Ralls Nursing Home
1111 AVENUE P, Ralls, TX, 79357
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 - Partnership
- Certified beds
- 46 · avg 35 residents/day
- Total nursing staff turnover
- 46.2% — lower than most Texas nursing homesTexas avg: 51.5% · National avg: 46.4% · per CMS Care Compare
- Administrators who left
- 2 departed — near the Texas averageTexas avg: 0.6 · National avg: 0.5 · per CMS Care Compare
Enforcement & Citations
- Fines (past 3 years)
- 5 fines · $501,656 total
- Payment denials
- 1 denial
State licensing & capacity
- License number
- 149051
- Service type
- Medicare/medicaid
- Licensed capacity
- 46 beds
- Bed type breakdown
- 7 Medicare-only · 39 Medicaid/Medicare
- Current license effective
- December 1, 2023
- Current license expires
- December 1, 2026
- Initial license date
- September 1, 1971
Texas HHSC licensing registry · as of April 16, 2026
Ownership & operations
- Licensee
- Childress County Hospital District (HOSPITAL DISTRICT/AUTHORITY)
- Operator / manager
- Ralls Nh Operations Ltd
- Administrator
- Jamie Crow
Texas HHSC licensing registry · as of April 16, 2026
Federal ownership record
Parent entity
Sss Holdings lp
Disclosed owners (10 on record)
- Andrew Buchok
Adp of The Snf · since 2025
- Childress County Hospital District
Adp of The Snf · since 2025
- Emilee Stratton
Adp of The Snf · since 2025
- Holly Holcomb
Adp of The Snf · since 2025
- Paul f Chebib
Adp of The Snf · since 2025
- Ralls nh Operations, Ltd
Adp of The Snf · since 2025
+ 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 34)
- J0609·Jan 14, 2026Complaint
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
- J0607·Jan 14, 2026Complaint
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
- E0602·Jan 14, 2026Complaint
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Protect each resident from the wrongful use of the resident's belongings or money.
- J0600·Jan 14, 2026Complaint
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.
- D0760·Nov 26, 2025Complaint
Pharmacy Service Deficiencies
Ensure that residents are free from significant medication errors.
- E0812·Sep 16, 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.
- E0727·Sep 16, 2025
Nursing and Physician Services Deficiencies
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.
- D0609·Sep 16, 2025
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Federal penalties
By year
- 20262 fines · $25K
- 20242 fines · $266K · 1 payment denial
- 20231 fine · $211K
Most recent events
- Jan 14, 2026Fine · $13K
- Jan 14, 2026Fine · $13K
- Jun 10, 2024Payment denial · 11 days · starting Jul 12, 2024
- Jun 10, 2024Fine · $203K
- May 9, 2024Fine · $62K
- Mar 24, 2023Fine · $211K
Largest single fine on record: $211K.
Fire-safety citations
7 Life-Safety-Code citations on file. Most recent: Sep 16, 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
Ralls Nursing Home is a 46-bed Medicare/Medicaid nursing home in Ralls, Crosby County, licensed since 1971 and operated by Ralls Nh Operations Ltd under a hospital district licensee. CMS rates it 1 star overall, 1 star on health inspections, and 1 star on staffing. CMS has substantiated findings of resident abuse or neglect within the past 36 months, and the facility has accumulated five fines totaling $501,656 since its inspection history. Quality-of-care measures rate 4 stars.
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 bottom tier among Texas nursing homes. Each resident receives about 151 minutes of nursing care per day, roughly 90 minutes less than at a 4-star-staffing facility in Texas. Of that, only 17 minutes comes from a registered nurse. Residents here need more hands-on care than at a typical facility — sicker or less mobile on average — so the same staffing hours stretch thinner than the raw minutes suggest.
Two administrators have left in the past year. That level of leadership turnover reaches the people who set staffing schedules, hire caregivers, and handle complaints.
CMS has substantiated findings of resident abuse or neglect here within the past 36 months. The abuse icon appears on a facility's CMS record only after a deficiency is confirmed through inspection.
The facility has five CMS fines totaling $501,656. The statewide median for fines among facilities that have any is $20,699; 30% of Texas nursing homes have no fines at all. This facility's total is roughly 24 times the state median.
Written from CMS Care Compare and state licensing records · last updated April 19, 2026
Questions to ask when you tour
Substantiated abuse findings
CMS confirmed at least one finding of resident abuse or neglect here within the past 36 months — ask what the specific deficiency was and what policy changes followed.
Five fines, $501,656 total
Ask what each of the five cited violations involved and whether any corrective actions have been verified by a follow-up inspection.
Two administrators in one year
With two administrators departing in the past year, ask who is currently in the role, how long they have been in place, and whether a permanent hire is planned.
Daily nursing coverage per resident
Residents currently receive about 151 minutes of nursing care per day — ask how many registered nurses are on duty on a typical weekday versus a weekend night.
Ownership and management structure
The facility is licensed to a hospital district but operated by a separate management company — ask how day-to-day decisions and complaint escalations flow between the two entities.
Quality measures versus staffing gap
Quality-of-care measures rate 4 stars despite 1-star staffing — ask which specific measures drive that rating and how staff levels are maintained during call-outs.
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.