Legend Oaks Healthcare and Rehabilitation Center Northwest Houston
Meets baseline Medicare standards with room for improvement. A tour and talking to current residents' families is the best next step.
based on 164 Google reviews
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What this means for your family
This facility offers an excellent rehabilitation and therapy program that has helped many patients regain mobility. However, families must remain extremely vigilant regarding daily hygiene and medication administration, as multiple reports indicate serious lapses in basic care and responsiveness to call lights.
Google Reviews
Google Reviews
164 reviews on Google“Families considering Legend Oaks should be aware of a significant divide in experiences: while many praise the exceptional physical therapy team and friendly nursing staff, there are serious, recurring allegations of neglect, including improper hygiene, medication errors, and unresponsiveness to call lights. While some recent reviews highlight recent renovations and a professional atmosphere, several recent reports describe severe issues with cleanliness and staffing shortages.”
Quality Themes
Tap a score for detailsStrengths
- Excellent physical and occupational therapy teams
- Professional and friendly nursing staff
- Clean and well-maintained recent renovations
- Responsive admissions and administrative staff
Concerns
- Neglect regarding hygiene and incontinence care (mentioned by 4 reviewers)
- Medication errors or missed doses (mentioned by 3 reviewers)
- Unresponsive call lights and slow staff response (mentioned by 4 reviewers)
- Facility cleanliness and unpleasant odors (mentioned by 3 reviewers)
- Staffing shortages, particularly at night (mentioned by 2 reviewers)
Rating Trends
Tap a year to see what changed
Distribution · 168 analyzed
How They Respond to Reviews
The owner provides highly personalized and warm responses to positive reviews, often addressing specific staff members or clinical outcomes mentioned. For negative reviews, the owner uses a professional, investigative tone, acknowledging the severity of the claims and inviting direct communication.
Questions for Your Tour
- 1I noticed some great feedback about your therapy teams; could you tell me more about how the physical and occupational therapists work with residents to maintain their mobility?
- 2With the recent renovations, how has the updated environment helped improve the overall cleanliness and atmosphere of the resident rooms?
- 3What specific protocols do you have in place to ensure medication is administered accurately and on schedule for every resident?
- 4How does the nursing staff manage call light responses during the night shift to ensure residents aren't left waiting for assistance?
- 5What is your process for ensuring consistent hygiene and personal care for residents who may need extra help with incontinence?
- 6Could you describe what a typical day looks like for residents, including meal service and any social activities or group outings?
Personalized based on this facility's data
Key Review Excerpts
“The therapy helped me get back to where I was. The nursing team was great. Any issues I may had was resolved timely.”
“I am grateful to the staff of Legend Oaks of being present for my mother. They are understanding, giving, and caring . They have really made my mother feel at home.”
“My mother asked for a Tylenol and they brought her a Tramadol, yes, Tramadol was on her chart to give, but they just wanted her to sleep so she would be less work. Left her in feces overnight and during the day over 3 hours before changing her”
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
12
measures
4
measures
1
measures
Residents on antipsychotic medication
Residents with depression symptoms
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
Residents whose walking got worse
Residents on anti-anxiety or sleep medication
Residents vaccinated for pneumonia
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 a concerning pattern of 10 complaint-triggered deficiencies, indicating families have filed reports about care problems. The most recurring issues involve care planning, medication management, and fire safety violations. Problems persist across multiple surveys, with care planning deficiencies appearing in five separate inspections from 2023 to 2025, and medication errors cited as recently as December 2025, suggesting ongoing systemic issues.
Dec 1, 2025Complaint6
Resident Assessment and Care Planning Deficiencies
Ensure each resident receives an accurate assessment.
Quality of Life and Care Deficiencies
Provide for the safe, appropriate administration of IV fluids for a resident when needed.
Nursing and Physician Services Deficiencies
Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being.
Pharmacy Service Deficiencies
Ensure that residents are free from significant medication errors.
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.
Nursing and Physician Services Deficiencies
Post nurse staffing information every day.
Jun 6, 2025Routine10
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
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
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Smoke Deficiencies
Install an approved automatic sprinkler system.
Smoke Deficiencies
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
Services Deficiencies
Have properly installed electrical wiring and gas equipment.
Gas, Vacuum, and Electrical Systems Deficiencies
Ensure proper usage of power strips and extension cords.
Quality of Life and Care Deficiencies
Provide safe and appropriate respiratory care for a resident when needed.
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.
Feb 28, 2025Complaint2
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.
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.
May 10, 2024Routine6
Nutrition and Dietary Deficiencies
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Egress Deficiencies
Have properly located and lighted "Exit" signs.
Smoke Deficiencies
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
Smoke Deficiencies
Provide properly protected cooking facilities.
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.
Apr 23, 2024Complaint4
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.
Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
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.
Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Mar 2, 2023Routine4
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.
Quality of Life and Care Deficiencies
Provide activities to meet all resident's needs.
Pharmacy Service Deficiencies
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Smoke Deficiencies
Inspect, test, and maintain automatic sprinkler systems.
Federal Penalties
Fine
Apr 23, 2024
$39,045
Ownership & Operations
Who Operates This Facility
Kirbyville I Enterprises, LLC
for profit
ARMSTRONG HEALTHCARE INC
AARON FARNSWORTH
Chain Affiliation
The Ensign Group
338 facilities nationwide
Chain avg rating: 2.9/5 · Rank 58 of 84
Ownership & Management
Owners
Liberty County Hospital District no. 1
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
164 reviews from families & visitors
Official Website
Visit legendnorthwesthouston.com
Medicare data downloads
Original nursing home datasets
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