A middle-range Medicare rating. Review each component and visit in person before deciding.
based on 361 Google reviews
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Legend Oaks Healthcare and Rehabilitation Center San Antonio has a middle-range Medicare overall rating. Strengths include compassionate and attentive nursing staff. Some reviewers note concerns about delays in responding to call lights and patient needs (mentioned by 3 reviewers). Review the health-inspection, staffing, and quality-measure components separately, then visit in person.
Families considering Legend Oaks can expect a facility highly praised for its exceptionally friendly, professional, and attentive nursing and therapy staff. While many reviewers highlight the cleanliness and the quality of the rehabilitation programs, there are significant, serious concerns regarding medication errors, delayed response to call lights, and occasional issues with the loss of personal belongings.
Quality Themes
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Concerns
Rating Trends
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Distribution · 253 analyzed
The owner provides personalized responses to positive reviews by referencing specific details like staff names, cleanliness, or family members. For negative reviews, they use a consistent professional template that acknowledges the issue and requests direct contact for resolution.
Personalized based on this facility's data
Key Review Excerpts
“My mother has late stage dementia and has been a resident of Legend Oaks for 2 years . Myself and my entire family are overwhelmed with the excellent care she has received.”
“The staff was very professional. The building was clean. I went to go visit a Family friend. She was well taken care of”
“My sister was there for less than four days and experienced negligent care and disregard for her physical needs. She required assistance to get out of her bed and to go to the bathroom. She asked for help and was ignored multiple times.”
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
1
measures
1
measures
Residents whose bladder or bowel control got worse
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 needing more daily help over time
Residents vaccinated for pneumonia
Residents on anti-anxiety or sleep medication
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 recurring deficiencies across multiple surveys, with families filing complaints that triggered federal investigations into dental care and care planning issues. The most frequent problems involve food safety and dietary services, care planning and resident assessments, and fire safety equipment. While all violations show correction dates, the repeated issues with food handling across three separate surveys and ongoing problems with resident care planning suggest potential systemic challenges that families should carefully evaluate.
Resident Rights Deficiencies
Reasonably accommodate the needs and preferences of each resident.
Resident Rights Deficiencies
Let each resident or the resident's legal representative access or purchase copies of all the resident's records.
Resident Rights Deficiencies
Keep residents' personal and medical records private and confidential.
Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Nutrition and Dietary Deficiencies
Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs.
Resident Rights Deficiencies
Allow residents to easily view the nursing home's survey results and communicate with advocate agencies.
Quality of Life and Care Deficiencies
Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube.
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.
Smoke Deficiencies
Properly select, install, inspect, or maintain portable fire extinguishes.
Resident Rights Deficiencies
Allow residents to self-administer drugs if determined clinically appropriate.
Resident Rights Deficiencies
Keep residents' personal and medical records private and confidential.
Resident Assessment and Care Planning Deficiencies
Ensure each resident receives an accurate assessment.
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
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
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Egress Deficiencies
Keep aisles, corridors, and exits free of obstruction in case of emergency.
Smoke Deficiencies
Have approved installation, maintenance and testing program for fire alarm systems.
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
Quality of Life and Care Deficiencies
Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail.
Nutrition and Dietary Deficiencies
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Gas, Vacuum, and Electrical Systems Deficiencies
Ensure electrical receptacles or cover plates have distinctive color or marking.
Resident Rights Deficiencies
Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.
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.
Quality of Life and Care Deficiencies
Provide safe, appropriate dialysis care/services for a resident who requires such services.
Administration Deficiencies
Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services.
Infection Control Deficiencies
Provide and implement an infection prevention and control program.
Smoke Deficiencies
Properly select, install, inspect, or maintain portable fire extinguishes.
Quality of Life and Care Deficiencies
Provide routine and 24-hour emergency dental care for 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.
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 Rights Deficiencies
Reasonably accommodate the needs and preferences of each resident.
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.
Resident Assessment and Care Planning Deficiencies
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Quality of Life and Care Deficiencies
Provide safe and appropriate respiratory care for a resident when needed.
Nursing and Physician Services Deficiencies
Ensure that the resident and his/her doctor meet face-to-face at all required visits.
Dewitt Medical District
for profit
HUTCHINS HEALTHCARE, INC
PETER TIERNEY
The Ensign Group
346 facilities nationwide
Chain avg rating: 2.9/5 · Rank 1 of 84 (Highest rating)
Key personnel
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361 reviews from families & visitors
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