Bryan, TX

Lampstand Nursing and Rehabilitation

1-star overall rating with 2-star inspections with $43,786 in total fines with 11 recent health deficiencies with 7 fire-safety deficiencies in the latest cycle

2001 E 29th St, Bryan, TX

(979) 822-6611

Compare this facility

Overall

1 / 5

CMS overall stars

Health inspections

2 / 5

Survey and complaint cycles

Staffing

1 / 5

RN + nurse staffing

Quality measures

2 / 5

Resident outcomes and process measures

Quick facts

Facility snapshot

Beds

140

Certified beds

Average residents

Average occupied residents

Ownership

For-Profit

Publicly displayed owner type

Chain

Creative Solutions In Healthcare

Operator or chain grouping

Approved since

2004-05-19

CMS approved date

Coverage

Medicare + Medicaid

Participation flags

Chain footprint

149 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

Staffing

Hours and turnover

RN hours / resident day

0.00

Registered nurse staffing

LPN hours / resident day

0.00

Licensed practical nurse staffing

Aide hours / resident day

0.00

Nurse aide staffing

Total nurse hours

0.00

All reported nurse hours

Licensed hours

0.00

RN + LPN hours

Weekend hours

0.00

Weekend nurse staffing

Weekend RN hours

0.00

Weekend registered nurse coverage

Physical therapist

0.00

Reported PT staffing

Adjusted RN hours

0.00

CMS adjusted RN staffing hours

Adjusted total hours

0.00

CMS adjusted total nurse staffing hours

Case-mix index

0.00

Higher values indicate more complex resident acuity

RN turnover

Annual RN turnover

Total nurse turnover

43%

Annual nurse turnover · state 52% · national 46%

SNF VBP

Value-based purchasing

Program rank

6,215

Lower is better among SNFs in the FY 2026 VBP program.

Performance score

33.62

Composite VBP score used to determine payment impact.

Payment multiplier

0.9878

Above 1.000 increases Medicare payment; below 1.000 reduces it.

Program components

How the VBP score is built

Readmission

2.45

Baseline 19.63% · Performance 20.29% · Measure score 2.45 · Achievement 2.45 · Improvement 0

Healthcare-associated infections

2.44

Baseline 7.00% · Performance 7.11% · Measure score 2.44 · Achievement 2.44 · Improvement 0

Total nurse turnover

8.02

Baseline 31.58% · Performance 30.88% · Measure score 8.02 · Achievement 8.02 · Improvement 0.54

Adjusted total nurse staffing

0.53

Baseline 3.24 hours · Performance 3.23 hours · Measure score 0.53 · Achievement 0.53 · Improvement 0

SNF QRP

Medicare quality reporting measures

Measure	Facility	National	Note
Potentially preventable 30-day readmission	11.61%	10.72% 0.9 pts worse	No Different than the National Rate · Eligible stays 59 · Observed rate 15.25% · Lower 95% interval 8.3%
Discharge to community	34.41%	50.57% 16.2 pts worse	No Different than the National Rate · Eligible stays 43 · Observed rate 20.93% · Lower 95% interval 21.61%
Medicare spending per beneficiary	1.49	1.02 0.5 pts worse
Drug regimen review with follow-up	100%	95.27% 4.7 pts better	Numerator 23 · Denominator 23
Falls with major injury	0%	0.77% 0.8 pts better	Numerator 0 · Denominator 23
Discharge self-care score	Not Available	53.69%	Numerator Not Available · Denominator 16 · Too few residents or stays to report publicly.
Discharge mobility score	Not Available	50.94%	Numerator Not Available · Denominator 16 · 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 23 · Adjusted rate 0%
Healthcare-associated infections requiring hospitalization	7.11%	7.12% About the same	No Different than the National Rate · Eligible stays 30 · Observed rate 6.67% · Lower 95% interval 3.79%
Staff COVID-19 vaccination coverage	0%	8.2% 8.2 pts worse	Numerator 0 · Denominator 108
Staff flu vaccination coverage	8.55%	42% 33.5 pts worse	Numerator 13 · Denominator 152
Discharge function score	Not Available	56.45%	Numerator Not Available · Denominator 16 · Too few residents or stays to report publicly.
Transfer of health information to provider	Not Available	95.95%	Numerator Not Available · Denominator 8 · 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 8 · 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	99.3%	97.1% 2.2 pts better	93.4% 5.9 pts better	Long Stay · 2024Q4-2025Q3 · Q1 100.0% · Q2 97.4% · Q3 100.0% · Q4 100.0% · 4Q avg 99.3%
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	1.6%	3.3% 1.7 pts better	3.3% 1.7 pts better	Long Stay · 2024Q4-2025Q3 · Q1 3.8% · Q2 2.6% · Q3 0.0% · Q4 0.0% · 4Q avg 1.6% · Used in QM five-star
Percentage of long-stay residents who have depressive symptoms	3.4%	2.7% 0.7 pts worse	11.4% 8 pts better	Long Stay · 2024Q4-2025Q3 · Q1 3.0% · Q2 2.9% · Q3 4.9% · Q4 3.2% · 4Q avg 3.4%
Percentage of long-stay residents who lose too much weight	0.8%	3.3% 2.5 pts better	5.4% 4.6 pts better	Long Stay · 2024Q4-2025Q3 · Q1 1.6% · Q2 1.6% · Q3 0.0% · Q4 0.0% · 4Q avg 0.8%
Percentage of long-stay residents who received an antianxiety or hypnotic medication	11.8%	18.9% 7.1 pts better	19.6% 7.8 pts better	Long Stay · 2024Q4-2025Q3 · Q1 9.4% · Q2 12.5% · Q3 14.3% · Q4 10.9% · 4Q avg 11.8%
Percentage of long-stay residents who received an antipsychotic medication	7.3%	10.8% 3.5 pts better	16.7% 9.4 pts better	Long Stay · 2024Q4-2025Q3 · Q1 3.9% · Q2 4.0% · Q3 7.8% · Q4 13.0% · 4Q avg 7.3% · 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	18.3%	15.4% 2.9 pts worse	16.3% 2 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 19.1% · Q2 20.3% · Q3 10.8% · Q4 23.2% · 4Q avg 18.3% · Used in QM five-star
Percentage of long-stay residents whose need for help with daily activities has increased	25.8%	16.1% 9.7 pts worse	14.9% 10.9 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 20.3% · Q2 28.1% · Q3 25.0% · Q4 30.0% · 4Q avg 25.8% · Used in QM five-star
Percentage of long-stay residents with a catheter inserted and left in their bladder	0.7%	0.5% 0.2 pts worse	1.0% 0.3 pts better	Long Stay · 2024Q4-2025Q3 · Q1 1.4% · Q2 1.3% · Q3 0.0% · Q4 0.0% · 4Q avg 0.7% · Used in QM five-star
Percentage of long-stay residents with a urinary tract infection	0.7%	0.8% 0.1 pts better	1.7% 1 pts better	Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 1.4% · Q4 1.3% · 4Q avg 0.7% · Used in QM five-star
Percentage of long-stay residents with new or worsened bowel or bladder incontinence	10.0%	15.0% 5 pts better	19.8% 9.8 pts better	Long Stay · 2024Q4-2025Q3 · Q1 6.6% · Q2 11.2% · Q3 9.2% · Q4 13.0% · 4Q avg 10.0%
Percentage of long-stay residents with pressure ulcers	3.9%	4.2% 0.3 pts better	5.1% 1.2 pts better	Long Stay · 2024Q4-2025Q3 · Q1 4.6% · Q2 5.2% · Q3 2.5% · Q4 3.2% · 4Q avg 3.9% · Used in QM five-star
Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine	79.6%	89.7% 10.1 pts worse	81.7% 2.1 pts worse	Short Stay · 2024Q4-2025Q3 · Q1 93.0% · Q2 82.2% · Q3 72.4% · Q4 70.3% · 4Q avg 79.6%
Percentage of short-stay residents who had an outpatient emergency department visit	17.8%	12.0% 5.8 pts worse	12.0% 5.8 pts worse	Short Stay · 20240701-20250630 · Adjusted 17.8% · Observed 18.2% · Expected 11.4% · Used in QM five-star
Percentage of short-stay residents who newly received an antipsychotic medication	1.4%	1.5% 0.1 pts better	1.6% 0.2 pts better	Short Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 2.4% · Q4 3.1% · 4Q avg 1.4% · Used in QM five-star
Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine	90.7%	88.0% 2.7 pts better	79.7% 11 pts better	Short Stay · 2024Q3-2025Q2 · 4Q avg 90.7%
Percentage of short-stay residents who were rehospitalized after a nursing home admission	25.2%	25.9% 0.7 pts better	23.9% 1.3 pts worse	Short Stay · 20240701-20250630 · Adjusted 25.2% · Observed 27.3% · Expected 25.8% · Used in QM five-star

Survey summary

Recent inspection cycles

Cycle 1 Health 2025-02-12 · Fire 2025-02-12

11 health deficiencies

Top issue: Resident Rights (3 deficiencies)

7 fire-safety deficiencies

Top issue: Smoke (4 deficiencies)

Cycle 2 Health 2024-01-09 · Fire 2024-01-09

23 health deficiencies

Top issue: Quality of Life and Care (8 deficiencies)

0 fire-safety deficiencies

No concentrated fire-safety issue counts in this cycle.

Cycle 3 Health 2022-10-27 · Fire 2022-10-27

9 health deficiencies

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

1 fire-safety deficiencies

Top issue: Smoke (1 deficiency)

Fire safety

Fire-safety citations

F · Potential for more than minimal harm 2025-02-12

E39 · Emergency Preparedness Deficiencies

Fire Safety

Conduct testing and exercise requirements.

Corrected 2025-05-16

F · Potential for more than minimal harm 2025-02-12

K355 · Smoke Deficiencies

Fire Safety

Properly select, install, inspect, or maintain portable fire extinguishes.

Corrected 2025-05-21

F · Potential for more than minimal harm 2025-02-12

K372 · Smoke Deficiencies

Fire Safety

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

Corrected 2025-05-15

D · Potential for more than minimal harm 2025-02-12

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 2025-05-15

D · Potential for more than minimal harm 2025-02-12

K324 · Smoke Deficiencies

Fire Safety

Provide properly protected cooking facilities.

Corrected 2025-05-25

D · Potential for more than minimal harm 2025-02-12

K741 · Miscellaneous Deficiencies

Fire Safety

Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.

Corrected 2025-05-15

D · Potential for more than minimal harm 2025-02-12

K920 · Gas, Vacuum, and Electrical Systems Deficiencies

Fire Safety

Ensure proper usage of power strips and extension cords.

Corrected 2025-05-15

D · Potential for more than minimal harm 2022-10-27

K353 · Smoke Deficiencies

Fire Safety

Inspect, test, and maintain automatic sprinkler systems.

Corrected 2023-01-18

Inspection history

Recent health citations

D · Potential for more than minimal harm 2025-12-15

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 2025-12-16

D · Potential for more than minimal harm 2025-12-04

F552 · Resident Rights Deficiencies

Health

Ensure that residents are fully informed and understand their health status, care and treatments.

Corrected 2025-12-05

J · Immediate jeopardy 2025-10-10

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 2025-10-07

J · Immediate jeopardy 2025-10-10

F760 · Pharmacy Service Deficiencies

Health

Ensure that residents are free from significant medication errors.

Corrected 2025-10-07

D · Potential for more than minimal harm 2025-10-10

F551 · Resident Rights Deficiencies

Health

Give the resident's representative the ability to exercise the resident's rights.

Corrected 2025-10-11

D · Potential for more than minimal harm 2025-04-24

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 2025-04-25

F · Potential for more than minimal harm 2025-02-12

F572 · Resident Rights Deficiencies

Health

Give residents a notice of rights, rules, services and charges.

Corrected 2025-02-15

E · Potential for more than minimal harm 2025-02-12

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 2025-02-15

E · Potential for more than minimal harm 2025-02-12

F880 · Infection Control Deficiencies

Health

Provide and implement an infection prevention and control program.

Corrected 2025-02-15

E · Potential for more than minimal harm 2025-02-12

F908 · Environmental Deficiencies

Health

Keep all essential equipment working safely.

Corrected 2025-02-15

D · Potential for more than minimal harm 2025-02-12

F802 · Nutrition and Dietary Deficiencies

Health

Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service.

Corrected 2025-02-15

E · Potential for more than minimal harm 2025-01-17

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 2025-01-18

D · Potential for more than minimal harm 2025-01-17

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 2025-01-18

D · Potential for more than minimal harm 2025-01-17

F585 · Resident Rights Deficiencies

Health

Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances.

Corrected 2025-01-18

D · Potential for more than minimal harm 2024-09-05

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 2024-09-06

D · Potential for more than minimal harm 2024-09-05

F880 · Infection Control Deficiencies

Health

Provide and implement an infection prevention and control program.

Corrected 2024-09-06

D · Potential for more than minimal harm 2024-08-14

F558 · Resident Rights Deficiencies

Health

Reasonably accommodate the needs and preferences of each resident.

Corrected 2024-09-04

J · Immediate jeopardy 2024-04-30

F660 · Resident Assessment and Care Planning Deficiencies

Health

Plan the resident's discharge to meet the resident's goals and needs.

Corrected 2024-05-01

D · Potential for more than minimal harm 2024-04-26

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 2024-04-27

F · Potential for more than minimal harm 2024-01-09

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 2024-01-31

E · Potential for more than minimal harm 2024-01-09

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 2024-01-10

E · Potential for more than minimal harm 2024-01-09

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 2024-01-10

E · Potential for more than minimal harm 2024-01-09

F688 · Quality of Life and Care Deficiencies

Health

Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.

Corrected 2024-01-10