Federal inspection record · CMS data as of October 1, 2026
River Hills Health and Rehabilitation Center
2091 Bandera Hwy, Kerrville, TX · (830) 257-9900
- Certified beds
- 150
- Residents per day
- 100
- Ownership
- Government
- Chain
- No chain reported
- Medicare / Medicaid
- Medicare + Medicaid
- Certified since
- October 1, 2006
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.
-
Staffing
★★★★★no change (already 1)
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
River Hills Health and Rehabilitation Center carries 243 inspection points. That is fewer than 5% 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
64 health citations on record since 2024. 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 (6)
-
J
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
-
J
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
-
J
Ensure that residents are free from significant medication errors.
-
J
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
-
J
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
-
J
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Everything else, by area of care
Resident Rights9E
- E
Honor the resident's right to organize and participate in resident/family groups in the facility.
- D
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
- D
Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.
- D
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
- D
Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.
- D
Keep residents' personal and medical records private and confidential.
- D
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.
- E
Reasonably accommodate the needs and preferences of each resident.
- E
Keep residents' personal and medical records private and confidential.
Pharmacy Service9E
- E
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
- D
Ensure that residents are free from significant medication errors.
- D
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
- D
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.
- E
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.
- D
Ensure that residents are free from significant medication errors.
- D
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
- 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.
- D
Ensure medication error rates are not 5 percent or greater.
Resident Assessment and Care Planning9E
- E
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
- D
Ensure each resident receives an accurate assessment.
- 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.
- 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
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
- D
Ensure each resident receives an accurate assessment.
- D
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Nutrition and Dietary8F
- E
Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician.
- E
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.
- E
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
- E
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
- D
Have a policy regarding use and storage of foods brought to residents by family and other visitors.
- F
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
- E
Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician.
- D
Have a policy regarding use and storage of foods brought to residents by family and other visitors.
Quality of Life and Care6E
- D
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
- D
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
- E
Provide care and assistance to perform activities of daily living for any resident who is unable.
- E
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
- D
Assist a resident in gaining access to vision and hearing services.
- D
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Infection Control5F
- F
Educate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status.
- E
Provide and implement an infection prevention and control program.
- F
Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home.
- D
Provide and implement an infection prevention and control program.
- E
Provide and implement an infection prevention and control program.
Freedom from Abuse, Neglect, and Exploitation4E
- D
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
- D
Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function.
- E
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
- E
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Environmental3E
- E
Keep all essential equipment working safely.
- D
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
- E
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
Administration3E
- D
Provide timely, quality laboratory services/tests to meet the needs of residents.
- D
Employ staff that are licensed, certified, or registered in accordance with state laws.
- E
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.
Nursing and Physician Services2F
- E
Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis.
- F
Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis.
Inspection history
2026-08-21
21 health deficiencies · 9 fire-safety deficiencies
Top issue: Resident Rights (5 deficiencies)
2025-06-13
26 health deficiencies · 4 fire-safety deficiencies
Top issue: Quality of Life and Care (7 deficiencies)
2024-04-19
17 health deficiencies · 5 fire-safety deficiencies
Top issue: Nutrition and Dietary (3 deficiencies)
4
Nursing time per resident, per day
Each resident here gets about 3 h 11 min of nursing staff time a day, 12 min of it from a registered nurse.
This home
3 h 11 min
Texas average
3 h 25 min
U.S. average
3 h 54 min
- Registered nurse
- Licensed practical nurse
- Nurse aide
Turnover: 73% of nursing staff and 67% 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
$112,133 in federal fines on record over the past three years.
| Date | Penalty | Amount |
|---|---|---|
| 2025-02-08 | Fine | $49,392 |
| 2024-12-21 | Fine | $47,467 |
| 2024-01-10 | Fine | $15,274 |
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 days0.5 pts worse | 2.5 | 2.0 | 1.8 |
| Number of outpatient emergency department visits per 1000 long-stay resident days1.1 pts worse | 3.1 | 2.0 | 1.7 |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine2.4 pts better | 98.8% | 96.4% | 93.7% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine0.8 pts better | 97.8% | 97.0% | 95.3% |
| Percentage of long-stay residents experiencing one or more falls with major injury1.7 pts better | 1.5% | 3.2% | 3.2% |
| Percentage of long-stay residents who have depressive symptoms1.9 pts better | 0.4% | 2.3% | 13.5% |
| Percentage of long-stay residents who lose too much weight2.5 pts better | 0.4% | 2.9% | 5.1% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication3 pts better | 14.8% | 17.8% | 19.5% |
| Percentage of long-stay residents who received an antipsychotic medication6 pts better | 3.8% | 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 worsened7.9 pts better | 5.0% | 12.9% | 12.7% |
| Percentage of long-stay residents whose need for help with daily activities has increased9.8 pts better | 6.0% | 15.8% | 13.5% |
| Percentage of long-stay residents with a catheter inserted and left in their bladder0.1 pts better | 0.2% | 0.3% | 0.7% |
| Percentage of long-stay residents with a urinary tract infection0.5 pts better | 0.3% | 0.8% | 1.5% |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence2.6 pts worse | 15.1% | 12.5% | 18.3% |
| Percentage of long-stay residents with pressure ulcers0.2 pts better | 3.5% | 3.7% | 4.5% |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine11 pts better | 99.7% | 88.7% | 82.3% |
| Percentage of short-stay residents who had an outpatient emergency department visit7.4 pts worse | 19.6% | 12.2% | 11.8% |
| Percentage of short-stay residents who newly received an antipsychotic medication1.4 pts better | 0.0% | 1.4% | 1.5% |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine11.2 pts better | 96.6% | 85.4% | 80.1% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission8.1 pts worse | 33.6% | 25.5% | 23.4% |
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Who owns and runs it
15 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 |
|---|---|---|---|
| Apolinar, Adam | Corporate Officer · Individual | 0% | 38 facilities |
| Aziz, Wesam | Managing Control - Governing Body · Individual | 0% | 9 facilities |
| Aziz, Wesam | Operational/Managerial Control · Individual | 0% | 9 facilities |
| Aziz, Wesam | Adp Of The SNF · Individual | 0% | 9 facilities |
| Bandera Hwy Health Holdings LLC | Adp Of The SNF · Organization | 0% | 1 facilities |
| Burnam, Soon | Corporate Officer · Individual | 0% | 353 facilities |
| Crown Mountain Healthcare LLC | Operational/Managerial Control · Organization | 0% | 1 facilities |
| Crown Mountain Healthcare LLC | Adp Of The SNF · Organization | 0% | 1 facilities |
| Ensign Services, Inc. | Adp Of The SNF · Organization | 0% | 4 facilities |
| Keetch, Chad | Corporate Director · Individual | 0% | 301 facilities |
| Lopez, Alan | Operational/Managerial Control · Individual | 0% | 1 facilities |
| Lopez, Alan | Adp Of The SNF · Individual | 0% | 1 facilities |
| Standard Bearer Healthcare Op LP | Adp Of The SNF · Organization | 0% | 21 facilities |
| The Ensign Group, Inc. | Adp Of The SNF · Organization | 0% | 4 facilities |
| Uvalde County Hospital Authority | Indirect Ownership Interest · Organization | 0% | 9 facilities |
·
Fire safety
18 life-safety citations (sprinklers, exits, alarms). These don't count toward the star rating.
Emergency Preparedness6F
- F
Establish policies and procedures including evacuation.
- F
Establish staff and initial training requirements.
- F
Conduct testing and exercise requirements.
- E
Provide primary/alternate means for communication.
- F
Conduct testing and exercise requirements.
- F
Develop and maintain an Emergency Preparedness Program (EP).
Smoke5E
- E
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
- E
Inspect, test, and maintain automatic sprinkler systems.
- E
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
- E
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
- E
Inspect, test, and maintain automatic sprinkler systems.
Miscellaneous3F
- E
Have simulated fire drills held at unexpected times.
- F
Have simulated fire drills held at unexpected times.
- E
Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.
Gas, Vacuum, and Electrical Systems2F
- F
Have generator or other power source capable of supplying service within 10 seconds.
- F
Have generator or other power source capable of supplying service within 10 seconds.
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.
Services1E
- E
Have properly installed electrical wiring and gas equipment.
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Other homes nearby
-
Avir at Kerrville
Kerrville, TX · Avir Health Group
★★★★★- Worst citation, 3 yrs
- K
- Nursing / resident / day
- 3 h 10 min
- Fines
- $20,467
-
Arbor View Nursing & Rehabilitation
Kerrville, TX
★★★★★- Worst citation, 3 yrs
- K
- Nursing / resident / day
- 3 h 16 min
- Fines
- $154,617
-
Hilltop Village Nursing And Rehabilitation
Kerrville, TX · Cross Healthcare Management
★★★★★- Worst citation, 3 yrs
- E
- Nursing / resident / day
- 2 h 55 min
- Fines
- $0