MISTY WILLOW HEALTHCARE AND REHABILITATION CENTER
Grade F — 55/100 composite score
CMS Star Ratings
Certified Beds
124
Ownership
For profit - Limited Liability company
Total Fines
$22,802
Last Survey
N/A
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Staffing Hours & Turnover
Hours per Resident per Day (PBJ)
Turnover Rates
Ownership
LIBERTY COUNTY HOSPITAL DISTRICT NO. 1
100%
MISTY WILLOW HEALTHCARE, INC.
BURNAM, SOON
FITZGERALD, TAMI
STRATTON, CHARLES
Penalties & Fines (2)
| Date | Type | Description | Amount |
|---|---|---|---|
| Mar 29, 2025 | Fine | — | $14,901 |
| Mar 1, 2023 | Fine | — | $7,901 |
Health Inspection Deficiencies (24)
Inform each resident of his or her visitation rights and ensure that all visitors enjoy equal visitation privileges.
Resident Rights Deficiencies
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Respond appropriately to all alleged violations.
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Resident Assessment and Care Planning Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Quality of Life and Care Deficiencies
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Pharmacy Service Deficiencies
Keep residents' personal and medical records private and confidential.
Resident Rights Deficiencies
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Quality of Life and Care Deficiencies
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
Quality of Life and Care Deficiencies
Provide safe and appropriate respiratory care for a resident when needed.
Quality of Life and Care Deficiencies
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.
Pharmacy Service Deficiencies
Provide and implement an infection prevention and control program.
Infection Control Deficiencies
Keep residents' personal and medical records private and confidential.
Resident Rights Deficiencies
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
Resident Assessment and Care Planning Deficiencies
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Resident Assessment and Care Planning Deficiencies
Provide safe and appropriate respiratory care for a resident when needed.
Quality of Life and Care Deficiencies
Ensure medication error rates are not 5 percent or greater.
Pharmacy Service Deficiencies
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.
Pharmacy Service Deficiencies
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.
Nutrition and Dietary Deficiencies
Provide care and assistance to perform activities of daily living for any resident who is unable.
Quality of Life and Care Deficiencies
Provide and implement an infection prevention and control program.
Infection Control Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Quality of Life and Care Deficiencies
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Frequently Asked Questions
What is the CareGrader rating for MISTY WILLOW HEALTHCARE AND REHABILITATION CENTER?
MISTY WILLOW HEALTHCARE AND REHABILITATION CENTER in HOUSTON, Texas has a CareGrader grade of F (Poor), with a composite score of 55.3 out of 100. This grade is based on health inspections, staffing levels, quality measures, and penalty history from official CMS government data.
What is the CMS star rating for MISTY WILLOW HEALTHCARE AND REHABILITATION CENTER?
MISTY WILLOW HEALTHCARE AND REHABILITATION CENTER has an overall CMS star rating of 1 out of 5, a health inspection rating of 1/5, and a staffing rating of 2/5. CareGrader combines this with additional data to calculate an A-F grade.
How many health deficiencies does MISTY WILLOW HEALTHCARE AND REHABILITATION CENTER have?
MISTY WILLOW HEALTHCARE AND REHABILITATION CENTER has 24 health deficiencies on record from CMS health inspection surveys. Deficiencies are rated from A (minimal harm potential) to L (immediate jeopardy, widespread). This facility has abuse citations on record. View the full inspection timeline above for details on each deficiency.
Has MISTY WILLOW HEALTHCARE AND REHABILITATION CENTER been fined?
Yes. MISTY WILLOW HEALTHCARE AND REHABILITATION CENTER has $22,802 in total fines from CMS enforcement actions across 2 penalties.
How many beds does MISTY WILLOW HEALTHCARE AND REHABILITATION CENTER have?
MISTY WILLOW HEALTHCARE AND REHABILITATION CENTER has 124 certified beds with approximately 95 current residents (77% occupancy). The facility is located at 12921 MISTY WILLOW DR, HOUSTON, Texas 77070. It is a for profit - limited liability company facility.
Data Disclaimer
Inspection data, staffing levels, and star ratings are sourced from CMS Medicare Nursing Home Compare and are largely self-reported by facilities. A 2019 GAO study found that 43% of facilities under-reported falls. CareGrader provides this data for informational purposes only and is not affiliated with CMS or Medicare. Always visit facilities in person before making a decision.