Deficiency Index

Westward Trails Nursing and Rehabilitation

Nacogdoches, Texas · CCN 455959

33 surveys since 2010, 15 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
158
Surveys
33
Harm or worse
15
Immediate jeopardyall corrected before survey
3
The record, 2010–2026
’10’15’20’25’26
No harm recordedHarm or worseNot surveyed
Immediate jeopardy3

Findings at the most serious level CMS records. All were recorded as past non-compliance — corrected before the survey.

Beyond CMS’s monthly file27/33

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

The facility

Certified beds
108
Ownership
For profit - Corporation
Chain
CREATIVE SOLUTIONS IN HEALTHCARE
County
Nacogdoches · rural
Medicare-certified since
1991

CMS ratings

Overall
3
Health inspection
4
Staffing
1
Quality measures
3

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 377 for-profit facilities of 100–127 beds in Texas.

Last survey on record

Nov 20, 2025

354 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 day3.273.25
Registered-nurse hours per resident day0.17—

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

Enforcement

Fines
$25,036 across 3 penalties

Federal civil money penalties and remedies as CMS currently publishes them. Amounts may still be under appeal.

Severity of recent findings

Citations by CMS scope and severity. Rows are harm level, columns are how widespread the finding was.
SeverityIsolatedPatternWidespread
Immediate jeopardyJ28.3%K—L—
Actual harmG—H—I—
No harm, potential for more than minimalD1458.3%E729.2%F14.2%
No harm, potential for minimalA—B—C—
CMS’s current file: 24 of the 158 citations on record.

Most frequently cited here

In CMS’s current monthly file.

  • F6893×

    Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

  • F6572×

    Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.

  • F6772×

    Provide care and assistance to perform activities of daily living for any resident who is unable.

  • F9262×

    Have policies on smoking.

  • F5821×

    Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.

In the surveyor’s words

From the most serious findings on record at Westward Trails Nursing and Rehabilitation, in the surveyor’s own words.

  • Immediate jeopardy, isolatedF689Jun 25, 2025

    Based on observations, interviews, and records review, the facility failed to ensure the resident environment was free of hazards for 1 of 4 residents reviewed for accidents. (Resident #81). The facility failed to ensure the safety and well-being of Resident #81 by not following procedures for exiting residents from the van using the wheelchair lift. The noncompliance was identified as PNC (past noncompliance). The IJ began on 05/28/2025 and ended on 05/28/2025. The facility had corrected the noncompliance before the survey began. This failure could place residents at risk for potential accidents, injuries, harm, or death. […]

  • Immediate jeopardy, isolatedF689Mar 31, 2025

    Based on observation, interview and record review, the facility failed to ensure the resident environment remained as free of accident hazards and each resident received adequate supervision as is possible for 2 of 6 resident (Resident #1 and Resident #2) reviewed for accidents and hazards. 1.The facility failed to ensure Resident #1 did not wander outside of the facility and down the road while wearing a wander guard. On 1/04/2025 Resident #1 while wearing a wander guard left the facility through the front door and was seen walking down the road by another resident's family member who notified the facility of Resident #1's whereabouts. The non-compliance was identified as past non-compliance. The Immediate Jeopardy (IJ) began 01/04/2025 and ended on 01/08/2025. […]

  • No harm, potential for more than minimal, widespreadF812Nov 20, 2025

    Based on interview and record reviews, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety for 1 (Kitchen 1) of 1 kitchen reviewed for food safety requirements .The facility failed to ensure temperatures of foods were checked as required for food safety on 9/1/25, 9/3/25, 9/4/25, 9/7/25 through 9/10/25, 9/13/25 through 9/24/25, 9/26/25, 9/30/25, 10/3/25 through 10/9/25, and 10/11/25 through 11/4/25.This failure could place residents at risk for food-borne illnesses and decreased quality of life.Findings included:Record review of temperature log forms provided by DM indicated: 9/1/25 - No log was provided. 9/3/25 - No temperatures were documented for Supper. 9/4/25 - No log was provided. […]

  • No harm, potential for more than minimal, widespreadF880Feb 3, 2023

    Based on observation, interview, and record review, the facility failed to maintain an infection and prevention control program to help prevent the development and transmission of communicable diseases and infections for 5 of 9 residents reviewed for infection control. (Residents #1, #2, #3, #4 and #9). 1. Med Aide A, CNA A, Restorative Aide, Laundry Staff, and Wound Care Nurse failed to maintain proper donning of facemasks within 3 feet of residents during a COVID-19 outbreak. This failure could place all residents at risk for development and spread of infection. […]

  • No harm, potential for more than minimal, patternF584Aug 19, 2026

    Based on observation, interview, and record review, the facility failed to provide a safe, functional, sanitary, and comfortable environment for 4 of 14 residents reviewed for resident rights. (Resident #19. Resident #37, Resident #73, and Resident #75).1. The facility failed to replace/repair the overbed table with loose trim and chipped edges located in Resident 19's room.2. The facility failed to repair broken and torn drywall at the corner, by the bathroom, of resident living space in Resident #37's room.3. The facility failed to repair broken and missing drywall at the corner at the entrance of resident living space in Resident #73 and Resident #75's room.These failures placed residents at risk of an uncomfortable environment and a diminished quality of life. […]

Read 33 findings in full →The most serious and the most recent: 33 of 158 on record.

Every survey on record

FindingsAt actual harm or above

  • Aug 19, 2026Standard3 findings
  • Nov 20, 2025Complaint1 finding
  • Jun 25, 2025Complaint1 finding · 1 harm
  • May 22, 2025Complaint1 finding
  • Mar 31, 2025Complaint5 findings · 1 harm
  • Apr 24, 2024Standard10 findings
  • Mar 15, 2023Standard6 findings
  • Feb 3, 2023Complaint1 finding
Show the 25 earlier surveys
  • Jan 19, 2022Standard3 findings
  • Oct 15, 2020Standard3 findings
  • Sep 4, 2020Complaint2 findings · 2 harm
  • Oct 11, 2019Complaint1 finding · 1 harm
  • Jun 26, 2019Complaint2 findings
  • Apr 9, 2019Standard3 findings
  • Aug 1, 2018Complaint1 finding
  • Mar 7, 2018Standard3 findings
  • Feb 21, 2018Complaint1 finding
  • Mar 29, 2017Standard6 findings
  • Apr 6, 2016Standard6 findings
  • Oct 15, 2015Complaint1 finding
  • Apr 16, 2015Standard16 findings · 1 harm
  • Oct 14, 2014Complaint2 findings
  • Mar 26, 2014Complaint4 findings · 4 harm
  • Mar 13, 2014Standard7 findings
  • May 15, 2013—2 findings
  • Feb 14, 2013—21 findings
  • Mar 28, 2012—4 findings
  • Dec 15, 2011—1 finding
  • Nov 18, 2011—3 findings
  • Jun 9, 2011—20 findings
  • Mar 15, 2011—11 findings · 5 harm
  • Jan 10, 2011—5 findings
  • Oct 9, 2010—2 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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