Federal inspection record · CMS data as of October 1, 2026
Graham Oaks Care Center
1325 First St, Graham, TX · (940) 549-8787
- Cited for abuse (CMS abuse icon)
- Certified beds
- 110
- Residents per day
- 81
- Ownership
- For-Profit
- Chain
- Creative Solutions In Healthcare
- Medicare / Medicaid
- Medicare + Medicaid
- Certified since
- October 28, 1991
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
★★★★★−1 star
Only a 5-star staffing rating adds a star, and only a 1-star rating removes one. Ratings of 2 to 4 change nothing.
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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.
This home carries CMS's abuse icon, which caps its inspection rating at 2 stars and so its overall rating at 4.
2
Where it sits among Texas homes
Graham Oaks Care Center carries 48 inspection points. That is fewer than 69% 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
15 health citations on record since 2023. 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 (3)
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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.
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G
Provide safe, appropriate pain management for a resident who requires such services.
Everything else, by area of care
Resident Assessment and Care Planning6E
- E
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
- D
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
- E
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
- D
Ensure each resident receives an accurate assessment.
- E
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
- D
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Freedom from Abuse, Neglect, and Exploitation2D
- D
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
- D
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
Quality of Life and Care1D
- D
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Infection Control1D
- D
Provide and implement an infection prevention and control program.
Administration1C
- C
Follow rules about disclosure of ownership requirements and tell the state agency about changes in ownership and/or administrative personnel.
Pharmacy Service1D
- D
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.
Inspection history
2026-04-09
6 health deficiencies · 4 fire-safety deficiencies
Top issue: Quality of Life and Care (2 deficiencies)
2025-01-22
4 health deficiencies · 1 fire-safety deficiencies
Top issue: Resident Assessment and Care Planning (3 deficiencies)
2023-12-07
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 21 min of nursing staff time a day, 23 min of it from a registered nurse.
This home
3 h 21 min
Texas average
3 h 25 min
U.S. average
3 h 54 min
- Registered nurse
- Licensed practical nurse
- Nurse aide
Turnover: 67% of nursing staff and 57% of registered nurses left in the past year.
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
$34,690 in federal fines on record over the past three years.
| Date | Penalty | Amount |
|---|---|---|
| 2025-10-10 | Fine | $17,345 |
| 2025-10-10 | Fine | $17,345 |
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. |
|---|---|---|---|
| Number of hospitalizations per 1000 long-stay resident days0.9 pts worse | 2.9 | 2.0 | 1.8 |
| Number of outpatient emergency department visits per 1000 long-stay resident days1.9 pts worse | 3.9 | 2.0 | 1.7 |
| 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 vaccine3 pts better | 100.0% | 97.0% | 95.3% |
| Percentage of long-stay residents experiencing one or more falls with major injury6.2 pts worse | 9.4% | 3.2% | 3.2% |
| Percentage of long-stay residents who have depressive symptoms1.1 pts better | 1.2% | 2.3% | 13.5% |
| Percentage of long-stay residents who lose too much weight1.8 pts better | 1.1% | 2.9% | 5.1% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication5.3 pts better | 12.5% | 17.8% | 19.5% |
| Percentage of long-stay residents who received an antipsychotic medication1.7 pts worse | 11.5% | 9.8% | 15.4% |
| Percentage of long-stay residents who were physically restrained0.3 pts worse | 0.3% | 0.0% | 0.1% |
| Percentage of long-stay residents whose ability to walk independently worsened2.9 pts better | 10.0% | 12.9% | 12.7% |
| Percentage of long-stay residents whose need for help with daily activities has increased17.7 pts worse | 33.5% | 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 infection0.4 pts better | 0.4% | 0.8% | 1.5% |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence4.8 pts worse | 17.3% | 12.5% | 18.3% |
| Percentage of long-stay residents with pressure ulcers0.7 pts better | 3.0% | 3.7% | 4.5% |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine11.3 pts better | 100.0% | 88.7% | 82.3% |
| Percentage of short-stay residents who had an outpatient emergency department visit4.7 pts worse | 16.9% | 12.2% | 11.8% |
| Percentage of short-stay residents who newly received an antipsychotic medication0.2 pts worse | 1.6% | 1.4% | 1.5% |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine14.6 pts better | 100.0% | 85.4% | 80.1% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission8.7 pts better | 16.8% | 25.5% | 23.4% |
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Who owns and runs it
17 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 |
|---|---|---|---|
| County Of Throckmorton | 5% Or Greater Direct Ownership Interest · Organization | 100% | 4 facilities |
| Blake, Gary | Operational/Managerial Control · Individual | 0% | 139 facilities |
| Blake, Gary | Adp Of The SNF · Individual | 0% | 139 facilities |
| Blake, Malisa | Operational/Managerial Control · Individual | 0% | 139 facilities |
| Brockman, Gregory | Managing Control - Governing Body · Individual | 0% | 1 facilities |
| Cook, Roxy | Adp Of The SNF · Individual | 0% | 1 facilities |
| Gober, Kirby | Managing Control - Governing Body · Individual | 0% | 4 facilities |
| Gober, Kirby | Corporate Officer · Individual | 0% | 4 facilities |
| Graham I Enterprises, LLC | Operational/Managerial Control · Organization | 0% | 1 facilities |
| Graham I Enterprises, LLC | Adp Of The SNF · Organization | 0% | 1 facilities |
| Hibbitts, Kasey | Managing Control - Governing Body · Individual | 0% | 1 facilities |
| Hodges, Caleb | Managing Control - Governing Body · Individual | 0% | 1 facilities |
| Huggins, Linda | Corporate Director · Individual | 0% | 138 facilities |
| Mitchell, Klayton | Managing Control - Governing Body · Individual | 0% | 1 facilities |
| Purdy, Aaron | Adp Of The SNF · Individual | 0% | 1 facilities |
| Wells, Casey | Managing Control - Governing Body · Individual | 0% | 1 facilities |
| Willig, Zachary | Corporate Director · Individual | 0% | 84 facilities |
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Fire safety
6 life-safety citations (sprinklers, exits, alarms). These don't count toward the star rating.
Services3C
- C
Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.
- C
Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.
- C
Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.
Emergency Preparedness1F
- F
Implement emergency and standby power systems.
Smoke1F
- F
Inspect, test, and maintain automatic sprinkler systems.
Gas, Vacuum, and Electrical Systems1F
- F
Have generator or other power source capable of supplying service within 10 seconds.
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Other homes nearby
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Avir at Graham
Graham, TX · Avir Health Group
★★★★★- Worst citation, 3 yrs
- F
- Nursing / resident / day
- 3 h 3 min
- Fines
- $0
-
Olney Rehabilitation And Care Center
Olney, TX
★★★★★- Worst citation, 3 yrs
- F
- Nursing / resident / day
- 2 h 58 min
- Fines
- $0
-
Avir At Jacksboro
Jacksboro, TX · Avir Health Group
★★★★★- Worst citation, 3 yrs
- F
- Nursing / resident / day
- 3 h 20 min
- Fines
- $0