Legend Oaks Healthcare and Rehabilitation Center Gladewater
Below-average Medicare ratings — review the inspection history and ask the administrator about recent corrections before visiting.
based on 86 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 (2/5 stars)
- High staff turnover (51%)
Below average in Texas · Below recommended RN staffing · Below chain average · $124,559 in fines
What this means for your family
This facility's physical therapy and nursing staff are frequently praised for their compassion and skill in post-surgical recovery. However, families should be extremely vigilant about hygiene standards and medication accuracy, as multiple reviewers have reported serious lapses in basic care and communication.
Google Reviews
Google Reviews
86 reviews analyzed“Families considering Legend Oaks can expect a highly compassionate rehabilitation and nursing team that many reviewers describe as treating residents like family. While many praise the physical therapy and the kindness of the staff, there are serious, documented allegations regarding neglect, medication errors, and poor communication between staff and doctors that should be investigated during a visit.”
Quality Themes
Tap a score for detailsStrengths
- Compassionate and attentive nursing staff
- Effective and professional physical therapy
- Clean and well-maintained environment
- Welcoming and friendly atmosphere
Concerns
- Allegations of resident neglect and hygiene issues (mentioned by 2 reviewers)
- Unreliable communication between staff and physicians
- Medication management errors
Rating Trends
Tap a year to see what changed
Distribution
How They Respond to Reviews
The owner provides highly personalized and empathetic responses to detailed reviews, often addressing specific staff members or patient situations. However, for simple star ratings without text, the responses shift to repetitive, templated gratitude.
Questions for Your Tour
- 1I noticed some wonderful comments about how friendly and welcoming the atmosphere is here; how do you foster that sense of community among the residents?
- 2Could you walk me through your specific protocols for medication administration and how you ensure accuracy for every resident?
- 3What is your process for ensuring seamless communication between the nursing staff and the attending physicians, especially regarding changes in a resident's condition?
- 4How do you manage daily hygiene routines and personal care to ensure every resident feels clean and comfortable?
- 5What does the daily meal schedule look like, and how do you involve residents in their dining experience?
- 6In the event of a medical emergency during the night, what are the immediate steps the on-site staff takes to coordinate care?
Personalized based on this facility's data
Key Review Excerpts
“Tamika was so gentle with my mother in law who had bad fall. She showed me that my mother in law is in good hands!”
“The first facility we had her in just kept her in bed and we need physical therapy!! Legend Oaks has done an outstanding job taking care of our mother and getting her the rehab she’s needed.”
“My mother is currently at the facility for extended rehab after a massive stroke left her partially paralyzed. Communication between the staff and her doctor is incredibly unreliable.”
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
10
measures
4
measures
3
measures
Residents needing more daily help over time
Residents on antipsychotic medication
Residents on anti-anxiety or sleep medication
Residents with depression symptoms
Residents whose walking got worse
Residents whose bladder or bowel control got worse
Short-stay residents vaccinated for the flu
Short-stay residents vaccinated for pneumonia
Short-stay residents newly given antipsychotics
US average from Medicare published data
Inspection History
Medicare Inspection History
3-year lookback · Medicare 2026
This facility has serious concerns with 15 family-reported complaints triggering inspections, including recent severe issues with abuse prevention and reporting that families complained about in 2024. The most recurring problems involve resident safety and accident prevention, medication management, and infection control. While most deficiencies show correction plans, the pattern of repeated issues across the same care areas and the high volume of family complaints suggest ongoing quality challenges that warrant careful consideration.
Jan 29, 2026Complaint1
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Jan 21, 2026Complaint1
Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Feb 12, 2025Routine7
Resident Rights Deficiencies
Reasonably accommodate the needs and preferences of each resident.
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.
Infection Control Deficiencies
Provide and implement an infection prevention and control program.
Quality of Life and Care Deficiencies
Provide safe and appropriate respiratory care for a resident when needed.
Nutrition and Dietary Deficiencies
Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service.
Nutrition and Dietary Deficiencies
Ensure each resident receives and the facility provides drinks consistent with resident needs and preferences and sufficient to maintain resident hydration.
Services Deficiencies
Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.
Oct 23, 2024Complaint4
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.
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Respond appropriately to all alleged violations.
Jun 19, 2024Complaint2
Environmental Deficiencies
Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.
Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Feb 22, 2024Complaint3
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Protect each resident from separation (from other residents, his/her room, or confinement to his/her room).
Infection Control Deficiencies
Provide and implement an infection prevention and control program.
Resident Rights Deficiencies
Honor the resident's right to receive visitors of his or her choosing, at the time of his or her choosing.
Federal Penalties
Fine
Oct 23, 2024
$16,801
Fine
Oct 23, 2024
$16,801
Fine
Oct 23, 2024
$16,801
Fine
Oct 23, 2024
$16,801
Fine
Jun 19, 2024
$43,070
Fine
Sep 13, 2023
$14,285
Ownership & Operations
Who Operates This Facility
Fannin County Hospital Authority
for profit
DAFFODIL HEALTHCARE, INC
LUCAS ARAGON
Chain Affiliation
The Ensign Group
338 facilities nationwide
Chain avg rating: 2.9/5 · Rank 57 of 84
Ownership & Management
Owners
Fannin County Hospital Authority
Owner · Organization
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
86 reviews from families & visitors
Official Website
Visit legendgladewater.com
Medicare data downloads
Original nursing home datasets
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Safer Alternatives Nearby
Based on current clinical data, we identified 2 nearby facilities within 10 miles that may offer a stronger care environment. We encourage families to compare options carefully.