Emory, TX

Emory Health And Rehab

4-star overall rating with 4-star inspections with $11,148 in total fines with 5 recent health deficiencies with 1 fire-safety deficiencies in the latest cycle

983 N Texas Street, Emory, TX

(903) 473-3752

Compare this facility

Overall

4 / 5

CMS overall stars

Health inspections

4 / 5

Survey and complaint cycles

Staffing

2 / 5

RN + nurse staffing

Quality measures

2 / 5

Resident outcomes and process measures

Quick facts

Facility snapshot

Beds

68

Certified beds

Average residents

42

Average occupied residents

Ownership

Government

Publicly displayed owner type

Chain

No chain reported

Operator or chain grouping

Approved since

2007-07-22

CMS approved date

Coverage

Medicare + 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

0.35

Registered nurse staffing · state 0.44 · national 0.68

LPN hours / resident day

0.77

Licensed practical nurse staffing · state 0.95 · national 0.87

Aide hours / resident day

1.99

Nurse aide staffing · state 2.01 · national 2.35

Total nurse hours

3.11

All reported nurse hours · state 3.40 · national 3.89

Licensed hours

1.12

RN + LPN hours · state 1.38 · national 1.54

Weekend hours

2.83

Weekend nurse staffing · state 2.99 · national 3.43

Weekend RN hours

0.26

Weekend registered nurse coverage · state 0.34 · national 0.47

Physical therapist

0.01

Reported PT staffing · state 0.07 · national 0.07

Adjusted RN hours

0.42

CMS adjusted RN staffing hours

Adjusted total hours

3.75

CMS adjusted total nurse staffing hours

Case-mix index

1.13

Higher values indicate more complex resident acuity

RN turnover

0%

Annual RN turnover

Total nurse turnover

0%

Annual nurse turnover

SNF QRP

Medicare quality reporting measures

Measure Facility National Note
Potentially preventable 30-day readmission 11.21%
10.72%
0.5 pts worse
No Different than the National Rate · Eligible stays 30 · Observed rate 13.33% · Lower 95% interval 6.18%
Discharge to community Not Available
50.57%
Not Available · Eligible stays 20 · Observed rate Not Available · Lower 95% interval Not Available · Too few residents or stays to report publicly.
Medicare spending per beneficiary 1.38
1.02
0.4 pts worse
Drug regimen review with follow-up Not Available
95.27%
Numerator Not Available · Denominator 11 · Too few residents or stays to report publicly.
Falls with major injury Not Available
0.77%
Numerator Not Available · Denominator 11 · Too few residents or stays to report publicly.
Discharge self-care score Not Available
53.69%
Numerator Not Available · Denominator 8 · Too few residents or stays to report publicly.
Discharge mobility score Not Available
50.94%
Numerator Not Available · Denominator 8 · Too few residents or stays to report publicly.
Pressure ulcers or injuries, new or worsened Not Available
2.29%
Numerator Not Available · Denominator 11 · Adjusted rate Not Available · Too few residents or stays to report publicly.
Healthcare-associated infections requiring hospitalization Not Available
7.12%
Not Available · Eligible stays 15 · Observed rate Not Available · Lower 95% interval Not Available · Too few residents or stays to report publicly.
Staff COVID-19 vaccination coverage Not Available
8.2%
Numerator Not Available · Denominator Not Available · No data were submitted for this measure.
Staff flu vaccination coverage Not Available
42%
Numerator Not Available · Denominator Not Available · No data were submitted for this measure.
Discharge function score Not Available
56.45%
Numerator Not Available · Denominator 8 · Too few residents or stays to report publicly.
Transfer of health information to provider Not Available
95.95%
Numerator Not Available · Denominator 2 · Too few residents or stays to report publicly.
Transfer of health information to patient Not Available
96.28%
Numerator Not Available · Denominator 4 · Too few residents or stays to report publicly.
Resident COVID-19 vaccinations up to date Not Available
25.2%
Numerator Not Available · Denominator 3 · Too few residents or stays to report publicly.

Quality measures

Resident outcomes and process scores

Measure Facility State National Note
Number of hospitalizations per 1000 long-stay resident days 1.9
2.1
0.2 pts better
1.9
About the same
Long Stay · 20240701-20250630 · Adjusted 1.9 · Observed 1.5 · Expected 1.4 · Used in QM five-star
Number of outpatient emergency department visits per 1000 long-stay resident days 2.6
2.1
0.5 pts worse
1.8
0.8 pts worse
Long Stay · 20240701-20250630 · Adjusted 2.6 · Observed 2.2 · Expected 1.4 · Used in QM five-star
Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine 94.1%
97.1%
3 pts worse
93.4%
0.7 pts better
Long Stay · 2024Q4-2025Q3 · Q1 91.9% · Q2 92.1% · Q3 94.6% · Q4 97.6% · 4Q avg 94.1%
Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine 92.9%
97.9%
5 pts worse
95.5%
2.6 pts worse
Long Stay · 2024Q3-2025Q2 · 4Q avg 92.9%
Percentage of long-stay residents experiencing one or more falls with major injury 5.2%
3.3%
1.9 pts worse
3.3%
1.9 pts worse
Long Stay · 2024Q4-2025Q3 · Q1 5.4% · Q2 2.6% · Q3 5.4% · Q4 7.3% · 4Q avg 5.2% · 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 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0%
Percentage of long-stay residents who lose too much weight 0.7%
3.3%
2.6 pts better
5.4%
4.7 pts better
Long Stay · 2024Q4-2025Q3 · Q1 3.4% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.7%
Percentage of long-stay residents who received an antianxiety or hypnotic medication 31.0%
18.9%
12.1 pts worse
19.6%
11.4 pts worse
Long Stay · 2024Q4-2025Q3 · Q1 21.2% · Q2 34.3% · Q3 35.3% · Q4 32.5% · 4Q avg 31.0%
Percentage of long-stay residents who received an antipsychotic medication 11.7%
10.8%
0.9 pts worse
16.7%
5 pts better
Long Stay · 2024Q4-2025Q3 · Q1 16.0% · Q2 16.0% · Q3 10.7% · Q4 6.1% · 4Q avg 11.7% · 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 46.1%
15.4%
30.7 pts worse
16.3%
29.8 pts worse
Long Stay · 2024Q4-2025Q3 · 4Q avg 46.1% · Used in QM five-star
Percentage of long-stay residents whose need for help with daily activities has increased 32.3%
16.1%
16.2 pts worse
14.9%
17.4 pts worse
Long Stay · 2024Q4-2025Q3 · Q1 41.9% · Q2 32.3% · Q3 21.9% · Q4 33.3% · 4Q avg 32.3% · Used in QM five-star
Percentage of long-stay residents with a catheter inserted and left in their bladder 0.6%
0.5%
0.1 pts worse
1.0%
0.4 pts better
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 2.0% · 4Q avg 0.6% · 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 13.4%
15.0%
1.6 pts better
19.8%
6.4 pts better
Long Stay · 2024Q4-2025Q3 · Q1 2.8% · Q2 10.3% · Q3 23.4% · Q4 16.0% · 4Q avg 13.4%
Percentage of long-stay residents with pressure ulcers 2.8%
4.2%
1.4 pts better
5.1%
2.3 pts better
Long Stay · 2024Q4-2025Q3 · Q1 4.7% · Q2 3.5% · Q3 0.0% · Q4 3.3% · 4Q avg 2.8% · Used in QM five-star
Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine 65.4%
89.7%
24.3 pts worse
81.7%
16.3 pts worse
Short Stay · 2024Q4-2025Q3 · 4Q avg 65.4%
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 · 4Q avg 0.0% · Used in QM five-star

Survey summary

Recent inspection cycles

Cycle 1 Health 2025-08-05 · Fire 2025-08-05

5 health deficiencies

Top issue: Pharmacy Service (2 deficiencies)

1 fire-safety deficiencies

Top issue: Services (1 deficiency)

Cycle 2 Health 2024-07-10 · Fire 2024-07-10

11 health deficiencies

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

3 fire-safety deficiencies

Top issue: Smoke (2 deficiencies)

Cycle 3 Health 2023-05-10 · Fire 2023-05-10

12 health deficiencies

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

5 fire-safety deficiencies

Top issue: Services (2 deficiencies)

Fire safety

Fire-safety citations

C · Minimal harm 2025-08-05

K521 · Services Deficiencies

Fire Safety

Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.

Not marked corrected

E · Potential for more than minimal harm 2024-07-10

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 2024-08-16

E · Potential for more than minimal harm 2024-07-10

K374 · Smoke Deficiencies

Fire Safety

Install smoke barrier doors that can resist smoke for at least 20 minutes.

Corrected 2024-08-16

C · Minimal harm 2024-07-10

K521 · Services Deficiencies

Fire Safety

Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.

Not marked corrected

F · Potential for more than minimal harm 2023-05-10

K511 · Services Deficiencies

Fire Safety

Have properly installed electrical wiring and gas equipment.

Corrected 2023-08-05

E · Potential for more than minimal harm 2023-05-10

K211 · Egress Deficiencies

Fire Safety

Keep aisles, corridors, and exits free of obstruction in case of emergency.

Corrected 2023-07-21

E · Potential for more than minimal harm 2023-05-10

K353 · Smoke Deficiencies

Fire Safety

Inspect, test, and maintain automatic sprinkler systems.

Corrected 2023-08-05

D · Potential for more than minimal harm 2023-05-10

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 2023-07-28

C · Minimal harm 2023-05-10

K521 · Services Deficiencies

Fire Safety

Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.

Not marked corrected

Inspection history

Recent health citations

D · Potential for more than minimal harm 2025-08-05

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 2025-09-29

D · Potential for more than minimal harm 2025-08-05

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 2025-09-29

D · Potential for more than minimal harm 2025-08-05

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 2025-09-29

D · Potential for more than minimal harm 2025-08-05

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 2025-09-29

D · Potential for more than minimal harm 2025-08-05

F880 · Infection Control Deficiencies

Health

Provide and implement an infection prevention and control program.

Corrected 2025-09-29

F · Potential for more than minimal harm 2024-07-10

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 2024-08-22

E · Potential for more than minimal harm 2024-07-10

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 2024-08-22

E · Potential for more than minimal harm 2024-07-10

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 2024-08-22

E · Potential for more than minimal harm 2024-07-10

F880 · Infection Control Deficiencies

Health

Provide and implement an infection prevention and control program.

Corrected 2024-08-22

D · Potential for more than minimal harm 2024-07-10

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 2024-08-22

D · Potential for more than minimal harm 2024-07-10

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 2024-08-22

D · Potential for more than minimal harm 2024-07-10

F695 · Quality of Life and Care Deficiencies

Health

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

Corrected 2024-08-22

D · Potential for more than minimal harm 2024-07-10

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 2024-08-22

D · Potential for more than minimal harm 2024-07-10

F808 · Nutrition and Dietary Deficiencies

Health

Ensure therapeutic diets are prescribed by the attending physician and may be delegated to a registered or licensed dietitian, to the extent allowed by State law.

Corrected 2024-08-22

D · Potential for more than minimal harm 2024-07-10

F849 · Administration Deficiencies

Health

Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services.

Corrected 2024-08-22

D · Potential for more than minimal harm 2024-07-10

F881 · Infection Control Deficiencies

Health

Implement a program that monitors antibiotic use.

Corrected 2024-08-22

J · Immediate jeopardy 2023-05-10

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 2023-06-01

F · Potential for more than minimal harm 2023-05-10

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 2023-06-01

E · Potential for more than minimal harm 2023-05-10

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 2023-06-01

D · Potential for more than minimal harm 2023-05-10

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 2023-06-01

D · Potential for more than minimal harm 2023-05-10

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 2023-06-01

D · Potential for more than minimal harm 2023-05-10

F686 · Quality of Life and Care Deficiencies

Health

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

Corrected 2023-06-01

D · Potential for more than minimal harm 2023-05-10

F695 · Quality of Life and Care Deficiencies

Health

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

Corrected 2023-06-01

D · Potential for more than minimal harm 2023-05-10

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 2023-06-01

D · Potential for more than minimal harm 2023-05-10

F770 · Administration Deficiencies

Health

Provide timely, quality laboratory services/tests to meet the needs of residents.

Corrected 2023-06-01

D · Potential for more than minimal harm 2023-05-10

F885 · Infection Control Deficiencies

Health

Report COVID19 data to residents and families.

Corrected 2023-06-01

C · Minimal harm 2023-05-10

F640 · Resident Assessment and Care Planning Deficiencies

Health

Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment.

Corrected 2023-06-01

C · Minimal harm 2023-05-10

F851 · Administration Deficiencies

Health

Electronically submit to CMS complete and accurate direct care staffing information, based on payroll and other verifiable and auditable data.

Corrected 2023-06-01

Penalties and ownership

What sits behind the stars

$11,148 2023-05-10

Fine

Fine · fine $11,148

Fine

Ownership

May, Amanda

Operational/Managerial Control · Individual

0% 2 facilities 2024-07-01
Newton, Elizabeth

Corporate Director · Individual

0% 20 facilities 2024-07-01
Selvaggi, Richard

Operational/Managerial Control · Individual

0% 1 facilities 2024-07-01
Senior Suite Care & Rehab LLC

Operational/Managerial Control · Organization

0% 1 facilities 2024-07-01
Senior Suite Properties LLC

5% Or Greater Mortgage Interest · Organization

0% 1 facilities 2024-07-01
Smith Family 2001 Trust

5% Or Greater Mortgage Interest · Organization

0% 2 facilities 2024-07-01
Smith, Bradley

Operational/Managerial Control · Individual

0% 5 facilities 2024-07-01

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