharge to community	Not Available	50.57%	Not Available · Eligible stays 23 · Observed rate Not Available · Lower 95% interval Not Available · Too few residents or stays to report publicly.
Medicare spending per beneficiary	0.96	1.02 0.1 pts better
Drug regimen review with follow-up	100%	95.27% 4.7 pts better	Numerator 29 · Denominator 29
Falls with major injury	0%	0.77% 0.8 pts better	Numerator 0 · Denominator 29
Discharge self-care score	Not Available	53.69%	Numerator Not Available · Denominator 14 · Too few residents or stays to report publicly.
Discharge mobility score	Not Available	50.94%	Numerator Not Available · Denominator 14 · Too few residents or stays to report publicly.
Pressure ulcers or injuries, new or worsened	0%	2.29% 2.3 pts better	Numerator 0 · Denominator 29 · Adjusted rate 0%
Healthcare-associated infections requiring hospitalization	Not Available	7.12%	Not Available · Eligible stays 18 · Observed rate Not Available · Lower 95% interval Not Available · Too few residents or stays to report publicly.
Staff COVID-19 vaccination coverage	0%	8.2% 8.2 pts worse	Numerator 0 · Denominator 113
Staff flu vaccination coverage	23.74%	42% 18.3 pts worse	Numerator 33 · Denominator 139
Discharge function score	Not Available	56.45%	Numerator Not Available · Denominator 14 · Too few residents or stays to report publicly.
Transfer of health information to provider	Not Available	95.95%	Numerator Not Available · Denominator 13 · Too few residents or stays to report publicly.
Transfer of health information to patient	Not Available	96.28%	Numerator Not Available · Denominator 10 · Too few residents or stays to report publicly.
Resident COVID-19 vaccinations up to date	Not Available	25.2%	Numerator Not Available · Denominator 14 · Too few residents or stays to report publicly.

Quality measures

Resident outcomes and process scores

Measure	Facility	State	National	Note
Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine	99.6%	97.1% 2.5 pts better	93.4% 6.2 pts better	Long Stay · 2024Q4-2025Q3 · Q1 98.5% · Q2 100.0% · Q3 100.0% · Q4 100.0% · 4Q avg 99.6%
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	1.8%	3.3% 1.5 pts better	3.3% 1.5 pts better	Long Stay · 2024Q4-2025Q3 · Q1 4.4% · Q2 1.4% · Q3 0.0% · Q4 1.4% · 4Q avg 1.8% · Used in QM five-star
Percentage of long-stay residents who have depressive symptoms	0.4%	2.7% 2.3 pts better	11.4% 11 pts better	Long Stay · 2024Q4-2025Q3 · Q1 1.8% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.4%
Percentage of long-stay residents who lose too much weight	2.1%	3.3% 1.2 pts better	5.4% 3.3 pts better	Long Stay · 2024Q4-2025Q3 · Q1 1.7% · Q2 3.3% · Q3 1.6% · Q4 1.6% · 4Q avg 2.1%
Percentage of long-stay residents who received an antianxiety or hypnotic medication	15.6%	18.9% 3.3 pts better	19.6% 4 pts better	Long Stay · 2024Q4-2025Q3 · Q1 22.0% · Q2 18.0% · Q3 12.9% · Q4 9.8% · 4Q avg 15.6%
Percentage of long-stay residents who received an antipsychotic medication	11.4%	10.8% 0.6 pts worse	16.7% 5.3 pts better	Long Stay · 2024Q4-2025Q3 · Q1 9.6% · Q2 13.7% · Q3 11.3% · Q4 10.9% · 4Q avg 11.4% · 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	13.5%	15.4% 1.9 pts better	16.3% 2.8 pts better	Long Stay · 2024Q4-2025Q3 · Q1 6.3% · Q2 24.0% · Q3 14.6% · Q4 9.2% · 4Q avg 13.5% · Used in QM five-star
Percentage of long-stay residents whose need for help with daily activities has increased	21.9%	16.1% 5.8 pts worse	14.9% 7 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 22.0% · Q2 32.1% · Q3 15.8% · Q4 17.9% · 4Q avg 21.9% · 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 · 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	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	18.2%	15.0% 3.2 pts worse	19.8% 1.6 pts better	Long Stay · 2024Q4-2025Q3 · Q1 25.8% · Q2 10.7% · Q3 18.0% · Q4 18.6% · 4Q avg 18.2%
Percentage of long-stay residents with pressure ulcers	8.9%	4.2% 4.7 pts worse	5.1% 3.8 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 8.3% · Q2 15.6% · Q3 5.6% · Q4 6.6% · 4Q avg 8.9% · Used in QM five-star
Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine	80.7%	89.7% 9 pts worse	81.7% 1 pts worse	Short Stay · 2024Q4-2025Q3 · Q1 81.7% · Q2 79.0% · Q3 78.7% · Q4 83.5% · 4Q avg 80.7%
Percentage of short-stay residents who had an outpatient emergency department visit	18.7%	12.0% 6.7 pts worse	12.0% 6.7 pts worse	Short Stay · 20240701-20250630 · Adjusted 18.7% · Observed 20.8% · Expected 12.4% · Used in QM five-star
Percentage of short-stay residents who newly received an antipsychotic medication	3.0%	1.5% 1.5 pts worse	1.6% 1.4 pts worse	Short Stay · 2024Q4-2025Q3 · Q1 5.6% · Q2 3.8% · Q3 0.0% · Q4 2.0% · 4Q avg 3.0% · Used in QM five-star
Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine	88.1%	88.0% 0.1 pts better	79.7% 8.4 pts better	Short Stay · 2024Q3-2025Q2 · 4Q avg 88.1%
Percentage of short-stay residents who were rehospitalized after a nursing home admission	34.6%	25.9% 8.7 pts worse	23.9% 10.7 pts worse	Short Stay · 20240701-20250630 · Adjusted 34.6% · Observed 33.3% · Expected 23.0% · Used in QM five-star

Survey summary

Recent inspection cycles

Cycle 1 Health 2025-08-07 · Fire 2025-08-07

5 health deficiencies

Top issue: Quality of Life and Care (2 deficiencies)

11 fire-safety deficiencies

Top issue: Miscellaneous (3 deficiencies)

Cycle 2 Health 2024-06-20 · Fire 2024-06-20

32 health deficiencies

Top issue: Quality of Life and Care (10 deficiencies)

3 fire-safety deficiencies

Top issue: Miscellaneous (1 deficiency)

Cycle 3 Health 2023-04-27 · Fire 2023-04-27

22 health deficiencies

Top issue: Resident Rights (6 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 2025-08-07

E39 · Emergency Preparedness Deficiencies

Fire Safety

Conduct testing and exercise requirements.

Corrected 2026-01-15

F · Potential for more than minimal harm 2025-08-07

E41 · Emergency Preparedness Deficiencies

Fire Safety

Implement emergency and standby power systems.

Corrected 2026-01-15

F · Potential for more than minimal harm 2025-08-07

K372 · Smoke Deficiencies

Fire Safety

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

Corrected 2026-01-15

F · Potential for more than minimal harm 2025-08-07

K712 · Miscellaneous Deficiencies

Fire Safety

Have simulated fire drills held at unexpected times.

Corrected 2026-01-15

F · Potential for more than minimal harm 2025-08-07

K751 · Miscellaneous Deficiencies

Fire Safety

Have restrictions on the use of flammable curtains.

Corrected 2026-01-15

F · Potential for more than minimal harm 2025-08-07

K918 · Gas, Vacuum, and Electrical Systems Deficiencies

Fire Safety

Have generator or other power source capable of supplying service within 10 seconds.

Corrected 2026-01-15

E · Potential for more than minimal harm 2025-08-07

K300 · Egress Deficiencies

Fire Safety

Meet other general requirements that are deficient.

Corrected 2026-01-15

E · Potential for more than minimal harm 2025-08-07

K324 · Smoke Deficiencies

Fire Safety

Provide properly protected cooking facilities.

Corrected 2026-01-15

E · Potential for more than minimal harm 2025-08-07

K341 · Smoke Deficiencies

Fire Safety

Install a fire alarm system that can be heard throughout the facility.

Corrected 2026-01-15

E · Potential for more than minimal harm 2025-08-07

K511 · Services Deficiencies

Fire Safety

Have properly installed electrical wiring and gas equipment.

Corrected 2026-01-15

E · Potential for more than minimal harm 2025-08-07

K754 · Miscellaneous Deficiencies

Fire Safety

Provide properly sized and located linen or trash receptacles.

Corrected 2026-01-15

F · Potential for more than minimal harm 2024-06-20

K324 · Smoke Deficiencies

Fire Safety

Provide properly protected cooking facilities.

Corrected 2024-08-02

F · Potential for more than minimal harm 2024-06-20

K511 · Services Deficiencies

Fire Safety

Have properly installed electrical wiring and gas equipment.

Corrected 2024-08-02

F · Potential for more than minimal harm 2024-06-20

K712 · Miscellaneous Deficiencies

Fire Safety

Have simulated fire drills held at unexpected times.

Corrected 2024-08-02

Inspection history

Recent health citations

F · Potential for more than minimal harm 2025-08-07

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 2025-08-29

D · Potential for more than minimal harm 2025-08-07

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 2025-08-29

D · Potential for more than minimal harm 2025-08-07

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 2025-08-28

D · Potential for more than minimal harm 2025-03-27

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 2025-04-26

D · Potential for more than minimal harm 2025-03-27

F695 · Quality of Life and Care Deficiencies

Health

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

Corrected 2025-04-26

F · Potential for more than minimal harm 2025-01-15

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 2025-02-15

D · Potential for more than minimal harm 2025-01-15

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 2025-02-15

D · Potential for more than minimal harm 2025-01-15

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 2025-02-15

D · Potential for more than minimal harm 2024-09-23

F604 · Freedom from Abuse, Neglect, and Exploitation Deficiencies

Health

Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment.

Corrected 2024-10-16

D · Potential for more than minimal harm 2024-09-17

F558 · Resident Rights Deficiencies

Health

Reasonably accommodate the needs and preferences of each resident.

Corrected 2024-10-10

D · Potential for more than minimal harm 2024-09-17

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 2024-10-10

D · Potential for more than minimal harm 2024-09-17

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 2024-10-10

D · Potential for more than minimal harm 2024-09-17

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 2024-10-10

D · Potential for more than minimal harm 2024-09-17

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 2024-10-10

E · Potential for more than minimal harm 2024-08-05

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 2024-08-26

E · Potential for more than minimal harm 2024-08-05

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 2024-08-26

E · Potential for more than minimal harm 2024-08-05

F687 · Quality of Life and Care Deficiencies

Health

Provide appropriate foot care.

Corrected 2024-08-26

D · Potential for more than minimal harm 2024-08-05

F641 · Resident Assessment and Care Planning Deficiencies

Health

Ensure each resident receives an accurate assessment.

Corrected 2024-08-26

D · Potential for more than minimal harm 2024-08-05

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 2024-08-26

D · Potential for more than minimal harm 2024-08-05

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 2024-08-26

F · Potential for more than minimal harm 2024-06-20

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 2024-07-20

F · Potential for more than minimal harm 2024-06-20

F908 · Environmental Deficiencies

Health

Keep all essential equipment working safely.

Corrected 2024-07-20

E · Potential for more than minimal harm 2024-06-20

F558 · Resident Rights Deficiencies

Health

Reasonably accommodate the needs and preferences of each resident.

Corrected 2024-07-20

E · Potential for more than minimal harm 2024-06-20

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 2024-07-20

E · Potential for more than minimal harm 2024-06-20

F679 · Quality of Life and Care Deficiencies

Health

Provide activities to meet all resident's needs.

Corrected 2024-07-20

E · Potential for more than minimal harm 2024-06-20

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 2024-07-20

D · Potential for more than minimal harm 2024-06-20

F607 · Freedom from Abuse, Neglect, and Exploitation Deficiencies

Health

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

Corrected 2024-07-20

D · Potential for more than minimal harm 2024-06-20

F676 · Quality of Life and Care Deficiencies

Health

Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason.

Corrected 2024-07-20

D · Potential for more than minimal harm 2024-06-20

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 2024-07-20

D · Potential for more than minimal harm 2024-06-20

F758 · Pharmacy Service Deficiencies

Health

Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.

Corrected 2024-07-20

D · Potential for more than minimal harm 2024-06-20

F880 · Infection Control Deficiencies

Health

Provide and implement an infection prevention and control program.

Corrected 2024-07-20

E · Potential for more than minimal harm 2024-04-16

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 2024-05-16

D · Potential for more than minimal harm 2024-04-16

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 2024-05-16

D · Potential for more than minimal harm 2024-04-16

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 2024-05-16

D · Potential for more than minimal harm 2024-04-16

F686 · Quality of Life and Care Deficiencies

Health

Provide appropriate pressure ulcer care and prevent new ulcers from developing.

Corrected 2024-05-16

D · Potential for more than minimal harm 2024-04-16

F814 · Nutrition and Dietary Deficiencies

Health

Dispose of garbage and refuse properly.

Corrected 2024-05-16

D · Potential for more than minimal harm 2024-04-16

F880 · Infection Control Deficiencies

Health

Provide and implement an infection prevention and control program.

Corrected 2024-05-16

D · Potential for more than minimal harm 2023-10-11

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 2023-10-12

D · Potential for more than minimal harm 2023-10-11

F880 · Infection Control Deficiencies

Health

Provide and implement an infection prevention and control program.

Corrected 2023-10-12

D · Potential for more than minimal harm 2023-10-11

F883 · Infection Control Deficiencies

Health

Develop and implement policies and procedures for flu and pneumonia vaccinations.

Corrected 2023-10-12

J · Immediate jeopardy 2023-09-01

F580 · Resident Rights Deficiencies

Health

Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.

Corrected 2023-09-05

J · Immediate jeopardy 2023-09-01

F684 · Quality of Life and Care Deficiencies

Health

Provide appropriate treatment and care according to orders, resident’s preferences and goals.

Corrected 2023-09-05

E · Potential for more than minimal harm 2023-09-01

F925 · Environmental Deficiencies

Health

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

Corrected 2023-09-05

D · Potential for more than minimal harm 2023-09-01

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 2023-09-05

D · Potential for more than minimal harm 2023-06-09

F558 · Resident Rights Deficiencies

Health

Reasonably accommodate the needs and preferences of each resident.

Corrected 2023-07-07

D · Potential for more than minimal harm 2023-06-09

F695 · Quality of Life and Care Deficiencies

Health

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

Corrected 2023-07-07

F · Potential for more than minimal harm 2023-04-27