Webster, TX

Ignite Medical Resort Webster, LLC

5-star overall rating with 5-star inspections with $42,280 in total fines with 2 recent health deficiencies with 4 fire-safety deficiencies in the latest cycle

16130 Galveston Rd, Webster, TX

(832) 426-7030

Compare this facility

Overall

5 / 5

CMS overall stars

Health inspections

5 / 5

Survey and complaint cycles

Staffing

2 / 5

RN + nurse staffing

Quality measures

5 / 5

Resident outcomes and process measures

Quick facts

Facility snapshot

Beds

70

Certified beds

Average residents

68

Average occupied residents

Ownership

For-Profit

Publicly displayed owner type

Chain

Ignite Medical Resorts

Operator or chain grouping

Approved since

2019-01-25

CMS approved date

Coverage

Medicare

Participation flags

Staffing

Hours and turnover

RN hours / resident day

0.72

Registered nurse staffing

LPN hours / resident day

1.43

Licensed practical nurse staffing

Aide hours / resident day

2.09

Nurse aide staffing

Weekend hours

3.84

Weekend nurse staffing

RN turnover

63%

Annual RN turnover

Total nurse turnover

44%

Annual nurse turnover

Quality measures

Resident outcomes and process scores

Measure	Facility	State	National	Note
Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine	99.6%	89.7% 9.9 pts better	81.7% 17.9 pts better	Short Stay · 2024Q4-2025Q3
Percentage of short-stay residents who had an outpatient emergency department visit	8.2%	12.0% 3.8 pts better	12.0% 3.8 pts better	Short Stay · 20240701-20250630
Percentage of short-stay residents who newly received an antipsychotic medication	0.5%	1.5% 1 pts better	1.6% 1.1 pts better	Short Stay · 2024Q4-2025Q3
Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine	89.0%	88.0% 1 pts better	79.7% 9.3 pts better	Short Stay · 2024Q3-2025Q2
Percentage of short-stay residents who were rehospitalized after a nursing home admission	21.4%	25.9% 4.5 pts better	23.9% 2.5 pts better	Short Stay · 20240701-20250630

Survey summary

Recent inspection cycles

Cycle 1 Health 2025-06-11 · Fire 2025-06-11

2 health deficiencies

Top issue: Resident Assessment and Care Planning (2 deficiencies)

4 fire-safety deficiencies

Top issue: Smoke (2 deficiencies)

Cycle 2 Health 2024-05-08 · Fire 2024-05-08

0 health deficiencies

No concentrated health issue counts in this cycle.

0 fire-safety deficiencies

No concentrated fire-safety issue counts in this cycle.

Cycle 3 Health 2023-03-22 · Fire 2023-03-22

9 health deficiencies

Top issue: Freedom from Abuse and Neglect and Exploitation (2 deficiencies)

3 fire-safety deficiencies

Top issue: Gas and Vacuum and Electrical Systems (1 deficiency)

Fire safety

Fire-safety citations

F · Potential for more than minimal harm 2025-06-11

K712 · Miscellaneous Deficiencies

Fire Safety

Have simulated fire drills held at unexpected times.

Corrected 2025-06-26

E · Potential for more than minimal harm 2025-06-11

K324 · Smoke Deficiencies

Fire Safety

Provide properly protected cooking facilities.

Corrected 2025-06-26

E · Potential for more than minimal harm 2025-06-11

K372 · Smoke Deficiencies

Fire Safety

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

Corrected 2025-06-26

E · Potential for more than minimal harm 2025-06-11

K929 · Gas, Vacuum, and Electrical Systems Deficiencies

Fire Safety

Ensure precautions for handling oxygen cylinders and equipment are correctly followed.

Corrected 2025-06-26

F · Potential for more than minimal harm 2023-03-22

K712 · Miscellaneous Deficiencies

Fire Safety

Have simulated fire drills held at unexpected times.

Corrected 2023-03-24

E · Potential for more than minimal harm 2023-03-22

K372 · Smoke Deficiencies

Fire Safety

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

Corrected 2023-03-24

E · Potential for more than minimal harm 2023-03-22

K929 · Gas, Vacuum, and Electrical Systems Deficiencies

Fire Safety

Ensure precautions for handling oxygen cylinders and equipment are correctly followed.

Corrected 2023-03-24

Inspection history

Recent health citations

D · Potential for more than minimal harm 2025-06-11

F655 · Resident Assessment and Care Planning Deficiencies

Health

Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted

Corrected 2025-07-11

D · Potential for more than minimal harm 2025-06-11

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 2025-07-11

G · Actual harm 2023-03-22

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 2023-03-24

G · Actual harm 2023-03-22

F742 · Quality of Life and Care Deficiencies

Health

Provide the appropriate treatment and services to a resident who displays or is diagnosed with mental disorder or psychosocial adjustment difficulty, or who has a history of trauma and/or post-traumatic stress disorder.

Corrected 2023-03-24

E · Potential for more than minimal harm 2023-03-22

F565 · Resident Rights Deficiencies

Health

Honor the resident's right to organize and participate in resident/family groups in the facility.

Corrected 2023-03-24

E · Potential for more than minimal harm 2023-03-22

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 2023-03-24

E · Potential for more than minimal harm 2023-03-22

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 2023-03-24

D · Potential for more than minimal harm 2023-03-22

F609 · Freedom from Abuse, Neglect, and Exploitation Deficiencies

Health

Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

Corrected 2023-03-24

D · Potential for more than minimal harm 2023-03-22

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 2023-03-24

D · Potential for more than minimal harm 2023-03-22

F759 · Pharmacy Service Deficiencies

Health

Ensure medication error rates are not 5 percent or greater.

Corrected 2023-03-24

D · Potential for more than minimal harm 2023-03-22

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 2023-03-24

Penalties and ownership

What sits behind the stars

$42,280 2023-03-22

Fine

Fine · fine $42,280

Fine

Ownership

Fields, Timothy

5% Or Greater Indirect Ownership Interest · Individual

20% 22 facilities 2022-04-01

Carr, Barry

5% Or Greater Indirect Ownership Interest · Individual

16% 22 facilities 2022-04-01

Carr, Barry