How to check nursing home ratings in Bexar County, Texas — using HHSC inspection records, CMS star ratings, and what the reports actually mean.
By San Antonio Senior Advisor Care Team · July 2, 2026
If you are comparing nursing home ratings in Bexar County, Texas, you are really working with two separate systems, and families get the most accurate picture when they use both. The first is the federal CMS Five-Star Quality Rating on Medicare's Care Compare site (medicare.gov/care-compare), which scores every Medicare- or Medicaid-certified nursing facility from one to five stars based on health inspections, staffing levels, and quality measures. The second — and the one far fewer San Antonio families know about — is the Texas HHSC inspection record. Texas Health and Human Services Commission licenses every nursing facility in the state under Texas Health and Safety Code Chapter 242, and its surveyors conduct unannounced inspections, investigate complaints, and document every deficiency they cite. Those records are public and searchable through the HHSC Long-Term Care Provider Search at apps.hhs.texas.gov/HSPubDisclosure. Bexar County has roughly seventy licensed nursing facilities spread from the Medical Center corridor to Windcrest, Converse, and the South Side, and their inspection histories vary enormously — which is exactly why reading the actual reports beats relying on a single star number.
The two systems overlap but do not duplicate each other. CMS stars compress years of data into one digit, which is useful for a first pass but hides recency: a facility can hold three stars while carrying a serious deficiency from a survey four months ago. The HHSC record, by contrast, shows you each individual survey, the date it happened, what was cited, and whether the facility corrected it. When I sit with San Antonio families choosing between two or three facilities their hospital discharge planner suggested, we pull both — the Care Compare page and the HHSC disclosure record — for every facility on the list before we ever schedule a tour.
Start at apps.hhs.texas.gov/HSPubDisclosure, the Texas HHSC public disclosure search. Search by facility name, or filter by county and select Bexar to see every licensed nursing facility in the San Antonio area at once. Each facility's page shows its license status, certified bed count, ownership, and — most importantly — its survey and complaint investigation history. Click into the inspection results and you will see each survey date along with any deficiencies cited, identified by federal F-tag numbers (for certified facilities) and state licensure violations under Chapter 242 and the associated Texas Administrative Code rules.
Two details matter when you read these reports. First, look at scope and severity. Every deficiency is graded on a letter scale from A through L: the letter reflects how serious the harm was and how many residents were affected. Citations in the G-through-L range involve actual harm or immediate jeopardy to residents — those are the ones that should stop you cold, especially if they recur. A scattering of lower-level citations (B through E) is common even at well-run facilities; nearly every nursing home in Texas gets cited for something during a standard survey. Second, look at the pattern over time. Texas facilities receive a standard survey roughly every nine to fifteen months. One bad survey followed by two clean ones suggests a problem that was fixed. The same infection-control or medication-error tag appearing in three consecutive surveys suggests a problem that management cannot or will not fix.
Staffing is the single strongest predictor of nursing home quality, and it is where San Antonio facilities differ most. On Care Compare, check the reported registered nurse hours and total nurse staffing hours per resident per day, and check the staffing star separately from the overall star — a facility can carry a decent overall rating on the strength of old quality-measure data while its staffing star sits at two. Ask the admissions director directly: what is your weekend RN coverage, what is your CNA-to-resident ratio on the evening shift, and what percentage of your direct-care staff are agency rather than permanent employees? High agency usage and weekend thinning are the two staffing patterns that show up again and again in Bexar County complaint investigations.
Complaint investigations appear in the HHSC record separately from standard surveys, and they deserve equal attention. A facility with few standard-survey deficiencies but a steady stream of substantiated complaints has a gap between how it performs when surveyors are scheduled to appear and how it performs the rest of the year. Also check ownership. Several San Antonio facilities have changed hands in the past few years, and a change in ownership or management company can make historical ratings — good or bad — much less predictive. The HHSC disclosure page lists the license holder; if the facility was sold recently, weight the surveys conducted after the sale far more heavily than anything before it.
Most families searching nursing home ratings in Bexar County are doing it under time pressure, because a parent is being discharged from Methodist Hospital, Baptist Medical Center, University Hospital, BAMC, or Christus Santa Rosa and the discharge planner has handed them a list of three facilities with available Medicare skilled beds. Discharge planners are required to respect your choice, and you are allowed to ask for time to check records — even twenty-four hours is enough to pull the HHSC disclosure page and Care Compare listing for every facility on the list. Do not assume the facilities offered are the best available; they are frequently just the ones with open beds that day and a relationship with that hospital system.
Geography matters in San Antonio's nursing facility market, but not the way many families assume. There are well-rated and poorly-rated facilities in every part of the metro — the Medical Center area, Stone Oak and the North Side, Alamo Heights, Windcrest, and the South Side all have both. Newer construction near Stone Oak does not automatically mean better inspection results, and some of the most consistent survey records in the county belong to older, smaller buildings. If your parent is a veteran being discharged from Audie L. Murphy VA Medical Center, also ask the VA social worker about VA-contracted community nursing home beds, which carry an additional layer of VA oversight on top of HHSC licensure.
A poor rating is not always disqualifying, and a good one is not a guarantee. If a facility you otherwise like carries a rough survey, bring the specific citations to the administrator and ask what changed. A credible answer names the root cause, the corrective action, and the follow-up result — for example, a new director of nursing, a revised medication pass procedure, and a clean revisit survey confirming correction. A defensive or vague answer tells you what you need to know. HHSC conducts revisit surveys to verify correction, and those revisit results appear in the public record too, so you can check whether the fix actually held rather than taking anyone's word for it.
If you place a parent and then see problems — unexplained weight loss, pressure sores, medication errors, or staff who cannot answer basic questions about your parent's care plan — you have three escalation paths in San Antonio, and you can use all three at once. First, request a care plan meeting with the facility in writing. Second, call the state Long-Term Care Ombudsman program, which in the San Antonio region is coordinated through AACOG, the Alamo Area Council of Governments, at (210) 362-5200 — ombudsmen advocate for residents at no cost and can attend care plan meetings with you. Third, file a complaint directly with Texas HHSC at 1-800-458-9858; complaints alleging serious harm trigger an unannounced investigation, and the results become part of the public record that helps the next family making this same decision.
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