Federal inspection record · CMS data as of October 1, 2026
Focused Care at Cedar Bayou
2000 W Baker Road, Baytown, TX · (281) 427-9120
- Certified beds
- 125
- Residents per day
- 75
- Ownership
- For-Profit
- Chain
- Focused Post Acute Care Partners
- Medicare / Medicaid
- Medicare + Medicaid
- Certified since
- December 8, 2008
1
How this home got 1 star
The overall rating isn't an average. CMS starts from the inspection rating and nudges it at most two steps. Here is the arithmetic for this home, using CMS's own rules.
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Health inspections
★★★★★starting point
Everything starts from what state inspectors found on site. This is a ranking against other homes in Texas.
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Staffing
★★★★★no change
Only a 5-star staffing rating adds a star, and only a 1-star rating removes one. Ratings of 2 to 4 change nothing.
-
Quality measures
★★★★★no change
Same rule: 5 stars adds one, 1 star takes one away. These measures are mostly reported by the home itself.
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Overall
★★★★★1 of 5
Matches the rating CMS publishes on Care Compare.
2
Where it sits among Texas homes
Focused Care at Cedar Bayou carries 290.5 inspection points. That is fewer than 3% of Texas's 1,166 rated homes.
Inspectors' citations earn points by how serious and how widespread they were (the grid below). CMS then ranks every home in Texas: the 10% with the fewest points get 5 stars, the 20% with the most get 1 star, and the middle 70% split evenly into 2, 3 and 4.
- 5★ 0–26 pts
- 4★ 26–51 pts
- 3★ 51–85 pts
- 2★ 85–145.75 pts
- 1★ over 145.75 pts
Bars show every rated home in Texas by its weighted inspection score. CMS recalibrates the cut points monthly but holds a home's rating until its own score changes, so a home can sit just outside today's band.
3
What inspectors found
27 health citations on record since 2022. Each one gets a letter: the row says how badly residents were affected, the column how many.
Immediate jeopardyResidents at risk of serious injury or death
Actual harmA resident was hurt
Potential for harmNo one was hurt, but could have been
Minimal harmPaperwork-level problems
Read the rows, not the total. Most citations nationwide are a D: one problem, nobody hurt. Rows G–I mean a resident was harmed; J–L mean inspectors found residents in immediate danger of serious injury or death.
Small numbers in each cell are the inspection points CMS assigns per citation. Those points are what the state curve above ranks.
Harm and immediate-jeopardy citations (11)
-
G
Provide safe, appropriate pain management for a resident who requires such services.
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G
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
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K
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
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K
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
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K
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
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K
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
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K
Ensure that residents are free from significant medication errors.
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K
Provide safe, appropriate pain management for a resident who requires such services.
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K
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
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J
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
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J
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Everything else, by area of care
Resident Assessment and Care Planning8E
- D
Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months.
- D
Ensure each resident receives an accurate assessment.
- D
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
- D
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
- D
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
- D
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
- E
Ensure each resident receives an accurate assessment.
- D
Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.
Pharmacy Service3E
- D
Ensure medication error rates are not 5 percent or greater.
- D
Ensure medication error rates are not 5 percent or greater.
- E
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Infection Control1D
- D
Provide and implement an infection prevention and control program.
Resident Rights1D
- D
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
Nutrition and Dietary1D
- D
Dispose of garbage and refuse properly.
Nursing and Physician Services1E
- E
Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.
Quality of Life and Care1D
- D
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.
Inspection history
2026-06-18
8 health deficiencies · 3 fire-safety deficiencies
Top issue: Resident Assessment and Care Planning (3 deficiencies)
2024-02-12
14 health deficiencies · 3 fire-safety deficiencies
Top issue: Pharmacy Service (4 deficiencies)
2022-12-02
5 health deficiencies · 1 fire-safety deficiencies
Top issue: Resident Assessment and Care Planning (2 deficiencies)
4
Nursing time per resident, per day
Each resident here gets about 3 h 37 min of nursing staff time a day, 39 min of it from a registered nurse.
This home
3 h 37 min
Texas average
3 h 25 min
U.S. average
3 h 54 min
- Registered nurse
- Licensed practical nurse
- Nurse aide
Turnover: 54% of nursing staff and 57% of registered nurses left in the past year, along with 1 administrator.
Reported hours from payroll data the home submits to CMS, divided by its daily resident count. Not adjusted for how sick residents are.
5
Fines and payment denials
$119,238 in federal fines on record over the past three years.
| Date | Penalty | Amount |
|---|---|---|
| 2026-08-30 | Fine | $19,610 |
| 2025-04-16 | Fine | $73,165 |
| 2025-04-16 | Payment Denial · 43 day denial | $0 |
| 2024-02-12 | Fine | $8,821 |
| 2024-02-12 | Fine | $8,821 |
| 2024-02-12 | Fine | $8,821 |
6
Resident outcomes
Quality measures compared with state and national averages. Most come from assessments the home itself reports.
| Measure | This home | State | U.S. |
|---|---|---|---|
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine3.6 pts better | 100.0% | 96.4% | 93.7% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine1.5 pts better | 98.5% | 97.0% | 95.3% |
| Percentage of long-stay residents experiencing one or more falls with major injury1.5 pts worse | 4.7% | 3.2% | 3.2% |
| Percentage of long-stay residents who have depressive symptoms2.3 pts better | 0.0% | 2.3% | 13.5% |
| Percentage of long-stay residents who lose too much weight0.9 pts worse | 3.8% | 2.9% | 5.1% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication0.1 pts better | 17.7% | 17.8% | 19.5% |
| Percentage of long-stay residents who received an antipsychotic medication5.5 pts better | 4.3% | 9.8% | 15.4% |
| Percentage of long-stay residents who were physically restrainedAbout the same | 0.0% | 0.0% | 0.1% |
| Percentage of long-stay residents whose ability to walk independently worsened0.3 pts worse | 13.2% | 12.9% | 12.7% |
| Percentage of long-stay residents whose need for help with daily activities has increased3.1 pts worse | 18.9% | 15.8% | 13.5% |
| Percentage of long-stay residents with a catheter inserted and left in their bladder0.3 pts better | 0.0% | 0.3% | 0.7% |
| Percentage of long-stay residents with a urinary tract infection0.8 pts better | 0.0% | 0.8% | 1.5% |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence4.6 pts better | 7.9% | 12.5% | 18.3% |
| Percentage of long-stay residents with pressure ulcers1.3 pts worse | 5.0% | 3.7% | 4.5% |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine9 pts better | 97.7% | 88.7% | 82.3% |
| Percentage of short-stay residents who had an outpatient emergency department visit6.2 pts worse | 18.4% | 12.2% | 11.8% |
| Percentage of short-stay residents who newly received an antipsychotic medication0.8 pts better | 0.6% | 1.4% | 1.5% |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine12 pts better | 97.4% | 85.4% | 80.1% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission10.4 pts better | 15.1% | 25.5% | 23.4% |
·
Who owns and runs it
20 owners and managers reported to CMS. The last column counts how many nursing homes each one is tied to.
Show ownership list
| Name | Role | Share | Homes |
|---|---|---|---|
| Conley, Shawn | Corporate Officer · Individual | 0% | 25 facilities |
| Conley, Shawn | Operational/Managerial Control · Individual | 0% | 25 facilities |
| Daniels, Sarah | Operational/Managerial Control · Individual | 0% | 1 facilities |
| Daniels, Sarah | Adp Of The SNF · Individual | 0% | 1 facilities |
| Davis, Jessica | Operational/Managerial Control · Individual | 0% | 1 facilities |
| Davis, Jessica | Adp Of The SNF · Individual | 0% | 1 facilities |
| Focused Post Acute Care Partners LLC | Direct Ownership Interest · Organization | 0% | 23 facilities |
| Focused Post Acute Care Partners LLC | Operational/Managerial Control · Organization | 0% | 23 facilities |
| Focused Post Acute Care Partners LLC | Adp Of The SNF · Organization | 0% | 23 facilities |
| Focused Post Acute Care Partners Management, LLC | Operational/Managerial Control · Organization | 0% | 25 facilities |
| Focused Post Acute Care Partners Management, LLC | Adp Of The SNF · Organization | 0% | 25 facilities |
| Fpacp Cedar Bayou LLC | Direct Ownership Interest · Organization | 0% | 1 facilities |
| Fpacp Cedar Bayou LLC | Operational/Managerial Control · Organization | 0% | 1 facilities |
| Lillie, Tiffany | Operational/Managerial Control · Individual | 0% | 1 facilities |
| Mckenzie, Mark | Corporate Officer · Individual | 0% | 25 facilities |
| Mckenzie, Mark | Operational/Managerial Control · Individual | 0% | 25 facilities |
| Roberts, Matthew | Operational/Managerial Control · Individual | 0% | 3 facilities |
| Roberts, Matthew | Adp Of The SNF · Individual | 0% | 3 facilities |
| Strubbe, Loretta | Corporate Officer · Individual | 0% | 25 facilities |
| Strubbe, Loretta | Operational/Managerial Control · Individual | 0% | 25 facilities |
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Fire safety
7 life-safety citations (sprinklers, exits, alarms). These don't count toward the star rating.
Smoke3E
- D
Properly select, install, inspect, or maintain portable fire extinguishes.
- E
Inspect, test, and maintain automatic sprinkler systems.
- D
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
Miscellaneous2F
- F
Have simulated fire drills held at unexpected times.
- F
Have simulated fire drills held at unexpected times.
Egress1E
- E
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.
Services1D
- D
Have properly installed electrical wiring and gas equipment.
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Other homes nearby
-
Rollingbrook Rehabilitation and Health Care Center
Baytown, TX · Momentum Skilled Services
★★★★★- Worst citation, 3 yrs
- J
- Nursing / resident / day
- 3 h 19 min
- Fines
- $23,676
-
Focused Care at Allenbrook
Baytown, TX · Focused Post Acute Care Partners
★★★★★- Worst citation, 3 yrs
- J
- Nursing / resident / day
- 3 h 1 min
- Fines
- $8,400
-
Focused Care at Burnet Bay
Baytown, TX · Focused Post Acute Care Partners
★★★★★- Worst citation, 3 yrs
- J
- Nursing / resident / day
- 2 h 55 min
- Fines
- $16,350