Legacy at Town Creek
2212 W Reagan St, Palestine, TX 75801
Legacy at Town Creek is a nursing home in Palestine, 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.
At a glance
- CMS overall star rating1 of 5
- Last standard health inspectionAugust 6, 2025 (1 year ago)
- Health citations since April 26, 202337 (Texas average 28)
- Fines in the past three years2, $294,608 in total
- CMS flagsNone listed by CMS
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One email per CMS update, only when something changed: a new citation, a fine, a star rating change, a new owner. Early access follows one home per address.
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CMS flags
CMS does not list this home as a Special Focus Facility or a candidate. CMS does not show an abuse icon for it. CMS lists no change of ownership in the past 12 months.
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 8, 2026
Name
CMS lists a new legal business name for this home.
CMS update of June 24, 2026
Name
CMS lists a new legal business name for this home.
Ownership
CMS ownership records list new owners for this home.
CMS update of May 27, 2026
Fine
CMS changed the fine from October 8, 2025 from $15,935 to $10,358.
CMS update of April 29, 2026
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.
Staffing
Total nurse staffing reported to CMS went from 3.9 to 3.4 hours per resident per day.
Health inspection on January 7, 2026
1 citationCMS lists this as a complaint inspection.
Show the 1 citation
Citation F0580. Severity D: potential for more than minimal harm, isolated.
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 January 8, 2026.
CMS update of November 20, 2025
Star rating
The CMS quality measures star rating changed from 3 of 5 to 2 of 5.
Name
CMS lists a new legal business name for this home.
Health inspection on October 8, 2025
1 citationCMS lists this as a complaint inspection.
Severity G is the second-highest of CMS's four levels. It means a resident was harmed.
107 of 1,177 Texas homes (9%) got a citation at the actual harm level in 2025.
CMS fine of $10,358 on October 8, 2025.
Show the 1 citation
Citation F0695. Severity G: actual harm, isolated.
The rule CMS cited:
Provide safe and appropriate respiratory care for a resident when needed.
CMS lists it as corrected on October 9, 2025.
CMS has cited this home for F0695 3 times since 2023.
Health inspection on August 6, 2025
4 citationsCMS lists this as a standard inspection.
Show the 4 citations
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 10, 2025.
CMS has cited this home for F0812 2 times since 2024.
Citation F0755. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
CMS lists it as corrected on September 10, 2025.
CMS has cited this home for F0755 3 times since 2023.
Citation F0813. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Have a policy regarding use and storage of foods brought to residents by family and other visitors.
CMS lists it as corrected on September 10, 2025.
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 September 10, 2025.
CMS has cited this home for F0880 4 times since 2023.
Fire safety inspection on August 6, 2025
2 citationsCMS lists this as a standard inspection.
Show the 2 citations
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 September 10, 2025.
Citation K0372. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
CMS lists it as corrected on September 10, 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 health inspection 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 2 of 5 to 3 of 5.
CMS abuse icon
CMS removed its abuse icon from this home.
Name
CMS lists a new legal business name for this home.
CMS update of April 30, 2025
Staffing
Total nurse staffing reported to CMS went from 4.6 to 3.9 hours per resident per day.
CMS update of December 20, 2024
Star rating
The CMS overall star rating changed from 2 of 5 to 1 of 5.
Star rating
The CMS health inspection star rating changed from 2 of 5 to 1 of 5.
CMS abuse icon
CMS added its abuse icon to this home.
CMS update of October 30, 2024
Star rating
The CMS quality measures star rating changed from 3 of 5 to 2 of 5.
CMS update of September 26, 2024
Star rating
The CMS overall star rating changed from 1 of 5 to 2 of 5.
Star rating
The CMS health inspection star rating changed from 1 of 5 to 2 of 5.
CMS abuse icon
CMS removed its abuse icon from this home.
CMS update of August 29, 2024
Star rating
The CMS overall star rating changed from 2 of 5 to 1 of 5.
Star rating
The CMS health inspection star rating changed from 2 of 5 to 1 of 5.
CMS abuse icon
CMS added its abuse icon to this home.
Health inspection on July 31, 2024
7 citationsCMS lists this as a standard inspection and a complaint inspection.
Show the 7 citations
Citation F0812. Severity F: potential for more than minimal harm, widespread.
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 August 12, 2024.
Citation F0689. Severity D: potential for more than minimal harm, isolated.
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 August 12, 2024.
CMS has cited this home for F0689 2 times since 2024.
Citation F0755. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
CMS lists it as corrected on August 12, 2024.
Citation F0761. Severity D: potential for more than minimal harm, isolated.
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 August 12, 2024.
CMS has cited this home for F0761 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 August 12, 2024.
Citation F0925. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.
CMS lists it as corrected on August 12, 2024.
Citation F0640. Severity B: potential for minimal harm, pattern.
The rule CMS cited:
Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment.
CMS lists it as corrected on August 12, 2024.
Fire safety inspection on July 31, 2024
1 citationCMS lists this as a standard inspection.
Show the 1 citation
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 August 22, 2024.
CMS update of July 31, 2024
Star rating
The CMS staffing star rating changed from 2 of 5 to 3 of 5. CMS changed how it scores this rating for many homes at once.
Star rating
The CMS quality measures star rating changed from 2 of 5 to 3 of 5.
Health inspection on June 6, 2024
6 citationsCMS 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.
411 of 1,177 Texas homes (35%) got a citation at the immediate jeopardy level in 2024.
CMS fine of $284,250 on June 6, 2024.
Show the 6 citations
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 June 7, 2024.
Citation F0607. Severity K: immediate jeopardy, pattern.
The rule CMS cited:
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
CMS lists it as corrected on June 7, 2024.
Citation F0610. Severity K: immediate jeopardy, pattern.
The rule CMS cited:
Respond appropriately to all alleged violations.
CMS lists it as corrected on June 7, 2024.
Citation F0689. Severity G: actual harm, isolated.
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 June 7, 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 June 7, 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 June 7, 2024.
CMS update of April 25, 2024
Star rating
The CMS overall star rating changed from 1 of 5 to 2 of 5.
Star rating
The CMS staffing star rating changed from 1 of 5 to 2 of 5.
CMS update of March 28, 2024
Health citation
CMS changed citation F0692 from severity G to D. It is from the health inspection on April 26, 2023. Severity D: potential for more than minimal harm, isolated.
CMS update of January 31, 2024
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.
Staffing
Total nurse staffing reported to CMS went from 4.2 to 3.7 hours per resident per day.
Health inspection on January 22, 2024
2 citationsCMS lists this as a complaint inspection.
Show the 2 citations
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 February 14, 2024.
Citation F0695. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Provide safe and appropriate respiratory care for a resident when needed.
CMS lists it as corrected on February 14, 2024.
Health inspection on April 26, 2023
16 citationsCMS lists this as a standard inspection.
Show the 16 citations
Citation F0552. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Ensure that residents are fully informed and understand their health status, care and treatments.
CMS lists it as corrected on May 19, 2023.
Citation F0584. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
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.
CMS lists it as corrected on May 19, 2023.
Citation F0655. Severity E: potential for more than minimal harm, pattern.
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 May 20, 2023.
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 May 16, 2023.
Citation F0677. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Provide care and assistance to perform activities of daily living for any resident who is unable.
CMS lists it as corrected on April 27, 2023.
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 May 12, 2023.
Citation F0758. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
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.
CMS lists it as corrected on May 19, 2023.
Citation F0921. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
CMS lists it as corrected on May 1, 2023.
Citation F0550. Severity D: potential for more than minimal harm, isolated.
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 May 12, 2023.
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 May 19, 2023.
Citation F0690. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
CMS lists it as corrected on May 15, 2023.
Citation F0692. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Provide enough food/fluids to maintain a resident's health.
CMS lists it as corrected on May 19, 2023.
Citation F0698. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Provide safe, appropriate dialysis care/services for a resident who requires such services.
CMS lists it as corrected on May 12, 2023.
Citation F0755. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
CMS lists it as corrected on May 12, 2023.
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 May 27, 2023.
Citation F0926. Severity D: potential for more than minimal harm, isolated.
The rule CMS cited:
Have policies on smoking.
CMS lists it as corrected on May 15, 2023.
Fire safety inspection on April 26, 2023
1 citationCMS lists this as a standard inspection.
Show the 1 citation
Citation K0345. Severity E: potential for more than minimal harm, pattern.
The rule CMS cited:
Have approved installation, maintenance and testing program for fire alarm systems.
CMS lists it as corrected on July 14, 2023.
CMS star ratings
- 1 of 5CMS overall star rating
- 2 of 5CMS health inspection star rating
- 1 of 5CMS staffing star rating
- 2 of 5CMS quality measures star rating
Facts from CMS
- Phone
- (903) 727-8500
- Last standard health inspection
- August 6, 2025 (1 year ago)
- Certified beds
- 199
- Residents per day, on average
- 80.5
- Ownership type
- Government - Hospital district
- Legal business name
- Liberty County Hospital District No 1
- Chain
- Southwest Ltc
- Takes part in
- Medicare and Medicaid
More health citations than the Texas average (37 vs 28).
Owners and managers
CMS lists these owners and managers for this home. Names are as CMS writes them.
- LIBERTY COUNTY HOSPITAL DISTRICT NO 15% or greater direct ownership interest · 100% · since 04/01/2018
- PMG OPCO- PALESTINE LLCOperational/managerial control · not applicable · since 10/01/2025
- ADEWALE, ADEBAYOOperational/managerial control · not applicable · since 10/01/2025
- FRANKLIN, BRADLEYOperational/managerial control · not applicable · since 10/01/2025
Questions
When was Legacy at Town Creek last inspected?
CMS lists August 6, 2025 as the date of its most recent standard health inspection.
How many citations (violations) does Legacy at Town Creek have?
CMS lists 37 health citations since April 26, 2023. CMS also calls these deficiencies.
Has Legacy at Town Creek been fined?
CMS lists 2 fines in the past three years, $294,608 in total.
What is the CMS star rating of Legacy at Town Creek?
Its CMS overall star rating is 1 of 5.
Is Legacy at Town Creek a Special Focus Facility?
No. CMS does not list it as a Special Focus Facility or a candidate.