Before you read this — a quick key
This issue uses specific terms pulled directly from government data. Here's what they mean in plain English:
ProximCares Score — our independent 0–100 rating for each Texas nursing home, built from four categories: quality of care, safety citations, staffing levels, and pharmacy access. Higher is better. Most decent facilities score above 60.
Quality Score — measures inspection results, health citations, and complaint history. A score near zero means the facility has been cited repeatedly for serious care failures.
Pharmacy Access Score — measures how close a licensed pharmacy is to the facility. A score of zero means no pharmacy within a reasonable distance. For residents who depend on daily medications, this matters more than most families realize.
RN Hours per Resident per Day — how many hours a registered nurse is present per resident, each day. The CMS national guideline is 0.75 hours. Anything below 0.30 is a red flag. Anything below 0.15 is an emergency.
CMS Citations — formal violations issued by the Centers for Medicare & Medicaid Services after a government inspection. These are not complaints — they are confirmed violations with documentation. More citations mean more confirmed failures.
Substantiated Complaints — complaints filed by residents or families that were investigated and found to be valid. Not rumors. Confirmed.
CMS Fines — dollar penalties paid to the federal government for confirmed violations. These come out of the facility's operating budget, not insurance.
Staffing Stars — CMS rates staffing on a 1–5 scale. Every facility on this list carries a 1-star staffing rating — the lowest possible — except one, which has no rating at all.
The Bottom of the List
Most nursing home data lives in a government spreadsheet that nobody reads. Column headers like "MDSCENSUS" and "WEIGHTED_ALL_CYCLES_SCORE" are not designed for a family trying to decide in two weeks.
We built ProximCares to fix that. We scored all 1,176 licensed nursing homes in Texas across four categories and made the results searchable by anyone, for free.
This week, we're showing you the bottom ten worst nursing homes in Texas with no bias, just transparent facts.
One pattern shows up before you even get to the individual facilities: every single facility on this list is for-profit, and nine out of ten are structured as LLCs. That ownership structure limits personal liability for investors. It also appears consistently in the nursing home research literature alongside lower staffing and higher citation rates. We're not saying the structure causes bad care. We're saying the pattern is there, and you should know it.
Now, the list.
#1 — Avir at Tierra Este | El Paso | ProximCares Score: 5.9
The lowest-scoring facility in Texas.
Intelligence snapshot: 0.21 RN hours per resident per day. That's about 13 minutes of registered nurse time daily — per person. The CMS guideline is 45 minutes. Total nurse coverage, including aides, is 2.08 hours per resident per day, which is below the national average of 3.9 hours. Fifty-eight confirmed citations. Thirty-one substantiated complaints. Pharmacy access score of zero.
El Paso is a large city, which makes the pharmacy access score surprising; this likely reflects the specific location within the metro rather than the city overall. The care metrics, however, are not a geography problem. Thirteen minutes of RN time per resident is a staffing decision.
#2 — Grace Care Center of Henrietta | Henrietta | ProximCares Score: 6.8
Located in a small North Texas town about 90 miles northwest of Fort Worth.
Intelligence snapshot: Grace Care did not report staffing hours to CMS. Under federal law, nursing homes that participate in Medicare and Medicaid are required to submit staffing data. A facility that doesn't report is either out of compliance with reporting requirements or has numbers it doesn't want published. Either interpretation is a problem. What is documented: 49 confirmed citations, 29 substantiated complaints, and $306,719 in CMS fines, making it the second-highest penalty total on this list. No pharmacy nearby, so most likely the meds have to be shipped, which could cause a delay.
When a facility won't tell the government how many nurses it has, that tells you something.
#3 — Paradigm at the Oak | Schulenburg | ProximCares Score: 9.3
On Interstate 10 between San Antonio and Houston — equidistant from two major cities and near neither one's resources.
Intelligence snapshot: 0.29 RN hours per resident per day. About 17 minutes daily. Fifty confirmed citations, 26 complaints, $112,673 in fines. Zero pharmacy access. The staffing number here is low, but not the lowest on this list; what keeps Paradigm in the top three is the combination of rural isolation, citation volume, and consistent 1-star ratings across every CMS category.
#4 — Benbrook Nursing & Rehabilitation | Benbrook | ProximCares Score: 10.0
Benbrook is a suburb of Fort Worth. This is not a rural access story.
Intelligence snapshot: 0.09 RN hours per resident per day.
Read that again. Zero point zero nine.
That is approximately 5 minutes of registered nurse time per resident per day. The CMS minimum guidance is 45 minutes. The national average is closer to an hour. Five minutes is not a staffing shortage — it is a near-total absence of nursing oversight in a facility caring for people who cannot advocate for themselves.
Forty-eight citations. Thirty-four complaints — the highest complaint count in the top five. Forty-one thousand dollars in fines. A quality score of 5.8. This facility is in a suburb of a major metro area with no geographic excuse for what the data shows.
#5 — Focused Care at Linden | Linden | ProximCares Score: 10.5
Linden is a small town in East Texas, Cass County, with a population under 2,000.
Intelligence snapshot: 0.60 RN hours per resident per day; one of the highest RN presence on this list, and still below the national guideline. Total nurse hours of 1.64 per resident per day are the second-lowest in the group. The staffing mix here suggests RNs are present, but overall coverage is stretched thin. What stands out most is the fine total: $364,167. For a small facility in a town of 2,000 people, that is an extraordinary penalty load. Fifty-two citations, 20 complaints. The government has been to this facility repeatedly and keeps finding problems.
#6 — Castro County Nursing & Rehabilitation | Dimmitt | ProximCares Score: 10.5
Deep in the Texas Panhandle. Dimmitt sits in Castro County, one of the most agriculturally isolated regions in the state.
Intelligence snapshot: 0.21 RN hours per resident per day — 13 minutes. Total nurse hours of 1.89. Forty-five citations, 27 complaints, $47,932 in fines. Zero pharmacy access. There are genuine geographic constraints here that a facility in Dimmitt cannot fully solve. What it can control is how many nurses it employs. The data suggests it has chosen not to.
#7 — Avir at Winnsboro | Winnsboro | ProximCares Score: 10.9
This is the second Avir-branded facility in the bottom ten. Avir at Tierra Este is #1. Avir at Winnsboro is #7.
Intelligence snapshot: 0.35 RN hours per resident per day. Total nurse hours of 1.86. Forty-nine citations, 16 complaints — the lowest complaint count in the group — $87,218 in fines. Zero pharmacy access.
Two facilities operating under the same brand name in the bottom ten of 1,176 is not a coincidence. It is a pattern. If you are researching any Avir-branded facility in Texas, start with the assumption that this brand's operational standards produce these outcomes and verify from there.
#8 — Harmony Care at Beaumont | Beaumont | ProximCares Score: 12.0
This is the one that requires the most attention.
Intelligence snapshot: Quality score of 0.0 — the lowest in the entire Texas dataset of 1,176 facilities. No CMS star rating at all, which typically means the facility is new, under active review, or has had its rating suspended due to compliance failures. Beaumont is Southeast Texas's largest city. Pharmacy access is not the issue — the facility scores a 40 on access.
Seventy-three confirmed citations. Fifty substantiated complaints — the highest on this list. $456,231 in CMS fines — also the highest on this list.
The score history on ProximCares shows a decline of 17.2 points over the past six months. This facility is not holding steady at all. It is actively getting worse.
RN hours are 0.39 per resident per day, 23 minutes. Total nurse coverage of 3.23 hours is the highest in this group, which suggests the staffing mix leans heavily on aides rather than licensed nurses. High aide hours with low RN hours mean residents are being watched but not clinically assessed.
#9 — Arbor Grace Wellness Center | Littlefield | ProximCares Score: 12.2
Littlefield is in Lamb County, the South Plains region, northwest of Lubbock.
Intelligence snapshot: 0.20 RN hours per resident per day, or about 12 minutes. Total nurse hours of 1.66 per resident per day, third-lowest in the group. Thirty-two citations, 18 complaints, $44,434 in fines. Zero pharmacy access. The citation and complaint volumes are lower than most on this list, but the staffing numbers place it firmly in the same pattern. Twelve minutes of RN time per resident per day in a rural facility with no nearby pharmacy is a compounding risk — when something goes wrong, there is no clinical escalation and no fast medication access.
#10 — Killeen Nursing & Rehabilitation | Killeen | ProximCares Score: 13.4
Killeen is home to Fort Cavazos, one of the largest military installations in the world. It is not a small town.
Intelligence snapshot: 0.31 RN hours per resident per day — 19 minutes. Total nurse hours of 2.21. Forty-seven citations, 29 complaints, $137,749 in fines. Pharmacy access score of 20, meaning some nearby access exists. The ownership structure here is a for-profit corporation rather than an LLC, the only such distinction in this group, though the performance outcomes are consistent with the rest.
For a city with Killeen's infrastructure and population, the performance gap between what should be possible and what the data shows is notable. Geography is not the excuse here. Staffing is a choice.
What the data says, taken together
Ten facilities. Ten for-profit ownership structures. Ten one-star staffing ratings. A combined $1.63 million in CMS fines. An average RN presence of roughly 17 minutes per resident per day across the group.
The staffing number is the one that stays with you. These are facilities caring for people who cannot get up, cannot call for help easily, and in many cases cannot communicate what is wrong. Seventeen minutes of registered nurse attention per day, on average, is what the data says they are receiving.
This is why transparency is important when it comes to finding a forever home for our loved ones.
You can look up all 1,176 Texas nursing homes, including the best-performing ones, at proximcares.com. Every score, every citation count, every trend line is there, free, no account required.
If this issue helped you or someone you know, forward it. The people who need this information most are usually the ones least likely to find it on their own. And if you want to support our mission to spread transparency in Texas, you can click here to donate.
Your family deserves honest answers. That is why we are here.
Until then, check your city at proximcares.com.
Theron Harris Founder, ProximCares
All data sourced from CMS Provider Information, Health Citations, Quality Measures, and Payroll-Based Journal staffing datasets. ProximCares scores reflect conditions as of the most recent CMS data refresh, May 2026. RN hours reflect CMS-reported payroll data. Facilities marked N/R did not submit staffing data to CMS.