healthcarefacts

Nursing home in San Antonio, Texas

Legend Oaks Healthcare and Rehabilitation Center -

Medicare and Medicaid

2003 W HUTCHINS PLACE, San Antonio, TX 78224
(210) 927-0800

CMS star ratings

CMS gives this nursing home an overall star rating of 3 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 home3
  • Texas average2.7 (1,165 rated)
  • U.S. average3.0 (14,565 rated)

Health inspections

  • This nursing home3
  • Texas average2.8 (1,165 rated)
  • U.S. average2.8 (14,565 rated)

Staffing

  • This nursing home2
  • Texas average1.9 (1,163 rated)
  • U.S. average2.9 (14,494 rated)

Quality measures

  • This nursing home4
  • Texas average3.7 (1,162 rated)
  • U.S. average3.6 (14,495 rated)

Health inspections

Most recent standard health inspection (rating cycle 1): Dec 4, 2025. CMS counts 15 health deficiencies in rating cycle 1.

  • This nursing home15
  • 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 25 health deficiencies on 4 inspection dates since Sep 30, 2023. By level of harm: 23 potential for harm, 2 minimal harm potential.

  • 0 Immediate jeopardy to resident health or safety
  • 0 Actual harm
  • 23 No actual harm, potential for more than minimal harm
  • 2 No actual harm, potential for minimal harm
The 10 most recent of 25 health deficiencies since Sep 30, 2023
DateTagDeficiencyScope and severityInspection typeStatus
May 15, 2026F0558Reasonably accommodate the needs and preferences of each resident.Resident Rights DeficienciesD Potential for harm, isolatedComplaintDeficient, Provider has date of correction May 16, 2026
May 15, 2026F0573Let each resident or the resident's legal representative access or purchase copies of all the resident's records.Resident Rights DeficienciesD Potential for harm, isolatedComplaintDeficient, Provider has date of correction May 16, 2026
May 15, 2026F0583Keep residents' personal and medical records private and confidential.Resident Rights DeficienciesD Potential for harm, isolatedComplaintDeficient, Provider has date of correction May 16, 2026
May 15, 2026F0689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.Quality of Life and Care DeficienciesD Potential for harm, isolatedComplaintDeficient, Provider has date of correction May 16, 2026
May 15, 2026F0805Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs.Nutrition and Dietary DeficienciesD Potential for harm, isolatedComplaintDeficient, Provider has date of correction May 16, 2026
May 15, 2026F0577Allow residents to easily view the nursing home's survey results and communicate with advocate agencies.Resident Rights DeficienciesB Minimal harm potential, patternComplaintDeficient, Provider has date of correction May 16, 2026
May 15, 2026F0693Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube.Quality of Life and Care DeficienciesB Minimal harm potential, patternComplaintDeficient, Provider has date of correction May 16, 2026
Dec 4, 2025F0690Provide 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 DeficienciesE Potential for harm, patternStandardDeficient, Provider has date of correction Dec 30, 2025
Dec 4, 2025F0554Allow residents to self-administer drugs if determined clinically appropriate.Resident Rights DeficienciesD Potential for harm, isolatedStandardDeficient, Provider has date of correction Dec 30, 2025
Dec 4, 2025F0583Keep residents' personal and medical records private and confidential.Resident Rights DeficienciesD Potential for harm, isolatedStandardDeficient, Provider has date of correction Dec 30, 2025
Show the other 15 deficiencies
Older health deficiencies since Sep 30, 2023
DateTagDeficiencyScope and severityInspection typeStatus
Dec 4, 2025F0641Ensure each resident receives an accurate assessment.Resident Assessment and Care Planning DeficienciesD Potential for harm, isolatedStandardDeficient, Provider has date of correction Dec 30, 2025
Dec 4, 2025F0759Ensure medication error rates are not 5 percent or greater.Pharmacy Service DeficienciesD Potential for harm, isolatedStandardDeficient, Provider has date of correction Dec 30, 2025
Dec 4, 2025F0761Ensure 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.Pharmacy Service DeficienciesD Potential for harm, isolatedStandardDeficient, Provider has date of correction Dec 30, 2025
Dec 4, 2025F0812Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.Nutrition and Dietary DeficienciesD Potential for harm, isolatedStandardDeficient, Provider has date of correction Dec 30, 2025
Dec 4, 2025F0842Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.Resident Assessment and Care Planning DeficienciesD Potential for harm, isolatedStandardDeficient, Provider has date of correction Dec 30, 2025
Sep 27, 2024F0655Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admittedResident Assessment and Care Planning DeficienciesE Potential for harm, patternStandardDeficient, Provider has date of correction Oct 20, 2024
Sep 27, 2024F0700Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail.Quality of Life and Care DeficienciesE Potential for harm, patternStandardDeficient, Provider has date of correction Oct 20, 2024
Sep 27, 2024F0812Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.Nutrition and Dietary DeficienciesE Potential for harm, patternStandardDeficient, Provider has date of correction Oct 20, 2024
Sep 27, 2024F0578Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.Resident Rights DeficienciesD Potential for harm, isolatedStandardDeficient, Provider has date of correction Oct 20, 2024
Sep 27, 2024F0690Provide 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 DeficienciesD Potential for harm, isolatedStandardDeficient, Provider has date of correction Oct 20, 2024
Sep 27, 2024F0698Provide safe, appropriate dialysis care/services for a resident who requires such services.Quality of Life and Care DeficienciesD Potential for harm, isolatedStandardDeficient, Provider has date of correction Oct 20, 2024
Sep 27, 2024F0849Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services.Administration DeficienciesD Potential for harm, isolatedStandardDeficient, Provider has date of correction Oct 20, 2024
Sep 27, 2024F0880Provide and implement an infection prevention and control program.Infection Control DeficienciesD Potential for harm, isolatedStandardDeficient, Provider has date of correction Oct 20, 2024
Mar 22, 2024F0790Provide routine and 24-hour emergency dental care for each resident.Quality of Life and Care DeficienciesE Potential for harm, patternComplaintDeficient, Provider has date of correction Mar 26, 2024
Mar 22, 2024F0656Develop 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 DeficienciesD Potential for harm, isolatedComplaintDeficient, Provider has date of correction Mar 26, 2024

Staffing

Total nurse staffing

Reported hours per resident per day.

  • This nursing home3.62 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 home0.42 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 home46.2%
  • Texas average55.3% (1,051 with data)
  • U.S. average45.8% (13,538 with data)

Penalties

CMS lists 0 penalties for this nursing home: 0 fines totaling $0, and 0 payment denials. CMS counts penalties from the last 3 years.

Facility details

Certified beds126
Average residents per day107.8
OwnershipFor profit - Individual
Provider typeMedicare and Medicaid
Inside a hospitalNo
Continuing care retirement communityNo
Resident and family councilResident
Automatic sprinklers in all required areasYes
ChainThe Ensign Group (344 facilities)
Legal business nameLegal Business Name Not Available
First approved for Medicare and MedicaidOct 10, 2006
CountyBexar
CMS certification number676113

Also in San Antonio

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The Lev at San Antonio106For profit - Limited Liability company
Hospitals in San Antonio
HospitalCMS overall ratingTypeEmergency services
San Antonio VA Medical Center (VA South Texas Healthcare System)Acute Care - Veterans AdministrationYes
Methodist HospitalAcute Care HospitalsYes
Baptist Medical CenterAcute Care HospitalsYes
CHRISTUS Santa Rosa Medical CenterAcute Care HospitalsYes
University Health SystemAcute Care HospitalsYes
Children's Hospital of San AntonioNot availableChildrensYes
San Antonio State Hosp State SchoolNot availablePsychiatricNo
South Texas Spine and Surgical HospitalNot availableAcute Care HospitalsYes

All 58 nursing homes and 19 hospitals in San Antonio