Graham Oaks Care Center
1325 FIRST STREET, Graham, TX, 76450
Federal Quality Data
Official records from CMS Care Compare — reported by the facility and audited by the Centers for Medicare & Medicaid Services. We present them unmodified. Refreshed March 2026.
CMS Abuse Flag
CMS has flagged this facility for a substantiated finding of resident abuse, neglect, or exploitation in its current or recent inspection cycle. Ask the facility for the specific citation and corrective-action plan during your visit, and consider contacting your state's long-term care ombudsman for context.
Source: CMS Care Compare.
CMS Star Ratings
Facility & Staffing
- Ownership
- For profit - Limited Liability company · Chain: Creative Solutions In Healthcare
- Certified beds
- 110 · avg 80 residents/day
- Total nursing staff turnover
- 74.5% — higher than most Texas nursing homesTexas avg: 51.5% · National avg: 46.4% · per CMS Care Compare
Enforcement & Citations
- Fines (past 3 years)
- 2 fines · $34,690 total
State licensing & capacity
- License number
- 144858
- Service type
- Medicare/medicaid
- Licensed capacity
- 110 beds
- Bed type breakdown
- 5 Medicare-only · 105 Medicaid/Medicare
- Current license effective
- June 18, 2025
- Current license expires
- June 18, 2028
- Initial license date
- January 28, 1988
Texas HHSC licensing registry · as of April 16, 2026
Ownership & operations
- Licensee
- County Of Throckmorton (COUNTY)
- Operator / manager
- Graham I Enterprises, Llc
- Administrator
- Roxy Cook
Texas HHSC licensing registry · as of April 16, 2026
Federal ownership record
Chain affiliation
Part of the Creative Solutions in Healthcare chain — 149 facilities. Chain-wide average overall rating 2.7 / 5.
Disclosed owners (14 on record)
- Aaron g Purdy
Adp of The Snf · since 2025
- Graham i Enterprises, Llc
Adp of The Snf · since 2025
- Roxy Cook
Adp of The Snf · since 2025
- Zachary Willig
Corporate Director · since 2025
- Caleb Hodges
Managing Control - Governing Body · since 2023
- County of Throckmorton
5% or Greater Direct Ownership Interest · 100% · since 2022
+ 8 additional owners on the federal record.
Source: CMS Provider Enrollment data — SNF Enrollments + All Owners + Chain Performance Measures, as of April 2026.
Federal inspection record
Immediate-jeopardy citations (CMS scope/severity J–L) are the most serious category federal inspectors issue — meaning a deficiency placed residents in immediate risk of serious harm. Ask the facility for the corrective-action plan filed with CMS, and consider contacting your state long-term care ombudsman for context.
Recent health-deficiency citations (most recent 8 of 20)
- C0844·Nov 8, 2025Complaint
Administration Deficiencies
Follow rules about disclosure of ownership requirements and tell the state agency about changes in ownership and/or administrative personnel.
- J0689·Oct 10, 2025Complaint
Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
- J0600·Oct 10, 2025Complaint
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
- D0842·May 23, 2025Complaint
Resident Assessment and Care Planning Deficiencies
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
- E0656·Jan 22, 2025Complaint
Resident Assessment and Care Planning Deficiencies
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
- D0641·Jan 22, 2025Complaint
Resident Assessment and Care Planning Deficiencies
Ensure each resident receives an accurate assessment.
- D0607·Oct 18, 2024Complaint
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
- D0607·Dec 7, 2023Complaint
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
Federal penalties
By year
- 20252 fines · $35K
Most recent events
- Oct 10, 2025Fine · $17K
- Oct 10, 2025Fine · $17K
Largest single fine on record: $17K.
Fire-safety citations
4 Life-Safety-Code citations on file. Most recent: Jan 22, 2025. Fire-safety inspections cover building-level Life Safety Code compliance, separate from the resident-care health survey.
Source: CMS Provider Data Catalog — Health Deficiencies, Fire Safety Deficiencies, and Penalties datasets, snapshot Mar 1, 2026.
About this community
Graham Oaks Care Center is a 110-bed nursing home in Graham, Texas, managed by Graham I Enterprises, LLC under a county licensee. CMS rates it 1 star overall — the lowest tier — with a substantiated abuse or neglect finding on record and a 1-star staffing rating. Two CMS fines totaling $34,690 have been issued. About 80 residents occupy the facility on an average day, roughly 72% of licensed capacity.
Written from CMS Care Compare and state licensing records · last updated April 19, 2026
What the data says
CMS rates staffing here 1 star — the bottom tier, shared by about 38% of Texas nursing homes. Each resident receives approximately 119 minutes of total nursing care per day, which is 122 minutes less than what a 4-star-staffing facility in Texas provides. Residents here also require more hands-on care than at a typical facility — they are sicker or less mobile on average — so those 119 minutes stretch thinner than the number alone suggests.
Approximately 7 in 10 nursing staff left in the past year. At that rate, a long-stay resident will likely go through two or three primary caregivers over the course of a year.
CMS has substantiated findings of resident abuse or neglect at this facility within the past 36 months.
Two CMS fines totaling $34,690 have been issued. The state median for facilities that receive any fine at all is about $20,699; about 30% of Texas nursing homes have no fines at all.
The facility is operating at roughly 72% of its licensed beds — about 80 residents in a 110-bed building. Paired with the staffing, turnover, and safety signals above, that occupancy level is part of the broader picture.
Written from CMS Care Compare and state licensing records · last updated April 19, 2026
Questions to ask when you tour
Nature of the abuse finding
CMS has a substantiated abuse or neglect finding here within the past 36 months — ask what happened, what corrective steps were taken, and how staff are trained now.
Staffing levels on nights and weekends
CMS rates staffing 1 star; weekend nursing hours reported are 1.708 per resident per day — ask how many nurses and aides are on the floor overnight and on weekends specifically.
Staff continuity for your family member
About 7 in 10 nursing staff left in the past year — ask how the facility assigns consistent caregivers and what the current open-position count is.
Details behind the two CMS fines
Two fines totaling $34,690 have been issued — ask what deficiencies triggered them and what policy or staffing changes followed.
Current census and waitlist status
The facility averages about 80 residents in a 110-bed building — ask whether that reflects voluntary admissions limits, staffing constraints, or other factors.
Role of the Resident Council
The facility has a Resident Council but no Family Council — ask how family members can raise concerns, attend meetings, or receive updates on care plan changes.
Where this information comes from
- License, capacity, ownership, administrator: Texas HHSC licensing registry, snapshot as of April 16, 2026.
- Star ratings, staffing, fines, deficiencies: CMS Care Compare, processed March 1, 2026.
- Summary, insights, and tour questions: Written from the state licensing and CMS records above, last updated April 19, 2026.
Read our methodology for how this information is collected and verified.