Federal inspection record · CMS data as of October 1, 2026
Twin Oaks Manor
112 Pioneer Dr, Booker, TX · (806) 658-9786
- Certified beds
- 40
- Residents per day
- 44
- Ownership
- Government
- Chain
- No chain reported
- Medicare / Medicaid
- Medicaid
- Certified since
- April 15, 1988
1
How this home got 3 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.
-
Staffing
★★★★★no change
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
★★★★★−1 star
Same rule: 5 stars adds one, 1 star takes one away. These measures are mostly reported by the home itself.
-
Overall
★★★★★3 of 5
Matches the rating CMS publishes on Care Compare.
2
Where it sits among Texas homes
Twin Oaks Manor carries 37 inspection points. That is fewer than 80% 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
18 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
Nutrition and Dietary5F
- 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
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
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.
- F
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Resident Assessment and Care Planning3D
- D
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
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Quality of Life and Care3E
- D
Provide safe and appropriate respiratory care for a resident when needed.
- E
Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail.
- D
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Pharmacy Service3D
- 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.
- 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 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.
Infection Control2E
- D
Provide and implement an infection prevention and control program.
- E
Provide and implement an infection prevention and control program.
Resident Rights1E
- E
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Freedom from Abuse, Neglect, and Exploitation1E
- E
Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function.
Inspection history
2026-06-11
6 health deficiencies · 4 fire-safety deficiencies
Top issue: Nutrition and Dietary (2 deficiencies)
2025-04-30
4 health deficiencies · 1 fire-safety deficiencies
Top issue: Nutrition and Dietary (2 deficiencies)
2024-03-14
8 health deficiencies · 1 fire-safety deficiencies
Top issue: Pharmacy Service (2 deficiencies)
4
Nursing time per resident, per day
Each resident here gets about 5 h 43 min of nursing staff time a day, 1 h 2 min of it from a registered nurse.
This home
5 h 43 min
Texas average
3 h 25 min
U.S. average
3 h 54 min
- Registered nurse
- Licensed practical nurse
- Nurse aide
Turnover: 69% of nursing staff and 86% 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 days0.6 pts better | 1.4 | 2.0 | 1.8 |
| Number of outpatient emergency department visits per 1000 long-stay resident days0.1 pts worse | 2.1 | 2.0 | 1.7 |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine20.8 pts worse | 75.6% | 96.4% | 93.7% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine0.7 pts better | 97.7% | 97.0% | 95.3% |
| Percentage of long-stay residents experiencing one or more falls with major injury3.7 pts worse | 6.9% | 3.2% | 3.2% |
| Percentage of long-stay residents who have depressive symptoms2.3 pts better | 0.0% | 2.3% | 13.5% |
| Percentage of long-stay residents who lose too much weight7.2 pts worse | 10.1% | 2.9% | 5.1% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication7.8 pts better | 10.0% | 17.8% | 19.5% |
| Percentage of long-stay residents who received an antipsychotic medication15.2 pts worse | 25.0% | 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 worsened9.9 pts worse | 22.8% | 12.9% | 12.7% |
| Percentage of long-stay residents whose need for help with daily activities has increased11.4 pts worse | 27.2% | 15.8% | 13.5% |
| Percentage of long-stay residents with a catheter inserted and left in their bladder2.4 pts worse | 2.7% | 0.3% | 0.7% |
| Percentage of long-stay residents with a urinary tract infection4.2 pts worse | 5.0% | 0.8% | 1.5% |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence17.6 pts worse | 30.1% | 12.5% | 18.3% |
| Percentage of long-stay residents with pressure ulcers2.2 pts better | 1.5% | 3.7% | 4.5% |
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Fire safety
6 life-safety citations (sprinklers, exits, alarms). These don't count toward the star rating.
Smoke5F
- F
Have approved installation, maintenance and testing program for fire alarm systems.
- F
Inspect, test, and maintain automatic sprinkler systems.
- E
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
- D
Install smoke barrier doors that can resist smoke for at least 20 minutes.
- D
Install corridor and hallway doors that block smoke.
Emergency Preparedness1F
- F
Develop and maintain an Emergency Preparedness Program (EP).
·
Other homes nearby
-
Capstone Healthcare of Perryton
Perryton, TX
★★★★★- Worst citation, 3 yrs
- E
- Nursing / resident / day
- —
- Fines
- $0
-
Beaver County Nursing Home
Beaver, OK
★★★★★- Worst citation, 3 yrs
- J
- Nursing / resident / day
- 3 h 48 min
- Fines
- $15,642
-
Shattuck Nursing Center
Shattuck, OK
★★★★★- Worst citation, 3 yrs
- F
- Nursing / resident / day
- 3 h 51 min
- Fines
- $0