Deficiency Index

Belterra Health & Rehab

Mckinney, Texas · CCN 676367

20 surveys since 2015, 5 of them producing a finding at harm level or worse.

Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.

Citations on record
74
Surveys
20
Harm or worse
5
Immediate jeopardy
5
The record, 2015–2026
’15’20’25’26
No harm recordedHarm or worseNot surveyed
Immediate jeopardy5

Findings at the most serious level CMS records.

Beyond CMS’s monthly file17/20

Older surveys no longer in CMS’s monthly file or on Care Compare. They are shown here.

The facility

Certified beds
103
Ownership
Government - Hospital district
Chain
PRIORITY MANAGEMENT
County
Collin
Medicare-certified since
2014

CMS ratings

Overall
4
Health inspection
4
Staffing
3
Quality measures
4

CMS’s own Five-Star ratings.

Compared with similar facilities

Since 2021, this facility recorded somewhat fewer weighted findings than its peer group.

Weighted by harm level, against 104 government-run facilities of 100–127 beds in Texas.

Last survey on record

Apr 23, 2026

200 days ago.

Counts surveys with at least one finding. A clean survey leaves no record here, so the real gap may be shorter.

Staffing

MeasureThis facilityPeer median
Nurse hours per resident day3.393.25
Registered-nurse hours per resident day0.80—
Annual nurse turnover36.7%48.1%

As reported by the facility to CMS, beside the peer-group median.

Enforcement

No fines, payment denials or special-focus designation on the current CMS record.

Severity of recent findings

Citations by CMS scope and severity. Rows are harm level, columns are how widespread the finding was.
SeverityIsolatedPatternWidespread
Immediate jeopardyJ—K—L—
Actual harmG—H—I—
No harm, potential for more than minimalD945.0%E1050.0%F—
No harm, potential for minimalA—B—C15.0%
CMS’s current file: 20 of the 74 citations on record.

Most frequently cited here

In CMS’s current monthly file.

  • F8803×

    Provide and implement an infection prevention and control program.

  • F6902×

    Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.

  • F6952×

    Provide safe and appropriate respiratory care for a resident when needed.

  • F7552×

    Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

  • F7612×

    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.

In the surveyor’s words

From the most serious findings on record at Belterra Health & Rehab, in the surveyor’s own words.

  • No harm, potential for more than minimal, widespreadF812Nov 18, 2021

    Based on observation, interview, and record review, the facility failed to store, prepare, distribute and serve food in accordance with professional standards for food service in the facility's only kitchen. The facility failed to ensure that expired foods in the refrigerator were discarded and foods in the refrigerator and dry storage were sealed and stored correctly. These failures could place residents at risk for food borne illness. Findings included: An observation of the facility's dry storage area on [DATE] at 9:32 AM revealed the following: - A large bottle of creole seasoning had a soft yellow substance on the outside the plastic jar. - A cornbread package, that was left open and exposed, with a tear in the plastic towards the top. […]

  • No harm, potential for more than minimal, patternF655Apr 23, 2026

    Based on observation, interview, and record review, the facility failed to develop and implement a baseline care plan within 48 hours for each resident that includes the instructions needed to provide effective and person-centered care of the resident that meet professional standards of quality care to four of eight residents (Residents #56, #83, #109, and #120) reviewed for baseline care plan. 1. The facility failed to ensure Residents #56 had a baseline care plan after admission to the facility on [DATE]. 2. The facility failed to ensure Residents #83 had a baseline care plan after admission to the facility on [DATE]. 3. The facility failed to ensure Residents #109 had a baseline care plan after admission to the facility on [DATE]. 4. […]

  • No harm, potential for more than minimal, patternF689Apr 23, 2026

    Based on observation, interview, and record review, the facility failed to ensure the residents received adequate supervision to prevent accidents and/or hazards for 3 (Residents #68, #107, and #110) of 8 residents reviewed for supervision and accidents/hazards.1. The facility failed to ensure there were no germicidal wipes on Resident #107's side table on 04/21/2026.2. The facility failed to ensure there were no germicidal wipes on the floor, in front of Resident #110's room on 04/21/2026.3. The facility failed to ensure Resident #68 received adequate supervision allowing Resident #68 to exit the facility without the knowledge of staff on 04/13/2026 for approximately 20 minutes. […]

  • No harm, potential for more than minimal, patternF761Apr 23, 2026

    Based on observation, interview, and record review the facility failed to, in accordance with State and Federal laws, store all drugs and biologicals in locked compartments under proper temperature controls, and permitted only authorized personnel to have access to the keys for five of twenty residents (Residents #63, #71, #79, #102, and #107) and one of four direct care staff (MA K) reviewed for medication storage. 1. The facility failed to ensure that Resident #71 did not have a pain reliever cream inside his room on 04/21/2026. 2. The facility failed to ensure that Resident #102 did not have a tube of zinc oxide and a bottle of multivitamins inside her room on 04/21/2026. 3. The facility failed to ensure that Resident #63 did not have a tube of zinc oxide inside her room on 04/21/2026. […]

  • No harm, potential for more than minimal, patternF880Apr 23, 2026

    Based on observation, interview, and record review the facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for three of twenty residents (Resident #4, #32 and #71) reviewed for infection control. 1. The facility failed to ensure CNA J did not put Resident #4's catheter bag on top of the resident's bed and changed her gloves after touching the catheter bag on 04/22/2026. 2. The facility failed to ensure CNA H performed hand hygiene and changed her gloves during Resident #32's incontinent care on 04/22/2026. 3. […]

Read 25 findings in full →The most serious and the most recent: 25 of 74 on record.

Every survey on record

FindingsAt actual harm or above

  • Apr 23, 2026Standard10 findings
  • Feb 13, 2025Standard5 findings
  • Jan 11, 2024Standard5 findings
  • Dec 13, 2022Complaint1 finding
  • Feb 8, 2022Complaint2 findings
  • Dec 15, 2021Complaint2 findings
  • Nov 18, 2021Complaint5 findings
  • Sep 23, 2021Standard10 findings
Show the 12 earlier surveys
  • Sep 17, 2021Infection control2 findings
  • Jul 13, 2020Complaint1 finding
  • Feb 8, 2020Complaint3 findings · 3 harm
  • Sep 13, 2019Complaint4 findings
  • Apr 4, 2019Complaint3 findings
  • Oct 18, 2018Standard9 findings
  • Jan 11, 2018Complaint1 finding
  • Sep 14, 2017Standard3 findings
  • Dec 14, 2016Complaint2 findings · 2 harm
  • Sep 15, 2016Standard2 findings
  • Aug 18, 2016Complaint1 finding
  • Sep 10, 2015Standard3 findings

Surveys that found no deficiencies are not in CMS’s files and do not appear here.

Comparable facilities

The nearest facilities to this one in the same peer group, by weighted findings.

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