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Nursing HomeMedicaid Investigative

Avir at Cowhorn Creek

Below-average Medicare ratings — review the inspection history and ask the administrator about recent corrections before visiting.

5524 Cowhorn Creek, Texarkana, TX 7550376 bedsLicensed & Active
1/5
Medicare
Inspection
Quality
Staffing
Google rating
2.8/5

based on 16 Google reviews

5
4
3
2
1
Avir at Cowhorn Creek Nursing Home in Texarkana, TX — Street View
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8/ 10
critical Risk

Quality Concerns Identified

Medicare inspection and quality data reveal areas that families should carefully evaluate before choosing this facility.

  • Abuse citation on record
  • Low overall rating (1/5 stars)
  • Low staffing rating (1/5 stars)
  • Above-median deficiencies (22 vs median 8.0)
  • High staff turnover (58%)
  • High RN turnover (67%)

Bottom 25% in Texas · Critically understaffed (RN) · Worst in AVIR HEALTH GROUP chain · $32,715 in fines · Abuse citation

Source: Medicare data

What this means for your family

While some families report exceptional end-of-life care and a clean environment, the presence of multiple reports regarding unresponsiveness to call buttons and communication breakdowns is alarming. If you choose this facility, you must implement a rigorous daily check-in schedule and verify that staff are actively responding to patient needs.

Google Reviews

Google Reviews

16 reviews on Google
Families should approach this facility with significant caution due to serious reports of medical neglect, including unresponsiveness to call buttons and failure to prevent falls. While some recent reviews praise the cleanliness and the caring nature of the nursing staff, there are recurring, severe allegations regarding poor communication, lack of oversight, and inadequate rehabilitation services.

Quality Themes

Tap a score for details
FoodN/AStaff3.0Clean6.0Activities2.0MedsN/AMemoryN/AComms1.0Value2.0

Strengths

  • Clean and well-maintained environment
  • Friendly and professional nursing staff
  • Responsive management in certain instances
  • Attentive care during end-of-life stages

Concerns

  • Unresponsiveness to call buttons and medical emergencies (mentioned by 2 reviewers)
  • Poor communication and unanswered phone calls from families (mentioned by 2 reviewers)
  • Inadequate rehabilitation and recovery services (mentioned by 2 reviewers)
  • Staff unprofessionalism and lack of engagement (mentioned by 2 reviewers)

Rating Trends

Tap a year to see what changed

2342.02013(1)5.02016(1)4.02018(1)1.02020(2)3.02021(2)1.02023(2)3.32024(9)

Distribution · 18 analyzed

5
7
4
1
3
0
2
2
1
8

How They Respond to Reviews

0%response rate

Questions for Your Tour

  • 1I've heard wonderful things about how clean and well-maintained the facility is; could you show me some of the common areas?
  • 2How do you ensure that call buttons are answered promptly, especially during busy shifts or overnight?
  • 3What is your process for keeping families updated on a loved one's health, particularly if we can't reach someone by phone?
  • 4Can you tell me more about the rehabilitation and recovery services available for residents working on their mobility?
  • 5What kind of daily activities or social events do you have planned to keep residents engaged and active?
  • 6How does the nursing team approach providing attentive care during sensitive end-of-life stages?

Personalized based on this facility's data


Key Review Excerpts

My mother was in this beautiful well kept place. Before my mom was admitted we checked other facilities and they stunk bad and residence were left alone soiled. Waterton never smelled and the residence were not left alone.

Long-term resident's family · 2024★★★★★

My father, a stroke patient, fell and got a brain bleed after calling with the “call button” for over an hour with no response. After a van took him (not an ambulance) to the hospital, we were told the button didn’t work.

Rehab patient's family · 2021☆☆☆☆

The care that is provided is Exceptional!! From the time you walk in the facility is clean and smells good. Residents look well taken care of. The staff are friendly and professional.

Frequent visitor · 2024★★★★★
Source: 16 Google reviews

Staffing

Staffing Hours

per resident/day · Medicare 2026
RN Hours
0.34hrs
45%
Registered nurses for medical care
Total Nursing
3.56hrs
87%
All nurses + aides combined
Staff Turnover
65%
Lower is better (< 30% = good)
RN Turnover
67%
Lower is better (< 30% = good)

Both RN and total nursing hours are below national benchmarks. This can mean less clinical attention per resident, so ask about their staffing plan.

Quality Measures

Quality Measures

Resident outcomes compared with national, state, and local averages · 17 measures

Medicare Rating
3/ 5
Better Than Avg

11

measures

Worse Than Avg

3

measures

Mixed Results

3

measures

Long-Stay Residents
🛏️

Residents needing more daily help over time

↓ Lower is better
This Facility26.0%
Worse than Avg
Here
26.0%
US
14.4%
TX
16.1%
Bowie
11.7%
💊

Residents on antipsychotic medication

↓ Lower is better
This Facility1.8%
Better than Avg
Here
1.8%
US
15.4%
TX
9.4%
Bowie
11.5%
🚶

Residents whose walking got worse

↓ Lower is better
This Facility22.2%
Worse than Avg
Here
22.2%
US
15.3%
TX
14.9%
Bowie
11.6%
😔

Residents with depression symptoms

↓ Lower is better
This Facility1.9%
Mixed vs Avgs
Here
1.9%
US
12.1%
TX
2.5%
Bowie
1.2%

Highly dependent on how each facility screens and codes depressive symptoms, so it varies widely between facilities.

🚿

Residents whose bladder or bowel control got worse

↓ Lower is better
This Facility9.3%
Better than Avg
Here
9.3%
US
19.4%
TX
14.2%
Bowie
12.8%
⚖️

Residents who lost too much weight

↓ Lower is better
This Facility0.0%
Better than Avg
Here
0.0%
US
5.3%
TX
3.2%
Bowie
7.5%
Short-Stay Residents (Rehab / Post-Acute)
💉

Short-stay residents vaccinated for pneumonia

↑ Higher is better
This Facility98.4%
Better than Avg
Here
98.4%
US
81.8%
TX
89.2%
Bowie
85.1%
💉

Short-stay residents vaccinated for the flu

↑ Higher is better
This Facility95.6%
Better than Avg
Here
95.6%
US
79.7%
TX
88.0%
Bowie
86.1%
💊

Short-stay residents newly given antipsychotics

↓ Lower is better
This Facility0.0%
Better than Avg
Here
0.0%
US
1.6%
TX
1.5%
Bowie
1.9%
Source: Medicare quality measures

US average from Medicare published data

Inspection History

Medicare Inspection History

3-year lookback · Medicare 2026

27deficiencies
2penalties
Well above state avg (9.1)
21 complaint-triggered
$32,715 in fines

Families have filed multiple complaints triggering 21 deficiencies, with concerning patterns in resident protection from abuse and neglect appearing across several surveys including recent ones in 2024-2025. The facility has recurring issues with resident rights, care planning and assessments, and nutrition services that persist despite corrections. While all violations show correction dates, the repeated nature of abuse protection failures and ongoing complaint activity suggests ongoing care quality concerns that families should carefully consider.

Feb 12, 2026Routine
21
0727Potential for harm · WidespreadCorrected

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.

0812Potential for harm · WidespreadCorrected

Nutrition and Dietary Deficiencies

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

0636Potential for harm · PatternCorrected

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.

0640Potential for harm · PatternCorrected

Resident Assessment and Care Planning Deficiencies

Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment.

0656Potential for harm · PatternCorrected

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.

0755Potential for harm · PatternCorrected

Pharmacy Service Deficiencies

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

0804Potential for harm · PatternCorrected

Nutrition and Dietary Deficiencies

Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.

0880Potential for harm · PatternCorrected

Infection Control Deficiencies

Provide and implement an infection prevention and control program.

0321Potential for harm · PatternCorrected

Smoke Deficiencies

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

0558Potential for harm · IsolatedCorrected

Resident Rights Deficiencies

Reasonably accommodate the needs and preferences of each resident.

0565Potential for harm · IsolatedCorrected

Resident Rights Deficiencies

Honor the resident's right to organize and participate in resident/family groups in the facility.

0582Potential for harm · IsolatedCorrected

Resident Rights Deficiencies

Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.

0637Potential for harm · IsolatedCorrected

Resident Assessment and Care Planning Deficiencies

Assess the resident when there is a significant change in condition

0641Potential for harm · IsolatedCorrected

Resident Assessment and Care Planning Deficiencies

Ensure each resident receives an accurate assessment.

0644Potential for harm · IsolatedCorrected

Resident Assessment and Care Planning Deficiencies

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

0677Potential for harm · IsolatedCorrected

Quality of Life and Care Deficiencies

Provide care and assistance to perform activities of daily living for any resident who is unable.

0685Potential for harm · IsolatedCorrected

Quality of Life and Care Deficiencies

Assist a resident in gaining access to vision and hearing services.

0689Potential for harm · IsolatedCorrected

Quality of Life and Care Deficiencies

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

0759Potential for harm · IsolatedCorrected

Pharmacy Service Deficiencies

Ensure medication error rates are not 5 percent or greater.

0806Potential for harm · IsolatedCorrected

Nutrition and Dietary Deficiencies

Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options.

0813Potential for harm · IsolatedCorrected

Nutrition and Dietary Deficiencies

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

Aug 15, 2025Complaint
7
0600Immediate jeopardy · PatternCorrected

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.

0675Immediate jeopardy · PatternCorrected

Quality of Life and Care Deficiencies

Honor each resident's preferences, choices, values and beliefs.

0585Potential for harm · PatternCorrected

Resident Rights Deficiencies

Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances.

0561Potential for harm · IsolatedCorrected

Resident Rights Deficiencies

Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.

0677Potential for harm · IsolatedCorrected

Quality of Life and Care Deficiencies

Provide care and assistance to perform activities of daily living for any resident who is unable.

0806Potential for harm · IsolatedCorrected

Nutrition and Dietary Deficiencies

Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options.

0838Potential for harm · IsolatedCorrected

Administration Deficiencies

Conduct and document a facility-wide assessment to determine what resources are necessary to care for residents competently during both day-to-day operations (including nights and weekends) and emergencies.

Apr 9, 2025Complaint
3
0550Potential for harm · PatternCorrected

Resident Rights Deficiencies

Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

0585Potential for harm · IsolatedCorrected

Resident Rights Deficiencies

Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances.

0600Potential for harm · IsolatedCorrected

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.

Dec 4, 2024Routine
11
0812Potential for harm · WidespreadCorrected

Nutrition and Dietary Deficiencies

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

0553Potential for harm · PatternCorrected

Resident Rights Deficiencies

Allow resident to participate in the development and implementation of his or her person-centered plan of care.

0804Potential for harm · PatternCorrected

Nutrition and Dietary Deficiencies

Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.

0809Potential for harm · PatternCorrected

Nutrition and Dietary Deficiencies

Ensure meals and snacks are served at times in accordance with resident’s needs, preferences, and requests. Suitable and nourishing alternative meals and snacks must be provided for residents who want to eat at non-traditional times or outside of scheduled meal times.

0558Potential for harm · IsolatedCorrected

Resident Rights Deficiencies

Reasonably accommodate the needs and preferences of each resident.

0623Potential for harm · IsolatedCorrected

Resident Rights Deficiencies

Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.

0655Potential for harm · IsolatedCorrected

Resident Assessment and Care Planning Deficiencies

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

0688Potential for harm · IsolatedCorrected

Quality of Life and Care Deficiencies

Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.

0692Potential for harm · IsolatedCorrected

Quality of Life and Care Deficiencies

Provide enough food/fluids to maintain a resident's health.

0758Potential for harm · IsolatedCorrected

Pharmacy Service Deficiencies

Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.

0640Minimal · PatternCorrected

Resident Assessment and Care Planning Deficiencies

Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment.

Dec 4, 2024Complaint
1
0685Potential for harm · IsolatedCorrected

Quality of Life and Care Deficiencies

Assist a resident in gaining access to vision and hearing services.

Oct 29, 2024Complaint
6
0550Potential for harm · IsolatedCorrected

Resident Rights Deficiencies

Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

0600Potential for harm · IsolatedCorrected

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.

0609Potential for harm · IsolatedCorrected

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

0610Potential for harm · IsolatedCorrected

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Respond appropriately to all alleged violations.

0689Potential for harm · IsolatedCorrected

Quality of Life and Care Deficiencies

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

0880Potential for harm · IsolatedCorrected

Infection Control Deficiencies

Provide and implement an infection prevention and control program.

Federal Penalties

Fine

Aug 15, 2025

$46,315

Payment Denial

Aug 15, 2025

5-day denial

Ownership & Operations

Who Operates This Facility

Owner / Operator

Guadalupe County Hospital Board

Organization Type

for profit

Management Company

5524 COWHORN CREEK OPCO, LLC

Administrator

BRITNEY BETTS CLEVELAND

Chain Affiliation

Chain Name

Avir Health Group

Chain Size

117 facilities nationwide

Chain avg rating: 2.3/5 · Rank 85 of 90 (Worst)

Ownership & Management

Owners

Undisclosed

Ownership Data Not Available · Organization

Source: Medicare provider data

Contact

Get in Touch

Contact this facility directly and verify the details that matter most to your family.

References & Resources

EveryPlace is a research directory. Facility information is compiled from public sources — Medicare.gov, state licensing portals, Google Places, and publicly available street-level imagery. Listings do not constitute endorsement, recommendation, or advertisement, and we do not accept payment for placement. Families should verify all details directly with the facility and the original sources linked above before making any care decisions. See our Research Policy for our editorial standards, correction process, and image-removal policy.

Safer Alternatives Nearby

Based on current clinical data, we identified 6 nearby facilities within 10 miles that may offer a stronger care environment. We encourage families to compare options carefully.

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