Merkel Nursing Center
1704 N. 1st, Merkel, TX 79536
Merkel Nursing Center is a nursing home in Merkel, Texas. This page lists the citations, fines and star ratings that CMS publishes for it. Each one has a date and a link to CMS.
Special Focus Facility candidate
CMS puts a small number of homes in this program. CMS inspects them more often until they meet the program's exit rules.
CMS abuse icon
CMS adds this icon when it cites a home for abuse that hurt a resident in the past year. It also adds it when it cites a home for abuse that could have hurt someone, in each of the past two years.
CMS star ratings
- 1 of 5CMS overall star rating
- 1 of 5CMS health inspection star rating
- 1 of 5CMS staffing star rating
- 1 of 5CMS quality measures star rating
Facts from CMS
- Phone
- (325) 928-5673
- Last standard health inspection
- December 4, 2025 (11 months ago)
- Certified beds
- 65
- Residents per day, on average
- 3.8
- Ownership type
- For profit - Limited Liability company
- Legal business name
- Emi Healthcare LLC
- Chain
- Not listed by CMS
- Takes part in
- Medicare and Medicaid
More health citations than the Texas average (64 vs 28).
Inspections, fines and changes
This list shows every citation and fine in CMS's current data, which covers about the last three years. It also shows changes CMS made to this home's ratings and records.
CMS update of October 28, 2026
Star rating
The CMS staffing star rating changed from 3 of 5 to 1 of 5.
Fine
CMS changed the fine from February 16, 2026 from $137,108 to $139,586.
CMS update of October 8, 2026
Fine
CMS changed the fine from February 16, 2026 from $210,935 to $137,108.
CMS update of July 29, 2026
Star rating
The CMS staffing star rating changed from 2 of 5 to 3 of 5.
Fine
CMS changed the fine from August 22, 2025 from $178,172 to $180,952.
CMS update of May 27, 2026
Fine
CMS changed the fine from August 22, 2025 from $274,110 to $178,172.
Fine
CMS changed the fine from February 16, 2026 from $204,535 to $210,935.
CMS update of April 29, 2026
Star rating
The CMS staffing star rating changed from 4 of 5 to 2 of 5.
Special Focus Facility
CMS now lists this home as a Special Focus Facility candidate.
CMS abuse icon
CMS added its abuse icon to this home.
Staffing
Total nurse staffing reported to CMS went from 3.8 to 3.2 hours per resident per day.
CMS update of February 25, 2026
Star rating
The CMS staffing star rating changed from 3 of 5 to 4 of 5.
Star rating
The CMS quality measures star rating changed from 2 of 5 to 1 of 5.
Fine
CMS changed the fine from August 22, 2025 from $106,110 to $274,110.
8 citations
Health inspection on February 16, 2026
CMS lists this as a complaint inspection.
Severity K is the highest of CMS's four levels. CMS uses it when residents' health or safety is at serious risk right away.
129 of 1,177 Texas homes (11%) got a citation at the immediate jeopardy level in 2026.
Citation F0600. Severity K: immediate jeopardy, pattern.
The rule CMS cited:
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
CMS lists it as corrected on March 4, 2026.
Citation F0689. Severity K: immediate jeopardy, pattern.
The rule CMS cited:
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
CMS lists it as corrected on March 4, 2026.
CMS has cited this home for F0689 3 times since 2024.
Citation F0725. Severity K: immediate jeopardy, pattern.
The rule CMS cited:
Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.
CMS lists it as corrected on March 4, 2026.
Citation F0726. Severity K: immediate jeopardy, pattern.
The rule CMS cited:
Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being.
CMS lists it as corrected on March 4, 2026.
Citation F0727. Severity F: potential for more than minimal harm, widespread.
The rule CMS cited:
Have 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.
CMS lists it as corrected on March 4, 2026.
CMS has cited this home for F0727 2 times since 2023.
Citation F0728. Severity F: potential for more than minimal harm, widespread.
The rule CMS cited:
Ensure that nurse aides who have worked more than 4 months, are trained and competent; and nurse aides who have worked less than 4 months are enrolled in appropriate training.
CMS lists it as corrected on March 4, 2026.
CMS has cited this home for F0728 2 times since 2024.
Citation F0881. Severity F: potential for more than minimal harm, widespread.
The rule CMS cited:
Implement a program that monitors antibiotic use.
CMS lists it as corrected on March 4, 2026.
Citation F0882. Severity F: potential for more than minimal harm, widespread.
The rule CMS cited:
Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home.
CMS lists it as corrected on March 4, 2026.
Fine
February 16, 2026 (8 months ago)
CMS fine of $139,586 on February 16, 2026.
13 citations
Health inspection on December 4, 2025
CMS lists this as a standard inspection.
Citation F0867. Severity F: potential for more than minimal harm, widespread.
The rule CMS cited:
Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.
CMS lists it as corrected on January 7, 2026.
Citation F0695. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Provide safe and appropriate respiratory care for a resident when needed.
CMS lists it as corrected on January 7, 2026.
CMS has cited this home for F0695 2 times since 2024.
Citation F0849. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services.
CMS lists it as corrected on January 7, 2026.
Citation F0909. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Regularly inspect all bed frames, mattresses, and bed rails (if any) for safety; and all bed rails and mattresses must attach safely to the bed frame.
CMS lists it as corrected on January 7, 2026.
CMS has cited this home for F0909 2 times since 2024.
Citation F0940. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Develop, implement, and/or maintain an effective training program for all new and existing staff members.
CMS lists it as corrected on January 7, 2026.
Citation F0941. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Develop, implement, and/or maintain an effective training program that includes effective communications for direct care staff members.
CMS lists it as corrected on January 7, 2026.
CMS has cited this home for F0941 2 times since 2024.
Citation F0942. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Ensure that staff members are educated on resident rights and facility responsibilities to properly care for its residents.
CMS lists it as corrected on January 7, 2026.
Citation F0943. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Give their staff education on dementia care, and what abuse, neglect, and exploitation are; and how to report abuse, neglect, and exploitation.
CMS lists it as corrected on January 7, 2026.
Citation F0944. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Conduct mandatory training, for all staff, on the facility’s Quality Assurance and Performance Improvement Program.
CMS lists it as corrected on January 7, 2026.
CMS has cited this home for F0944 2 times since 2024.
Citation F0945. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Include as part of its infection prevention and control program, mandatory training that includes written standards, policies, and procedures for the program.
CMS lists it as corrected on January 7, 2026.
Citation F0949. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Provide behavior health training consistent with the requirements and as determined by a facility assessment.
CMS lists it as corrected on January 7, 2026.
CMS has cited this home for F0949 2 times since 2024.
Citation F0842. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
CMS lists it as corrected on January 7, 2026.
CMS has cited this home for F0842 2 times since 2024.
Citation F0880. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Provide and implement an infection prevention and control program.
CMS lists it as corrected on January 7, 2026.
CMS has cited this home for F0880 4 times since 2023.
5 citations
Fire safety inspection on December 4, 2025
CMS lists this as a standard inspection.
Citation K0211. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Keep aisles, corridors, and exits free of obstruction in case of emergency.
CMS lists it as corrected on January 31, 2026.
Citation K0321. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
CMS lists it as corrected on January 31, 2026.
Citation K0511. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Have properly installed electrical wiring and gas equipment.
CMS lists it as corrected on January 31, 2026.
Citation K0923. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Have proper medical gas storage and administration areas.
CMS lists it as corrected on January 31, 2026.
Citation K0521. Severity C: potential for minimal harm, widespread.
The rule CMS cited:
Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.
CMS lists it as corrected on January 12, 2026.
CMS has cited this home for K0521 3 times since 2023.
CMS update of November 20, 2025
Star rating
The CMS overall star rating changed from 2 of 5 to 1 of 5. CMS changed how it scores this rating for many homes at once.
Star rating
The CMS health inspection star rating changed from 2 of 5 to 1 of 5. CMS changed how it scores this rating for many homes at once.
8 citations
Health inspection on August 22, 2025
CMS lists this as a complaint inspection.
Severity K is the highest of CMS's four levels. CMS uses it when residents' health or safety is at serious risk right away.
407 of 1,177 Texas homes (35%) got a citation at the immediate jeopardy level in 2025.
Citation F0689. Severity K: immediate jeopardy, pattern.
The rule CMS cited:
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
CMS lists it as corrected on September 1, 2025.
Citation F0801. Severity F: potential for more than minimal harm, widespread.
The rule CMS cited:
Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician.
CMS lists it as corrected on September 25, 2025.
Citation F0835. Severity F: potential for more than minimal harm, widespread.
The rule CMS cited:
Administer the facility in a manner that enables it to use its resources effectively and efficiently.
CMS lists it as corrected on September 15, 2025.
Citation F0838. Severity F: potential for more than minimal harm, widespread.
The rule CMS cited:
Conduct and document a facility-wide assessment to determine what resources are necessary to care for residents competently during both day-to-day operations (including nights and weekends) and emergencies.
CMS lists it as corrected on September 16, 2025.
Citation F0607. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
CMS lists it as corrected on September 17, 2025.
CMS has cited this home for F0607 2 times since 2024.
Citation F0609. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
CMS lists it as corrected on September 17, 2025.
Citation F0610. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Respond appropriately to all alleged violations.
CMS lists it as corrected on September 17, 2025.
Citation F0844. Severity C: potential for minimal harm, widespread.
The rule CMS cited:
Follow rules about disclosure of ownership requirements and tell the state agency about changes in ownership and/or administrative personnel.
CMS lists it as corrected on September 18, 2025.
Fine
August 22, 2025 (1 year ago)
CMS fine of $180,952 on August 22, 2025.
CMS update of July 30, 2025
Star rating
The CMS overall star rating changed from 1 of 5 to 2 of 5. CMS changed how it scores this rating for many homes at once.
Star rating
The CMS staffing star rating changed from 1 of 5 to 3 of 5.
CMS update of April 30, 2025
Star rating
The CMS overall star rating changed from 2 of 5 to 1 of 5.
Star rating
The CMS staffing star rating changed from 2 of 5 to 1 of 5.
CMS update of February 26, 2025
Star rating
The CMS overall star rating changed from 1 of 5 to 2 of 5. CMS changed how it scores this rating for many homes at once.
Star rating
The CMS staffing star rating changed from 3 of 5 to 2 of 5.
Star rating
The CMS quality measures star rating changed from 1 of 5 to 2 of 5. CMS changed how it scores this rating for many homes at once.
Staffing
Total nurse staffing reported to CMS went from 3.9 to 3.3 hours per resident per day.
1 citation
Health inspection on December 12, 2024
CMS lists this as a complaint inspection.
Citation F0880. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Provide and implement an infection prevention and control program.
CMS lists it as corrected on January 1, 2025.
CMS update of October 30, 2024
Star rating
The CMS staffing star rating changed from 2 of 5 to 3 of 5.
6 citations
Health inspection on October 17, 2024
CMS lists this as a complaint inspection.
Citation F0580. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
CMS lists it as corrected on November 8, 2024.
Citation F0656. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
CMS lists it as corrected on November 8, 2024.
CMS has cited this home for F0656 2 times since 2024.
Citation F0842. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
CMS lists it as corrected on November 8, 2024.
Citation F0926. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Have policies on smoking.
CMS lists it as corrected on November 8, 2024.
Citation F0655. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
CMS lists it as corrected on November 8, 2024.
Citation F0657. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
CMS lists it as corrected on November 8, 2024.
19 citations
Health inspection on July 31, 2024
CMS lists this as a standard inspection and a complaint inspection.
Citation F0868. Severity F: potential for more than minimal harm, widespread.
The rule CMS cited:
Have the Quality Assessment and Assurance group have the required members and meet at least quarterly
CMS lists it as corrected on September 15, 2024.
CMS has cited this home for F0868 2 times since 2023.
Citation F0550. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
CMS lists it as corrected on September 1, 2024.
Citation F0656. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
CMS lists it as corrected on September 1, 2024.
Citation F0689. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
CMS lists it as corrected on September 5, 2024.
Citation F0695. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Provide safe and appropriate respiratory care for a resident when needed.
CMS lists it as corrected on September 5, 2024.
Citation F0728. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Ensure that nurse aides who have worked more than 4 months, are trained and competent; and nurse aides who have worked less than 4 months are enrolled in appropriate training.
CMS lists it as corrected on September 15, 2024.
Citation F0803. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.
CMS lists it as corrected on September 2, 2024.
Citation F0812. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
CMS lists it as corrected on September 2, 2024.
CMS has cited this home for F0812 2 times since 2023.
Citation F0880. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Provide and implement an infection prevention and control program.
CMS lists it as corrected on September 2, 2024.
Citation F0909. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Regularly inspect all bed frames, mattresses, and bed rails (if any) for safety; and all bed rails and mattresses must attach safely to the bed frame.
CMS lists it as corrected on August 20, 2024.
Citation F0558. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Reasonably accommodate the needs and preferences of each resident.
CMS lists it as corrected on September 1, 2024.
CMS has cited this home for F0558 2 times since 2023.
Citation F0607. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
CMS lists it as corrected on September 15, 2024.
Citation F0686. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
CMS lists it as corrected on September 1, 2024.
Citation F0576. Severity C: potential for minimal harm, widespread.
The rule CMS cited:
Ensure residents have reasonable access to and privacy in their use of communication methods.
CMS lists it as corrected on August 31, 2024.
Citation F0680. Severity C: potential for minimal harm, widespread.
The rule CMS cited:
Ensure the activities program is directed by a qualified professional.
CMS lists it as corrected on August 19, 2024.
Citation F0732. Severity B: potential for minimal harm, pattern.
The rule CMS cited:
Post nurse staffing information every day.
CMS lists it as corrected on September 5, 2024.
Citation F0941. Severity B: potential for minimal harm, pattern.
The rule CMS cited:
Develop, implement, and/or maintain an effective training program that includes effective communications for direct care staff members.
CMS lists it as corrected on September 5, 2024.
Citation F0944. Severity B: potential for minimal harm, pattern.
The rule CMS cited:
Conduct mandatory training, for all staff, on the facility’s Quality Assurance and Performance Improvement Program.
CMS lists it as corrected on September 5, 2024.
Citation F0949. Severity B: potential for minimal harm, pattern.
The rule CMS cited:
Provide behavior health training consistent with the requirements and as determined by a facility assessment.
CMS lists it as corrected on September 5, 2024.
3 citations
Fire safety inspection on July 31, 2024
CMS lists this as a standard inspection.
Citation E0039. Severity F: potential for more than minimal harm, widespread.
The rule CMS cited:
Conduct testing and exercise requirements.
CMS lists it as corrected on September 30, 2024.
Citation K0353. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Inspect, test, and maintain automatic sprinkler systems.
CMS lists it as corrected on October 1, 2024.
Citation K0521. Severity C: potential for minimal harm, widespread.
The rule CMS cited:
Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.
CMS lists it as corrected on October 1, 2024.
1 citation
Health inspection on December 15, 2023
CMS lists this as a complaint inspection.
Citation F0908. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Keep all essential equipment working safely.
CMS lists it as corrected on December 20, 2023.
8 citations
Health inspection on June 8, 2023
CMS lists this as a standard inspection.
Citation F0558. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Reasonably accommodate the needs and preferences of each resident.
CMS lists it as corrected on July 7, 2023.
Citation F0567. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Honor the resident's right to manage his or her financial affairs.
CMS lists it as corrected on July 7, 2023.
Citation F0711. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Ensure the resident's doctor reviews the resident's care, writes, signs and dates progress notes and orders, at each required visit.
CMS lists it as corrected on July 7, 2023.
Citation F0727. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Have 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.
CMS lists it as corrected on July 7, 2023.
Citation F0761. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
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.
CMS lists it as corrected on July 7, 2023.
Citation F0812. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
CMS lists it as corrected on July 7, 2023.
Citation F0868. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Have the Quality Assessment and Assurance group have the required members and meet at least quarterly
CMS lists it as corrected on July 7, 2023.
Citation F0880. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Provide and implement an infection prevention and control program.
CMS lists it as corrected on July 7, 2023.
1 citation
Fire safety inspection on June 8, 2023
CMS lists this as a standard inspection.
Citation K0521. Severity C: potential for minimal harm, widespread.
The rule CMS cited:
Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.
CMS lists it as corrected on July 9, 2023.
Owners and managers
CMS lists these owners and managers for this home. Names are as CMS writes them.
- ALEXANDER, RAINEYDirect ownership interest · not applicable · since 01/01/2022
- ALEXANDER, RAINEYOperational/managerial control · not applicable · since 01/01/2022
Questions
When was Merkel Nursing Center last inspected?
CMS lists December 4, 2025 as the date of its most recent standard health inspection.
How many citations (violations) does Merkel Nursing Center have?
CMS lists 64 health citations since June 8, 2023. CMS also calls these deficiencies.
Has Merkel Nursing Center been fined?
CMS lists 2 fines in the past three years, $320,538 in total.
What is the CMS star rating of Merkel Nursing Center?
Its CMS overall star rating is 1 of 5.
Is Merkel Nursing Center a Special Focus Facility?
Yes. CMS lists it as a Special Focus Facility candidate.