River Hills Health And Rehabilitation Center
2091 BANDERA HWY, Kerrville, TX, 78028
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 Star Ratings
Facility & Staffing
- Ownership
- For profit - Individual
- Certified beds
- 150 · avg 106 residents/day
- Total nursing staff turnover
- 68.9% — higher than most Texas nursing homesTexas avg: 51.5% · National avg: 46.4% · per CMS Care Compare
- RN turnover
- 100% — higher than most Texas nursing homesTexas avg: 50.5% · National avg: 43.6% · per CMS Care Compare
Enforcement & Citations
- Fines (past 3 years)
- 3 fines · $112,133 total
State licensing & capacity
- License number
- 147649
- Service type
- Medicare/medicaid
- Licensed capacity
- 150 beds
- Bed type breakdown
- 28 Medicare-only · 122 Medicaid/Medicare
- Current license effective
- April 1, 2026
- Current license expires
- April 1, 2029
- Initial license date
- August 28, 2006
Texas HHSC licensing registry · as of April 16, 2026
Ownership & operations
- Licensee
- Uvalde County Hospital Authority (HOSPITAL DISTRICT/AUTHORITY)
- Operator / manager
- River Hills Chm Llc
- Administrator
- Alan Lopez
Texas HHSC licensing registry · as of April 16, 2026
Federal ownership record
Parent entity
Uvalde County Hospital Authority
Disclosed owners (10 on record)
- Lauren Hernandez
Corporate Director · since 2025
- Alan Lopez
Operational/managerial Control · since 2025
- Christopher r Lockhart
Corporate Director · since 2024
- Adam Apolinar
Corporate Officer · since 2022
- Terri Contreras
Corporate Officer · since 2019
- 2091kv LlcREIT
Adp of The Snf · since 2017
+ 4 additional owners on the federal record.
Source: CMS Provider Enrollment data — SNF Enrollments + All Owners, 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 55)
- F0882·Nov 26, 2025Complaint
Infection Control Deficiencies
Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home.
- D0689·Sep 16, 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.
- D0605·Jun 13, 2025Complaint
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function.
- D0880·Jun 13, 2025
Infection Control Deficiencies
Provide and implement an infection prevention and control program.
- D0813·Jun 13, 2025
Nutrition and Dietary Deficiencies
Have a policy regarding use and storage of foods brought to residents by family and other visitors.
- E0812·Jun 13, 2025
Nutrition and Dietary Deficiencies
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
- E0761·Jun 13, 2025
Pharmacy Service Deficiencies
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.
- D0760·Jun 13, 2025
Pharmacy Service Deficiencies
Ensure that residents are free from significant medication errors.
Federal penalties
By year
- 20251 fine · $49K
- 20242 fines · $63K
Most recent events
- Feb 8, 2025Fine · $49K
- Dec 21, 2024Fine · $47K
- Jan 10, 2024Fine · $15K
Largest single fine on record: $49K.
Fire-safety citations
11 Life-Safety-Code citations on file. Most recent: Jun 13, 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
River Hills Health And Rehabilitation Center is a 150-bed nursing home in Kerrville, Texas, accepting Medicare and Medicaid. CMS rates it 2 stars overall, with 1-star ratings on both health inspections and staffing. Three fines totaling $112,133 have been levied — more than five times the Texas median of $20,699. Quality-of-care outcome measures rate 5 stars. About 106 of 150 beds are occupied on a given day.
Written from CMS Care Compare and state licensing records · last updated April 19, 2026
What the data says
CMS rates staffing here at 1 star — the lowest tier, shared by about 38% of Texas nursing homes. Each resident receives roughly 180 minutes of total nursing care per day, about 61 minutes less than at a 4-star-staffing facility in Texas. Residents here also need more hands-on care than at a typical facility — they tend to be sicker or less mobile on average — so those 180 minutes stretch thinner than the raw number suggests.
Roughly 7 in 10 nursing staff left in the past year. A long-stay resident will likely cycle through two or three primary caregivers. RN turnover ran at 100% over the same period — meaning effectively every registered nurse on staff was replaced within the year.
Three CMS fines totaling $112,133 have been issued. About 30% of Texas nursing homes received no fines at all, and the Texas median for fines is $20,699 — putting this facility's total at more than five times that midpoint.
CMS rates quality-of-care outcomes at 5 stars, the highest tier, for both long-stay and short-stay residents. This rating reflects documented outcomes — things like rates of falls, pressure injuries, and hospital readmissions — and stands in contrast to the 1-star staffing and inspection ratings.
The facility is operating at roughly 71% of its licensed beds. That level of occupancy, alongside the staffing and inspection ratings, is the context in which the 71% figure sits.
Written from CMS Care Compare and state licensing records · last updated April 19, 2026
Questions to ask when you tour
Staffing levels on nights and weekends
Weekend nursing hours average 2.65 minutes per resident per hour — below the already-low weekday figure; ask how many nurses and aides are on duty during those shifts.
RN coverage and continuity
Every registered nurse on staff was replaced within the past year; ask how many RNs are currently employed and how long they have been here.
What the three fines were for
Three CMS fines totaling $112,133 have been levied; ask what specific deficiencies triggered each fine and what changes were made in response.
1-star health inspection findings
CMS rates health inspections at 1 star; ask to see the most recent inspection report and what deficiencies were cited.
Why occupancy is at 71%
About 44 licensed beds are unfilled on a typical day; ask whether that reflects a staffing cap, a discharge trend, or reduced admissions — and what the current waitlist looks like.
How the 5-star outcomes are maintained
Outcome measures rate 5 stars despite 1-star staffing; ask which specific measures drive that rating and how care plans are reviewed when a resident's condition 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.