Hearth Record

Merkel Nursing Center

A nursing home in Merkel, Texas 79536

1704 N. 1st, Merkel, Texas 79536. (325) 928-5673.

  • A candidate for CMS’s special focus list
  • Cited for abuse (CMS flag)
CMS’s own record, on Care Compare

Watch and the shortlist are kept with a free account, on every device. Your watch list. CMS’s own record is on Care Compare.

The short answer

Record last released by CMS on Oct 28, 2026.

The last 24 months 56 citations in 7 months of the last 36. Last cited Feb 2026. Most serious: immediate jeopardy to health or safety (K). Every month

Each figure’s source sits beside it, in its section below.

What these words mean8
Star ratings
CMS rates some kinds of place from 1 to 5 stars, more stars meaning better on CMS’s own measures for that kind: for a nursing home, its health inspections, staffing and quality measures. A rating is CMS’s summary of those measures; it doesn’t promise good care. Source: CMS, Care Compare and the Five-Star Quality Rating System.
Inspection (survey)
A visit by state inspectors, often unannounced, who check a place against the rules it must meet. For nursing homes and other places Medicare pays, CMS calls these visits surveys: a standard survey of a nursing home comes at least every 15 months, and a complaint survey whenever a complaint calls for one. Source: CMS; 42 CFR 488.308.
Deficiency, citation, violation
What inspectors write up when a place didn’t meet a rule: the rule, what they saw, and when. CMS calls it a deficiency; states may say citation or violation. It is the inspectors’ finding, not a court’s, and the place is usually asked for a plan to correct it. Source: CMS, statement of deficiencies (Form CMS-2567); each state’s licensing agency.
Scope and severity (A to L)
CMS grades each nursing home deficiency with a letter. A to C: no actual harm, with potential for minimal harm. D to F: no actual harm, but potential for more. G to I: actual harm. J to L: immediate jeopardy. Within each band, the letter rises as more residents were affected or could be: one or a few, a pattern, or widespread. Source: CMS, nursing home scope and severity grid (State Operations Manual, chapter 7).
Nurse staffing hours
The hours registered nurses, licensed practical nurses and nurse aides worked, per resident per day, from the payroll records each home sends CMS. Source: CMS, Payroll-Based Journal.
Fines and payment denials
A fine (civil money penalty) is money CMS makes a nursing home pay when it falls short of federal rules. A payment denial means Medicare and Medicaid stop paying for new admissions until the home meets the rules again. Source: CMS; 42 CFR 488.430 and 488.417.
Immediate jeopardy
CMS’s most serious finding: the place’s failure to meet a rule caused, or was likely to cause, serious injury, harm, impairment or death to someone in its care. Source: CMS; 42 CFR 489.3.
Capacity
The most people the licence or certification lets the place care for at once: residents, children, beds or apartments, as the state counts them. It isn’t how many are there now. Source: Each state’s licensing agency.

What did inspectors find?

21 health citations at the latest inspection cycle

The Texas average is 9.6.

Last standard inspection Dec 4, 2025.

Most serious in three years: immediate jeopardy to health or safety (K), at a complaint inspection on Feb 16, 2026

Source:

CMS, Provider Information, State and US Averages and Health Deficiencies. Released Oct 28, 2026. Updated monthly.

When those citations happened

56 citations in 7 months of the last 36. Last cited Feb 2026. Most serious: immediate jeopardy to health or safety (K). The last 3 years, to Nov 5, 2026.

56 citations by month over the last 3 years. Each cell is one month.
JanFebMarAprMayJunJulAugSepOctNovDec
2023 Dec
2024 JanFebMarAprMayJunJulAugSepOctNovDec
2025 JanFebMarAprMayJunJulAugSepOctNovDec
2026 JanFebMarAprMayJunJulAugSepOctNov

Hover or focus a month to read it.

No visit on record Visited, nothing cited A stronger orange is more serious, on its source’s own levels, read onto four bands: from the least serious it publishes to the most
Source:

Hearth Record drew this from the dates and levels in the source’s own records.

All 56 citations in the last three years

Grouped by inspection, newest first. Each carries , from A, the least serious, to L, the most. 43 came from complaint inspections.

Source:

CMS, Health Deficiencies. Released Oct 28, 2026. Updated monthly.

Feb 16, 2026: complaint inspection8 citations

  • Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

    Rule F0600. K: immediate jeopardy to health or safety. From a complaint. Correction date, as CMS recorded it: Mar 4, 2026.

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

    Rule F0689. K: immediate jeopardy to health or safety. From a complaint. Correction date, as CMS recorded it: Mar 4, 2026.

  • Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.

    Rule F0725. K: immediate jeopardy to health or safety. From a complaint. Correction date, as CMS recorded it: Mar 4, 2026.

  • Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident’s well being.

    Rule F0726. K: immediate jeopardy to health or safety. From a complaint. Correction date, as CMS recorded it: Mar 4, 2026.

  • Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis.

    Rule F0727. F: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Mar 4, 2026.

  • Ensure that nurse aides who have worked more than 4 months, are trained and competent; and nurse aides who have worked less than 4 months are enrolled in appropriate training.

    Rule F0728. F: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Mar 4, 2026.

  • Implement a program that monitors antibiotic use.

    Rule F0881. F: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Mar 4, 2026.

  • Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home.

    Rule F0882. F: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Mar 4, 2026.

Dec 4, 2025: standard inspection13 citations

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

    Rule F0695. E: no actual harm, potential for more than minimal harm. Correction date, as CMS recorded it: Jan 7, 2026.

  • Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.

    Rule F0842. D: no actual harm, potential for more than minimal harm. Correction date, as CMS recorded it: Jan 7, 2026.

  • 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.

    Rule F0849. E: no actual harm, potential for more than minimal harm. Correction date, as CMS recorded it: Jan 7, 2026.

  • Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.

    Rule F0867. F: no actual harm, potential for more than minimal harm. Correction date, as CMS recorded it: Jan 7, 2026.

  • Provide and implement an infection prevention and control program.

    Rule F0880. D: no actual harm, potential for more than minimal harm. Correction date, as CMS recorded it: Jan 7, 2026.

  • Regularly inspect all bed frames, mattresses, and bed rails (if any) for safety; and all bed rails and mattresses must attach safely to the bed frame.

    Rule F0909. E: no actual harm, potential for more than minimal harm. Correction date, as CMS recorded it: Jan 7, 2026.

  • Develop, implement, and/or maintain an effective training program for all new and existing staff members.

    Rule F0940. E: no actual harm, potential for more than minimal harm. Correction date, as CMS recorded it: Jan 7, 2026.

  • Develop, implement, and/or maintain an effective training program that includes effective communications for direct care staff members.

    Rule F0941. E: no actual harm, potential for more than minimal harm. Correction date, as CMS recorded it: Jan 7, 2026.

  • Ensure that staff members are educated on resident rights and facility responsibilities to properly care for its residents.

    Rule F0942. E: no actual harm, potential for more than minimal harm. Correction date, as CMS recorded it: Jan 7, 2026.

  • Give their staff education on dementia care, and what abuse, neglect, and exploitation are; and how to report abuse, neglect, and exploitation.

    Rule F0943. E: no actual harm, potential for more than minimal harm. Correction date, as CMS recorded it: Jan 7, 2026.

  • Conduct mandatory training, for all staff, on the facility’s Quality Assurance and Performance Improvement Program.

    Rule F0944. E: no actual harm, potential for more than minimal harm. Correction date, as CMS recorded it: Jan 7, 2026.

  • Include as part of its infection prevention and control program, mandatory training that includes written standards, policies, and procedures for the program.

    Rule F0945. E: no actual harm, potential for more than minimal harm. Correction date, as CMS recorded it: Jan 7, 2026.

  • Provide behavior health training consistent with the requirements and as determined by a facility assessment.

    Rule F0949. E: no actual harm, potential for more than minimal harm. Correction date, as CMS recorded it: Jan 7, 2026.

Aug 22, 2025: complaint inspection8 citations

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

    Rule F0689. K: immediate jeopardy to health or safety. From a complaint. Correction date, as CMS recorded it: Sep 1, 2025.

  • Develop and implement policies and procedures to prevent abuse, neglect, and theft.

    Rule F0607. E: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Sep 17, 2025.

  • Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

    Rule F0609. E: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Sep 17, 2025.

  • Respond appropriately to all alleged violations.

    Rule F0610. E: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Sep 17, 2025.

  • Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician.

    Rule F0801. F: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Sep 25, 2025.

  • Administer the facility in a manner that enables it to use its resources effectively and efficiently.

    Rule F0835. F: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Sep 15, 2025.

  • Conduct and document a facility-wide assessment to determine what resources are necessary to care for residents competently during both day-to-day operations (including nights and weekends) and emergencies.

    Rule F0838. F: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Sep 16, 2025.

  • Follow rules about disclosure of ownership requirements and tell the state agency about changes in ownership and/or administrative personnel.

    Rule F0844. C: no actual harm, potential for minimal harm. From a complaint. Correction date, as CMS recorded it: Sep 18, 2025.

Dec 12, 2024: complaint inspection1 citation

  • Provide and implement an infection prevention and control program.

    Rule F0880. D: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Jan 1, 2025.

Oct 17, 2024: complaint inspection6 citations

  • Immediately tell the resident, the resident’s doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.

    Rule F0580. E: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Nov 8, 2024.

  • Create and put into place a plan for meeting the resident’s most immediate needs within 48 hours of being admitted

    Rule F0655. D: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Nov 8, 2024.

  • Develop and implement a complete care plan that meets all the resident’s needs, with timetables and actions that can be measured.

    Rule F0656. E: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Nov 8, 2024.

  • Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.

    Rule F0657. D: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Nov 8, 2024.

  • Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.

    Rule F0842. E: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Nov 8, 2024.

  • Have policies on smoking.

    Rule F0926. E: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Nov 8, 2024.

Jul 31, 2024: standard and complaint inspection19 citations

  • Honor the resident’s right to a dignified existence, self-determination, communication, and to exercise his or her rights.

    Rule F0550. E: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Sep 1, 2024.

  • Reasonably accommodate the needs and preferences of each resident.

    Rule F0558. D: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Sep 1, 2024.

  • Develop and implement policies and procedures to prevent abuse, neglect, and theft.

    Rule F0607. D: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Sep 15, 2024.

  • Develop and implement a complete care plan that meets all the resident’s needs, with timetables and actions that can be measured.

    Rule F0656. E: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Sep 1, 2024.

  • Provide appropriate pressure ulcer care and prevent new ulcers from developing.

    Rule F0686. D: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Sep 1, 2024.

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

    Rule F0689. E: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Sep 5, 2024.

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

    Rule F0695. E: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Sep 5, 2024.

  • Ensure that nurse aides who have worked more than 4 months, are trained and competent; and nurse aides who have worked less than 4 months are enrolled in appropriate training.

    Rule F0728. E: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Sep 15, 2024.

  • Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.

    Rule F0803. E: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Sep 2, 2024.

  • Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

    Rule F0812. E: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Sep 2, 2024.

  • Have the Quality Assessment and Assurance group have the required members and meet at least quarterly

    Rule F0868. F: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Sep 15, 2024.

  • Provide and implement an infection prevention and control program.

    Rule F0880. E: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Sep 2, 2024.

  • Regularly inspect all bed frames, mattresses, and bed rails (if any) for safety; and all bed rails and mattresses must attach safely to the bed frame.

    Rule F0909. E: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Aug 20, 2024.

  • Ensure residents have reasonable access to and privacy in their use of communication methods.

    Rule F0576. C: no actual harm, potential for minimal harm. From a complaint. Correction date, as CMS recorded it: Aug 31, 2024.

  • Ensure the activities program is directed by a qualified professional.

    Rule F0680. C: no actual harm, potential for minimal harm. From a complaint. Correction date, as CMS recorded it: Aug 19, 2024.

  • Post nurse staffing information every day.

    Rule F0732. B: no actual harm, potential for minimal harm. From a complaint. Correction date, as CMS recorded it: Sep 5, 2024.

  • Develop, implement, and/or maintain an effective training program that includes effective communications for direct care staff members.

    Rule F0941. B: no actual harm, potential for minimal harm. From a complaint. Correction date, as CMS recorded it: Sep 5, 2024.

  • Conduct mandatory training, for all staff, on the facility’s Quality Assurance and Performance Improvement Program.

    Rule F0944. B: no actual harm, potential for minimal harm. From a complaint. Correction date, as CMS recorded it: Sep 5, 2024.

  • Provide behavior health training consistent with the requirements and as determined by a facility assessment.

    Rule F0949. B: no actual harm, potential for minimal harm. From a complaint. Correction date, as CMS recorded it: Sep 5, 2024.

Dec 15, 2023: complaint inspection1 citation

  • Keep all essential equipment working safely.

    Rule F0908. E: no actual harm, potential for more than minimal harm. From a complaint. Correction date, as CMS recorded it: Dec 20, 2023.

Is it certified, and in good standing?

  • Certified for Medicare and Medicaid since Jun 1, 2005.
  • A candidate for CMS’s special focus list, which CMS keeps for homes with a history of serious problems.
  • CMS marks it with its abuse icon: cited for abuse or neglect that harmed a resident.
  • No change of ownership in the last 12 months.
  • CMS lists its ownership as for profit, limited liability company.
  • 65 certified beds.
Source:

CMS, Provider Information. Released Oct 28, 2026. Updated monthly.

Has it been fined or penalized?

  • 2 fines in the last three years, $320,538 in all.
  • No Medicare payment denials in the last three years.
  • 43 citations in the last three years came from complaint inspections.
Source:

CMS, Penalties and Health Deficiencies. Released Oct 28, 2026. Updated monthly.

Fines and payment denials, newest first
DateKindAmount
Feb 16, 2026Fine$139,586
Aug 22, 2025Fine$180,952

Who does the caring?

Staffing measures
MeasureThis homeTexas average
Nurse hours per resident per dayNot given3.42
Of which registered nursesNot given0.44
At weekendsNot given2.99
Nursing staff turnoverNot given50.8%
Registered nurse turnoverNot given49.8%
Administrators who leftNot givenNot given

Who owns it?

  • 5 owners or officers are people: Rainey Renee Alexander (owns a share directly, 100%); Joe Alexander (additional disclosable party (controls, leases property to, or provides services to the home)); Axel Martinez Irizarry (additional disclosable party (controls, leases property to, or provides services to the home)); Clarence Stroh (additional disclosable party (controls, leases property to, or provides services to the home)); Rainey Renee Alexander (runs it (operational or managerial control)).
  • No private-equity firm among the owners CMS lists.
  • No real-estate investment trust among the owners CMS lists.
Source:

CMS, All Owners. Checked Nov 5, 2026. Updated monthly.

CMS, Provider Information. Released Oct 28, 2026. Updated monthly.

How do residents fare?

  • CMS rates its quality measures 1 of 5 (Texas average 3.8).
Source:

CMS, Provider Information and State and US Averages. Released Oct 28, 2026. Updated monthly.

CMS’s star ratings, from 1 to 5
MeasureRating
Overall rating1 of 5
Health inspections1 of 5
Staffing1 of 5
Quality measures1 of 5

How does it compare nearby?

  • Among the 12 nearest homes, within 18.7 miles, this one had the 1st most health citations at the latest inspection cycle (21; the middle value was 9).
Source:

CMS, Provider Information. Released Oct 28, 2026. Updated monthly.

The 12 nearest, by straight-line distance
PlaceMiles awayCitations, latest cycle
Merkel Nursing Center This nursing home21
Willowcreek Rehab and Nursing13.87
Wisteria Place15.410
Mesa Springs Healthcare Center15.811
Northern Oaks Living & Rehabilitation Center16.010
Avir at Coronado16.315
Hendrick Skilled Nursing Facility16.81
Wesley Court Health Center17.05
Windcrest Health & Rehabilitation17.47
The Oaks at Radford Hills Healthcare Center18.08
Avir at Abilene18.410
Silver Spring18.72

What the record doesn’t say

  • Complaints that didn’t lead to a citation aren’t published.
  • Inspections reach CMS’s data about six weeks after they happen, and staffing about four months after.
  • CMS publishes the inspectors’ full written findings in a separate monthly file, which isn’t loaded yet.
  • Fines and Medicare payment denials are the only enforcement CMS publishes; state licence actions aren’t included.

Sources

  • Centers for Medicare & Medicaid Services, Provider Information (4pq5-n9py).

    Released Oct 28, 2026 and checked Nov 5, 2026. Updated monthly. Public domain (U.S. Government work).

  • Centers for Medicare & Medicaid Services, Health Deficiencies (r5ix-sfxw).

    Released Oct 28, 2026 and checked Nov 5, 2026. Updated monthly. Public domain (U.S. Government work).

  • Centers for Medicare & Medicaid Services, Penalties (g6vv-u9sr).

    Released Oct 28, 2026 and checked Nov 5, 2026. Updated monthly. Public domain (U.S. Government work).

  • Centers for Medicare & Medicaid Services, All Owners (afe44b85-cc6d-40d7-b5df-00ae8910d1d2).

    Checked Nov 5, 2026. Updated monthly. Public domain (U.S. Government work).

  • Centers for Medicare & Medicaid Services, State and US Averages (xcdc-v8bm).

    Released Oct 28, 2026 and checked Nov 5, 2026. Updated monthly. Public domain (U.S. Government work).

If you believe something here is wrong, a correction starts with the agency whose record this copies: CMS. CMS’s own record is on Care Compare. If Hearth Record copied something wrongly, it will fix it and log the correction publicly, with its date: how corrections work.

Source:

This copy of the record was made on Nov 5, 2026.

From the home

The public record above comes first. Anything the home adds will appear here, below it, and say who wrote it.

Replies

None. Replies aren’t open yet. When they open, the home will be able to answer any finding for free, and the reply will show beside that finding, unedited and dated.

Paid listing

None. Paid listings aren’t open yet. When they open, anything paid for will say “Paid by the home”, and paying will never change a finding, a rating or the order of results.

How to read a record

Four things every record does, shown on an example record made up for this guide.

An example record, made up for this guide

An example nursing home

Made up for this guide: no real place is shown

Not fully inspected in over two years (CMS flag)

11 health citations at the latest inspection cycle

The state average is 14.3.

Source:

CMS, State and US Averages and Health Deficiencies. Released Oct 28, 2026. Updated monthly.

From the homeNone yet. Replies and paid listings aren’t open, and when they open they will sit here, below the record.

1 of 4

Every fact names its source.

Who published it, when, and how often it changes sit beside each fact, with a link to the agency’s own file.

Sign in

A free account keeps your watch list, shortlists, comparisons and saved searches on every device, and can email you when something you watch changes. Browsing never needs one.