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VILLA HAVEN HEALTH AND REHABILITATION CENTER

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VILLA HAVEN HEALTH AND REHABILITATION CENTER is a government - hospital district facility in BRECKENRIDGE, TX with 92 certified beds and a 5-star overall CMS rating. The facility has 9 deficiency records on file.

300 S JACKSON ST, BRECKENRIDGE, TX 76424

Phone: 2545593386

Overall Rating

5/5

Health Inspection

5/5

Staffing

4/5

Quality Measures

5/5

Long-Stay Quality

5/5

Facility Information

Provider Number
675279
Ownership
Government - Hospital district
Provider Type
Medicare and Medicaid
Beds
92
Residents
30
In Hospital
No
County
Stephens
Last Inspection
Dec 19, 2024

Staffing Data

RN Hours
0.47 (nat'l avg: 0.68)
LPN Hours
1.29
CNA Hours
2.17
Total Nursing Hours
3.93 (nat'l avg: 3.89)
PT Hours
0.03
Nursing Turnover
47.6%

What the CMS Record Reveals About VILLA HAVEN HEALTH AND REHABILITATION CENTER

VILLA HAVEN HEALTH AND REHABILITATION CENTER operates 92 certified beds in BRECKENRIDGE, TX with approximately 30 residents currently in care, and carries a CMS overall rating of 5 out of 5 stars. The overall score is a composite of three weighted sub-ratings published by the Centers for Medicare & Medicaid Services: health inspection results (5★), staffing levels (4★), and quality measures (5★). Because CMS caps the overall score at the health-inspection tier and then adjusts up or down based on staffing and quality, the sub-scores often tell a sharper story than the headline star count alone — a 3-star facility with weak inspection history reads differently from one held back by thin staffing.

The inspection file contains 9 deficiency records from recent surveys, all falling in the no-harm or minimal-harm bands of the CMS scope-and-severity grid. No fines or payment denials have been assessed against this provider, suggesting issues — if any — did not rise to the enforcement threshold. Staffing is reported at 3.93 total nursing hours per resident day (national average 3.89), with RN coverage at 0.47 per resident day — the single staffing metric most strongly tied to resident outcomes in peer-reviewed literature.

Classified as "Government - Hospital district" ownership and operating as a "Medicare and Medicaid" provider, VILLA HAVEN HEALTH AND REHABILITATION CENTER falls into a category where comparative context matters. National research consistently shows that ownership structure, staffing hours, and turnover are the three operational levers that correlate most strongly with resident outcomes — ratings and fines are lagging indicators of those upstream choices. Reported nursing turnover at this facility is 47.6%, within a range generally associated with stable care teams. For families evaluating this facility, the CMS record should be read alongside a site visit, direct conversation with current residents and their families, and review of the state health department's most recent inspection report — the star rating is a starting point, not a verdict. All data on this page is sourced from CMS Provider Data and the Nursing Home Compare program; always verify details directly with the facility or your state survey agency before making placement decisions.

Deficiency History (9 most recent)

C — Widespread - No harm Dec 27, 2025 Tag: 0844

Follow rules about disclosure of ownership requirements and tell the state agency about changes in ownership and/or administrative personnel.

Category: Administration Deficiencies

E — Pattern - Minimal harm Dec 19, 2024 Tag: 0880

Provide and implement an infection prevention and control program.

Category: Infection Control Deficiencies

Corrected: Jan 9, 2025

D — Isolated - Minimal harm Dec 19, 2024 Tag: 0657

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

Category: Resident Assessment and Care Planning Deficiencies

Corrected: Dec 23, 2024

D — Isolated - Minimal harm Jul 18, 2024 Tag: 0880

Provide and implement an infection prevention and control program.

Category: Infection Control Deficiencies

Corrected: Aug 6, 2024

E — Pattern - Minimal harm Nov 2, 2023 Tag: 0880

Provide and implement an infection prevention and control program.

Category: Infection Control Deficiencies

Corrected: Nov 20, 2023

E — Pattern - Minimal harm Nov 2, 2023 Tag: 0812

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

Category: Nutrition and Dietary Deficiencies

Corrected: Nov 21, 2023

E — Pattern - Minimal harm Nov 2, 2023 Tag: 0656

Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

Category: Resident Assessment and Care Planning Deficiencies

Corrected: Nov 20, 2023

E — Pattern - Minimal harm Sep 8, 2022 Tag: 0803

Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.

Category: Nutrition and Dietary Deficiencies

Corrected: Sep 23, 2022

B — Pattern - No harm Sep 8, 2022 Tag: 0655

Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted

Category: Resident Assessment and Care Planning Deficiencies

Corrected: Sep 23, 2022

Quality Measures

Measure Type Score Used in Rating
Percentage of long-stay residents whose need for help with daily activities has increased Long Stay 14.9% Yes
Percentage of long-stay residents who lose too much weight Long Stay 0.0% No
Percentage of long-stay residents with a catheter inserted and left in their bladder Long Stay 0.0% Yes
Percentage of long-stay residents with a urinary tract infection Long Stay 0.0% Yes
Percentage of long-stay residents who have depressive symptoms Long Stay 2.3% No
Percentage of long-stay residents who were physically restrained Long Stay 0.0% No
Percentage of long-stay residents experiencing one or more falls with major injury Long Stay 1.1% Yes
Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine Long Stay 100.0% No
Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine Short Stay 100.0% No
Percentage of short-stay residents who newly received an antipsychotic medication Short Stay 0.0% Yes
Percentage of long-stay residents whose ability to walk independently worsened Long Stay 9.6% Yes
Percentage of long-stay residents who received an antianxiety or hypnotic medication Long Stay 23.1% No
Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine Long Stay 96.2% No
Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine Short Stay 100.0% No
Percentage of long-stay residents with pressure ulcers Long Stay 1.0% Yes
Percentage of long-stay residents with new or worsened bowel or bladder incontinence Long Stay 3.2% No
Percentage of long-stay residents who received an antipsychotic medication Long Stay 3.0% Yes

Penalty History

No penalties on record.

Frequently Asked Questions

What is the overall CMS rating for VILLA HAVEN HEALTH AND REHABILITATION CENTER?
VILLA HAVEN HEALTH AND REHABILITATION CENTER has an overall CMS rating of 5 out of 5 stars. This rating combines health inspection results (5★), staffing levels (4★), and quality measures (5★).
What are the staffing levels at VILLA HAVEN HEALTH AND REHABILITATION CENTER?
VILLA HAVEN HEALTH AND REHABILITATION CENTER reports 3.93 total nursing hours per resident day (national average: 3.89). RN hours are 0.47 per resident day (national average: 0.68). Nursing staff turnover is 47.6%.
How many beds does VILLA HAVEN HEALTH AND REHABILITATION CENTER have?
VILLA HAVEN HEALTH AND REHABILITATION CENTER has 92 certified beds with approximately 30 residents. The facility is located at 300 S JACKSON ST, BRECKENRIDGE, TX 76424.
Does VILLA HAVEN HEALTH AND REHABILITATION CENTER have any deficiencies on record?
Yes, VILLA HAVEN HEALTH AND REHABILITATION CENTER has 9 deficiencies on record from recent inspections. Most deficiencies are classified as no harm or minimal harm.
Has VILLA HAVEN HEALTH AND REHABILITATION CENTER received any fines or penalties?
No, VILLA HAVEN HEALTH AND REHABILITATION CENTER has no fines or penalties on record.
Who owns VILLA HAVEN HEALTH AND REHABILITATION CENTER?
VILLA HAVEN HEALTH AND REHABILITATION CENTER is classified as "Government - Hospital district" ownership. The facility type is "Medicare and Medicaid".
When was VILLA HAVEN HEALTH AND REHABILITATION CENTER last inspected?
The most recent health inspection for VILLA HAVEN HEALTH AND REHABILITATION CENTER was on Dec 19, 2024. The facility received a health inspection rating of 5 out of 5 stars.
What quality measures are tracked for VILLA HAVEN HEALTH AND REHABILITATION CENTER?
VILLA HAVEN HEALTH AND REHABILITATION CENTER is evaluated on 17 quality measures, of which 8 are used in the CMS star rating calculation. These include measures for both long-stay and short-stay residents covering areas like infections, falls, pressure ulcers, and medication use.

Data Sources

Data source: CMS Nursing Home Compare. Ratings, staffing, deficiency, quality measure, and penalty data are from CMS Provider Data. For informational purposes only. Always verify information directly with the facility or your state health department.

Related

Data sourced from official U.S. government datasets. See our methodology for details. Retrieved and formatted by PlainNursing Editorial