Legend Oaks Healthcare And Rehabilitation Fort Worth

Penalties

• Jun 13, 2026 — Fine ($11,850)
• Mar 5, 2026 — Fine ($18,150)
• Mar 5, 2026 — Fine ($19,135)
• Sep 11, 2025 — Fine ($10,361)
• Feb 26, 2025 — Fine ($9,110)
• Oct 8, 2024 — Fine ($8,827)

Inspection findings

1. Jun 30, 2026 Health · 1 finding
   • Not serious Scope/severity D Complaint

     F0627 Resident Rights Deficiencies

     Ensure the transfer/discharge meets the resident's needs/preferences and that the resident is prepared for a safe transfer/discharge.

     Corrected Jul 1, 2026 · CMS health inspection

2. Jun 23, 2026 Health · 1 finding
   • Not serious Scope/severity E Complaint

     F0813 Nutrition and Dietary Deficiencies

     Have a policy regarding use and storage of foods brought to residents by family and other visitors.

     Corrected Jun 25, 2026 · CMS health inspection

3. Jun 13, 2026 Health · 1 finding
   • Serious Scope/severity K Complaint

     F0760 Pharmacy Service Deficiencies

     Ensure that residents are free from significant medication errors.

     Corrected Jun 14, 2026 · CMS health inspection

4. Apr 17, 2026 Health · 1 finding
   • Serious Scope/severity H Complaint

     F0689 Quality of Life and Care Deficiencies

     Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

     Corrected Apr 27, 2026 · CMS health inspection

5. Mar 26, 2026 Health · 1 finding
   • Serious Scope/severity G Complaint

     F0686 Quality of Life and Care Deficiencies

     Provide appropriate pressure ulcer care and prevent new ulcers from developing.

     Corrected Apr 22, 2026 · CMS health inspection

6. Mar 5, 2026 Health · 8 findings
   • Not serious Scope/severity D

     F0656 Resident Assessment and Care Planning Deficiencies

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

     Corrected Apr 3, 2026 · CMS health inspection

   • Not serious Scope/severity D

     F0690 Quality of Life and Care Deficiencies

     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 Apr 3, 2026 · CMS health inspection

   • Not serious Scope/severity D

     F0695 Quality of Life and Care Deficiencies

     Provide safe and appropriate respiratory care for a resident when needed.

     Corrected Apr 3, 2026 · CMS health inspection

   • Not serious Scope/severity D

     F0755 Pharmacy Service Deficiencies

     Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

     Corrected Apr 3, 2026 · CMS health inspection

   • Not serious Scope/severity E

     F0812 Nutrition and Dietary Deficiencies

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

     Corrected Apr 3, 2026 · CMS health inspection

   • Not serious Scope/severity E

     F0814 Nutrition and Dietary Deficiencies

     Dispose of garbage and refuse properly.

     Corrected Apr 3, 2026 · CMS health inspection

   • Not serious Scope/severity E

     F0842 Resident Assessment and Care Planning Deficiencies

     Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.

     Corrected Apr 3, 2026 · CMS health inspection

   • Not serious Scope/severity D

     K0321 Smoke Deficiencies

     Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.

     Corrected Mar 6, 2026 · CMS fire safety

7. Sep 11, 2025 Health · 1 finding
   • Serious Scope/severity J Complaint

     F0689 Quality of Life and Care Deficiencies

     Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

     Corrected Jul 29, 2025 · CMS health inspection

8. Feb 26, 2025 Health · 1 finding
   • Serious Scope/severity G Complaint

     F0600 Freedom from Abuse, Neglect, and Exploitation Deficiencies

     Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

     Corrected Jan 30, 2025 · CMS health inspection

9. Dec 19, 2024 Health · 4 findings
   • Not serious Scope/severity D

     F0693 Quality of Life and Care Deficiencies

     Ensure 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.

     Corrected Dec 20, 2024 · CMS health inspection

   • Not serious Scope/severity D

     F0694 Quality of Life and Care Deficiencies

     Provide for the safe, appropriate administration of IV fluids for a resident when needed.

     Corrected Dec 20, 2024 · CMS health inspection

   • Not serious Scope/severity D

     F0698 Quality of Life and Care Deficiencies

     Provide safe, appropriate dialysis care/services for a resident who requires such services.

     Corrected Dec 20, 2024 · CMS health inspection

   • Not serious Scope/severity D

     K0355 Smoke Deficiencies

     Properly select, install, inspect, or maintain portable fire extinguishes.

     Corrected Dec 20, 2024 · CMS fire safety

10. Oct 8, 2024 Health · 2 findings
    • Not serious Scope/severity D Complaint

      F0684 Quality of Life and Care Deficiencies

      Provide appropriate treatment and care according to orders, resident’s preferences and goals.

      Corrected Oct 10, 2024 · CMS health inspection

    • Serious Scope/severity J Complaint

      F0689 Quality of Life and Care Deficiencies

      Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

      Corrected Sep 23, 2024 · CMS health inspection

11. Jun 6, 2024 Health · 2 findings
    • Not serious Scope/severity D Complaint

      F0558 Resident Rights Deficiencies

      Reasonably accommodate the needs and preferences of each resident.

      Corrected Jun 30, 2024 · CMS health inspection

    • Not serious Scope/severity D Complaint

      F0644 Resident Assessment and Care Planning Deficiencies

      Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.

      Corrected Jun 30, 2024 · CMS health inspection

12. Nov 16, 2023 Health · 7 findings
    • Not serious Scope/severity D

      F0558 Resident Rights Deficiencies

      Reasonably accommodate the needs and preferences of each resident.

      Corrected Nov 17, 2023 · CMS health inspection

    • Not serious Scope/severity D

      F0636 Resident Assessment and Care Planning Deficiencies

      Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months.

      Corrected Nov 17, 2023 · CMS health inspection

    • Not serious Scope/severity E

      F0727 Nursing and Physician Services Deficiencies

      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 Nov 17, 2023 · CMS health inspection

    • Not serious Scope/severity D

      F0755 Pharmacy Service Deficiencies

      Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

      Corrected Nov 17, 2023 · CMS health inspection

    • Not serious Scope/severity E

      F0812 Nutrition and Dietary Deficiencies

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

      Corrected Nov 17, 2023 · CMS health inspection

    • Not serious Scope/severity F

      K0324 Smoke Deficiencies

      Provide properly protected cooking facilities.

      Corrected Dec 11, 2023 · CMS fire safety

    • Not serious Scope/severity F

      K0511 Services Deficiencies

      Have properly installed electrical wiring and gas equipment.

      Corrected Dec 11, 2023 · CMS fire safety

Owners and managers (as published by CMS)

• BURNAM, SOON — corporate officer, NOT APPLICABLE, since 03/02/2016
• CANTRELL, CHRISTOPHER — managing control - governing body, NOT APPLICABLE, since 06/01/2017
• CANTRELL, CHRISTOPHER — operational/managerial control, NOT APPLICABLE, since 06/01/2017
• CANTRELL, CHRISTOPHER — adp of the snf, NOT APPLICABLE, since 06/01/2017
• KEETCH, CHAD — corporate officer, NOT APPLICABLE, since 03/01/2011
• PORTER, KRIS — adp of the snf, NOT APPLICABLE, since 10/23/2023
• PORTER, KRIS — operational/managerial control, NOT APPLICABLE, since 10/23/2023
• PORTER, KRIS — managing control - governing body, NOT APPLICABLE, since 10/23/2023
• TAYLOR, STEPHEN — corporate officer, NOT APPLICABLE, since 07/01/2025
• EASTLAND MEMORIAL HOSPITAL DISTRICT — 5% or greater direct ownership interest, 100%, since 04/01/2019
• ENSIGN SERVICES INC — adp of the snf, NOT APPLICABLE, since 06/01/2017
• NATIONAL HEALTH INVESTORS, INC. — adp of the snf, NOT APPLICABLE, since 06/01/2017
• NB BROWN ROCK HEALTHCARE, INC. — adp of the snf, NOT APPLICABLE, since 08/15/2025
• NB BROWN ROCK HEALTHCARE, INC. — operational/managerial control, NOT APPLICABLE, since 04/01/2019
• TEXAS NHI INVESTORS, LLC — adp of the snf, NOT APPLICABLE, since 06/01/2017