River Hills Health and Rehabilitation Center
2091 Bandera Hwy · Kerrville, TX · 78028 · 8302579900
150 certified beds For profit - Individual
Why this verdict
- Inspection record is far worse than the national median (deficiency count and severity).
- Staffing levels are well below research benchmarks for safe care.
- Federal penalties on record: $96,859 in fines in the last 24 months.
- 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
6 immediate-jeopardy citations in prior inspection cycles
Serious past findings — check whether the underlying problems were fixed and stayed fixed.
$96,859 in federal fines in the last 24 months
2 fines — CMS fines are reserved for verified, serious non-compliance.
RN staffing in the bottom 10% nationally
0.23 registered-nurse hours per resident per day, vs a 0.58 national median and 0.75 benchmark.
77% of nursing staff left within a year
High turnover disrupts continuity of care; the national median is 45%.
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: 4 of 5
| Total nurse hours / resident-day | 3.16 | 3.48 min · 4.1 strong |
|---|---|---|
| RN hours / resident-day | 0.23 | 0.55–0.75 |
| Weekend hours / resident-day | 2.73 | ≈ weekday level |
| Nursing turnover / year | 77% | median 45% |
| Fines (3-yr window) | 3 · $112,133 |
Inspection citations (56 in the current record)
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Potential for harm · D February 4, 2026 · found via complaint
Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.
Corrected February 6, 2026 · Resident Rights
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Potential for harm · D February 4, 2026 · found via complaint
Ensure each resident receives an accurate assessment.
Corrected February 6, 2026 · Resident Assessment and Care Planning
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Potential for harm · F November 26, 2025 · found via complaint
Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home.
Corrected December 19, 2025 · Infection Control
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Potential for harm · D September 16, 2025 · found via complaint
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected October 1, 2025 · Quality of Life and Care
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Potential for harm · D June 13, 2025
Keep residents' personal and medical records private and confidential.
Corrected July 11, 2025 · Resident Rights
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Potential for harm · D June 13, 2025
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 July 11, 2025 · Resident Rights
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Potential for harm · E June 13, 2025
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Corrected July 11, 2025 · Resident Assessment and Care Planning
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Potential for harm · E June 13, 2025
Provide care and assistance to perform activities of daily living for any resident who is unable.
Corrected July 11, 2025 · Quality of Life and Care
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Potential for harm · D June 13, 2025
Assist a resident in gaining access to vision and hearing services.
Corrected July 11, 2025 · Quality of Life and Care
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Potential for harm · D June 13, 2025
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected July 11, 2025 · Quality of Life and Care
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Potential for harm · E June 13, 2025
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 July 11, 2025 · Quality of Life and Care
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Potential for harm · E June 13, 2025
Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis.
Corrected July 11, 2025 · Nursing and Physician Services
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Potential for harm · D June 13, 2025
Ensure that residents are free from significant medication errors.
Corrected July 11, 2025 · Pharmacy Service
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Potential for harm · E June 13, 2025
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 July 11, 2025 · Pharmacy Service
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Potential for harm · E June 13, 2025
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected July 11, 2025 · Nutrition and Dietary
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Potential for harm · D June 13, 2025
Have a policy regarding use and storage of foods brought to residents by family and other visitors.
Corrected July 11, 2025 · Nutrition and Dietary
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Potential for harm · D June 13, 2025
Provide and implement an infection prevention and control program.
Corrected July 11, 2025 · Infection Control
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Potential for harm · D June 13, 2025 · found via complaint
Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function.
Corrected July 11, 2025 · Freedom from Abuse, Neglect, and Exploitation
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Potential for harm · E May 13, 2025 · found via complaint
Reasonably accommodate the needs and preferences of each resident.
Corrected June 3, 2025 · Resident Rights
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Potential for harm · D May 13, 2025 · found via complaint
Ensure each resident receives an accurate assessment.
Corrected June 3, 2025 · Resident Assessment and Care Planning
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Immediate jeopardy · J February 8, 2025 · found via complaint
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected February 9, 2025 · Quality of Life and Care
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Immediate jeopardy · J February 8, 2025 · found via complaint
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Corrected February 9, 2025 · Pharmacy Service
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Immediate jeopardy · J February 8, 2025 · found via complaint
Ensure that residents are free from significant medication errors.
Corrected February 9, 2025 · Pharmacy Service
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Potential for harm · D February 8, 2025 · found via complaint
Provide timely, quality laboratory services/tests to meet the needs of residents.
Corrected February 9, 2025 · Administration
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Immediate jeopardy · J December 21, 2024 · found via complaint
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected December 22, 2024 · 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 |
|---|---|---|
| February 8, 2025 | Fine | $49,392 |
| December 21, 2024 | Fine | $47,467 |
| January 10, 2024 | Fine | $15,274 |
Family & resident reviews — a separate signal, never mixed into the score
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Source: CMS Care Compare (public domain), data as of June 1, 2026 · CCN 676114 · certified since October 1, 2006. The score is a screen, not a verdict on any one resident's experience — read how it's computed, then visit in person.