Map showing the location of Avir at Town Creek in PALESTINE, Texas
1816 TILE FACTORY RD, PALESTINE, TX, 75801

Overall Score

CMS Five-Star Quality Rating
1/5Much below averageCMS Five-Star overall rating
  1. Much below average
  2. Below average
  3. Average
  4. Above average
  5. Much above average

Where it ranks

  • TexasLowest tier among peers1,167 rated homes · average 2.8★
  • Anderson CountyLowest tier among peers6 rated homes · average 3.2★
  • United StatesLowest tier among peers14,574 rated homes · average 3.0★

How the rating is built

  • Health inspectionsStarting point1★−1.8 vs TX avg
  • StaffingCan add or remove a star4★+1.9 vs TX avg
  • Quality measuresCan add or remove a star3★−0.8 vs TX avg

CMS starts from the health inspection stars, then adds or subtracts a star for staffing and for quality measures. Stars are assigned relative to other facilities in the same state.

Ratings & measures

Tap a row to see what it means
Health inspection ratingCMS stars from the last three on-site inspection cycles1★Lowest tier among peersTX avg2.8★U.S. avg2.8★
What is health inspection rating?

Stars assigned from the last three standard surveys and every complaint investigation in that window, weighted toward the most recent and the most serious findings. CMS assigns these stars relative to other facilities in the same state.

Why it matters

It carries the most weight in the overall rating and is the only domain based on what trained inspectors saw on site rather than what the facility reported.

Staffing ratingCMS stars from payroll-reported hours and turnover4★Above 88% of peersTX avg2.1★U.S. avg2.9★
What is staffing rating?

Nurse and aide hours per resident day from payroll records CMS collects every quarter, adjusted for how much care residents need, plus staff turnover and weekend coverage.

Why it matters

More hours and lower turnover are the strongest predictors of fewer falls, pressure sores, and avoidable hospital stays.

Quality measures ratingCMS stars from clinical outcomes and resident assessments3★Above only 15% of peersTX avg3.8★U.S. avg3.6★
What is quality measures rating?

Clinical outcomes from resident assessments and Medicare claims: falls with injury, pressure ulcers, hospitalizations, antipsychotic use, and more, for both short-stay and long-stay residents.

Why it matters

It shows whether care is working, but part of it comes from the facility’s own assessments, so read it alongside the inspection results.

Total nurse hoursPer resident per day, all nursing staff4.45hrsTop 7%TX avg3.40Benchmark4.10
What is total nurse hours?

All licensed nurse and aide hours worked, divided by the number of residents, on an average day. Reported from payroll, not self-reported.

Why it matters

Federal research links 4.1 hours a day to fewer avoidable harms. Below about 3 hours, residents wait longer for help with basics like toileting and repositioning.

RN hoursPer resident per day, registered nurses only0.68hrsTop 10%TX avg0.44Benchmark0.75
What is rn hours?

Registered nurse hours only. RNs assess residents, manage medications, and catch changes in condition; LPNs and aides deliver most hands-on care.

Why it matters

RN coverage is the staffing measure most tied to fewer hospital transfers and infections, and it is where thinly staffed facilities cut first.

Nursing staff turnoverShare of nursing staff who left within a year · lower is better53%Above only 44% of peersTX avg51%RN turnover60%
What is nursing staff turnover?

The share of nursing staff who left within the past year, from the same payroll data.

Why it matters

High turnover means residents are cared for by people who do not know them, and it is one of the strongest predictors of inspection problems.

Fines in the last three yearsCivil money penalties imposed by CMS · lower is better$76,268Above only 22% of peersTX avg$55,368Fines · denials3 · 1
What is fines in the last three years?

Civil money penalties CMS imposed after serious or uncorrected deficiencies, and denials of Medicare payment for new admissions.

Why it matters

Penalties follow the worst inspection findings. A recent fine is the clearest sign that inspectors found real harm.

Inspection history

Last three inspection cycles
29citations
8inspection dates
2actual harm (G–I)
5immediate jeopardy (J–L)
Aug 13, 2025most recent

Citations by monthJun 2023 – Aug 2025

  • No actual harm (D–F)
  • Actual harm (G–I)
  • Immediate jeopardy (J–L)
  • $Fine or payment denial

Click a month or a year to filter the findings below. Arrow keys move between months; Esc clears.

Aug 13, 20256 citationsCycle 1worst E · no actual harm
  1. F812Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.Nutrition and DietaryE · patternCorrected Sep 2, 2025
  2. F926Have policies on smoking.EnvironmentalD · isolatedCorrected Sep 2, 2025
  3. F880Provide and implement an infection prevention and control program.Infection ControlE · patternCorrected Sep 2, 2025
  4. F583Keep residents' personal and medical records private and confidential.Resident RightsD · isolatedCorrected Sep 2, 2025
  5. F584Honor 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.Resident RightsD · isolatedCorrected Sep 2, 2025
  6. F693Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube.Quality of Life and CareD · isolatedCorrected Sep 2, 2025
Mar 25, 20252 citationsCycle 2worst E · no actual harm
  1. F813Have a policy regarding use and storage of foods brought to residents by family and other visitors.Nutrition and DietaryD · isolatedCorrected Mar 28, 2025
  2. F677Provide care and assistance to perform activities of daily living for any resident who is unable.Quality of Life and CareE · patternCorrected Mar 28, 2025
Feb 3, 20252 citationsCycle 1worst H · actual harm$17,345
  1. Provide appropriate treatment and care according to orders, resident’s preferences and goals.Quality of Life and CareH · patternCorrected Jan 27, 2025
  2. F917Make sure each resident has 1) at least one window to the outside in a room; 2) a room at or above ground level; 3) adequate bedding; 4) furniture that meets the resident's needs; or 5) adequate closet space.EnvironmentalH · patternCorrected Jan 27, 2025
Oct 1, 20245 citationsCycle 3worst F · no actual harm
  1. F880Provide and implement an infection prevention and control program.Infection ControlD · isolatedCorrected Oct 31, 2024
  2. F727Have 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.Nursing and Physician ServicesF · widespreadCorrected Oct 31, 2024
  3. F758Implement 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.Pharmacy ServiceD · isolatedCorrected Oct 31, 2024
  4. F812Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.Nutrition and DietaryF · widespreadCorrected Oct 31, 2024
  5. F851Electronically submit to CMS complete and accurate direct care staffing information, based on payroll and other verifiable and auditable data.AdministrationF · widespreadCorrected Oct 31, 2024
Nov 29, 20231 citationCycle 3worst D · no actual harm
  1. F880Provide and implement an infection prevention and control program.Infection ControlD · isolatedCorrected Dec 26, 2023
Oct 26, 20234 citationsCycle 3worst E · no actual harm
  1. F600Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.Freedom from Abuse, Neglect, and ExploitationE · patternCorrected Oct 27, 2023
  2. F689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.Quality of Life and CareD · isolatedCorrected Oct 27, 2023
  3. F609Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.Freedom from Abuse, Neglect, and ExploitationD · isolatedCorrected Oct 27, 2023
  4. F607Develop and implement policies and procedures to prevent abuse, neglect, and theft.Freedom from Abuse, Neglect, and ExploitationE · patternCorrected Oct 27, 2023
Aug 9, 20232 citationsCycle 3worst J · immediate jeopardy
  1. F602Protect each resident from the wrongful use of the resident's belongings or money.Freedom from Abuse, Neglect, and ExploitationE · patternCorrected Aug 10, 2023
  2. F607Develop and implement policies and procedures to prevent abuse, neglect, and theft.Freedom from Abuse, Neglect, and ExploitationJ · isolatedCorrected Aug 10, 2023
Jun 28, 20237 citationsCycle 3worst K · immediate jeopardy$27,203, payment denial
  1. F755Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.Pharmacy ServiceD · isolatedCorrected Jun 29, 2023
  2. F880Provide and implement an infection prevention and control program.Infection ControlD · isolatedCorrected Jun 29, 2023
  3. F740Ensure each resident must receive and the facility must provide necessary behavioral health care and services.Quality of Life and CareK · patternCorrected Jun 29, 2023
  4. F689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.Quality of Life and CareJ · isolatedCorrected Jun 29, 2023
  5. F607Develop and implement policies and procedures to prevent abuse, neglect, and theft.Freedom from Abuse, Neglect, and ExploitationK · patternCorrected Aug 10, 2023
  6. F602Protect each resident from the wrongful use of the resident's belongings or money.Freedom from Abuse, Neglect, and ExploitationE · patternCorrected Aug 10, 2023
  7. F600Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.Freedom from Abuse, Neglect, and ExploitationK · patternCorrected Aug 10, 2023

Staffing

From quarterly payroll reports

Hours per resident per day

  • All nursing staffRNs, LPNs and aides combined4.45hrsTop 7%+1.05 vs TX avg
  • Registered nursesRN hours only0.68hrsTop 10%+0.24 vs TX avg
  • Licensed practical nursesLPN hours1.55hrs
  • Nurse aidesCNA hours2.22hrs
  • Weekend nursingAll staff on Saturdays and Sundays4.02hrs
  • Texas average
  • Research benchmark (4.10 total, 0.75 RN)

Turnover & capacity

  • Nursing staff turnoverShare who left within a year · lower is better53%Above only 44% of peersTX avg 51%
  • RN turnoverRegistered nurses only60%Not ranked by CMS
  • Administrators who leftIn the past year1Leadership changed
  • Occupancy102 certified beds · ~30 residents a day29%Above only 1% of peersTX avg 67%

Fines & penalties

Roughly the past three years

Enforcement summary

  • $76,268In fines
  • 3Fines
  • 1Payment denial
  • $55,368TX avg in fines
Above only 22% of peersFewer fines than 22% of rated homes in Texas

Actions on record

  1. Feb 3, 2025Civil money penalty$17,345
  2. Apr 5, 2024Civil money penalty$31,720
  3. Jun 28, 2023Civil money penalty$27,203
  4. Jun 28, 2023Denial of payment for new admissionsfrom Jul 28, 2023

Ownership

As filed with CMS

Structure

Ownership type
For profit - Limited Liability company
Chain
Avir Health Group79 facilities in the chain2.2★ chain average
Certification
Medicare and Medicaid
Location type
Rural
Ownership change
None in the last 12 months

People and entities on file

Direct owners (5%+)
  • Winnie-Stowell Hospital District
Operational or managerial control
  • Slp Palestine LLC
  • Joshua Leonard
Corporate directors
  • Edward Murrell
Mortgage or security interest (5%+)
  • Carlisle Taylor Whitworth 2020 Irrevocable Trust
  • Gary Scott Whitworth 2019 Irrevocable Trust
  • Lqcp Management, LLC
  • Wm 41 Palestine Re, LLC
  • Wm-Lqc Mm, LLC
  • Wt Holdings, LP

Person Organization

Sources & notes

Public data, updated quarterly

Data sources

  • CMS Care Compare · Provider InformationStar ratings, staffing hours, turnover, penalties and flags · processed February 2026.
  • CMS Health CitationsEvery deficiency from the last three inspection cycles, with scope, severity and inspection cycle.
  • CMS Penalties and Ownership filesCivil money penalties, payment denials, and the owners and managers on file.

Notes

  • CMS Certification Number 455565 · 1816 TILE FACTORY RD, PALESTINE, TX, 75801.
  • Percentiles compare this facility with every rated nursing home in Texas and Anderson County. Turnover and fines are inverted so a high percentile is always good.
  • This is an informational summary of public data, not medical, legal, or placement advice. Facilities cannot pay to change it; a facility that believes a record is wrong can dispute it with CMS.

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