Legend Oaks Healthcare and Rehabilitation-Kyle
Legend Oaks Healthcare and Rehabilitation-Kyle is a 126-bed nursing home in Kyle, Texas. CMS has certified it for Medicare and Medicaid since 2011-02-08. It averages 115.9 residents a day.
What harm was found in the violations cited at Legend Oaks Healthcare and Rehabilitation-Kyle?
CMS lists 29 health-inspection deficiencies for Legend Oaks Healthcare and Rehabilitation-Kyle since 2023-06-30, 21 of them in the three years to 2026-08-01: the highest scope-and-severity letter on record is G; the most recent health inspection was 2026-05-26.
| Survey date | Tag | Deficiency | Severity |
|---|---|---|---|
| 2026-05-26 | F0695, F0842 | Provide safe and appropriate respiratory care for a resident when needed. / Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | E |
| 2026-01-29 | F0584 | 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 |
| 2026-01-29 | F0552 | Ensure that residents are fully informed and understand their health status, care and treatments. | D |
| 2025-12-12 | F0686 | Provide appropriate pressure ulcer care and prevent new ulcers from developing. | G |
| 2025-12-12 | F0812 | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | F |
| 2025-12-12 | F0636, F0880 | Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months. / Provide and implement an infection prevention and control program. | D |
| 2024-11-20 | F0880 | Provide and implement an infection prevention and control program. | E |
| 2024-11-20 | F0600 | Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | D |
| 2024-09-05 | F0550, F0583, F0812 | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. / Keep residents' personal and medical records private and confidential. / Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | E |
| 2024-09-05 | F0578, F0677, F0791, F0919 | 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. / Provide care and assistance to perform activities of daily living for any resident who is unable. / Provide or obtain dental services for each resident. / Make sure that a working call system is available in each resident's bathroom and bathing area. | D |
| 2023-11-21 | F0609 | Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | D |
| 2023-08-10 | F0552, F0658, F0758 | Ensure that residents are fully informed and understand their health status, care and treatments. / Ensure services provided by the nursing facility meet professional standards of quality. / 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. | E |
| 2023-06-30 | F0755, F0812 | Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. / Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | E |
| 2023-06-30 | F0578, F0684, F0698, F0758, F0805, F0814 | 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. / Provide appropriate treatment and care according to orders, resident’s preferences and goals. / Provide safe, appropriate dialysis care/services for a resident who requires such services. / 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. / Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. / Dispose of garbage and refuse properly. | D |
Why was Legend Oaks Healthcare and Rehabilitation-Kyle fined?
| Date | Type | Amount |
|---|---|---|
| 2025-12-12 | Fine | $8,407 |
How is Legend Oaks Healthcare and Rehabilitation-Kyle staffed relative to the TX average?
| Measure | This facility | TX average |
|---|---|---|
| Total nurse staffing hours per resident per day | 3.38222 | 3.38539 |
| Total nursing staff turnover (%) | 38.1 | 55.3 |
| Average number of residents per day | 115.9 | 75.8 |
Who owns Legend Oaks Healthcare and Rehabilitation-Kyle, and what chain is it in?
Legend Oaks Healthcare and Rehabilitation-Kyle is registered with CMS as For profit - Limited Liability company, operates under the legal business name GUADALUPE COUNTY HOSPITAL BOARD and belongs to the THE ENSIGN GROUP chain.
| Role | Owner | Association date |
|---|---|---|
| 5% OR GREATER DIRECT OWNERSHIP INTEREST | GUADALUPE COUNTY HOSPITAL BOARD | since 04/01/2017 |
| MANAGING CONTROL - GOVERNING BODY | FOWERS, MATTHEW, KROL, MICHAEL | since 03/12/2019 |
| CORPORATE OFFICER | BURNAM, SOON, GANN, KODY, KEETCH, CHAD | since 02/01/2021 |
| OPERATIONAL/MANAGERIAL CONTROL | TREATY HEALTHCARE, INC, FOWERS, MATTHEW, KROL, MICHAEL | since 03/12/2019 |
| ADP OF THE SNF | ENSIGN SERVICES INC, NATIONAL HEALTH INVESTORS, INC., TEXAS NHI INVESTORS, LLC, TREATY HEALTHCARE, INC, FOWERS, MATTHEW, KROL, MICHAEL | since 03/12/2019 |
Were you or a family member harmed at Legend Oaks Healthcare and Rehabilitation-Kyle?