Avir at Tierra Este
Below-average Medicare ratings — review the inspection history and ask the administrator about recent corrections before visiting.
based on 190 Google reviews

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Quality Concerns Identified
Medicare inspection and quality data reveal areas that families should carefully evaluate before choosing this facility.
- Low overall rating (1/5 stars)
- Low staffing rating (1/5 stars)
- Above-median deficiencies (11 vs median 8.0)
- High staff turnover (69%)
- High RN turnover (100%)
Bottom 25% in Texas · Critically understaffed (RN) · Worst in AVIR HEALTH GROUP chain · $31,752 in fines
What this means for your family
This facility is an excellent choice for those prioritizing a clean, modern, and aesthetically pleasing environment with great rehab services. However, families should closely monitor daily hygiene and medication administration, as several reviewers have noted serious lapses in care due to staffing shortages.
Google Reviews
Google Reviews
190 reviews on Google“AVIR AT TIERRA ESTE is frequently praised for its beautiful, modern, and exceptionally clean facility and its welcoming admissions process. While many families report high satisfaction with the nursing staff and physical therapy, there are serious, recurring reports of understaffing, neglect regarding hygiene, and issues with medication management.”
Quality Themes
Tap a score for detailsStrengths
- Clean and modern facility
- Professional and welcoming admissions staff
- Effective physical therapy and rehab services
- Friendly and attentive nursing staff
Concerns
- Understaffing leading to delayed care and hygiene issues (mentioned by 5 reviewers)
- Inconsistent medication management and clinical errors (mentioned by 2 reviewers)
- High noise levels and lack of privacy in shared rooms (mentioned by 2 reviewers)
- Difficulty with transportation coordination (mentioned by 2 reviewers)
Rating Trends
Tap a year to see what changed
Distribution · 155 analyzed
How They Respond to Reviews
The owner provides personalized responses that frequently use the reviewer's name and acknowledge specific details like staff members or facility cleanliness. For negative reviews, the owner uses a consistent professional template that denies the validity of the claims and provides a phone number for direct resolution.
Questions for Your Tour
- 1Since the admissions team is known for being so welcoming, could you walk us through the specific steps for transitioning a loved one into a room here?
- 2With the recent focus on improving clinical care, what specific new protocols have been put in place to ensure medication management is 100% accurate?
- 3How does the nursing team manage care during busy shifts to ensure that hygiene needs and personal requests are never delayed?
- 4We've heard great things about the physical therapy services; how often do residents participate in rehab or movement programs?
- 5In the shared room settings, what steps are taken to help residents maintain their privacy and manage noise levels for better sleep?
- 6What is the process for coordinating transportation if a resident needs to attend an outside medical appointment or family event?
Personalized based on this facility's data
Key Review Excerpts
“The dietary manager was incredible! He made sure my gluten free meals were properly prepare”
“The facility is new, spotless, and has a lovely charm to it. Our appointment began with a tour of all the communal spaces.”
“My mother was there until she passed away. She was the one who told me 'Every single person of their stuff are extremely nice'.”
Staffing
Staffing Hours
per resident/day · Medicare 2026Both 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
7
measures
9
measures
1
measures
Residents vaccinated for the flu
Residents on antipsychotic medication
Residents on anti-anxiety or sleep medication
Residents with depression symptoms
Highly dependent on how each facility screens and codes depressive symptoms, so it varies widely between facilities.
Residents whose walking got worse
Residents whose bladder or bowel control got worse
Short-stay residents vaccinated for pneumonia
Short-stay residents vaccinated for the flu
Short-stay residents newly given antipsychotics
US average from Medicare published data
Inspection History
Medicare Inspection History
3-year lookback · Medicare 2026
This facility shows a concerning pattern with 73 deficiencies across 14 surveys, including numerous family complaints that triggered investigations. Most frequent problems involve infection control, medication management, and food safety - with food safety violations recurring without correction plans. Recent deficiencies from 2025-2026 remain uncorrected, and complaints continue into 2025 regarding nursing staffing and care planning, suggesting ongoing systemic issues that persist despite correction attempts.
Jan 15, 2026Complaint2
Nutrition and Dietary Deficiencies
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
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.
Sep 5, 2025Routine16
Smoke Deficiencies
Inspect, test, and maintain automatic sprinkler systems.
Miscellaneous Deficiencies
Have simulated fire drills held at unexpected times.
Gas, Vacuum, and Electrical Systems Deficiencies
Have generator or other power source capable of supplying service within 10 seconds.
Resident Rights Deficiencies
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Quality of Life and Care Deficiencies
Provide care and assistance to perform activities of daily living for any resident who is unable.
Quality of Life and Care Deficiencies
Provide safe and appropriate respiratory care for a resident when needed.
Pharmacy Service Deficiencies
Ensure 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.
Emergency Preparedness Deficiencies
Implement emergency and standby power systems.
Smoke Deficiencies
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
Miscellaneous Deficiencies
Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.
Gas, Vacuum, and Electrical Systems Deficiencies
Meet requirements for the installation and maintenance of electrical systems.
Gas, Vacuum, and Electrical Systems Deficiencies
Have proper medical gas storage and administration areas.
Resident Rights Deficiencies
Reasonably accommodate the needs and preferences of each resident.
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.
Pharmacy Service Deficiencies
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Infection Control Deficiencies
Provide and implement an infection prevention and control program.
Apr 1, 2025Complaint1
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.
Feb 20, 2025Complaint1
Quality of Life and Care Deficiencies
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Nov 27, 2024Complaint1
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.
Aug 2, 2024Routine22
Environmental Deficiencies
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
Emergency Preparedness Deficiencies
Conduct testing and exercise requirements.
Emergency Preparedness Deficiencies
Implement emergency and standby power systems.
Gas, Vacuum, and Electrical Systems Deficiencies
Have generator or other power source capable of supplying service within 10 seconds.
Resident Rights Deficiencies
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
Pharmacy Service Deficiencies
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
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.
Pharmacy Service Deficiencies
Ensure medication error rates are not 5 percent or greater.
Pharmacy Service Deficiencies
Ensure 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.
Nutrition and Dietary Deficiencies
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Nutrition and Dietary Deficiencies
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Nutrition and Dietary Deficiencies
Dispose of garbage and refuse properly.
Administration Deficiencies
Have the Quality Assessment and Assurance group have the required members and meet at least quarterly
Infection Control Deficiencies
Provide and implement an infection prevention and control program.
Resident Rights Deficiencies
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Resident Rights Deficiencies
Reasonably accommodate the needs and preferences of each resident.
Resident Rights Deficiencies
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
Keep residents' personal and medical records private and confidential.
Resident Assessment and Care Planning Deficiencies
Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.
Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Quality of Life and Care Deficiencies
Provide safe and appropriate respiratory care for a resident when needed.
Pharmacy Service Deficiencies
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
Federal Penalties
Fine
Feb 20, 2024
$4,178
Fine
Feb 12, 2024
$3,798
Fine
Jan 22, 2024
$9,116
Fine
Jan 8, 2024
$2,279
Fine
Jan 2, 2024
$1,764
Fine
Dec 11, 2023
$3,174
Fine
Nov 9, 2023
$7,443
Ownership & Operations
Who Operates This Facility
West Wharton County Hospital District
for profit
14300 PEBBLE HILLS BOULEVARD OPCO LLC
SARA D HUCKINS
Chain Affiliation
Avir Health Group
117 facilities nationwide
Chain avg rating: 2.3/5 · Rank 64 of 90 (Worst)
Ownership & Management
Owners
East El Paso Healthcare Operations LLC
Owner (parent company) · Organization
Douglas, Lloyd
Owner (parent company)
Key personnel
Contact
Get in Touch
Contact this facility directly and verify the details that matter most to your family.
References & Resources
Medicare Care Compare
Official Medicare quality ratings, inspections & staffing data
Google Maps
Photos, directions & neighborhood info
Google Reviews
190 reviews from families & visitors
Official Website
Visit tierraestehc.com
Medicare data downloads
Original nursing home datasets
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