Bowie County, Texas · Nursing home
Avir at Cowhorn Creek
1 of 5 overall from CMS
5524 Cowhorn Creek, Texarkana, TX 75503
At a glance
- Overall rating 1 of 5 Below the state average of 2.7
- Nurse time per resident, per day 3.26 hours Below the state average of 3.39
- Nursing staff who left in a year 68.2% Above the state average of 55.3%
- Health citations, last 3 inspection cycles 68 2 at the harm level or above
- Fines in 3 years $30,545 1 fine
- Certified beds in use 89.2% of 76 beds, on an average day
Arrows only show whether a figure is above or below the state average. They are not a judgment of the home.
Avir at Cowhorn Creek is a 76-bed nursing home in Texarkana, Texas (Bowie County). CMS rates it 1 of 5 stars overall as of Sep 2026. It reports 3.26 nurse staffing hours per resident per day, below the Texas average of 3.39. CMS lists 1 fine totaling $30,545 in the past three years.
- Certified beds
- 76
- Residents per day (average)
- 67.8
- Certified since
- 2002 (24 yrs)
Government - Hospital district Participates in Medicare and MedicaidPart of Avir Health Group (118 homes)
Bed use is this site's calculation: average residents per day divided by certified beds. It is an average, so it does not show today's openings.
Terms used on this page
- CMS
- The Centers for Medicare & Medicaid Services, the federal agency that publishes the ratings, staffing figures, inspection results and penalties shown here.
- Certified beds
- The number of federally certified beds CMS lists for the home.
- Deficiency or citation
- A federal requirement that inspectors found the home did not meet. Each one gets a letter from A to L for how serious it was and how many residents were affected. What the letters mean
- Actual harm
- Letters G, H and I: actual harm to a resident that is not immediate jeopardy.
- Immediate jeopardy
- Letters J, K and L: the problem caused, or was likely to cause, serious injury, harm, impairment or death to a resident.
- Inspection cycle
- A standard inspection plus the complaint and infection-control citations CMS assigns to it. This page shows the three most recent cycles.
- Special Focus Facility (SFF)
- A home CMS has placed under closer oversight because of its inspection record. More about the program
Questions to ask Avir at Cowhorn Creek
Chosen from this home's public data.
- CMS lists 1 fine totaling $30,545 in the past three years. What changed after the most recent one?Penalties in CMS data
- CMS counts 24 health deficiencies in the latest inspection cycle (the standard inspection on Feb 12, 2026 plus complaint and infection-control inspections); the Texas average is 9.4. Which have been corrected?Inspection results in CMS data
- Nursing staff turnover is 68.2%, above the Texas average of 55.3%. How often would the same aides care for my relative?Turnover in CMS data
More in what to ask on a nursing home tour.
CMS star ratings
- Overall 1 of 5 Texas average 2.7
- Health inspections 1 of 5 Texas average 2.8
- Staffing 1 of 5 Texas average 1.9
- Quality measures 3 of 5 Texas average 3.7
The vertical line marks the Texas average. Ratings run from 1 to 5. How to read CMS star ratings
Nurse staffing
Hours of care per resident per day, as the home reported to CMS.
What these roles do
Nurse aides give most hands-on daily care, such as help with bathing, dressing and meals. Licensed practical nurses give medications and routine nursing care. Registered nurses assess residents and direct their care.
- All nursing staff 3.26 h Texas average 3.39
- Nurse aides 1.94 h Texas average 2.01
- Licensed practical nurses 0.94 h Texas average 0.95
- Registered nurses 0.38 h Texas average 0.43
- All staff, weekends 2.93 h Texas average 2.98
How much nurse staffing is enough? All bars share one scale, 0 to 11 hours. The vertical line marks the Texas average; the national average for all nursing staff is 3.86 hours.
- Nursing staff turnover68.2%
- Texas average55.3%
- Registered nurse turnoverNot reported
- Texas average54.6%
- Administrators who left0
Quality measures
CMS calculates these from residents' assessments and Medicare claims. They are shown as published, next to the Texas and national averages. marks the measures CMS uses in its quality star rating; for those, the rating gives more points for a lower rate.
Long-stay residents
| Measure | This home | Texas | U.S. |
|---|---|---|---|
| ★ Percentage of long-stay residents whose need for help with daily activities has increased | 25.1% | 15.8% | 13.9% |
| Percentage of long-stay residents who lose too much weight | 0.0% | 3.0% | 5.2% |
| ★ Percentage of long-stay residents with a catheter inserted and left in their bladder | 0.0% | 0.3% | 0.8% |
| ★ Percentage of long-stay residents with a urinary tract infection | 0.9% | 0.8% | 1.6% |
| Percentage of long-stay residents who have depressive symptoms | 1.4% | 2.4% | 12.8% |
| Percentage of long-stay residents who were physically restrained | 0.0% | 0.0% | 0.1% |
| ★ Percentage of long-stay residents experiencing one or more falls with major injury | 0.4% | 3.3% | 3.2% |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 96.5% | 96.6% | 93.6% |
| ★ Percentage of long-stay residents whose ability to walk independently worsened | 21.5% | 14.0% | 14.1% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 17.6% | 18.0% | 19.5% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine | 95.4% | 98.0% | 95.5% |
| ★ Percentage of long-stay residents with pressure ulcers | 4.5% | 3.8% | 4.6% |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | 10.9% | 13.4% | 19.0% |
| ★ Percentage of long-stay residents who received an antipsychotic medication | 1.8% | 9.6% | 15.4% |
| ★ Number of hospitalizations per 1000 long-stay resident days | 2.78 | 2.17 | 1.90 |
| ★ Number of outpatient emergency department visits per 1000 long-stay resident days | 2.03 | 2.06 | 1.78 |
Short-stay residents
| Measure | This home | Texas | U.S. |
|---|---|---|---|
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 98.2% | 88.9% | 82.0% |
| ★ Percentage of short-stay residents who newly received an antipsychotic medication | 0.0% | 1.5% | 1.6% |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 95.6% | 88.0% | 79.8% |
| ★ Percentage of short-stay residents who were rehospitalized after a nursing home admission | 20.8% | 25.7% | 23.8% |
| ★ Percentage of short-stay residents who had an outpatient emergency department visit | 9.9% | 12.3% | 12.0% |
Measure periods: April 2025 to March 2026 for most measures; July 2024 to June 2025 for the flu vaccine measures; January to December 2025 for the hospital and emergency department measures, which CMS risk-adjusts. See the measures on Medicare.gov
Inspection history
Inspectors cited 68 health deficiencies in the three most recent inspection cycles. Of these, 2 were at the immediate jeopardy level; the rest were graded as no actual harm. 25 were cited in connection with a complaint investigation. The most recent citation at the harm level or above was on Aug 15, 2025: Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
| Standard inspection | Health | Fire safety |
|---|---|---|
| Feb 12, 2026 | 24 | 1 |
| Dec 4, 2024 | 28 | 0 |
| Nov 16, 2023 | 16 | 3 |
Texas homes averaged 9.4 health deficiencies in the latest cycle; the national average is 9.2. Each cycle's health count covers the standard inspection on that date plus the complaint and infection-control citations CMS assigns to that cycle.
Health citations, three most recent inspection cycles (68)
-
DPotential for more than minimal harm, isolated
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Complaint investigation · Resident Assessment and Care Planning · Deficient, Provider has date of correction (Jul 30, 2026)
-
DPotential for more than minimal harm, isolated
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Complaint investigation · Quality of Life and Care · Deficient, Provider has date of correction (Jul 30, 2026)
-
DPotential for more than minimal harm, isolated
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Complaint investigation · Quality of Life and Care · Deficient, Provider has date of correction (Jul 7, 2026)
-
DPotential for more than minimal harm, isolated
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Complaint investigation · Pharmacy Service · Deficient, Provider has date of correction (Apr 14, 2026)
-
FPotential for more than minimal harm, widespread
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.
Nursing and Physician Services · Deficient, Provider has date of correction (Feb 13, 2026)
Show 25 more
-
FPotential for more than minimal harm, widespread
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Nutrition and Dietary · Deficient, Provider has date of correction (Feb 13, 2026)
-
EPotential for more than minimal harm, pattern
Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months.
Resident Assessment and Care Planning · Deficient, Provider has date of correction (Feb 13, 2026)
-
EPotential for more than minimal harm, pattern
Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment.
Resident Assessment and Care Planning · Deficient, Provider has date of correction (Feb 13, 2026)
-
EPotential for more than minimal harm, pattern
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Resident Assessment and Care Planning · Deficient, Provider has date of correction (Feb 13, 2026)
-
EPotential for more than minimal harm, pattern
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Pharmacy Service · Deficient, Provider has date of correction (Feb 13, 2026)
-
EPotential for more than minimal harm, pattern
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Nutrition and Dietary · Deficient, Provider has date of correction (Feb 13, 2026)
-
EPotential for more than minimal harm, pattern
Provide and implement an infection prevention and control program.
Infection Control · Deficient, Provider has date of correction (Feb 13, 2026)
-
DPotential for more than minimal harm, isolated
Reasonably accommodate the needs and preferences of each resident.
Resident Rights · Deficient, Provider has date of correction (Feb 13, 2026)
-
DPotential for more than minimal harm, isolated
Honor the resident's right to organize and participate in resident/family groups in the facility.
Resident Rights · Deficient, Provider has date of correction (Feb 13, 2026)
-
DPotential for more than minimal harm, isolated
Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.
Resident Rights · Deficient, Provider has date of correction (Feb 13, 2026)
-
DPotential for more than minimal harm, isolated
Assess the resident when there is a significant change in condition
Resident Assessment and Care Planning · Deficient, Provider has date of correction (Feb 13, 2026)
-
DPotential for more than minimal harm, isolated
Ensure each resident receives an accurate assessment.
Resident Assessment and Care Planning · Deficient, Provider has date of correction (Feb 13, 2026)
-
DPotential for more than minimal harm, isolated
Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.
Resident Assessment and Care Planning · Deficient, Provider has date of correction (Feb 13, 2026)
-
DPotential for more than minimal harm, isolated
Provide care and assistance to perform activities of daily living for any resident who is unable.
Quality of Life and Care · Deficient, Provider has date of correction (Feb 13, 2026)
-
DPotential for more than minimal harm, isolated
Assist a resident in gaining access to vision and hearing services.
Quality of Life and Care · Deficient, Provider has date of correction (Feb 13, 2026)
-
DPotential for more than minimal harm, isolated
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Quality of Life and Care · Deficient, Provider has date of correction (Feb 13, 2026)
-
DPotential for more than minimal harm, isolated
Ensure medication error rates are not 5 percent or greater.
Pharmacy Service · Deficient, Provider has date of correction (Feb 13, 2026)
-
DPotential for more than minimal harm, isolated
Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options.
Nutrition and Dietary · Deficient, Provider has date of correction (Feb 13, 2026)
-
DPotential for more than minimal harm, isolated
Have a policy regarding use and storage of foods brought to residents by family and other visitors.
Nutrition and Dietary · Deficient, Provider has date of correction (Feb 13, 2026)
-
KImmediate jeopardy, pattern
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Complaint investigation · Freedom from Abuse, Neglect, and Exploitation · Deficient, Provider has date of correction (Aug 16, 2025)
-
KImmediate jeopardy, pattern
Honor each resident's preferences, choices, values and beliefs.
Complaint investigation · Quality of Life and Care · Deficient, Provider has date of correction (Aug 16, 2025)
-
EPotential for more than minimal harm, pattern
Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances.
Complaint investigation · Resident Rights · Deficient, Provider has date of correction (Aug 18, 2025)
-
DPotential for more than minimal harm, isolated
Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.
Complaint investigation · Resident Rights · Deficient, Provider has date of correction (Aug 18, 2025)
-
DPotential for more than minimal harm, isolated
Provide care and assistance to perform activities of daily living for any resident who is unable.
Complaint investigation · Quality of Life and Care · Deficient, Provider has date of correction (Aug 18, 2025)
-
DPotential for more than minimal harm, isolated
Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options.
Complaint investigation · Nutrition and Dietary · Deficient, Provider has date of correction (Aug 18, 2025)
Showing the 30 most recent of 68.
What severity letters A to L mean
Each sentence above is the requirement that was not met, in CMS's wording. For the inspection results as Medicare publishes them, open this home's page on Medicare.gov and look under "Health inspections".
Penalties, past three years
| Date | Type | Amount |
|---|---|---|
| Aug 15, 2025 | Fine | $30,545 |
| Aug 15, 2025 | Payment Denial | 5 days |
Texas homes averaged 1.5 fines and $44,141 in fine amounts; the national averages are 0.9 and $30,972.
Cost
Not in the public data. CMS does not publish what a nursing home charges.
Ask the home for its daily private-pay rate and whether a bed is open for your coverage. See what Medicare covers and how Medicaid pays for a nursing home.
Compared within Texas
- Size993 of 1177 by certified beds
- Texas average residents per day75.8
- ChainAvir Health Group
- Chain average overall rating2.3 of 5
- Resident or family councilResident
- Homes in Texarkana8
- Homes in Bowie County8
Common questions
What is the CMS star rating for Avir at Cowhorn Creek?
Avir at Cowhorn Creek has an overall rating of 1 of 5 stars from CMS as of Sep 2026. Its health inspection rating is 1, staffing is 1 and quality measures is 3.
How many beds does Avir at Cowhorn Creek have?
Avir at Cowhorn Creek has 76 certified beds. It averages 67.8 residents per day, about 89.2% of its certified beds.
How much nursing care do residents get at Avir at Cowhorn Creek?
The home reports 3.26 hours of nurse staffing per resident per day, including 0.38 hours from registered nurses. The Texas average is 3.39 hours and 0.43 hours from registered nurses.
Has Avir at Cowhorn Creek been fined?
Yes. CMS lists 1 fine totaling $30,545 in the past three years. It also lists 1 payment denial.
Does Avir at Cowhorn Creek accept Medicare or Medicaid?
CMS lists its participation as "Medicare and Medicaid". Ask the home whether a bed is open for your coverage.
Guides for families looking at this home
- Understanding the recordWhat to ask on a nursing home tourQuestions that turn a home's public record into a useful conversation when you tour, plus what to look for yourself.
- Understanding the recordInspection severity letters A to LHow inspectors grade each deficiency by harm and by how many residents were affected.
- Understanding the recordHow to read CMS star ratingsWhat the overall, health inspection, staffing and quality measure ratings cover, and what they leave out.
Nearest nursing homes
- 4 of 5 Cornerstone Retirement Community 40beds 80.0%in use 4.08nurse hours a day
- 1 of 5 Reunion Plaza Senior Care and Rehabilitation Cente 129beds 64.7%in use 3.01nurse hours a day
- 3 of 5 Avir at Sweetwater 79beds 63.8%in use 2.55nurse hours a day
Sorted by straight-line distance. This is not a ranking or a recommendation. Compare all homes in Bowie County
Who to call in Texas
These offices serve residents of every nursing home in Texas.
- Long-term care ombudsman Office of the State Long-Term Care Ombudsman 1-800-252-2412 An advocate for residents and their families.
- File a complaint about a nursing home Complaint and Incident Intake 1-800-458-9858 (Monday to Friday, 7 a.m. to 7 p.m. Central) The state agency that inspects nursing homes.
Texas staffing, bed-hold and Medicaid rules · Residents' rights in every state
Source: CMS Provider Data Catalog, nursing home datasets processed Sep 1, 2026. CMS Certification Number 675949. See this home's official record on Medicare.gov
See something shown incorrectly? Tell us. This site shows each record as CMS publishes it and cannot change the underlying record.