Nursing HomeInspections

Autumn Leaves Nursing and Rehab INC

Nursing home in Henderson, TX

Medicare & Medicaid certified2★ overall (CMS)

Call (903) 657-1923Send a messageMap ↗

Public-record details

Address
321 Kilgore Drive, Henderson, TX 75652
Phone
(903) 657-1923
Listed under
Government-owned
Medicare CCN
676025
Overall star rating
2 of 5 ★★☆☆☆
Health inspection rating
2 of 5
Staffing rating
1 of 5
Quality measures rating
5 of 5
Certified beds
125
Average residents per day
99
Ownership
Government, hospital district
Legal business name
Frio Hospital District
Chain
Ml Healthcare (6 facilities)
Certified for
Medicare and Medicaid
First approved by Medicare/Medicaid
Jun 18, 2004
Changed ownership in last 12 months
No
Continuing care retirement community
No
Located inside a hospital
No
Resident or family council
Resident council
Sprinklers in all required areas
Yes

CMS certification number 676025. Source: CMS Nursing Home Provider Information, Health Deficiencies and Penalties (record). Data as of 2026-09-30.

Inspection record

Most recent standard health inspection: May 7, 2026. CMS lists 42 health citations for this facility across its last three standard inspection cycles and complaint inspections (Jan 31, 2024 to May 7, 2026): 15 from complaint inspections, 1 at the “actual harm” level or higher, including 1 at “immediate jeopardy”.

InspectionCitationSeverity
May 7, 2026Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Resident Rights · complaint inspection		D
Potential for more than minimal harm, isolated
May 7, 2026Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function.
Freedom from Abuse, Neglect, and Exploitation		D
Potential for more than minimal harm, isolated
May 7, 2026Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.
Quality of Life and Care		D
Potential for more than minimal harm, isolated
May 7, 2026Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Quality of Life and Care		D
Potential for more than minimal harm, isolated
May 7, 2026Provide 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		D
Potential for more than minimal harm, isolated
May 7, 2026Provide timely, quality laboratory services/tests to meet the needs of residents.
Administration		D
Potential for more than minimal harm, isolated
May 7, 2026Provide and implement an infection prevention and control program.
Infection Control		D
Potential for more than minimal harm, isolated
May 7, 2026Implement a program that monitors antibiotic use.
Infection Control		D
Potential for more than minimal harm, isolated
May 7, 2026Develop 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		E
Potential for more than minimal harm, pattern
May 7, 2026Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
Pharmacy Service		E
Potential for more than minimal harm, pattern
May 7, 2026Ensure meals and snacks are served at times in accordance with resident’s needs, preferences, and requests. Suitable and nourishing alternative meals and snacks must be…
Nutrition and Dietary		E
Potential for more than minimal harm, pattern
May 7, 2026Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Pharmacy Service		F
Potential for more than minimal harm, widespread

Showing the 12 most recent of 42. Full inspection reports are on Medicare Care Compare.

Severity letters follow CMS's scope-and-severity grid: A–C potential for minimal harm, D–F potential for more than minimal harm, G–I actual harm, J–L immediate jeopardy. Most citations are corrected; a citation is what inspectors found on that date. Source: CMS Health Deficiencies file, processed Aug 1, 2026.

Fines and payment denials

CMS records 1 fine totalling $14,901 in the last three years.

Jun 24, 2025Fine: $14,901

Source: CMS Penalties file, processed Aug 1, 2026. Amounts are as CMS reports them and may reflect later reductions or appeals.

Staffing

Total nurse staffing per resident per day
2.79 hours
Registered nurse (RN) time per resident per day
0.23 hours
Nurse aide time per resident per day
1.87 hours
Total nurse staffing on weekends
2.44 hours
Nursing staff turnover (yearly)
57%
RN turnover (yearly)
20%
Administrators who left in the past year
0

From payroll-based staffing data the facility submits to CMS. Hours are per resident per day.

A citation is what inspectors found on one date; most are corrected within weeks. Look for patterns — the same problem cited in several inspections — and for anything at the G–L level (actual harm or immediate jeopardy). The full inspection narrative (Form CMS-2567) is linked from Medicare Care Compare, and your state long-term care ombudsman can tell you about complaints.

Other nursing homes in Henderson

Henderson Health & Rehabilitation Center1010 W. Main St. · Henderson, TX 75652 · (903) 657-6513 · For-profit30 health citations in 3 inspection cycles · last standard inspection May 14, 2025 · $10,546 in CMS fines (3 yrs)Medicare & Medicaid certified2★ overall (CMS)CMS abuse icon

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