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Villages of Lake Highlands

Below-average Medicare ratings — review the inspection history and ask the administrator about recent corrections before visiting.

8615 Lullwater Drive, Lake Highlands · Dallas, TX 75238126 bedsLicensed & Active
2/5
Medicare
Inspection
Quality
Staffing
Google rating
4.3/5

based on 252 Google reviews

5
4
3
2
1

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2/ 10
low Risk

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)

Below average in Texas · Below recommended RN staffing · Above recommended total nurse staffing · $28,814 in fines

Source: Medicare data

What this means for your family

This facility offers exceptional physical therapy and a wonderful activities program that can greatly improve a resident's quality of life. However, families must be extremely vigilant regarding staffing levels and medication accuracy, as multiple recent reports indicate serious lapses in care during night and weekend shifts.

Google Reviews

Google Reviews

252 reviews on Google
Families considering The Villages of Lake Highlands will find a facility highly praised for its exceptional physical therapy, social work, and vibrant activities programs. However, there are significant and recurring reports of severe understaffing, particularly on weekends and nights, which has led to serious allegations of neglect and medication errors.

Quality Themes

Tap a score for details
Food3.0Staff5.0Clean4.0Activities9.0Meds2.0MemoryN/AComms4.0Value5.0

Strengths

  • Exceptional physical therapy and rehab services
  • Engaging and thoughtful activities programs
  • Compassionate social work and admissions staff
  • Clean and beautiful physical environment

Concerns

  • Severe understaffing on nights and weekends (mentioned by 4 reviewers)
  • Neglect regarding hygiene and cleanliness of rooms (mentioned by 3 reviewers)
  • Medication administration errors (mentioned by 3 reviewers)
  • Poor food quality and dietary management (mentioned by 3 reviewers)
  • Lack of communication from management/nursing (mentioned by 2 reviewers)

Rating Trends

Tap a year to see what changed

2344.92021(17)4.82022(107)4.42023(24)4.02024(14)4.02025(38)4.32026(6)

Distribution · 206 analyzed

5
179
4
4
3
1
2
2
1
20
22 reviews posted between Jan 24, 2022Jan 29, 2022 · 21 were 5-star
13 reviews posted between Dec 5, 2022Dec 6, 2022 · 13 were 5-star
11 reviews posted between Dec 13, 2021Dec 16, 2021 · 11 were 5-star

How They Respond to Reviews

70%response rate
Good

The owner provides highly personalized responses to positive reviews, frequently using the reviewer's name and acknowledging specific staff members or events mentioned. However, the response to the most severe negative review is overtly defensive and argumentative.

Questions for Your Tour

  • 1It is wonderful to see how much management engages with the community online; how does the leadership team ensure that communication remains consistent between the nursing staff and families?
  • 2We have heard great things about your physical therapy and rehab services; could you tell us more about how those programs are integrated into a resident's daily routine?
  • 3What kind of engaging activities or social programs do you have planned to keep the residents active and connected?
  • 4With the high staffing rating you have, how do you ensure that the same level of care and attention is maintained during the night shifts and over the weekends?
  • 5Could you walk us through your specific protocols for medication administration and how you track accuracy to ensure resident safety?
  • 6How do you manage dietary needs and meal quality to ensure that every resident enjoys nutritious and appetizing food?

Personalized based on this facility's data


Key Review Excerpts

The activities team is amazing. They truly care about providing the residents with a high quality of life. They constantly organize activities to keep the residents active and engaged.

Long-term resident's family · 2025★★★★★

The physical therapy she received helped her tremendously! So much so, that she's having the other knee replacement surgery and plans to go back again.

Rehab patient's family · 2024★★★★★

We were surrounded by staff that cried and prayed with us during our final days. Her favorite 'entertainer' that we called 'The Cowboy Guy' came and played to her personally by her bedside.

Hospice patient's family · 2024★★★★★
Source: 252 Google reviews

Staffing

Staffing Hours

per resident/day · Medicare 2026
RN Hours
0.39hrs
52%
Registered nurses for medical care
Total Nursing
4.44hrs
OK
All nurses + aides combined
Staff Turnover
40%
Lower is better (< 30% = good)
RN Turnover
63%
Lower is better (< 30% = good)

RN hours are below the national benchmark. RNs handle complex medical needs and medication, so ask about coverage during your visit.

Quality Measures

Quality Measures

Resident outcomes compared with national, state, and local averages · 17 measures

Medicare Rating
5/ 5
Better Than Avg

7

measures

Worse Than Avg

8

measures

Mixed Results

2

measures

Long-Stay Residents
💊

Residents on antipsychotic medication

↓ Lower is better
This Facility4.7%
Better than Avg
Here
4.7%
US
15.4%
TX
9.4%
Dallas
10.8%
🚶

Residents whose walking got worse

↓ Lower is better
This Facility6.5%
Better than Avg
Here
6.5%
US
15.3%
TX
14.9%
Dallas
17.1%
😔

Residents with depression symptoms

↓ Lower is better
This Facility9.6%
Mixed vs Avgs
Here
9.6%
US
12.1%
TX
2.5%
Dallas
2.0%

Highly dependent on how each facility screens and codes depressive symptoms, so it varies widely between facilities.

💊

Residents on anti-anxiety or sleep medication

↓ Lower is better
This Facility12.6%
Better than Avg
Here
12.6%
US
19.5%
TX
18.4%
Dallas
16.2%
🚿

Residents whose bladder or bowel control got worse

↓ Lower is better
This Facility19.9%
Worse than Avg
Here
19.9%
US
19.4%
TX
14.2%
Dallas
16.2%
💉

Residents vaccinated for pneumonia

↑ Higher is better
This Facility93.2%
Worse than Avg
Here
93.2%
US
93.4%
TX
96.9%
Dallas
95.6%
Short-Stay Residents (Rehab / Post-Acute)
💉

Short-stay residents vaccinated for the flu

↑ Higher is better
This Facility45.4%
Worse than Avg
Here
45.4%
US
79.7%
TX
88.0%
Dallas
78.8%
💉

Short-stay residents vaccinated for pneumonia

↑ Higher is better
This Facility48.7%
Worse than Avg
Here
48.7%
US
81.8%
TX
89.2%
Dallas
86.4%
💊

Short-stay residents newly given antipsychotics

↓ Lower is better
This Facility0.5%
Better than Avg
Here
0.5%
US
1.6%
TX
1.5%
Dallas
1.3%
Source: Medicare quality measures

US average from Medicare published data

Inspection History

Medicare Inspection History

3-year lookback · Medicare 2026

7deficiencies
3penalties
Near state avg (9.1)
11 complaint-triggered
$28,814 in fines

Multiple families have filed complaints leading to 11 deficiencies, with recurring issues in treatment and care, medication management, and care planning. The facility shows a pattern of problems with providing appropriate care according to orders and developing complete care plans, with these issues appearing across multiple surveys. While all deficiencies show correction dates, the repeated nature of complaints and similar violations across different time periods suggests ongoing care quality concerns.

Dec 1, 2025Complaint
1
0656Potential for harm · IsolatedCorrected

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 13, 2025Complaint
2
0684Immediate jeopardy · IsolatedResolved (past non-compliance)

Quality of Life and Care Deficiencies

Provide appropriate treatment and care according to orders, resident’s preferences and goals.

0842Potential for harm · PatternResolved (past non-compliance)

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.

Aug 28, 2025Complaint
1
0684Immediate jeopardy · PatternCorrected

Quality of Life and Care Deficiencies

Provide appropriate treatment and care according to orders, resident’s preferences and goals.

May 16, 2025Complaint
1
0695Immediate jeopardy · PatternCorrected

Quality of Life and Care Deficiencies

Provide safe and appropriate respiratory care for a resident when needed.

May 16, 2025Routine
5
0918Potential for harm · WidespreadCorrected

Gas, Vacuum, and Electrical Systems Deficiencies

Have generator or other power source capable of supplying service within 10 seconds.

0761Potential for harm · PatternCorrected

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.

0880Potential for harm · IsolatedCorrected

Infection Control Deficiencies

Provide and implement an infection prevention and control program.

0321Potential for harm · IsolatedCorrected

Smoke Deficiencies

Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.

0923Potential for harm · IsolatedCorrected

Gas, Vacuum, and Electrical Systems Deficiencies

Have proper medical gas storage and administration areas.

Oct 24, 2024Complaint
1
0689Actual harm · IsolatedResolved (past non-compliance)

Quality of Life and Care Deficiencies

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Federal Penalties

Fine

Aug 28, 2025

$11,879

Fine

Oct 24, 2024

$8,976

Fine

Apr 18, 2024

$8,167

Ownership & Operations

Who Operates This Facility

Owner / Operator

Jsc Lake Highlands Operations, Lp

Organization Type

for profit

Management Company

VILLAGE SENIOR CARE LLC

Administrator

MUBASHIR M KAMRAN

Ownership & Management

Owners

Jsc Lake Highlands I Senior Living, Lp

Owner · Organization

100%

Javelin Group Funding I, Lp

Owner (parent company) · Organization

100%

Key personnel

Wolfe, KellyW-2 Managing EmployeeEden, KevinOfficer / DirectorNaul, AlanOfficer / DirectorVillage Senior Care LLCManagerJavelin Group Gen Par I, LLCGeneral Partnership Interest
Source: Medicare provider data

Contact

Get in Touch

Contact this facility directly and verify the details that matter most to your family.

References & Resources

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. 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.

Safer Alternatives Nearby

Based on current clinical data, we identified 6 nearby facilities within 10 miles that may offer a stronger care environment. We encourage families to compare options carefully.

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