Anderson County, Texas · Nursing home
Legacy at Town Creek
1 of 5 overall from CMS
2212 W Reagan St, Palestine, TX 75801
At a glance
- Overall rating 1 of 5 Below the state average of 2.7
- Nurse time per resident, per day 3.37 hours Below the state average of 3.39
- Nursing staff who left in a year 53.8% Below the state average of 55.3%
- Health citations, last 3 inspection cycles 37 5 at the harm level or above
- Fines in 3 years $294,608 2 fines
- Certified beds in use 38.8% of 199 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.
Legacy at Town Creek is a 199-bed nursing home in Palestine, Texas (Anderson County). CMS rates it 1 of 5 stars overall as of Sep 2026. It reports 3.37 nurse staffing hours per resident per day, below the Texas average of 3.39. CMS lists 2 fines totaling $294,608 in the past three years.
- Certified beds
- 199
- Residents per day (average)
- 77.2
- Certified since
- 2004 (22 yrs)
Government - Hospital district Participates in Medicare and MedicaidPart of Southwest LTC (10 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 Legacy at Town Creek
Chosen from this home's public data.
- CMS lists 2 fines totaling $294,608 in the past three years. What changed after the most recent one?Penalties in CMS data
- About 38.8% of certified beds are in use on an average day. Are any units closed, or are admissions limited?Certified beds and average residents in CMS data
- Registered nurse time is 0.27 hours per resident per day; the Texas average is 0.43. Is an RN on site overnight?RN staffing 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 2 of 5 Texas average 2.8
- Staffing 1 of 5 Texas average 1.9
- Quality measures 2 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 3.37 h Texas average 3.39
- Nurse aides 2.00 h Texas average 2.01
- Licensed practical nurses 1.10 h Texas average 0.95
- Registered nurses 0.27 h Texas average 0.43
- All staff, weekends 3.06 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 turnover53.8%
- Texas average55.3%
- Registered nurse turnover55.6%
- Texas average54.6%
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 | 23.5% | 15.8% | 13.9% |
| Percentage of long-stay residents who lose too much weight | 7.4% | 3.0% | 5.2% |
| ★ Percentage of long-stay residents with a catheter inserted and left in their bladder | 0.8% | 0.3% | 0.8% |
| ★ Percentage of long-stay residents with a urinary tract infection | 0.3% | 0.8% | 1.6% |
| Percentage of long-stay residents who have depressive symptoms | 0.7% | 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 | 4.3% | 3.3% | 3.2% |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 99.4% | 96.6% | 93.6% |
| ★ Percentage of long-stay residents whose ability to walk independently worsened | 36.7% | 14.0% | 14.1% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 32.7% | 18.0% | 19.5% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine | 99.1% | 98.0% | 95.5% |
| ★ Percentage of long-stay residents with pressure ulcers | 6.0% | 3.8% | 4.6% |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | 20.9% | 13.4% | 19.0% |
| ★ Percentage of long-stay residents who received an antipsychotic medication | 5.0% | 9.6% | 15.4% |
| ★ Number of hospitalizations per 1000 long-stay resident days | 4.06 | 2.17 | 1.90 |
| ★ Number of outpatient emergency department visits per 1000 long-stay resident days | 4.45 | 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 | 90.0% | 88.9% | 82.0% |
| ★ Percentage of short-stay residents who newly received an antipsychotic medication | 1.0% | 1.5% | 1.6% |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 91.5% | 88.0% | 79.8% |
| ★ Percentage of short-stay residents who were rehospitalized after a nursing home admission | 21.1% | 25.7% | 23.8% |
| ★ Percentage of short-stay residents who had an outpatient emergency department visit | 23.6% | 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 37 health deficiencies in the three most recent inspection cycles. Of these, 3 were at the immediate jeopardy level and 2 involved actual harm; the rest were graded as no actual harm. 11 were cited in connection with a complaint investigation. The most recent citation at the harm level or above was on Oct 8, 2025: Provide safe and appropriate respiratory care for a resident when needed.
| Standard inspection | Health | Fire safety |
|---|---|---|
| Aug 6, 2025 | 6 | 2 |
| Jul 31, 2024 | 7 | 1 |
| Apr 26, 2023 | 24 | 1 |
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 (37)
-
DPotential for more than minimal harm, isolated
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
Complaint investigation · Resident Rights · Deficient, Provider has date of correction (Jan 8, 2026)
-
GActual harm, isolated
Provide safe and appropriate respiratory care for a resident when needed.
Complaint investigation · Quality of Life and Care · Deficient, Provider has date of correction (Oct 9, 2025)
-
EPotential for more than minimal harm, pattern
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 (Sep 10, 2025)
-
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.
Pharmacy Service · Deficient, Provider has date of correction (Sep 10, 2025)
-
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 (Sep 10, 2025)
Show 25 more
-
DPotential for more than minimal harm, isolated
Provide and implement an infection prevention and control program.
Infection Control · Deficient, Provider has date of correction (Sep 10, 2025)
-
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 (Aug 12, 2024)
-
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 (Aug 12, 2024)
-
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.
Pharmacy Service · Deficient, Provider has date of correction (Aug 12, 2024)
-
DPotential for more than minimal harm, isolated
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.
Pharmacy Service · Deficient, Provider has date of correction (Aug 12, 2024)
-
DPotential for more than minimal harm, isolated
Provide and implement an infection prevention and control program.
Infection Control · Deficient, Provider has date of correction (Aug 12, 2024)
-
DPotential for more than minimal harm, isolated
Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.
Complaint investigation · Environmental · Deficient, Provider has date of correction (Aug 12, 2024)
-
BPotential for 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 (Aug 12, 2024)
-
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 (Jun 7, 2024)
-
KImmediate jeopardy, pattern
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
Complaint investigation · Freedom from Abuse, Neglect, and Exploitation · Deficient, Provider has date of correction (Jun 7, 2024)
-
KImmediate jeopardy, pattern
Respond appropriately to all alleged violations.
Complaint investigation · Freedom from Abuse, Neglect, and Exploitation · Deficient, Provider has date of correction (Jun 7, 2024)
-
GActual 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 (Jun 7, 2024)
-
EPotential for more than minimal harm, pattern
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Complaint investigation · Freedom from Abuse, Neglect, and Exploitation · Deficient, Provider has date of correction (Jun 7, 2024)
-
DPotential for more than minimal harm, isolated
Provide and implement an infection prevention and control program.
Complaint investigation · Infection Control · Deficient, Provider has date of correction (Jun 7, 2024)
-
EPotential for more than minimal harm, pattern
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.
Complaint investigation · Pharmacy Service · Deficient, Provider has date of correction (Feb 14, 2024)
-
DPotential for more than minimal harm, isolated
Provide safe and appropriate respiratory care for a resident when needed.
Complaint investigation · Quality of Life and Care · Deficient, Provider has date of correction (Feb 14, 2024)
-
EPotential for more than minimal harm, pattern
Ensure that residents are fully informed and understand their health status, care and treatments.
Resident Rights · Deficient, Provider has date of correction (May 19, 2023)
-
EPotential for more than minimal harm, pattern
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
Resident Rights · Deficient, Provider has date of correction (May 19, 2023)
-
EPotential for more than minimal harm, pattern
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
Resident Assessment and Care Planning · Deficient, Provider has date of correction (May 20, 2023)
-
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 (May 16, 2023)
-
EPotential for more than minimal harm, pattern
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 (Apr 27, 2023)
-
EPotential for more than minimal harm, pattern
Provide safe and appropriate respiratory care for a resident when needed.
Quality of Life and Care · Deficient, Provider has date of correction (May 12, 2023)
-
EPotential for more than minimal harm, pattern
Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.
Pharmacy Service · Deficient, Provider has date of correction (May 19, 2023)
-
EPotential for more than minimal harm, pattern
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
Environmental · Deficient, Provider has date of correction (May 1, 2023)
-
DPotential for more than minimal harm, isolated
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Resident Rights · Deficient, Provider has date of correction (May 12, 2023)
Showing the 30 most recent of 37.
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 |
|---|---|---|
| Oct 8, 2025 | Fine | $10,358 |
| Jun 6, 2024 | Fine | $284,250 |
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
- Size29 of 1177 by certified beds
- Texas average residents per day75.8
- ChainSouthwest LTC
- Chain average overall rating2.4 of 5
- Resident or family councilResident
- Homes in Palestine4
- Homes in Anderson County5
Common questions
What is the CMS star rating for Legacy at Town Creek?
Legacy at Town Creek has an overall rating of 1 of 5 stars from CMS as of Sep 2026. Its health inspection rating is 2, staffing is 1 and quality measures is 2.
How many beds does Legacy at Town Creek have?
Legacy at Town Creek has 199 certified beds. It averages 77.2 residents per day, about 38.8% of its certified beds.
How much nursing care do residents get at Legacy at Town Creek?
The home reports 3.37 hours of nurse staffing per resident per day, including 0.27 hours from registered nurses. The Texas average is 3.39 hours and 0.43 hours from registered nurses.
Has Legacy at Town Creek been fined?
Yes. CMS lists 2 fines totaling $294,608 in the past three years.
Does Legacy at Town 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
- 5 of 5 Trucare Living Centers 120beds 67.5%in use 3.59nurse hours a day
- 3 of 5 Avir at Town Creek 102beds 39.2%in use 3.76nurse hours a day
- 4 of 5 Greenbrier Nursing & Rehabilitation Center of Pale 120beds 38.8%in use 3.18nurse hours a day
Sorted by straight-line distance. This is not a ranking or a recommendation. Compare all homes in Anderson 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 675998. 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.