Federal inspection record · CMS data as of October 1, 2026
Southbrooke Manor Nursing And Rehabilitation Cente
1401 W Main St, Edna, TX · (361) 782-7614
- Certified beds
- 120
- Residents per day
- 84
- Ownership
- Non-Profit
- Chain
- Wellsential Health
- Medicare / Medicaid
- Medicare + Medicaid
- Certified since
- July 1, 1993
1
How this home got 4 stars
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.
-
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
★★★★★4 of 5
Matches the rating CMS publishes on Care Compare.
2
Where it sits among Texas homes
Southbrooke Manor Nursing And Rehabilitation Cente carries 24 inspection points. That is fewer than 91% 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.
No citation on record at the harm or immediate-jeopardy level.
Everything else, by area of care
Resident Assessment and Care Planning4E
- E
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
- 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 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.
Nutrition and Dietary2E
- 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.
Infection Control2E
- D
Provide and implement an infection prevention and control program.
- E
Provide and implement an infection prevention and control program.
Quality of Life and Care2D
- D
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
- D
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Resident Rights2E
- E
Ensure residents have reasonable access to and privacy in their use of communication methods.
- D
Keep residents' personal and medical records private and confidential.
Pharmacy Service2E
- 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.
- 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.
Administration1B
- B
Conduct mandatory training, for all staff, on the facility’s Quality Assurance and Performance Improvement Program.
Inspection history
2026-02-20
2 health deficiencies · 0 fire-safety deficiencies
Top issue: Nutrition and Dietary (1 deficiency)
2024-11-22
9 health deficiencies · 1 fire-safety deficiencies
Top issue: Pharmacy Service (2 deficiencies)
2023-09-22
4 health deficiencies · 1 fire-safety deficiencies
Top issue: Infection Control (1 deficiency)
4
Nursing time per resident, per day
Each resident here gets about 2 h 58 min of nursing staff time a day, 16 min of it from a registered nurse.
This home
2 h 58 min
Texas average
3 h 25 min
U.S. average
3 h 54 min
- Registered nurse
- Licensed practical nurse
- Nurse aide
Turnover: 45% of nursing staff and 80% 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
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 days0.1 pts worse | 2.1 | 2.0 | 1.8 |
| Number of outpatient emergency department visits per 1000 long-stay resident daysAbout the same | 2.0 | 2.0 | 1.7 |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine1.7 pts better | 98.1% | 96.4% | 93.7% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine0.3 pts worse | 96.7% | 97.0% | 95.3% |
| Percentage of long-stay residents experiencing one or more falls with major injury1.9 pts worse | 5.1% | 3.2% | 3.2% |
| Percentage of long-stay residents who have depressive symptoms1 pts better | 1.3% | 2.3% | 13.5% |
| Percentage of long-stay residents who lose too much weight2.2 pts better | 0.7% | 2.9% | 5.1% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication7 pts better | 10.8% | 17.8% | 19.5% |
| Percentage of long-stay residents who received an antipsychotic medication0.4 pts better | 9.4% | 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 worsened4.6 pts better | 8.3% | 12.9% | 12.7% |
| Percentage of long-stay residents whose need for help with daily activities has increased2.2 pts worse | 18.0% | 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 infection0.5 pts worse | 1.3% | 0.8% | 1.5% |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence1.3 pts better | 11.2% | 12.5% | 18.3% |
| Percentage of long-stay residents with pressure ulcers0.3 pts better | 3.4% | 3.7% | 4.5% |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine0.5 pts worse | 88.2% | 88.7% | 82.3% |
| Percentage of short-stay residents who had an outpatient emergency department visit4.3 pts worse | 16.5% | 12.2% | 11.8% |
| Percentage of short-stay residents who newly received an antipsychotic medication2.9 pts worse | 4.3% | 1.4% | 1.5% |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine1.1 pts better | 86.5% | 85.4% | 80.1% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission3.5 pts better | 22.0% | 25.5% | 23.4% |
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Who owns and runs it
41 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 |
|---|---|---|---|
| Citizens Medical Center County Of Victoria | 5% Or Greater Direct Ownership Interest · Organization | 100% | 5 facilities |
| 1401 West Main Street LLC | Adp Of The SNF · Organization | 0% | 1 facilities |
| Baird, Daniel | Managing Control - Governing Body · Individual | 0% | 58 facilities |
| Carvajal, Antonio | Managing Control - Governing Body · Individual | 0% | 28 facilities |
| Citizens Medical Center County Of Victoria | Operational/Managerial Control · Organization | 0% | 5 facilities |
| Citizens Medical Center County Of Victoria | Adp Of The SNF · Organization | 0% | 5 facilities |
| Clapp, Barbara | Managing Control - Governing Body · Individual | 0% | 69 facilities |
| Cortese, Daren | Managing Control - Governing Body · Individual | 0% | 58 facilities |
| Csv Rhea Management Holdco, LLC | Indirect Ownership Interest · Organization | 0% | 63 facilities |
| Dekowski, Donovan | Operational/Managerial Control · Individual | 0% | 69 facilities |
| Dekowski, Donovan | Adp Of The SNF · Individual | 0% | 69 facilities |
| Dwd Tx Holdings LLC | Indirect Ownership Interest · Organization | 0% | 63 facilities |
| Galvin, Ben | Managing Control - Governing Body · Individual | 0% | 4 facilities |
| Gibson, Patricia | Managing Control - Governing Body · Individual | 0% | 57 facilities |
| Gonzales, Veronica | Managing Control - Governing Body · Individual | 0% | 27 facilities |
| Gorouhi, Fariborz | Managing Control - Governing Body · Individual | 0% | 5 facilities |
| Guerra, Luis | Managing Control - Governing Body · Individual | 0% | 5 facilities |
| Holm, Paul | Managing Control - Governing Body · Individual | 0% | 5 facilities |
| Jack And Nancy Dwyer Workforce Development Center Inc | Indirect Ownership Interest · Organization | 0% | 68 facilities |
| Kaufman, Nicole | Managing Control - Governing Body · Individual | 0% | 28 facilities |
| Korenek, Courtney | Operational/Managerial Control · Individual | 0% | 1 facilities |
| Korenek, Courtney | Adp Of The SNF · Individual | 0% | 1 facilities |
| Mandelbaum, Elliot | Managing Control - Governing Body · Individual | 0% | 61 facilities |
| Marshall, Russell | Managing Control - Governing Body · Individual | 0% | 5 facilities |
| Neumann, James | Managing Control - Governing Body · Individual | 0% | 5 facilities |
| Olson, Michael | Managing Control - Governing Body · Individual | 0% | 5 facilities |
| Olson, Michael | Corporate Officer · Individual | 0% | 5 facilities |
| Quinn-Frankel, Molly | Adp Of The SNF · Individual | 0% | 2 facilities |
| Reg Hg Opco 1, LLC | Indirect Ownership Interest · Organization | 0% | 19 facilities |
| Reg Hg Opco LLC | Indirect Ownership Interest · Organization | 0% | 39 facilities |
| Reg Operator Holdco LLC | Indirect Ownership Interest · Organization | 0% | 63 facilities |
| Regency Ihs Clinical Consulting, LLC | Adp Of The SNF · Organization | 0% | 70 facilities |
| Regency Ihs Master Tenant LLC | Adp Of The SNF · Organization | 0% | 17 facilities |
| Regency Ihs Of Southbrooke Manor LLC | Direct Ownership Interest · Organization | 0% | 1 facilities |
| Regency Ihs Of Southbrooke Manor LLC | Operational/Managerial Control · Organization | 0% | 1 facilities |
| Regency Ihs Of Southbrooke Manor LLC | Adp Of The SNF · Organization | 0% | 1 facilities |
| Regency Ihs Rehab LLC | Adp Of The SNF · Organization | 0% | 68 facilities |
| Regency Integrated Health Services LLC | Operational/Managerial Control · Organization | 0% | 70 facilities |
| Regency Integrated Health Services LLC | Adp Of The SNF · Organization | 0% | 70 facilities |
| Regency Texas Holdings LLC | Indirect Ownership Interest · Organization | 0% | 63 facilities |
| Thomas, Ashlie | Managing Control - Governing Body · Individual | 0% | 5 facilities |
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Fire safety
2 life-safety citations (sprinklers, exits, alarms). These don't count toward the star rating.
Egress1E
- E
Keep aisles, corridors, and exits free of obstruction in case of emergency.
Smoke1E
- E
Inspect, test, and maintain automatic sprinkler systems.
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Other homes nearby
-
Ganado Nursing And Rehabilitation Center
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★★★★★- Worst citation, 3 yrs
- J
- Nursing / resident / day
- 3 h 19 min
- Fines
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-
Twin Pines Nursing and Rehabilitation
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★★★★★- Worst citation, 3 yrs
- J
- Nursing / resident / day
- 2 h 47 min
- Fines
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-
The Courtyard Rehabilitation And Healthcare Center
Victoria, TX · The Ensign Group
★★★★★- Worst citation, 3 yrs
- E
- Nursing / resident / day
- 3 h 10 min
- Fines
- $17,992