Government - Hospital district · 125 certified beds · CMS number 676025

Autumn Leaves Nursing and Rehab INC, Henderson, TX

CMS records 42 health deficiencies at Autumn Leaves Nursing and Rehab INC in Henderson, Texas in its last 3 inspection cycles; the Texas median is 25. Its most recent standard inspection was on May 7, 2026. The highest severity cited is J (immediate jeopardy to resident health or safety). 1 citation was at the immediate jeopardy level, 1 of them recorded as past non-compliance (fixed before the inspection). CMS lists 1 fine totaling $14,901 in the last three years.

Inspections and deficiencies

CMS findings for Autumn Leaves Nursing and Rehab INC as of Sep 1, 2026, grouped by inspection cycle (3 cycles); each is a requirement inspectors found not met, and Autumn Leaves Nursing and Rehab INC may since have corrected or disputed it. Severity letters · Inspection cycles · Care Compare

Most recent cycle (16 deficiencies)

Standard inspection May 7, 2026. CMS counts 16 health deficiencies and 4 fire safety deficiencies in this cycle.

May 7, 2026 · Standard + complaint inspection

12 deficiencies, highest F

F881 · Antibiotic stewardship

Requirement cited (CMS): Implement a program that monitors antibiotic use.

Severity
D No actual harm, potential for more than minimal harm, isolated
Status
Correction date Jun 5, 2026

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 Jun 5, 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 Jun 5, 2026

F770 · Timely laboratory services

Requirement cited (CMS): Provide timely, quality laboratory services/tests to meet the needs of residents.

Severity
D No actual harm, potential for more than minimal harm, isolated
Status
Correction date Jun 5, 2026

F756 · Monthly pharmacist medication review

Requirement cited (CMS): Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.

Severity
E No actual harm, potential for more than minimal harm, pattern
Status
Correction date Jun 5, 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
F No actual harm, potential for more than minimal harm, widespread
Status
Correction date Jun 5, 2026

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 Jun 5, 2026

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 Jun 5, 2026

F688 · Range of motion and mobility

Requirement cited (CMS): Provide 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.

Severity
D No actual harm, potential for more than minimal harm, isolated
Status
Correction date Jun 5, 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
E No actual harm, potential for more than minimal harm, pattern
Status
Correction date Jun 5, 2026

F605 · Limits on psychotropic drugs and chemical restraints

Requirement cited (CMS): Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function.

Severity
D No actual harm, potential for more than minimal harm, isolated
Status
Correction date Jun 5, 2026

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 Jun 5, 2026

Apr 22, 2026 · Complaint inspection

1 deficiency, highest D

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 Apr 27, 2026

Jan 16, 2026 · Complaint inspection

1 deficiency, highest D

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 Jan 22, 2026

Nov 26, 2025 · Complaint inspection

1 deficiency, highest D

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 Nov 28, 2025

Nov 18, 2025 · Complaint inspection

1 deficiency, highest E

F698 · Dialysis care

Requirement cited (CMS): Provide safe, appropriate dialysis care/services for a resident who requires such services.

Severity
E No actual harm, potential for more than minimal harm, pattern
Status
Correction date Nov 20, 2025
Previous cycle: 15 deficiencies (standard inspection Mar 19, 2025)

Standard inspection Mar 19, 2025. CMS counts 15 health deficiencies and 4 fire safety deficiencies in this cycle.

Jun 24, 2025 · 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), Mar 27, 2025

Mar 19, 2025 · Standard + complaint inspection

13 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 Apr 15, 2025

F881 · Antibiotic stewardship

Requirement cited (CMS): Implement a program that monitors antibiotic use.

Severity
D No actual harm, potential for more than minimal harm, isolated
Status
Correction date Apr 15, 2025

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 15, 2025

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
E No actual harm, potential for more than minimal harm, pattern
Status
Correction date Apr 15, 2025

F757 · Avoiding unnecessary drugs

Requirement cited (CMS): Ensure each resident’s drug regimen must be free from unnecessary drugs.

Severity
D No actual harm, potential for more than minimal harm, isolated
Status
Correction date Apr 15, 2025

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 Apr 15, 2025

F695 · Respiratory and oxygen care

Requirement cited (CMS): Provide safe and appropriate respiratory care for a resident when needed.

Severity
E No actual harm, potential for more than minimal harm, pattern
Status
Correction date Apr 15, 2025

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 Apr 15, 2025

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 Apr 15, 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 Apr 15, 2025

F641 · Accurate resident assessments

Requirement cited (CMS): Ensure each resident receives an accurate assessment.

Severity
D No actual harm, potential for more than minimal harm, isolated
Status
Correction date Apr 15, 2025

F561 · Making everyday choices

Requirement cited (CMS): Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.

Severity
D No actual harm, potential for more than minimal harm, isolated
Status
Correction date Apr 15, 2025

F558 · Accommodating individual needs and preferences

Requirement cited (CMS): Reasonably accommodate the needs and preferences of each resident.

Severity
E No actual harm, potential for more than minimal harm, pattern
Status
Correction date Apr 15, 2025

Sep 17, 2024 · Complaint inspection

1 deficiency, highest D

F573 · Access to personal and medical records

Requirement cited (CMS): Let each resident or the resident's legal representative access or purchase copies of all the resident's records.

Severity
D No actual harm, potential for more than minimal harm, isolated
Status
Correction date Oct 2, 2024
Earlier cycle: 11 deficiencies (standard inspection Jan 31, 2024)

Standard inspection Jan 31, 2024. CMS counts 11 health deficiencies and 0 fire safety deficiencies in this cycle.

Jun 27, 2024 · Complaint inspection

1 deficiency, highest E

F695 · Respiratory and oxygen care

Requirement cited (CMS): Provide safe and appropriate respiratory care for a resident when needed.

Severity
E No actual harm, potential for more than minimal harm, pattern
Status
Correction date Jul 12, 2024

Jan 31, 2024 · Standard + complaint inspection

10 deficiencies, highest E

F942 · Resident rights training for staff

Requirement cited (CMS): Ensure that staff members are educated on resident rights and facility responsibilities to properly care for its residents.

Severity
D No actual harm, potential for more than minimal harm, isolated
Status
Correction date Feb 26, 2024

F940 · Staff training program

Requirement cited (CMS): Develop, implement, and/or maintain an effective training program for all new and existing staff members.

Severity
D No actual harm, potential for more than minimal harm, isolated
Status
Correction date Feb 26, 2024

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 Feb 26, 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 Feb 26, 2024

F695 · Respiratory and oxygen care

Requirement cited (CMS): Provide safe and appropriate respiratory care for a resident when needed.

Severity
E No actual harm, potential for more than minimal harm, pattern
Status
Correction date Feb 26, 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 Feb 26, 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
E No actual harm, potential for more than minimal harm, pattern
Status
Correction date Feb 26, 2024

F641 · Accurate resident assessments

Requirement cited (CMS): Ensure each resident receives an accurate assessment.

Severity
D No actual harm, potential for more than minimal harm, isolated
Status
Correction date Feb 26, 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 Feb 26, 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 Feb 26, 2024

Tags cited in more than one inspection

11 tags cited on more than one inspection date at Autumn Leaves Nursing and Rehab INC; each date counts once and does not mean the same incident. PNC = past non-compliance.

TagInspectionsDates
F550 Dignity and the right to exercise rights3May 7, 2026; Apr 22, 2026; Jan 31, 2024
F656 Comprehensive person-centered care plan3May 7, 2026; Jan 16, 2026; Jan 31, 2024
F689 Accident prevention and supervision3May 7, 2026; Nov 26, 2025; Jun 24, 2025 (PNC)
F695 Respiratory and oxygen care3Mar 19, 2025; Jun 27, 2024; Jan 31, 2024
F880 Infection prevention and control program3May 7, 2026; Mar 19, 2025; Jan 31, 2024
F641 Accurate resident assessments2Mar 19, 2025; Jan 31, 2024
F677 Help with daily care2Mar 19, 2025; Jan 31, 2024
F690 Bladder, bowel, and catheter care2May 7, 2026; Mar 19, 2025
F755 Pharmacy services and a consultant pharmacist2May 7, 2026; Mar 19, 2025
F761 Drug labeling and secure storage2Mar 19, 2025; Jan 31, 2024
F881 Antibiotic stewardship2May 7, 2026; Mar 19, 2025

Fines and payment denials

DateTypeAmount / length
Jun 24, 2025Fine$14,901

Staffing and CMS ratings

Total nurse staff hours per resident per day
2.79 h (below the Texas median of 3.27 h)
RN hours per resident per day
0.23 h (below the Texas median of 0.38 h)
Weekend nurse staff hours per resident per day
2.44 h
Nursing staff turnover
56.8% (Texas median 52.1%)
Administrators who left
0
CMS overall rating
2 of 5
Health inspection rating
2 of 5
Staffing rating
1 of 5
Quality measure rating
5 of 5

CMS figures for Autumn Leaves Nursing and Rehab INC, copied as published; Texas medians are ours.

Facility details

Address
321 Kilgore Drive, Henderson, TX 75652
Phone
(903) 657-1923
County
Rusk
Accepts
Medicare and Medicaid
Ownership
Government - Hospital district
Chain (CMS)
ML Healthcare
Certified beds
125
Average residents per day
98.9
In Medicare/Medicaid since
Jun 18, 2004
Inside a hospital
No
Continuing care retirement community
No
Resident and family council
Resident
Sprinklers in all required areas
Yes

Questions to ask on a visit

Based on the tags cited most often here.

  • How do staff learn about and respect each resident's personal routines and choices? (F550, cited 3 times)
  • How are a resident's goals and preferences written into the care plan? (F656, cited 3 times)
  • How does the home assess each resident's fall risk and plan to prevent falls? (F689, cited 3 times)
  • How are oxygen equipment and breathing treatments managed and checked? (F695, cited 3 times)

Other nursing homes in Henderson and the same chain

Source

CMS Provider Data Catalog: Provider Information, Health Deficiencies, Penalties, Survey Summary. Processed by CMS Sep 1, 2026; next update Oct 28, 2026.

How we build this · Report an error