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Below-average Medicare ratings — review the inspection history and ask the administrator about recent corrections before visiting.
based on 169 Google reviews
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These current public-data fields deserve follow-up with the facility and the official Medicare record. They are not a clinical risk score or a substitute for an in-person assessment.
This facility has areas of concern that warrant careful consideration. Registered Nurse hours are 39% of the EveryPlace reference benchmark; ask how RN coverage is allocated across shifts. The latest standard survey recorded 12 findings, above the TX average of 9.1. We recommend asking the administrator directly: "How are you addressing recent staffing shortfalls?" These are not reasons to panic, but they are reasons to ask tough questions and visit in person.
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
Concerns
Rating Trends
Tap a year to see what changed
Distribution · 174 analyzed
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.
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.”
“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”
“The facility is being renovated and the new nurses station is looking really nice. The front lobby is welcoming and the staff is attentive, friendly, and helpful.”
Both RN and total nursing hours are below the EveryPlace reference benchmarks. Ask the facility how it staffs each shift for current resident needs.
Reference benchmarks (0.75 RN and 4.1 total nursing hours per resident/day) are comparison targets, not current federal minimum requirements.
Resident outcomes compared with national, state, and local averages · 17 measures
15
measures
2
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 on anti-anxiety or sleep medication
Residents whose walking got worse
Residents who lost too much weight
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
Detailed Medicare record · up to 3-year lookback
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.
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.
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.
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.
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.
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
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
Kirbyville I Enterprises, LLC
for profit
ARMSTRONG HEALTHCARE INC
AARON FARNSWORTH
The Ensign Group
346 facilities nationwide
Chain avg rating: 2.9/5 · Rank 58 of 84
Owners
Liberty County Hospital District no.1
Owner · Organization
Key personnel
Contact this facility directly and verify the details that matter most to your family.
Medicare Care Compare
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Google Reviews
169 reviews from families & visitors
Official Website
Visit legendnorthwesthouston.com
Medicare data downloads
Original nursing home datasets
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. Some summaries, interpretations, suggested questions, and pricing research are AI-generated or AI-assisted and may contain errors or omit important context. 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.
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