For profit - Limited Liability company · 280 certified beds · CMS number 455895
Five Points at Lake Highlands Nursing and Rehab, Dallas, TX
CMS records 53 health deficiencies at Five Points at Lake Highlands Nursing and Rehab in Dallas, Texas in its last 3 inspection cycles; the Texas median is 25. Its most recent standard inspection was on Mar 31, 2026. The highest severity cited is J (immediate jeopardy to resident health or safety). 4 citations were at the immediate jeopardy level, 2 of them recorded as past non-compliance (fixed before the inspection). CMS lists 5 fines totaling $58,149 in the last three years.
- 53deficiencies, 3 cycles (TX median 25)
- 20in the latest cycle (TX median 8)
- Jhighest severity · Immediate jeopardy
- $58,149fines, last 3 years
- 1CMS overall rating (of 5)
Inspections and deficiencies
CMS findings for Five Points at Lake Highlands Nursing and Rehab as of Sep 1, 2026, grouped by inspection cycle (3 cycles); each is a requirement inspectors found not met, and Five Points at Lake Highlands Nursing and Rehab may since have corrected or disputed it. Severity letters · Inspection cycles · Care Compare
Most recent cycle (20 deficiencies)
Standard inspection Mar 31, 2026. CMS counts 20 health deficiencies and 13 fire safety deficiencies in this cycle.
May 26, 2026 · Complaint inspection
1 deficiency, highest D
F677 · Help with daily care
Requirement cited (CMS): Provide care and assistance to perform activities of daily living for any resident who is unable.
- Severity
- D No actual harm, potential for more than minimal harm, isolated
- Status
- Correction date May 27, 2026
Mar 31, 2026 · Standard inspection
10 deficiencies, highest E
F880 · Infection prevention and control program
Requirement cited (CMS): Provide and implement an infection prevention and control program.
- Severity
- D No actual harm, potential for more than minimal harm, isolated
- Status
- Correction date Apr 1, 2026
F812 · Food safety and sanitation
Requirement cited (CMS): Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
- Severity
- E No actual harm, potential for more than minimal harm, pattern
- Status
- Correction date Apr 1, 2026
F809 · Meal times and snacks
Requirement cited (CMS): Ensure 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 provided for residents who want to eat at non-traditional times or outside of scheduled meal times.
- Severity
- E No actual harm, potential for more than minimal harm, pattern
- Status
- Correction date Apr 1, 2026
F804 · Palatable, attractive food at safe temperatures
Requirement cited (CMS): Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
- Severity
- E No actual harm, potential for more than minimal harm, pattern
- Status
- Correction date Apr 1, 2026
F761 · Drug labeling and secure storage
Requirement cited (CMS): 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.
- Severity
- D No actual harm, potential for more than minimal harm, isolated
- Status
- Correction date Apr 1, 2026
F755 · Pharmacy services and a consultant pharmacist
Requirement cited (CMS): Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
- Severity
- D No actual harm, potential for more than minimal harm, isolated
- Status
- Correction date Apr 1, 2026
F695 · Respiratory and oxygen care
Requirement cited (CMS): Provide safe and appropriate respiratory care for a resident when needed.
- Severity
- D No actual harm, potential for more than minimal harm, isolated
- Status
- Correction date Apr 1, 2026
F677 · Help with daily care
Requirement cited (CMS): Provide care and assistance to perform activities of daily living for any resident who is unable.
- Severity
- E No actual harm, potential for more than minimal harm, pattern
- Status
- Correction date Apr 1, 2026
F657 · Care plan timing and team review
Requirement cited (CMS): Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
- Severity
- E No actual harm, potential for more than minimal harm, pattern
- Status
- Correction date Apr 1, 2026
F656 · Comprehensive person-centered care plan
Requirement cited (CMS): Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
- Severity
- D No actual harm, potential for more than minimal harm, isolated
- Status
- Correction date Apr 1, 2026
Dec 11, 2025 · Complaint inspection
6 deficiencies, highest J
F914 · Visual privacy in bedrooms
Requirement cited (CMS): Provide bedrooms that don't allow residents to see each other when privacy is needed.
- Severity
- D No actual harm, potential for more than minimal harm, isolated
- Status
- Correction date Dec 12, 2025
F849 · Hospice services
Requirement cited (CMS): 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.
- Severity
- D No actual harm, potential for more than minimal harm, isolated
- Status
- Correction date Dec 12, 2025
F689 · Accident prevention and supervision
Requirement cited (CMS): Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
- Severity
- J Immediate jeopardy to resident health or safety, isolated
- Status
- Past non-compliance (fixed before the inspection), Sep 30, 2025
F677 · Help with daily care
Requirement cited (CMS): Provide care and assistance to perform activities of daily living for any resident who is unable.
- Severity
- D No actual harm, potential for more than minimal harm, isolated
- Status
- Correction date Dec 12, 2025
F584 · Safe, clean, homelike surroundings
Requirement cited (CMS): Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
- Severity
- D No actual harm, potential for more than minimal harm, isolated
- Status
- Correction date Dec 12, 2025
F580 · Telling residents and families about changes
Requirement cited (CMS): Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
- Severity
- D No actual harm, potential for more than minimal harm, isolated
- Status
- Correction date Dec 12, 2025
Nov 6, 2025 · Complaint inspection
2 deficiencies, highest D
F880 · Infection prevention and control program
Requirement cited (CMS): Provide and implement an infection prevention and control program.
- Severity
- D No actual harm, potential for more than minimal harm, isolated
- Status
- Correction date Nov 7, 2025
F677 · Help with daily care
Requirement cited (CMS): Provide care and assistance to perform activities of daily living for any resident who is unable.
- Severity
- D No actual harm, potential for more than minimal harm, isolated
- Status
- Correction date Nov 7, 2025
Sep 19, 2025 · Complaint inspection
1 deficiency, highest J
F627 · Permitted transfers, discharge planning, and return rights
Requirement cited (CMS): Ensure the transfer/discharge meets the resident's needs/preferences and that the resident is prepared for a safe transfer/discharge.
- Severity
- J Immediate jeopardy to resident health or safety, isolated
- Status
- Correction date Sep 20, 2025
Previous cycle: 21 deficiencies (standard inspection Dec 10, 2024)
Standard inspection Dec 10, 2024. CMS counts 21 health deficiencies and 10 fire safety deficiencies in this cycle.
Jul 8, 2025 · Complaint inspection
3 deficiencies, highest J
F761 · Drug labeling and secure storage
Requirement cited (CMS): 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.
- Severity
- D No actual harm, potential for more than minimal harm, isolated
- Status
- Correction date Jul 9, 2025
F689 · Accident prevention and supervision
Requirement cited (CMS): Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
- Severity
- J Immediate jeopardy to resident health or safety, isolated
- Status
- Correction date Jul 9, 2025
F677 · Help with daily care
Requirement cited (CMS): Provide care and assistance to perform activities of daily living for any resident who is unable.
- Severity
- D No actual harm, potential for more than minimal harm, isolated
- Status
- Correction date Jul 9, 2025
May 14, 2025 · Complaint inspection
4 deficiencies, highest E
F921 · Safe, functional, sanitary building
Requirement cited (CMS): Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
- Severity
- E No actual harm, potential for more than minimal harm, pattern
- Status
- Correction date May 16, 2025
F678 · CPR and basic life support
Requirement cited (CMS): Provide basic life support, including CPR, prior to the arrival of emergency medical personnel , subject to physician orders and the resident’s advance directives.
- Severity
- D No actual harm, potential for more than minimal harm, isolated
- Status
- Correction date May 16, 2025
F677 · Help with daily care
Requirement cited (CMS): Provide care and assistance to perform activities of daily living for any resident who is unable.
- Severity
- D No actual harm, potential for more than minimal harm, isolated
- Status
- Correction date May 16, 2025
F656 · Comprehensive person-centered care plan
Requirement cited (CMS): Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
- Severity
- D No actual harm, potential for more than minimal harm, isolated
- Status
- Correction date May 16, 2025
Jan 23, 2025 · Complaint inspection
2 deficiencies, highest E
F755 · Pharmacy services and a consultant pharmacist
Requirement cited (CMS): Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
- Severity
- E No actual harm, potential for more than minimal harm, pattern
- Status
- Correction date Jan 25, 2025
F609 · Reporting suspected abuse and crimes
Requirement cited (CMS): Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
- Severity
- E No actual harm, potential for more than minimal harm, pattern
- Status
- Correction date Jan 25, 2025
Dec 10, 2024 · Standard + complaint inspection
9 deficiencies, highest E
F880 · Infection prevention and control program
Requirement cited (CMS): Provide and implement an infection prevention and control program.
- Severity
- E No actual harm, potential for more than minimal harm, pattern
- Status
- Correction date Dec 12, 2024
F812 · Food safety and sanitation
Requirement cited (CMS): Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
- Severity
- E No actual harm, potential for more than minimal harm, pattern
- Status
- Correction date Dec 12, 2024
F805 · Food prepared for individual needs
Requirement cited (CMS): Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs.
- Severity
- D No actual harm, potential for more than minimal harm, isolated
- Status
- Correction date Dec 12, 2024
F761 · Drug labeling and secure storage
Requirement cited (CMS): 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.
- Severity
- D No actual harm, potential for more than minimal harm, isolated
- Status
- Correction date Dec 12, 2024
F690 · Bladder, bowel, and catheter care
Requirement cited (CMS): Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
- Severity
- D No actual harm, potential for more than minimal harm, isolated
- Status
- Correction date Dec 12, 2024
F677 · Help with daily care
Requirement cited (CMS): Provide care and assistance to perform activities of daily living for any resident who is unable.
- Severity
- D No actual harm, potential for more than minimal harm, isolated
- Status
- Correction date Dec 12, 2024
F656 · Comprehensive person-centered care plan
Requirement cited (CMS): Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
- Severity
- D No actual harm, potential for more than minimal harm, isolated
- Status
- Correction date Dec 12, 2024
F645 · Pre-admission screening for mental disorder or intellectual disability
Requirement cited (CMS): PASARR screening for Mental disorders or Intellectual Disabilities
- Severity
- D No actual harm, potential for more than minimal harm, isolated
- Status
- Correction date Dec 12, 2024
F584 · Safe, clean, homelike surroundings
Requirement cited (CMS): Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
- Severity
- D No actual harm, potential for more than minimal harm, isolated
- Status
- Correction date Dec 12, 2024
Dec 6, 2024 · Complaint inspection
3 deficiencies, highest E
F880 · Infection prevention and control program
Requirement cited (CMS): Provide and implement an infection prevention and control program.
- Severity
- D No actual harm, potential for more than minimal harm, isolated
- Status
- Correction date Dec 8, 2024
F584 · Safe, clean, homelike surroundings
Requirement cited (CMS): Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
- Severity
- E No actual harm, potential for more than minimal harm, pattern
- Status
- Correction date Dec 8, 2024
F583 · Personal privacy and confidential records
Requirement cited (CMS): Keep residents' personal and medical records private and confidential.
- Severity
- D No actual harm, potential for more than minimal harm, isolated
- Status
- Correction date Dec 8, 2024
Earlier cycle: 12 deficiencies (standard inspection Nov 7, 2023)
Standard inspection Nov 7, 2023. CMS counts 12 health deficiencies and 7 fire safety deficiencies in this cycle.
Jun 3, 2024 · Complaint inspection
1 deficiency, highest J
F689 · Accident prevention and supervision
Requirement cited (CMS): Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
- Severity
- J Immediate jeopardy to resident health or safety, isolated
- Status
- Past non-compliance (fixed before the inspection), Jun 2, 2024
May 18, 2024 · Complaint inspection
1 deficiency, highest E
F790 · Dental care in skilled nursing facilities
Requirement cited (CMS): Provide routine and 24-hour emergency dental care for each resident.
- Severity
- E No actual harm, potential for more than minimal harm, pattern
- Status
- Correction date May 20, 2024
Jan 20, 2024 · Complaint inspection
4 deficiencies, highest E
F689 · Accident prevention and supervision
Requirement cited (CMS): Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
- Severity
- D No actual harm, potential for more than minimal harm, isolated
- Status
- Correction date Jan 22, 2024
F677 · Help with daily care
Requirement cited (CMS): Provide care and assistance to perform activities of daily living for any resident who is unable.
- Severity
- E No actual harm, potential for more than minimal harm, pattern
- Status
- Correction date Jan 22, 2024
F584 · Safe, clean, homelike surroundings
Requirement cited (CMS): Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
- Severity
- E No actual harm, potential for more than minimal harm, pattern
- Status
- Correction date Jan 22, 2024
F550 · Dignity and the right to exercise rights
Requirement cited (CMS): Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
- Severity
- D No actual harm, potential for more than minimal harm, isolated
- Status
- Correction date Jan 22, 2024
Nov 7, 2023 · Standard inspection
5 deficiencies, highest E
F926 · Smoking policies
Requirement cited (CMS): Have policies on smoking.
- Severity
- E No actual harm, potential for more than minimal harm, pattern
- Status
- Correction date Nov 24, 2023
F880 · Infection prevention and control program
Requirement cited (CMS): Provide and implement an infection prevention and control program.
- Severity
- D No actual harm, potential for more than minimal harm, isolated
- Status
- Correction date Nov 24, 2023
F759 · Medication error rate under 5 percent
Requirement cited (CMS): Ensure medication error rates are not 5 percent or greater.
- Severity
- D No actual harm, potential for more than minimal harm, isolated
- Status
- Correction date Nov 24, 2023
F693 · Feeding tube use and care
Requirement cited (CMS): 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.
- Severity
- D No actual harm, potential for more than minimal harm, isolated
- Status
- Correction date Nov 24, 2023
F689 · Accident prevention and supervision
Requirement cited (CMS): Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
- Severity
- E No actual harm, potential for more than minimal harm, pattern
- Status
- Correction date Nov 24, 2023
Oct 11, 2023 · Complaint inspection
1 deficiency, highest G
F686 · Pressure ulcer prevention and care
Requirement cited (CMS): Provide appropriate pressure ulcer care and prevent new ulcers from developing.
- Severity
- G Actual harm (not immediate jeopardy), isolated
- Status
- Correction date Nov 24, 2023
Tags cited in more than one inspection
8 tags cited on more than one inspection date at Five Points at Lake Highlands Nursing and Rehab; each date counts once and does not mean the same incident. PNC = past non-compliance.
| Tag | Inspections | Dates |
|---|---|---|
| F677 Help with daily care | 8 | May 26, 2026; Mar 31, 2026; Dec 11, 2025; Nov 6, 2025; Jul 8, 2025; May 14, 2025; Dec 10, 2024; Jan 20, 2024 |
| F689 Accident prevention and supervision | 5 | Dec 11, 2025 (PNC); Jul 8, 2025; Jun 3, 2024 (PNC); Jan 20, 2024; Nov 7, 2023 |
| F880 Infection prevention and control program | 5 | Mar 31, 2026; Nov 6, 2025; Dec 10, 2024; Dec 6, 2024; Nov 7, 2023 |
| F584 Safe, clean, homelike surroundings | 4 | Dec 11, 2025; Dec 10, 2024; Dec 6, 2024; Jan 20, 2024 |
| F656 Comprehensive person-centered care plan | 3 | Mar 31, 2026; May 14, 2025; Dec 10, 2024 |
| F761 Drug labeling and secure storage | 3 | Mar 31, 2026; Jul 8, 2025; Dec 10, 2024 |
| F755 Pharmacy services and a consultant pharmacist | 2 | Mar 31, 2026; Jan 23, 2025 |
| F812 Food safety and sanitation | 2 | Mar 31, 2026; Dec 10, 2024 |
Fines and payment denials
| Date | Type | Amount / length |
|---|---|---|
| Dec 11, 2025 | Fine | $16,149 |
| Sep 19, 2025 | Fine | $10,361 |
| Jul 8, 2025 | Fine | $15,143 |
| May 18, 2024 | Fine | $8,985 |
| Oct 11, 2023 | Fine | $7,511 |
Staffing and CMS ratings
- Total nurse staff hours per resident per day
- 3.36 h (about the same as the Texas median of 3.27 h)
- RN hours per resident per day
- 0.42 h (above the Texas median of 0.38 h)
- Weekend nurse staff hours per resident per day
- 2.87 h
- Nursing staff turnover
- 64.0% (Texas median 52.1%)
- Administrators who left
- 2
- CMS overall rating
- 1 of 5
- Health inspection rating
- 1 of 5
- Staffing rating
- 1 of 5
- Quality measure rating
- 3 of 5
CMS figures for Five Points at Lake Highlands Nursing and Rehab, copied as published; Texas medians are ours.
Facility details
- Address
- 315 East 19th Street, Dallas, TX 75238
- Phone
- (214) 355-3300
- County
- Dallas
- Accepts
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Chain (CMS)
- Creative Solutions in Healthcare
- Certified beds
- 280
- Average residents per day
- 173.8
- In Medicare/Medicaid since
- Oct 4, 1990
- Inside a hospital
- Yes
- Continuing care retirement community
- No
- Resident and family council
- Both
- Sprinklers in all required areas
- Yes
Questions to ask on a visit
Based on the tags cited most often here.
- How often do residents who need help get assistance with bathing, grooming, and mouth care? (F677, cited 8 times)
- How does the home assess each resident's fall risk and plan to prevent falls? (F689, cited 5 times)
- How do staff track and report infections among residents? (F880, cited 5 times)
- How often are rooms cleaned and bed linens changed? (F584, cited 4 times)
Other nursing homes in Dallas and the same chain
- South Dallas Nursing & Rehabilitation
Dallas · 62 deficiencies - Forest Park Nursing & Rehabilitation
Dallas · 51 deficiencies - Avir at The Meadow
Dallas · 44 deficiencies - Lakewest Rehabilitation and Skilled Care
Dallas · 44 deficiencies - The Hillcrest of North Dallas
Dallas · 44 deficiencies - Signature Pointe
Dallas · 43 deficiencies - Franklin Heights Nursing & Rehabilitation
El Paso · 76 deficiencies - St. Teresa Nursing & Rehab Center
El Paso · 75 deficiencies - Mountain View Health & Rehabilitation
El Paso · 72 deficiencies - Pleasant Springs Healthcare Center
Mount Pleasant · 66 deficiencies
Source
CMS Provider Data Catalog: Provider Information, Health Deficiencies, Penalties, Survey Summary. Processed by CMS Sep 1, 2026; next update Oct 28, 2026.