F58

LEGACY AT TOWN CREEK

Grade F 58/100 composite score

Government - Hospital district

CMS Star Ratings

Overall
2/5
Health Insp.
2/5
Quality
2/5
Staffing
2/5
RN Staffing
Not rated

Certified Beds

199

Ownership

Government - Hospital district

Total Fines

$300,185

Last Survey

N/A

2212 W REAGAN ST, PALESTINE, TX 75801
9037278500

Get Pricing & Availability for LEGACY AT TOWN CREEK

Request current pricing, availability, and tour information from LEGACY AT TOWN CREEK in PALESTINE, Texas.

Staffing Hours & Turnover

Hours per Resident per Day (PBJ)

RN
0.38h
LPN
1.06h
CNA
2.99h
Total
4.42h
Facility
State Average

Turnover Rates

RN Turnover
N/A
Total Nurse Turnover
N/A
Admin Turnover
N/A

Ownership

LIBERTY COUNTY HOSPITAL DISTRICT NO. 1

Organization5% OR GREATER DIRECT OWNERSHIP INTERESTSince Apr 2018

100%

SOUTHWEST LTC- PALESTINE, LLC

OrganizationOPERATIONAL/MANAGERIAL CONTROLSince Apr 2018

STRATTON, CHARLES

IndividualCORPORATE OFFICERSince Apr 2018

BELTRAN, LARRY

IndividualW-2 MANAGING EMPLOYEESince Apr 2018

Penalties & Fines (2)

$300,185total fines
DateTypeDescriptionAmount
Oct 8, 2025Fine$15,935
Jun 6, 2024Fine$284,250

Health Inspection Deficiencies (37)

October 8, 2025Health1 deficiency1 severe
0695GActual harm, Isolated

Provide safe and appropriate respiratory care for a resident when needed.

Quality of Life and Care Deficiencies

Corrected Oct 9, 2025
August 6, 2025Health4 deficiencies
0755DMinimal harm, Isolated

Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

Pharmacy Service Deficiencies

Corrected Sep 10, 2025
0812EMinimal harm, Pattern

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

Nutrition and Dietary Deficiencies

Corrected Sep 10, 2025
0813DMinimal harm, Isolated

Have a policy regarding use and storage of foods brought to residents by family and other visitors.

Nutrition and Dietary Deficiencies

Corrected Sep 10, 2025
0880DMinimal harm, Isolated

Provide and implement an infection prevention and control program.

Infection Control Deficiencies

Corrected Sep 10, 2025
July 31, 2024Health7 deficiencies
0640BNo harm, Pattern

Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment.

Resident Assessment and Care Planning Deficiencies

Corrected Aug 12, 2024
0689DMinimal harm, Isolated

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

Quality of Life and Care Deficiencies

Corrected Aug 12, 2024
0755DMinimal harm, Isolated

Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

Pharmacy Service Deficiencies

Corrected Aug 12, 2024
0761DMinimal harm, Isolated

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

Corrected Aug 12, 2024
0812FMinimal harm, Widespread

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

Nutrition and Dietary Deficiencies

Corrected Aug 12, 2024
0880DMinimal harm, Isolated

Provide and implement an infection prevention and control program.

Infection Control Deficiencies

Corrected Aug 12, 2024
0925DMinimal harm, Isolated

Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.

Environmental Deficiencies

Corrected Aug 12, 2024
June 6, 2024Health6 deficiencies4 severe
0880DMinimal harm, Isolated

Provide and implement an infection prevention and control program.

Infection Control Deficiencies

Corrected Jun 7, 2024
0600KImmediate jeopardy, Pattern

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

Corrected Jun 7, 2024
0607KImmediate jeopardy, Pattern

Develop and implement policies and procedures to prevent abuse, neglect, and theft.

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Corrected Jun 7, 2024
0609EMinimal harm, Pattern

Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Corrected Jun 7, 2024
0610KImmediate jeopardy, Pattern

Respond appropriately to all alleged violations.

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Corrected Jun 7, 2024
0689GActual harm, Isolated

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

Quality of Life and Care Deficiencies

Corrected Jun 7, 2024
January 22, 2024Health2 deficiencies
0695DMinimal harm, Isolated

Provide safe and appropriate respiratory care for a resident when needed.

Quality of Life and Care Deficiencies

Corrected Feb 14, 2024
0761EMinimal harm, Pattern

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

Corrected Feb 14, 2024
August 8, 2023Health1 deficiency
0607DMinimal harm, Isolated

Develop and implement policies and procedures to prevent abuse, neglect, and theft.

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Corrected Aug 9, 2023
April 26, 2023Health16 deficiencies
0550DMinimal harm, Isolated

Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

Resident Rights Deficiencies

Corrected May 12, 2023
0552EMinimal harm, Pattern

Ensure that residents are fully informed and understand their health status, care and treatments.

Resident Rights Deficiencies

Corrected May 19, 2023
0584EMinimal harm, Pattern

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.

Resident Rights Deficiencies

Corrected May 19, 2023
0655EMinimal harm, Pattern

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

Corrected May 20, 2023
0656EMinimal harm, Pattern

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

Corrected May 16, 2023
0657DMinimal harm, Isolated

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

Resident Assessment and Care Planning Deficiencies

Corrected May 19, 2023
0677EMinimal harm, Pattern

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

Quality of Life and Care Deficiencies

Corrected Apr 27, 2023
0690DMinimal harm, Isolated

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

Corrected May 15, 2023
0692DMinimal harm, Isolated

Provide enough food/fluids to maintain a resident's health.

Quality of Life and Care Deficiencies

Corrected May 19, 2023
0695EMinimal harm, Pattern

Provide safe and appropriate respiratory care for a resident when needed.

Quality of Life and Care Deficiencies

Corrected May 12, 2023
0698DMinimal harm, Isolated

Provide safe, appropriate dialysis care/services for a resident who requires such services.

Quality of Life and Care Deficiencies

Corrected May 12, 2023
0755DMinimal harm, Isolated

Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

Pharmacy Service Deficiencies

Corrected May 12, 2023
0758EMinimal harm, Pattern

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.

Pharmacy Service Deficiencies

Corrected May 19, 2023
0880DMinimal harm, Isolated

Provide and implement an infection prevention and control program.

Infection Control Deficiencies

Corrected May 27, 2023
0921EMinimal harm, Pattern

Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.

Environmental Deficiencies

Corrected May 1, 2023
0926DMinimal harm, Isolated

Have policies on smoking.

Environmental Deficiencies

Corrected May 15, 2023

Request Information from LEGACY AT TOWN CREEK

Get pricing, schedule a tour, or ask about availability.

Request information from LEGACY AT TOWN CREEK

Frequently Asked Questions

What is the CareGrader rating for LEGACY AT TOWN CREEK?

LEGACY AT TOWN CREEK in PALESTINE, Texas has a CareGrader grade of F (Poor), with a composite score of 58.3 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 LEGACY AT TOWN CREEK?

LEGACY AT TOWN CREEK has an overall CMS star rating of 2 out of 5, a health inspection rating of 2/5, and a staffing rating of 2/5. CareGrader combines this with additional data to calculate an A-F grade.

How many health deficiencies does LEGACY AT TOWN CREEK have?

LEGACY AT TOWN CREEK has 37 health deficiencies on record from CMS health inspection surveys. Deficiencies are rated from A (minimal harm potential) to L (immediate jeopardy, widespread). View the full inspection timeline above for details on each deficiency.

Has LEGACY AT TOWN CREEK been fined?

Yes. LEGACY AT TOWN CREEK has $300,185 in total fines from CMS enforcement actions across 2 penalties.

How many beds does LEGACY AT TOWN CREEK have?

LEGACY AT TOWN CREEK has 199 certified beds with approximately 87 current residents (44% occupancy). The facility is located at 2212 W REAGAN ST, PALESTINE, Texas 75801. It is a government - hospital district 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.