Elgin Nursing and Rehabilitation Center
1373 North Avenue C · Elgin, TX · 78621 · 5122852457
114 certified beds Non profit - Corporation Chain: Wellsential Health
Why this verdict
- Inspectors found immediate jeopardy — danger of serious harm or death — in the most recent cycle (1 citation).
- Inspection record is far worse than the national median (deficiency count and severity).
- Inspection results are getting worse cycle over cycle, not better.
Red flags
1 immediate-jeopardy citation in the most recent inspection cycle
Immediate jeopardy is the most serious finding an inspector can make: a situation likely to cause serious injury, harm, or death.
RN staffing in the bottom 10% nationally
0.24 registered-nurse hours per resident per day, vs a 0.58 national median and 0.75 benchmark.
Total nurse staffing below 3.0 hours per resident-day
2.79 reported hours vs the 3.48 minimum CMS's own staffing study recommends.
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: 2 of 5 Inspections: 2 of 5 Staffing: 2 of 5 Quality measures: 3 of 5
| Total nurse hours / resident-day | 2.79 | 3.48 min · 4.1 strong |
|---|---|---|
| RN hours / resident-day | 0.24 | 0.55–0.75 |
| Weekend hours / resident-day | 2.46 | ≈ weekday level |
| Nursing turnover / year | 29% | median 45% |
| Fines (3-yr window) | 1 · $36,221 |
Inspection citations (27 in the current record)
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Potential for harm · D April 17, 2026 · 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 May 1, 2026 · Resident Assessment and Care Planning
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Potential for harm · D December 4, 2025 · found via complaint
Protect each resident from the wrongful use of the resident's belongings or money.
Corrected December 5, 2025 · Freedom from Abuse, Neglect, and Exploitation
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Immediate jeopardy · K April 25, 2025
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Corrected April 28, 2025 · Quality of Life and Care
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Potential for harm · E April 25, 2025
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Corrected April 28, 2025 · Resident Rights
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Potential for harm · D April 25, 2025
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Corrected April 28, 2025 · Resident Assessment and Care Planning
-
Potential for harm · E April 25, 2025
Provide care and assistance to perform activities of daily living for any resident who is unable.
Corrected April 28, 2025 · Quality of Life and Care
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Potential for harm · E April 25, 2025
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Corrected April 28, 2025 · Nutrition and Dietary
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Potential for harm · E April 25, 2025
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected April 28, 2025 · Nutrition and Dietary
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Potential for harm · D April 25, 2025
Provide and implement an infection prevention and control program.
Corrected April 28, 2025 · Infection Control
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Potential for harm · D April 4, 2024 · found via complaint
Provide safe, appropriate pain management for a resident who requires such services.
Corrected April 5, 2024 · Quality of Life and Care
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Potential for harm · D March 21, 2024 · found via complaint
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
Corrected April 10, 2024 · Quality of Life and Care
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Potential for harm · E March 5, 2024
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Corrected March 19, 2024 · Resident Assessment and Care Planning
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Potential for harm · D March 5, 2024
Provide activities to meet all resident's needs.
Corrected March 19, 2024 · Quality of Life and Care
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Potential for harm · D March 5, 2024
Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.
Corrected March 19, 2024 · Quality of Life and Care
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Potential for harm · E March 5, 2024
Provide care or services that was trauma informed and/or culturally competent.
Corrected March 19, 2024 · Quality of Life and Care
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Potential for harm · E March 5, 2024
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Corrected March 19, 2024 · Nutrition and Dietary
-
Potential for harm · E March 5, 2024
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected March 19, 2024 · Nutrition and Dietary
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Potential for harm · D March 5, 2024
Provide and implement an infection prevention and control program.
Corrected March 19, 2024 · Infection Control
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Potential for harm · D October 9, 2023 · found via complaint
Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.
Corrected October 30, 2023 · Resident Assessment and Care Planning
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Potential for harm · E July 12, 2023 · found via complaint
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Corrected July 28, 2023 · Resident Assessment and Care Planning
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Potential for harm · D February 14, 2023
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.
Corrected March 10, 2023 · Resident Rights
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Potential for harm · D February 14, 2023
Ensure each resident receives an accurate assessment.
Corrected March 10, 2023 · Resident Assessment and Care Planning
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Potential for harm · D February 14, 2023
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Corrected March 10, 2023 · Resident Assessment and Care Planning
-
Potential for harm · D February 14, 2023
Provide activities to meet all resident's needs.
Corrected March 10, 2023 · Quality of Life and Care
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Potential for harm · E February 14, 2023
Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.
Corrected March 10, 2023 · Quality of Life and Care
Showing the 25 most recent. The Safety Report includes every citation with full findings.
Federal penalties
| Date | Type | Amount / length |
|---|---|---|
| April 25, 2025 | Fine | $36,221 |
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.
Sign in to share your family's experience — reviews are moderated and never affect the Safety Score.
Source: CMS Care Compare (public domain), data as of June 1, 2026 · CCN 676180 · certified since February 14, 2008. The score is a screen, not a verdict on any one resident's experience — read how it's computed, then visit in person.