Abilene, TX

Northern Oaks Living & Rehabilitation Center

3-star overall rating with 3-star inspections with 12 recent health deficiencies with 8 fire-safety deficiencies in the latest cycle

2722 Old Anson Rd, Abilene, TX

(325) 676-1677

Compare this facility

Overall

3 / 5

CMS overall stars

Health inspections

3 / 5

Survey and complaint cycles

Staffing

2 / 5

RN + nurse staffing

Quality measures

4 / 5

Resident outcomes and process measures

Quick facts

Facility snapshot

Beds

Certified beds

Average residents

Average occupied residents

Ownership

For-Profit

Publicly displayed owner type

Chain

The Ensign Group

Operator or chain grouping

Approved since

1991-07-30

CMS approved date

Coverage

Medicare + Medicaid

Participation flags

Chain footprint

329 facilities

Chain averages 3 overall / 3 health / 3 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

0.55

Registered nurse staffing · state 0.44 · national 0.68

LPN hours / resident day

0.63

Licensed practical nurse staffing · state 0.95 · national 0.87

Aide hours / resident day

1.84

Nurse aide staffing · state 2.01 · national 2.35

Total nurse hours

3.02

All reported nurse hours · state 3.40 · national 3.89

Licensed hours

1.18

RN + LPN hours · state 1.38 · national 1.54

Weekend hours

2.59

Weekend nurse staffing · state 2.99 · national 3.43

Weekend RN hours

0.36

Weekend registered nurse coverage · state 0.34 · national 0.47

Physical therapist

0.15

Reported PT staffing · state 0.07 · national 0.07

Adjusted RN hours

0.56

CMS adjusted RN staffing hours

Adjusted total hours

3.11

CMS adjusted total nurse staffing hours

Case-mix index

1.33

Higher values indicate more complex resident acuity

RN turnover

55%

Annual RN turnover · state 52% · national 45%

Total nurse turnover

55%

Annual nurse turnover · state 52% · national 46%

SNF VBP

Value-based purchasing

Program rank

13,725

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

Performance score

0.02

Composite VBP score used to determine payment impact.

Payment multiplier

0.9803

Above 1.000 increases Medicare payment; below 1.000 reduces it.

Program components

How the VBP score is built

Readmission

Not reported

This facility did not meet this measure's case minimum policy requirement and therefore no measure data is publicly reported.

Healthcare-associated infections

Baseline 6.89% · Performance 8.77% · Measure score 0 · Achievement 0 · Improvement 0

Total nurse turnover

Baseline 59.02% · Performance 64.47% · Measure score 0 · Achievement 0 · Improvement 0

Adjusted total nurse staffing

Baseline 3.05 hours · Performance 3.18 hours · Measure score 0 · Achievement 0 · Improvement 0

SNF QRP

Medicare quality reporting measures

Measure	Facility	National	Note
Potentially preventable 30-day readmission	11.65%	10.72% 0.9 pts worse	No Different than the National Rate · Eligible stays 81 · Observed rate 17.28% · Lower 95% interval 8.12%
Discharge to community	47.24%	50.57% 3.3 pts worse	No Different than the National Rate · Eligible stays 44 · Observed rate 40.91% · Lower 95% interval 37.67%
Medicare spending per beneficiary	1.08	1.02 0.1 pts worse
Drug regimen review with follow-up	100%	95.27% 4.7 pts better	Numerator 40 · Denominator 40
Falls with major injury	0%	0.77% 0.8 pts better	Numerator 0 · Denominator 40
Discharge self-care score	33.33%	53.69% 20.4 pts worse	Numerator 9 · Denominator 27
Discharge mobility score	25.93%	50.94% 25 pts worse	Numerator 7 · Denominator 27
Pressure ulcers or injuries, new or worsened	5%	2.29% 2.7 pts worse	Numerator 2 · Denominator 40 · Adjusted rate 4.34%
Healthcare-associated infections requiring hospitalization	8.77%	7.12% 1.6 pts worse	No Different than the National Rate · Eligible stays 28 · Observed rate 21.43% · Lower 95% interval 4.54%
Staff COVID-19 vaccination coverage	0%	8.2% 8.2 pts worse	Numerator 0 · Denominator 113
Staff flu vaccination coverage	22.15%	42% 19.9 pts worse	Numerator 33 · Denominator 149
Discharge function score	40.74%	56.45% 15.7 pts worse	Numerator 11 · Denominator 27
Transfer of health information to provider	Not Available	95.95%	Numerator Not Available · Denominator 12 · Too few residents or stays to report publicly.
Transfer of health information to patient	Not Available	96.28%	Numerator Not Available · Denominator 13 · Too few residents or stays to report publicly.
Resident COVID-19 vaccinations up to date	20%	25.2% 5.2 pts worse	Numerator 4 · Denominator 20

Quality measures

Resident outcomes and process scores

Measure	Facility	State	National	Note
Number of hospitalizations per 1000 long-stay resident days	1.5	2.1 0.6 pts better	1.9 0.4 pts better	Long Stay · 20240701-20250630 · Adjusted 1.5 · Observed 1.4 · Expected 1.8 · Used in QM five-star
Number of outpatient emergency department visits per 1000 long-stay resident days	1.6	2.1 0.5 pts better	1.8 0.2 pts better	Long Stay · 20240701-20250630 · Adjusted 1.6 · Observed 1.4 · Expected 1.5 · Used in QM five-star
Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine	96.1%	97.1% 1 pts worse	93.4% 2.7 pts better	Long Stay · 2024Q4-2025Q3 · Q1 97.1% · Q2 94.1% · Q3 96.7% · Q4 96.6% · 4Q avg 96.1%
Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine	93.5%	97.9% 4.4 pts worse	95.5% 2 pts worse	Long Stay · 2024Q3-2025Q2 · 4Q avg 93.5%
Percentage of long-stay residents experiencing one or more falls with major injury	2.0%	3.3% 1.3 pts better	3.3% 1.3 pts better	Long Stay · 2024Q4-2025Q3 · Q1 1.5% · Q2 2.9% · Q3 1.6% · Q4 1.7% · 4Q avg 2.0% · Used in QM five-star
Percentage of long-stay residents who have depressive symptoms	1.0%	2.7% 1.7 pts better	11.4% 10.4 pts better	Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 4.5% · Q4 0.0% · 4Q avg 1.0%
Percentage of long-stay residents who lose too much weight	1.3%	3.3% 2 pts better	5.4% 4.1 pts better	Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 1.6% · Q3 0.0% · Q4 3.8% · 4Q avg 1.3%
Percentage of long-stay residents who received an antianxiety or hypnotic medication	12.2%	18.9% 6.7 pts better	19.6% 7.4 pts better	Long Stay · 2024Q4-2025Q3 · Q1 13.3% · Q2 13.1% · Q3 11.1% · Q4 11.1% · 4Q avg 12.2%
Percentage of long-stay residents who received an antipsychotic medication	13.8%	10.8% 3 pts worse	16.7% 2.9 pts better	Long Stay · 2024Q4-2025Q3 · Q1 20.0% · Q2 12.5% · Q3 14.0% · Q4 8.5% · 4Q avg 13.8% · 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	4.0%	15.4% 11.4 pts better	16.3% 12.3 pts better	Long Stay · 2024Q4-2025Q3 · 4Q avg 4.0% · Used in QM five-star
Percentage of long-stay residents whose need for help with daily activities has increased	8.0%	16.1% 8.1 pts better	14.9% 6.9 pts better	Long Stay · 2024Q4-2025Q3 · Q1 20.6% · Q3 0.0% · Q4 2.6% · 4Q avg 8.0% · Used in QM five-star
Percentage of long-stay residents with a catheter inserted and left in their bladder	0.0%	0.5% 0.5 pts better	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% · Used in QM five-star
Percentage of long-stay residents with a urinary tract infection	0.4%	0.8% 0.4 pts better	1.7% 1.3 pts better	Long Stay · 2024Q4-2025Q3 · Q1 1.5% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.4% · Used in QM five-star
Percentage of long-stay residents with new or worsened bowel or bladder incontinence	18.3%	15.0% 3.3 pts worse	19.8% 1.5 pts better	Long Stay · 2024Q4-2025Q3 · Q1 17.8% · Q2 17.5% · Q3 15.5% · Q4 22.8% · 4Q avg 18.3%
Percentage of long-stay residents with pressure ulcers	7.1%	4.2% 2.9 pts worse	5.1% 2 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 6.3% · Q2 8.1% · Q3 8.6% · Q4 5.5% · 4Q avg 7.1% · Used in QM five-star
Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine	79.2%	89.7% 10.5 pts worse	81.7% 2.5 pts worse	Short Stay · 2024Q4-2025Q3 · Q1 89.1% · Q2 83.8% · Q3 73.9% · Q4 74.8% · 4Q avg 79.2%
Percentage of short-stay residents who had an outpatient emergency department visit	20.7%	12.0% 8.7 pts worse	12.0% 8.7 pts worse	Short Stay · 20240701-20250630 · Adjusted 20.7% · Observed 22.0% · Expected 11.8% · Used in QM five-star
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 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0% · Used in QM five-star
Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine	86.7%	88.0% 1.3 pts worse	79.7% 7 pts better	Short Stay · 2024Q3-2025Q2 · 4Q avg 86.7%
Percentage of short-stay residents who were rehospitalized after a nursing home admission	16.6%	25.9% 9.3 pts better	23.9% 7.3 pts better	Short Stay · 20240701-20250630 · Adjusted 16.6% · Observed 17.1% · Expected 24.5% · Used in QM five-star

Survey summary

Recent inspection cycles

Cycle 1 Health 2024-10-29 · Fire 2024-10-29

12 health deficiencies

Top issue: Resident Assessment and Care Planning (4 deficiencies)

8 fire-safety deficiencies

Top issue: Smoke (6 deficiencies)

Cycle 2 Health 2023-08-29 · Fire 2023-08-29

13 health deficiencies

Top issue: Resident Assessment and Care Planning (3 deficiencies)

0 fire-safety deficiencies

No concentrated fire-safety issue counts in this cycle.

Cycle 3 Health 2022-06-23 · Fire 2022-06-23

6 health deficiencies

Top issue: Administration (1 deficiency)

0 fire-safety deficiencies

No concentrated fire-safety issue counts in this cycle.

Fire safety

Fire-safety citations

F · Potential for more than minimal harm 2024-10-29

K341 · Smoke Deficiencies

Fire Safety

Install a fire alarm system that can be heard throughout the facility.

Corrected 2024-11-22

F · Potential for more than minimal harm 2024-10-29

K372 · Smoke Deficiencies

Fire Safety

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

Corrected 2024-11-22

E · Potential for more than minimal harm 2024-10-29

K131 · Construction Deficiencies

Fire Safety

Meet requirements for sections of health care facilities separated by fire resistive construction.

Corrected 2024-11-22

E · Potential for more than minimal harm 2024-10-29

K222 · Egress Deficiencies

Fire Safety

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.

Corrected 2024-11-22

E · Potential for more than minimal harm 2024-10-29

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 2024-11-22

E · Potential for more than minimal harm 2024-10-29

K324 · Smoke Deficiencies

Fire Safety

Provide properly protected cooking facilities.

Corrected 2024-11-22

E · Potential for more than minimal harm 2024-10-29

K353 · Smoke Deficiencies

Fire Safety

Inspect, test, and maintain automatic sprinkler systems.

Corrected 2024-11-22

E · Potential for more than minimal harm 2024-10-29

K364 · Smoke Deficiencies

Fire Safety

Install properly constructed windows in hallway walls or doors.

Corrected 2024-11-22

Inspection history

Recent health citations

E · Potential for more than minimal harm 2026-01-22

F605 · Freedom from Abuse, Neglect, and Exploitation Deficiencies

Health

Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function.

Not marked corrected

E · Potential for more than minimal harm 2026-01-22

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.

Not marked corrected

E · Potential for more than minimal harm 2026-01-22

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.

Not marked corrected

D · Potential for more than minimal harm 2026-01-22

F552 · Resident Rights Deficiencies

Health

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

Not marked corrected

D · Potential for more than minimal harm 2026-01-22

F690 · Quality of Life and Care Deficiencies

Health

Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.

Not marked corrected

D · Potential for more than minimal harm 2026-01-22

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.

Not marked corrected

C · Minimal harm 2026-01-22

F577 · Resident Rights Deficiencies

Health

Allow residents to easily view the nursing home's survey results and communicate with advocate agencies.

Not marked corrected

D · Potential for more than minimal harm 2025-11-07

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 2025-11-08

E · Potential for more than minimal harm 2025-03-07

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 2025-03-08

E · Potential for more than minimal harm 2024-10-29

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 2024-11-22

D · Potential for more than minimal harm 2024-10-29

F641 · Resident Assessment and Care Planning Deficiencies

Health

Ensure each resident receives an accurate assessment.

Corrected 2024-11-22

D · Potential for more than minimal harm 2024-10-29

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 2024-11-22

E · Potential for more than minimal harm 2023-09-20

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 2023-10-12

E · Potential for more than minimal harm 2023-09-20

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 2023-10-12

F · Potential for more than minimal harm 2023-08-29

F809 · Nutrition and Dietary Deficiencies

Health

Ensure meals and snacks are served at times in accordance with resident’s needs, preferences, and requests. Suitable and nourishing alternative meals and snacks must be provided for residents who want to eat at non-traditional times or outside of scheduled meal times.

Corrected 2023-09-22

F · Potential for more than minimal harm 2023-08-29

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 2023-09-22