Avir at San Angelo
5455 Knickerbocker Rd · San Angelo, TX · 76904 · 3259441660
125 certified beds For profit - Individual Chain: Avir Health Group
Why this verdict
- Inspection record is far worse than the national median (deficiency count and severity).
- Federal penalties on record: $54,919 in fines in the last 24 months.
- 3 citations involved actual harm to residents.
- Inspection results have improved across recent cycles.
The complete Safety Report — $19
Everything on this page plus the full citation-by-citation history with inspector findings, the complete penalty record, staffing vs benchmarks, side-by-side nearby comparisons, and the printable tour checklist. One PDF, emailed in minutes, yours to keep and share with family.
Red flags
4 immediate-jeopardy citations in prior inspection cycles
Serious past findings — check whether the underlying problems were fixed and stayed fixed.
3 abuse-related citations at the actual-harm level
Inspectors cited failures in the abuse-prevention rules (F600–F610) that resulted in actual harm to a resident.
2 actual-harm citations in the most recent cycle
Inspectors found deficiencies that caused real harm to residents, beyond potential-harm paperwork findings.
$54,919 in federal fines in the last 24 months
1 fine — CMS fines are reserved for verified, serious non-compliance.
RN staffing in the bottom 10% nationally
0.16 registered-nurse hours per resident per day, vs a 0.58 national median and 0.75 benchmark.
If someone you love was harmed at a facility with findings like these, you have options — read this.
Score breakdown
Quality-measure stars are deliberately excluded — they're largely self-reported by facilities. Full method.
CMS ratings & staffing
Overall: 1 of 5 Inspections: 1 of 5 Staffing: 1 of 5 Quality measures: 1 of 5
| Total nurse hours / resident-day | 3.23 | 3.48 min · 4.1 strong |
|---|---|---|
| RN hours / resident-day | 0.16 | 0.55–0.75 |
| Weekend hours / resident-day | 3.05 | ≈ weekday level |
| Nursing turnover / year | — | median 45% |
| Fines (3-yr window) | 4 · $217,215 |
Inspection citations (35 in the current record)
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Potential for harm · D February 17, 2026 · found via complaint
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Corrected March 13, 2026 · Quality of Life and Care
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Potential for harm · E November 19, 2025 · found via complaint
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Corrected November 20, 2025 · Resident Assessment and Care Planning
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Potential for harm · D June 14, 2025 · found via complaint
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected July 8, 2025 · Quality of Life and Care
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Actual harm · H March 6, 2025
Assist a resident in gaining access to vision and hearing services.
Corrected March 7, 2025 · Quality of Life and Care
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Actual harm · H March 6, 2025
Provide medically-related social services to help each resident achieve the highest possible quality of life.
Corrected March 7, 2025 · Quality of Life and Care
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Potential for harm · E March 6, 2025
Provide and implement an infection prevention and control program.
Corrected March 7, 2025 · Infection Control
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Potential for harm · F March 6, 2025
Keep all essential equipment working safely.
Corrected March 7, 2025 · Environmental
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Potential for harm · D October 3, 2024 · found via complaint
Honor the resident's right to share a room with spouse or roommate of choice and receive written notice before a change is made.
Corrected October 16, 2024 · Resident Rights
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Potential for harm · D October 3, 2024 · found via complaint
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Corrected October 16, 2024 · Freedom from Abuse, Neglect, and Exploitation
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Potential for harm · D October 3, 2024 · found via complaint
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
Corrected October 16, 2024 · Freedom from Abuse, Neglect, and Exploitation
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Immediate jeopardy · K December 22, 2023 · found via complaint
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected December 23, 2023 · Quality of Life and Care
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Potential for harm · E December 22, 2023
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Corrected December 23, 2023 · Resident Rights
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Potential for harm · E December 22, 2023
Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.
Corrected December 23, 2023 · Resident Rights
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Potential for harm · D December 22, 2023
Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.
Corrected December 23, 2023 · Resident Assessment and Care Planning
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Potential for harm · E December 22, 2023
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
Corrected December 23, 2023 · Resident Assessment and Care Planning
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Potential for harm · D December 22, 2023
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Corrected December 23, 2023 · Resident Assessment and Care Planning
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Potential for harm · E December 22, 2023
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.
Corrected December 23, 2023 · Pharmacy Service
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Potential for harm · E December 22, 2023
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected December 23, 2023 · Nutrition and Dietary
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Potential for harm · E December 22, 2023
Provide and implement an infection prevention and control program.
Corrected December 23, 2023 · Infection Control
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Potential for harm · F December 22, 2023
Implement a program that monitors antibiotic use.
Corrected December 23, 2023 · Infection Control
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Potential for harm · E December 22, 2023 · found via complaint
Provide care and assistance to perform activities of daily living for any resident who is unable.
Corrected December 23, 2023 · Quality of Life and Care
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Potential for harm · E December 22, 2023 · found via complaint
Provide safe and appropriate respiratory care for a resident when needed.
Corrected December 23, 2023 · Quality of Life and Care
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Potential for harm · F December 22, 2023 · found via complaint
Observe each nurse aide's job performance and give regular training.
Corrected December 23, 2023 · Nursing and Physician Services
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Actual harm · H September 13, 2023 · found via complaint
Ensure that residents are free from significant medication errors.
Corrected August 14, 2023 · Pharmacy Service
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Potential for harm · D September 13, 2023 · found via complaint
Provide and implement an infection prevention and control program.
Corrected October 12, 2023 · Infection Control
Showing the 25 most recent. The Safety Report includes every citation with full findings.
Federal penalties
| Date | Type | Amount / length |
|---|---|---|
| March 6, 2025 | Fine | $54,919 |
| December 22, 2023 | Fine | $23,941 |
| September 13, 2023 | Fine | $12,220 |
| July 28, 2023 | Fine | $126,135 |
Family & resident reviews — a separate signal, never mixed into the score
No approved reviews yet. If your family has experience with this facility, yours could be the review that helps the next family decide.
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Source: CMS Care Compare (public domain), data as of June 1, 2026 · CCN 676100 · certified since April 11, 2006. The score is a screen, not a verdict on any one resident's experience — read how it's computed, then visit in person.