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Belterra Health & Rehab
2170 North Lake Forest Drive, Mckinney, TX 75071 · CMS Certification Number (CCN) 676367
At a glance
- CMS overall rating
- ★★★★☆ 4 of 5
- Health inspection citations
- 20 in the last 3 inspection cycles (0 immediate jeopardy, 0 actual harm, 0 from complaints)
- Fire safety citations
- 0
- Fines (last 3 years)
- 0 fines, total $0
- Payment denials
- 0
- Most recent standard inspection
- April 23, 2026
- Official record
- Medicare Care Compare page for this facility
Source: CMS Nursing Home Provider Information: data.cms.gov · data as of September 1, 2026 · last checked October 26, 2026
CMS star ratings
CMS rates every Medicare- and Medicaid-certified nursing home from 1 to 5 stars. Health inspection stars are relative to other homes in the same state: the top 10% get 5 stars and the bottom 20% get 1 star. CMS says to use the ratings together with other information, including a visit. Technical Users’ Guide
| Rating | This facility | Texas average | U.S. average |
|---|---|---|---|
| Overall | ★★★★☆ 4 of 5 | 2.7 | 3 |
| Health inspections | ★★★★☆ 4 of 5 | 2.8 | 2.8 |
| Staffing | ★★★☆☆ 3 of 5 | 1.9 | 2.9 |
| Quality measures | ★★★★☆ 4 of 5 | 3.7 | 3.6 |
| Long-stay quality | ★★★★★ 5 of 5 | Not published | Not published |
| Short-stay quality | ★★★☆☆ 3 of 5 | Not published | Not published |
Averages: CMS State and US Averages: data.cms.gov · data as of September 1, 2026 · last checked October 26, 2026
Health inspections
| Inspection cycle | Standard survey date | Health citations | From standard survey | From complaints |
|---|---|---|---|---|
| Cycle 1 (most recent) | April 23, 2026 | 10 | 10 | 0 |
| Cycle 2 | February 13, 2025 | 5 | 5 | 0 |
CMS weighted health inspection score: 48 (lower is better; it counts citation severity, complaints and repeat revisits). Citations from infection control inspections: Not published. How to read these citations
20 health citations across 3 inspection dates, newest first. The letter is CMS’s scope/severity code: A–C means potential for minimal harm, D–F potential for more than minimal harm, G–I actual harm, and J–L immediate jeopardy.
April 23, 2026: 10 citations (Standard)
| Severity | Tag | What was cited | Type | Status |
|---|---|---|---|---|
| E | F-0880 | Provide and implement an infection prevention and control program. Infection Control Deficiencies | Standard | Deficient, Provider has date of correction Corrected 05/13/2026 |
| E | F-0761 | 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. Pharmacy Service Deficiencies | Standard | Deficient, Provider has date of correction Corrected 05/13/2026 |
| D | F-0755 | Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Pharmacy Service Deficiencies | Standard | Deficient, Provider has date of correction Corrected 05/13/2026 |
| C | F-0732 | Post nurse staffing information every day. Nursing and Physician Services Deficiencies | Standard | Deficient, Provider has date of correction Corrected 05/13/2026 |
| D | F-0695 | Provide safe and appropriate respiratory care for a resident when needed. Quality of Life and Care Deficiencies | Standard | Deficient, Provider has date of correction Corrected 05/13/2026 |
| D | F-0690 | 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 | Standard | Deficient, Provider has date of correction Corrected 05/13/2026 |
| E | F-0689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Quality of Life and Care Deficiencies | Standard | Deficient, Provider has date of correction Corrected 05/13/2026 |
| D | F-0656 | 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 | Standard | Deficient, Provider has date of correction Corrected 05/13/2026 |
| E | F-0655 | Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted Resident Assessment and Care Planning Deficiencies | Standard | Deficient, Provider has date of correction Corrected 05/13/2026 |
| D | F-0583 | Keep residents' personal and medical records private and confidential. Resident Rights Deficiencies | Standard | Deficient, Provider has date of correction Corrected 05/13/2026 |
February 13, 2025: 5 citations (Standard)
| Severity | Tag | What was cited | Type | Status |
|---|---|---|---|---|
| D | F-0880 | Provide and implement an infection prevention and control program. Infection Control Deficiencies | Standard | Deficient, Provider has date of correction Corrected 03/03/2025 |
| E | F-0812 | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Nutrition and Dietary Deficiencies | Standard | Deficient, Provider has date of correction Corrected 03/03/2025 |
| E | F-0761 | 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. Pharmacy Service Deficiencies | Standard | Deficient, Provider has date of correction Corrected 03/03/2025 |
| E | F-0760 | Ensure that residents are free from significant medication errors. Pharmacy Service Deficiencies | Standard | Deficient, Provider has date of correction Corrected 03/03/2025 |
| E | F-0755 | Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Pharmacy Service Deficiencies | Standard | Deficient, Provider has date of correction Corrected 03/03/2025 |
January 11, 2024: 5 citations (Standard)
| Severity | Tag | What was cited | Type | Status |
|---|---|---|---|---|
| E | F-0880 | Provide and implement an infection prevention and control program. Infection Control Deficiencies | Standard | Deficient, Provider has date of correction Corrected 01/15/2024 |
| E | F-0812 | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Nutrition and Dietary Deficiencies | Standard | Deficient, Provider has date of correction Corrected 01/15/2024 |
| D | F-0695 | Provide safe and appropriate respiratory care for a resident when needed. Quality of Life and Care Deficiencies | Standard | Deficient, Provider has date of correction Corrected 01/15/2024 |
| D | F-0690 | 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 | Standard | Deficient, Provider has date of correction Corrected 01/15/2024 |
| D | F-0558 | Reasonably accommodate the needs and preferences of each resident. Resident Rights Deficiencies | Standard | Deficient, Provider has date of correction Corrected 01/15/2024 |
Source: CMS Health Deficiencies: data.cms.gov · data as of September 1, 2026 · last checked October 26, 2026
Fire safety inspections
No fire safety citations published for this facility in the CMS Fire Safety Deficiencies file.
Automatic sprinklers in all required areas: Yes. CMS does not count fire safety citations in the health inspection star rating.
Source: CMS Fire Safety Deficiencies: data.cms.gov · data as of September 1, 2026 · last checked October 26, 2026
Penalties
No fines or payment denials published for this facility in the CMS Penalties file (last 3 years).
Source: CMS Penalties: data.cms.gov · data as of September 1, 2026 · last checked October 26, 2026
Staffing
| Measure | This facility | Texas average | U.S. average |
|---|---|---|---|
| Total nurse staff hours per resident per day | 3.39 | 3.39 | 3.86 |
| Registered nurse (RN) hours per resident per day | 0.8 | 0.43 | 0.69 |
| LPN/LVN hours per resident per day | 0.61 | Not published | Not published |
| Nurse aide hours per resident per day | 1.98 | Not published | Not published |
| Total nurse staff hours per resident per day, weekends | 3.07 | Not published | Not published |
| RN hours per resident per day, weekends | 0.76 | Not published | Not published |
| Total nursing staff turnover (%) | 36.7 | 55.3 | 45.8 |
| Registered nurse turnover (%) | 35.3 | Not published | Not published |
| Administrators who have left | 0 | Not published | Not published |
Reported hours come from the Payroll-Based Journal (PBJ) staffing data that facilities submit to CMS each quarter.
Source: CMS Provider Information; State and US Averages: data.cms.gov · data as of September 1, 2026 · last checked October 26, 2026
Facility details
- Legal business name
- Fannin County Hospital Authority
- Ownership type
- Government - Hospital district
- Chain
- Priority Management (38 facilities)
- Ownership changed in last 12 months
- No
- Certified beds
- 103
- Average residents per day
- 91.1
- Participates in
- Medicare and Medicaid
- Located inside a hospital
- No
- Continuing care retirement community
- No
- Resident and family council
- Resident
- First approved for Medicare/Medicaid
- August 28, 2014
- County/parish
- Collin
Source: CMS Provider Information: data.cms.gov · data as of September 1, 2026 · last checked October 26, 2026
Owners and managers reported to CMS
36 ownership and management records
| Name | Role | Type | Ownership % | Since |
|---|---|---|---|---|
| FANNIN COUNTY HOSPITAL AUTHORITY | 5% OR GREATER DIRECT OWNERSHIP INTEREST | Organization | 100% | undefined undefined, NaN |
| BAUDER FAMILY INVESTMENTS, LLC | 5% OR GREATER MORTGAGE INTEREST | Organization | NOT APPLICABLE | undefined undefined, NaN |
| BOULWARE ST JAMES LLC | 5% OR GREATER MORTGAGE INTEREST | Organization | NOT APPLICABLE | undefined undefined, NaN |
| PMG REALCO-MCKINNEY, LLC | 5% OR GREATER MORTGAGE INTEREST | Organization | NOT APPLICABLE | undefined undefined, NaN |
| BAUDER, KELLY | 5% OR GREATER MORTGAGE INTEREST | Individual | NOT APPLICABLE | undefined undefined, NaN |
| BAUDER, MADISON | 5% OR GREATER MORTGAGE INTEREST | Individual | NOT APPLICABLE | undefined undefined, NaN |
| BAUDER, PARKER | 5% OR GREATER MORTGAGE INTEREST | Individual | NOT APPLICABLE | undefined undefined, NaN |
| BAUDER, WILLIAM | 5% OR GREATER MORTGAGE INTEREST | Individual | NOT APPLICABLE | undefined undefined, NaN |
| BOULWARE, DOUGLAS | 5% OR GREATER MORTGAGE INTEREST | Individual | NOT APPLICABLE | undefined undefined, NaN |
| BOULWARE, SANDRA | 5% OR GREATER MORTGAGE INTEREST | Individual | NOT APPLICABLE | undefined undefined, NaN |
| BOULWARE, STEVEN | 5% OR GREATER MORTGAGE INTEREST | Individual | NOT APPLICABLE | undefined undefined, NaN |
| BOULWARE, THOMAS | 5% OR GREATER MORTGAGE INTEREST | Individual | NOT APPLICABLE | undefined undefined, NaN |
| WALKER, KATIE | 5% OR GREATER MORTGAGE INTEREST | Individual | NOT APPLICABLE | undefined undefined, NaN |
| SANDERSON, CLARK | CORPORATE DIRECTOR | Individual | NOT APPLICABLE | undefined undefined, NaN |
| PMG OPCO - MCKINNEY LLC | OPERATIONAL/MANAGERIAL CONTROL | Organization | NOT APPLICABLE | undefined undefined, NaN |
| BAUDER, WILLIAM | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | undefined undefined, NaN |
| BOULWARE, STEVEN | OPERATIONAL/MANAGERIAL CONTROL | Individual | NOT APPLICABLE | undefined undefined, NaN |
| BAUDER FAMILY INVESTMENTS, LLC | ADP OF THE SNF | Organization | NOT APPLICABLE | undefined undefined, NaN |
| BOULWARE ST JAMES LLC | ADP OF THE SNF | Organization | NOT APPLICABLE | undefined undefined, NaN |
| BRIDGEPOINTE FINANICAL SERVICES, LLC | ADP OF THE SNF | Organization | NOT APPLICABLE | undefined undefined, NaN |
| INNOVATIVE NURSE CONSULTING, LLC | ADP OF THE SNF | Organization | NOT APPLICABLE | undefined undefined, NaN |
| PMG OPCO - MCKINNEY LLC | ADP OF THE SNF | Organization | NOT APPLICABLE | undefined undefined, NaN |
| PMG REALCO-MCKINNEY, LLC | ADP OF THE SNF | Organization | NOT APPLICABLE | undefined undefined, NaN |
| PRIORITY MANAGEMENT GROUP, LLC | ADP OF THE SNF | Organization | NOT APPLICABLE | undefined undefined, NaN |
| PROGRESSIVE REHAB SOLUTIONS, LLC | ADP OF THE SNF | Organization | NOT APPLICABLE | undefined undefined, NaN |
| ALI, MALIK | ADP OF THE SNF | Individual | NOT APPLICABLE | undefined undefined, NaN |
| BAUDER, KELLY | ADP OF THE SNF | Individual | NOT APPLICABLE | undefined undefined, NaN |
| BAUDER, MADISON | ADP OF THE SNF | Individual | NOT APPLICABLE | undefined undefined, NaN |
| BAUDER, PARKER | ADP OF THE SNF | Individual | NOT APPLICABLE | undefined undefined, NaN |
| BAUDER, WILLIAM | ADP OF THE SNF | Individual | NOT APPLICABLE | undefined undefined, NaN |
| BOULWARE, DOUGLAS | ADP OF THE SNF | Individual | NOT APPLICABLE | undefined undefined, NaN |
| BOULWARE, SANDRA | ADP OF THE SNF | Individual | NOT APPLICABLE | undefined undefined, NaN |
| BOULWARE, STEVEN | ADP OF THE SNF | Individual | NOT APPLICABLE | undefined undefined, NaN |
| BOULWARE, THOMAS | ADP OF THE SNF | Individual | NOT APPLICABLE | undefined undefined, NaN |
| ROBINSON, JOHN | ADP OF THE SNF | Individual | NOT APPLICABLE | undefined undefined, NaN |
| WALKER, KATIE | ADP OF THE SNF | Individual | NOT APPLICABLE | undefined undefined, NaN |
Source: CMS Ownership: data.cms.gov · data as of September 1, 2026 · last checked October 26, 2026
Check it yourself
- Medicare Care Compare: Belterra Health & Rehab. Full inspection reports, quality measures and staffing.
- HHSC long-term care complaint portal (TULIP). The state agency also takes nursing home complaints.
- Ask the facility to show you its most recent inspection report and plan of correction.
Page built from CMS data files processed September 1, 2026 (CMS refreshes monthly). Last checked October 26, 2026. Not a ranking or endorsement.