College Street Health Care Center
Beaumont, Texas · CCN 675695
18 surveys since 2011, 2 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
- 113
- Surveys
- 18
- Harm or worse
- 2
- Immediate jeopardy
- 0
Findings where a surveyor recorded actual harm to a resident.
Older surveys no longer in CMS’s monthly file or on Care Compare. They are shown here.
The facility
- Certified beds
- 50
- Ownership
- Government - Hospital district
- Chain
- HEALTH SERVICES MANAGEMENT
- County
- Jefferson
- Medicare-certified since
- 1997
CMS ratings
- Overall
- 4
- Health inspection
- 4
- Staffing
- 2
- Quality measures
- 2
CMS’s own Five-Star ratings.
Compared with similar facilities
Since 2021, this facility recorded somewhat more weighted findings than its peer group.
Weighted by harm level, against 24 government-run facilities with fewer than 66 beds in Texas.
Last survey on record
Aug 6, 2025
460 days ago.
Counts surveys with at least one finding. A clean survey leaves no record here, so the real gap may be shorter.
Staffing
| Measure | This facility | Peer median |
|---|---|---|
| Nurse hours per resident day | 3.52 | 4.31 |
| Registered-nurse hours per resident day | 0.30 | — |
| Annual nurse turnover | 55.6% | 52.2% |
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
| Severity | Isolated | Pattern | Widespread |
|---|---|---|---|
| Immediate jeopardy | J— | K— | L— |
| Actual harm | G14.5% | H— | I— |
| No harm, potential for more than minimal | D1463.6% | E731.8% | F— |
| No harm, potential for minimal | A— | B— | C— |
Most frequently cited here
In CMS’s current monthly file.
- F8803×
Provide and implement an infection prevention and control program.
- F6562×
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
- F7552×
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
- F5781×
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.
- F5801×
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
In the surveyor’s words
From the most serious findings on record at College Street Health Care Center, in the surveyor’s own words.
- Actual harm, isolatedF600Jun 14, 2023
Based on interview and record review the facility failed to ensure residents were free from abuse for 1 of 14 residents (Resident #14) reviewed for resident abuse. The facility did not ensure Resident #14 was free from abuse, as a result Resident #14 was physically assaulted by Resident #138 and was injured. This failure could place residents at risk of physical harm, mental anguish, or emotional distress. The noncompliance was identified as PNC. The noncompliance began on 4/9/23 and ended on 4/18/23. The facility had corrected the noncompliance before the survey began. The findings included: 1. […]
- No harm, potential for more than minimal, patternF580Aug 6, 2025
Based on interview and record review, the facility failed to ensure the physician was consulted regarding a need to alter treatment for 2 of 13 residents reviewed for notification of changes. (Resident #16 and Resident #24) The facility did not consult with Resident #16's physician about the pattern of low blood pressure over consecutive days and of the blood pressure medication being held for 52 of 60 opportunities in July 2025 or 9 of 12 opportunities for August 2025. The facility did not consult with Resident #24's physician about the pattern of low blood pressure over consecutive days and of the blood pressure medication being held for 7 of 31 opportunities in July 2025 or 3 of 6 opportunities for August 2025. […]
- No harm, potential for more than minimal, patternF755Aug 6, 2025
Based on observation, interview, and record review, the facility failed to provide pharmaceutical services including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals to meet the needs of each resident for 2 of 7 residents (CR #1 and CR #2) reviewed for pharmacy services. The facility failed to ensure 20 boxes of Fiberone chocolate donuts that expired 06/08/25, (58 days expired) were removed from use. The facility failed to ensure discharged residents' (CR #1 and CR #2) medications were removed from use. […]
- No harm, potential for more than minimal, patternF756Aug 6, 2025
Based on interview and record review, the facility failed to ensure any drug regimen irregularities were accurately reported by the pharmacist consultant for 2 of 13 residents reviewed for pharmacy services. (Resident #16 and Resident #24) The Pharmacy Consultant failed to thoroughly review the medication regimen and identify possible and/or actual irregularities in the blood pressure and heart rate for Residents #16 and #24. The failure could place residents at risk of receiving inaccurate administration of medications which could result in possible adverse effects or residents not receiving therapeutic benefits of medications. Findings included: 1. […]
- No harm, potential for more than minimal, patternF761Aug 6, 2025
Based on observation, interview, and record review, the facility failed to ensure all drugs and biological were labeled, stored under proper temperature controls and in accordance with currently accepted professional principles for 1 of 1 medication rooms and 1 of 1 medication refrigerators reviewed for storage of medication and biologicals. The facility failed to store medications within recommended temperature range in the medication refrigerator in the medication storage room. The facility failed to ensure that there were not 3-4 inches of ice build-up and no standing water in the medication storage refrigerator. The facility failed to ensure there was no stool specimen comingled with medications and stored in the medication room refrigerator. […]
Read 21 findings in full →The most serious and the most recent: 21 of 113 on record.
Every survey on record
FindingsAt actual harm or above
- Aug 6, 2025Standard6 findings
- Jun 3, 2025Complaint3 findings
- Jul 17, 2024Standard3 findings
- Jun 14, 2023Standard and complaint11 findings · 1 harm
- May 11, 2022Standard4 findings
- May 28, 2021Infection control1 finding
- Feb 4, 2020Standard6 findings
- Apr 24, 2019Standard8 findings
Show the 10 earlier surveys
- Jun 13, 2018Standard3 findings
- Jul 12, 2017Standard7 findings
- Aug 17, 2016Standard6 findings
- Sep 2, 2015Standard2 findings
- Sep 30, 2014Standard8 findings
- Jun 25, 2014Complaint4 findings · 1 harm
- Dec 10, 2013—12 findings
- Jan 10, 2013—22 findings
- Feb 14, 2012—3 findings
- Mar 2, 2011—4 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.
Deficiency Index is independent and is not affiliated with, endorsed by, or approved by CMS, Medicare, or any government agency. About this data · Report a correction