Nursing home in Pasadena, Texas
Focused Care at Pasadena
Medicare and Medicaid
3434 Watters Road, Pasadena, TX 77504
(713) 941-9155
CMS star ratings
CMS gives this nursing home an overall star rating of 1 out of 5. Each rating is compared with the mean of rated nursing homes in Texas (1,165 for the overall rating) and in the U.S. (14,565). How to read an inspection report.
Overall rating
- This nursing home1
- Texas average2.7 (1,165 rated)
- U.S. average3.0 (14,565 rated)
Health inspections
- This nursing home1
- Texas average2.8 (1,165 rated)
- U.S. average2.8 (14,565 rated)
Staffing
- This nursing home1
- Texas average1.9 (1,163 rated)
- U.S. average2.9 (14,494 rated)
Quality measures
- This nursing home3
- Texas average3.7 (1,162 rated)
- U.S. average3.6 (14,495 rated)
Health inspections
Most recent standard health inspection (rating cycle 1): Feb 13, 2026. CMS counts 9 health deficiencies in rating cycle 1.
- This nursing home9
- Texas average9.4 (1,171 with data)
- U.S. average9.2 (14,652 with data)
Rating cycle 1 health deficiencies. Averages include every nursing home with a count in the CMS file; fewer is better.
Deficiencies since Sep 30, 2023
Inspectors cited 34 health deficiencies on 11 inspection dates since Sep 30, 2023. By level of harm: 6 immediate jeopardy, 28 potential for harm.
- 6 Immediate jeopardy to resident health or safety
- 0 Actual harm
- 28 No actual harm, potential for more than minimal harm
- 0 No actual harm, potential for minimal harm
| Date | Tag | Deficiency | Scope and severity | Inspection type | Status |
|---|---|---|---|---|---|
| Jul 9, 2026 | F0641 | Ensure each resident receives an accurate assessment.Resident Assessment and Care Planning Deficiencies | D Potential for harm, isolated | Complaint | Deficient, Provider has no plan of correction |
| Jul 9, 2026 | F0656 | Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.Resident Assessment and Care Planning Deficiencies | D Potential for harm, isolated | Complaint | Deficient, Provider has no plan of correction |
| Mar 18, 2026 | F0760 | Ensure that residents are free from significant medication errors.Pharmacy Service Deficiencies | E Potential for harm, pattern | Complaint | Deficient, Provider has date of correction Apr 10, 2026 |
| Mar 18, 2026 | F0842 | Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.Resident Assessment and Care Planning Deficiencies | D Potential for harm, isolated | Complaint | Deficient, Provider has date of correction Apr 24, 2026 |
| Feb 13, 2026 | F0641 | Ensure each resident receives an accurate assessment.Resident Assessment and Care Planning Deficiencies | E Potential for harm, pattern | Standard | Deficient, Provider has date of correction Mar 27, 2026 |
| Feb 13, 2026 | F0645 | PASARR screening for Mental disorders or Intellectual DisabilitiesResident Assessment and Care Planning Deficiencies | E Potential for harm, pattern | Standard | Deficient, Provider has date of correction Mar 27, 2026 |
| Feb 13, 2026 | F0759 | Ensure medication error rates are not 5 percent or greater.Pharmacy Service Deficiencies | E Potential for harm, pattern | Standard | Deficient, Provider has date of correction Mar 27, 2026 |
| Feb 13, 2026 | F0656 | Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.Resident Assessment and Care Planning Deficiencies | D Potential for harm, isolated | Standard | Deficient, Provider has date of correction Mar 27, 2026 |
| Feb 13, 2026 | F0880 | Provide and implement an infection prevention and control program.Infection Control Deficiencies | D Potential for harm, isolated | Standard | Deficient, Provider has date of correction Apr 13, 2026 |
| Nov 20, 2024 | F0812 | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.Nutrition and Dietary Deficiencies | E Potential for harm, pattern | Standard | Deficient, Provider has date of correction Nov 21, 2024 |
Show the other 24 deficiencies
| Date | Tag | Deficiency | Scope and severity | Inspection type | Status |
|---|---|---|---|---|---|
| Oct 16, 2024 | F0580 | Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.Resident Rights Deficiencies | E Potential for harm, pattern | Complaint | Deficient, Provider has date of correction Nov 12, 2024 |
| Oct 16, 2024 | F0690 | Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.Quality of Life and Care Deficiencies | E Potential for harm, pattern | Complaint | Deficient, Provider has date of correction Nov 12, 2024 |
| Oct 16, 2024 | F0812 | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.Nutrition and Dietary Deficiencies | E Potential for harm, pattern | Complaint | Deficient, Provider has date of correction Nov 12, 2024 |
| Oct 16, 2024 | F0814 | Dispose of garbage and refuse properly.Nutrition and Dietary Deficiencies | E Potential for harm, pattern | Complaint | Deficient, Provider has date of correction Nov 12, 2024 |
| Aug 28, 2024 | F0580 | Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.Resident Rights Deficiencies | J Immediate jeopardy, isolated | Complaint | Deficient, Provider has date of correction Nov 12, 2024 |
| Aug 28, 2024 | F0684 | Provide appropriate treatment and care according to orders, resident’s preferences and goals.Quality of Life and Care Deficiencies | J Immediate jeopardy, isolated | Complaint | Deficient, Provider has date of correction Aug 29, 2024 |
| Aug 8, 2024 | F0550 | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.Resident Rights Deficiencies | D Potential for harm, isolated | Complaint | Deficient, Provider has date of correction Aug 10, 2024 |
| Aug 8, 2024 | F0656 | Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.Resident Assessment and Care Planning Deficiencies | D Potential for harm, isolated | Complaint | Deficient, Provider has date of correction Aug 10, 2024 |
| Aug 8, 2024 | F0677 | Provide care and assistance to perform activities of daily living for any resident who is unable.Quality of Life and Care Deficiencies | D Potential for harm, isolated | Complaint | Deficient, Provider has date of correction Aug 10, 2024 |
| Feb 20, 2024 | F0600 | Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.Freedom from Abuse, Neglect, and Exploitation Deficiencies | K Immediate jeopardy, pattern | Complaint | Deficient, Provider has date of correction Mar 15, 2024 |
| Feb 20, 2024 | F0689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.Quality of Life and Care Deficiencies | K Immediate jeopardy, pattern | Complaint | Deficient, Provider has date of correction Mar 15, 2024 |
| Dec 1, 2023 | F0550 | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.Resident Rights Deficiencies | D Potential for harm, isolated | Complaint | Deficient, Provider has date of correction Dec 6, 2023 |
| Dec 1, 2023 | F0600 | Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.Freedom from Abuse, Neglect, and Exploitation Deficiencies | D Potential for harm, isolated | Complaint | Deficient, Provider has date of correction Dec 6, 2023 |
| Nov 12, 2023 | F0580 | Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.Resident Rights Deficiencies | J Immediate jeopardy, isolated | Complaint | Deficient, Provider has date of correction Nov 30, 2023 |
| Nov 12, 2023 | F0689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.Quality of Life and Care Deficiencies | J Immediate jeopardy, isolated | Complaint | Deficient, Provider has date of correction Nov 30, 2023 |
| Oct 13, 2023 | F0636 | Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months.Resident Assessment and Care Planning Deficiencies | E Potential for harm, pattern | Standard | Deficient, Provider has date of correction Oct 27, 2023 |
| Oct 13, 2023 | F0641 | Ensure each resident receives an accurate assessment.Resident Assessment and Care Planning Deficiencies | E Potential for harm, pattern | Standard | Deficient, Provider has date of correction Oct 27, 2023 |
| Oct 13, 2023 | F0657 | Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.Resident Assessment and Care Planning Deficiencies | E Potential for harm, pattern | Standard | Deficient, Provider has date of correction Oct 27, 2023 |
| Oct 13, 2023 | F0727 | 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.Nursing and Physician Services Deficiencies | E Potential for harm, pattern | Standard | Deficient, Provider has date of correction Oct 27, 2023 |
| Oct 13, 2023 | F0804 | Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.Nutrition and Dietary Deficiencies | E Potential for harm, pattern | Standard | Deficient, Provider has date of correction Oct 27, 2023 |
| Oct 13, 2023 | F0812 | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.Nutrition and Dietary Deficiencies | E Potential for harm, pattern | Standard | Deficient, Provider has date of correction Oct 27, 2023 |
| Oct 13, 2023 | F0850 | Hire a qualified full-time social worker in a facility with more than 120 beds.Administration Deficiencies | E Potential for harm, pattern | Standard, Complaint | Deficient, Provider has date of correction Oct 27, 2023 |
| Oct 13, 2023 | F0609 | Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.Freedom from Abuse, Neglect, and Exploitation Deficiencies | D Potential for harm, isolated | Standard | Deficient, Provider has date of correction Oct 27, 2023 |
| Oct 13, 2023 | F0655 | Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admittedResident Assessment and Care Planning Deficiencies | D Potential for harm, isolated | Standard | Deficient, Provider has date of correction Oct 27, 2023 |
Staffing
Total nurse staffing
Reported hours per resident per day.
- This nursing home2.95 hours
- Texas average3.39 hours (1,148 with data)
- U.S. average3.86 hours (14,351 with data)
Registered nurse staffing
Reported hours per resident per day.
- This nursing home0.40 hours
- Texas average0.43 hours (1,148 with data)
- U.S. average0.69 hours (14,351 with data)
Nursing staff turnover
Share of nursing staff who left during the year, as reported to CMS.
- This nursing home76.6%
- Texas average55.3% (1,051 with data)
- U.S. average45.8% (13,538 with data)
Penalties
CMS lists 4 penalties for this nursing home: 3 fines totaling $131,012, and 1 payment denial. CMS counts penalties from the last 3 years.
Facility details
| Certified beds | 125 |
|---|---|
| Average residents per day | 73.3 |
| Ownership | For profit - Corporation |
| Provider type | Medicare and Medicaid |
| Inside a hospital | No |
| Continuing care retirement community | No |
| Resident and family council | Resident |
| Automatic sprinklers in all required areas | Yes |
| Chain | Focused Post Acute Care Partners (25 facilities) |
| Legal business name | CHAMBERS COUNTY PUBLIC HOSPITAL DISTRICT NO. 1 |
| First approved for Medicare and Medicaid | May 16, 2005 |
| County | Harris |
| CMS certification number | 676050 |
Also in Pasadena
| Nursing home | CMS overall rating | Health inspection rating | Certified beds | Ownership |
|---|---|---|---|---|
| HCA Houston Healthcare Southeast | 30 | For profit - Corporation | ||
| Avir at Pasadena | 131 | For profit - Limited Liability company | ||
| Baywood Crossing Rehabilitation & Healthcare Cente | 124 | For profit - Corporation | ||
| Paradigm at Faith Memorial | 112 | For profit - Limited Liability company | ||
| Pasadena Post Acute | 116 | For profit - Partnership | ||
| The Courtyards at Pasadena | 196 | For profit - Limited Liability company | ||
| The Suites Pasadena | 50 | For profit - Corporation |
| Hospital | CMS overall rating | Type | Emergency services |
|---|---|---|---|
| HCA Houston Healthcare Southeast | Acute Care Hospitals | Yes | |
| St Luke's Patients Medical Center | Acute Care Hospitals | Yes | |
| Oceans Behavioral Hospital of Pasadena | Not available | Psychiatric | No |
| Surgery Specialty Hospitals of America SE Houston | Not available | Acute Care Hospitals | Yes |