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River Hills Health and Rehabilitation Center

All states › Texas › Kerrville › River Hills Health and Rehabilitation Center

2091 Bandera Hwy Kerrville, TX 78028 · Kerr County

(830) 257-9900

All 4 nursing homes in Kerrville, TX (4 take Medicaid)

Accepts Medicare Accepts Medicaid 150 certified beds Government

CMS certification number 676114 · See this home on Medicare Care Compare

Ratings come from CMS and are updated monthly; these are from October 2026. Check the latest inspection report and visit in person before you decide.

Is River Hills Health and Rehabilitation Center a good nursing home? Reviews, ratings and inspection record

There are no official resident reviews of nursing homes: Medicare's Care Compare publishes inspections, staffing and quality data instead. Here is what that record shows for River Hills Health and Rehabilitation Center as of October 2026.

CMS rates it 1 out of 5 stars overall, below the Texas average of 2.8. Inspectors issued 64 citations in the last three years. CMS imposed 3 penalties, including $112,133 in fines, in that time. For short-term rehab patients CMS rates quality 2 out of 5; for long-term residents, 5 out of 5. Those results differ a lot, so ask about the unit your family member would be on.

Online reviews from families and residents are on Google Maps and other sites; they reflect individual experiences and aren't checked by CMS. The full inspection reports, including what inspectors observed, are on Medicare Care Compare.

Staffing

Nursing staff spend about 3.18 hours per resident per day at River Hills Health and Rehabilitation Center, below the Texas median of 3.30 (US median: 3.72). About 0.21 of those hours are from registered nurses. On weekends it falls to 2.73 hours, 14% below its all-week average. 72.5% of nursing staff left within a year (Texas median 50.2%). High turnover can mean residents see unfamiliar caregivers; ask how long the nurses on the unit have worked there.

Nursing care per resident per day 3.18 hours
Below the Texas median of 3.30 Registered nurses, licensed practical nurses and aides combined, from payroll records.
Registered nurse hours 0.21 per resident a day RNs handle assessments, medications and changes in condition.
Weekend nursing care 2.73 hours Per resident a day. A big drop from weekdays can mean thin weekend staffing.
Nursing staff turnover 72.5% a year Share of nursing staff who left over a year. Lower usually means steadier care.
Registered nurse turnover 66.7% a year Share of registered nurses who left over a year.
Administrators who left — Frequent leadership changes are worth asking about on a visit.

About this nursing home

Certified beds150
Residents per day 100 About 66% of beds filled, on average
OwnershipGovernment - Hospital district
Payment acceptedMedicare and Medicaid
Certified sinceOctober 2006
Legal business nameUVALDE COUNTY HOSPITAL AUTHORITY

Paying for care at River Hills Health and Rehabilitation Center: Medicare and Medicaid

River Hills Health and Rehabilitation Center is certified for both Medicare and Medicaid. Medicare Part A can cover a short skilled-nursing or rehab stay here after a qualifying hospital stay of at least three inpatient days (observation days don't count), for up to 100 days per benefit period. Medicaid can pay for long-term care for residents who meet Texas's income and asset rules. Being certified doesn't guarantee a Medicaid bed is open, so ask whether the home accepts residents whose Medicaid application is still pending.

In 2026 Medicare covers days 1–20 in full after the Part A deductible ($1,736 per benefit period); for days 21–100 you pay $217 a day; after day 100 you pay all costs. Medicare doesn't pay for long-term custodial care. Medicare's coverage rules.

Health inspections

The most recent standard inspection was on August 21, 2026 and found 14 deficiencies, plus 7 from complaint inspections in the same period. In total, inspectors issued 64 citations in the last three years.

Each citation has a scope and severity letter from A to L. A–C: potential for minimal harm. D–F: potential for more than minimal harm. G–I: actual harm. J–L: immediate jeopardy to resident health or safety.

What the inspections found

Over the last three years, inspectors issued 64 citations at River Hills Health and Rehabilitation Center across 13 inspection dates, 26 of them from complaint investigations. 6 were at the immediate-jeopardy level (J–L), CMS's most serious category, most recently on February 8, 2025 (complaint inspection). The most common areas cited were pharmacy service (11) and resident rights (10). The most serious was cited under the CMS rule to "provide appropriate treatment and care according to orders, resident’s preferences and goals" (tag F0684, level J, February 8, 2025). 4 citations were under CMS's abuse, neglect and exploitation rules.

August 21, 2026 · 14 citations

FEducate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status.

Potential for more than minimal harm · Infection Control Deficiencies · Tag F0887 · Deficient, Provider has no plan of correction

EHonor the resident's right to organize and participate in resident/family groups in the facility.

Potential for more than minimal harm · Resident Rights Deficiencies · Tag F0565 · Deficient, Provider has no plan of correction

EProvide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

Potential for more than minimal harm · Pharmacy Service Deficiencies · Tag F0755 · Deficient, Provider has no plan of correction

EEmploy sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician.

Potential for more than minimal harm · Nutrition and Dietary Deficiencies · Tag F0801 · Deficient, Provider has no plan of correction

EEnsure meals and snacks are served at times in accordance with resident’s needs, preferences, and requests. Suitable and nourishing alternative meals and snacks must be provided for residents who want to eat at non-traditional times or outside of scheduled meal times.

Potential for more than minimal harm · Nutrition and Dietary Deficiencies · Tag F0809 · Deficient, Provider has no plan of correction

EProcure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

Potential for more than minimal harm · Nutrition and Dietary Deficiencies · Tag F0812 · Deficient, Provider has no plan of correction

ESafeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.

Potential for more than minimal harm · Resident Assessment and Care Planning Deficiencies · Tag F0842 · Deficient, Provider has no plan of correction

EProvide and implement an infection prevention and control program.

Potential for more than minimal harm · Infection Control Deficiencies · Tag F0880 · Deficient, Provider has no plan of correction

EKeep all essential equipment working safely.

Potential for more than minimal harm · Environmental Deficiencies · Tag F0908 · Deficient, Provider has no plan of correction

DHonor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

Potential for more than minimal harm · Resident Rights Deficiencies · Tag F0550 · Deficient, Provider has no plan of correction

DHonor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.

Potential for more than minimal harm · Resident Rights Deficiencies · Tag F0578 · Deficient, Provider has no plan of correction

DProvide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.

Potential for more than minimal harm · Quality of Life and Care Deficiencies · Tag F0690 · Deficient, Provider has no plan of correction

DEnsure that residents are free from significant medication errors.

Potential for more than minimal harm · Pharmacy Service Deficiencies · Tag F0760 · Deficient, Provider has no plan of correction

DMake sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.

Potential for more than minimal harm · Environmental Deficiencies · Tag F0921 · Deficient, Provider has no plan of correction

June 19, 2026 · 1 citation · includes complaint inspection

DHonor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

Potential for more than minimal harm · Resident Rights Deficiencies · Tag F0550 · Complaint inspection · Deficient, Provider has date of correction (Jul 7, 2026)

May 7, 2026 · 3 citations · includes complaint inspection

DTimely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

Potential for more than minimal harm · Freedom from Abuse, Neglect, and Exploitation Deficiencies · Tag F0609 · Complaint inspection · Deficient, Provider has date of correction (Jun 1, 2026)

DProvide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

Potential for more than minimal harm · Pharmacy Service Deficiencies · Tag F0755 · Complaint inspection · Deficient, Provider has date of correction (Jun 1, 2026)

DEnsure 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.

Potential for more than minimal harm · Pharmacy Service Deficiencies · Tag F0761 · Complaint inspection · Deficient, Provider has date of correction (Jun 1, 2026)

February 4, 2026 · 2 citations · includes complaint inspection

DProvide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.

Potential for more than minimal harm · Resident Rights Deficiencies · Tag F0628 · Complaint inspection · Deficient, Provider has date of correction (Feb 6, 2026)

DEnsure each resident receives an accurate assessment.

Potential for more than minimal harm · Resident Assessment and Care Planning Deficiencies · Tag F0641 · Complaint inspection · Deficient, Provider has date of correction (Feb 6, 2026)

November 26, 2025 · 1 citation · includes complaint inspection

FDesignate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home.

Potential for more than minimal harm · Infection Control Deficiencies · Tag F0882 · Complaint inspection · Deficient, Provider has date of correction (Dec 19, 2025)

September 16, 2025 · 1 citation · includes complaint inspection

DEnsure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Potential for more than minimal harm · Quality of Life and Care Deficiencies · Tag F0689 · Complaint inspection · Deficient, Provider has date of correction (Oct 1, 2025)

June 13, 2025 · 14 citations · includes complaint inspection

EDevelop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

Potential for more than minimal harm · Resident Assessment and Care Planning Deficiencies · Tag F0656 · Deficient, Provider has date of correction (Jul 11, 2025)

EProvide care and assistance to perform activities of daily living for any resident who is unable.

Potential for more than minimal harm · Quality of Life and Care Deficiencies · Tag F0677 · Deficient, Provider has date of correction (Jul 11, 2025)

EProvide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.

Potential for more than minimal harm · Quality of Life and Care Deficiencies · Tag F0690 · Deficient, Provider has date of correction (Jul 11, 2025)

EHave 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.

Potential for more than minimal harm · Nursing and Physician Services Deficiencies · Tag F0727 · Deficient, Provider has date of correction (Jul 11, 2025)

EEnsure 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.

Potential for more than minimal harm · Pharmacy Service Deficiencies · Tag F0761 · Deficient, Provider has date of correction (Jul 11, 2025)

EProcure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

Potential for more than minimal harm · Nutrition and Dietary Deficiencies · Tag F0812 · Deficient, Provider has date of correction (Jul 11, 2025)

DKeep residents' personal and medical records private and confidential.

Potential for more than minimal harm · Resident Rights Deficiencies · Tag F0583 · Deficient, Provider has date of correction (Jul 11, 2025)

DHonor 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.

Potential for more than minimal harm · Resident Rights Deficiencies · Tag F0584 · Deficient, Provider has date of correction (Jul 11, 2025)

DPrevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function.

Potential for more than minimal harm · Freedom from Abuse, Neglect, and Exploitation Deficiencies · Tag F0605 · Complaint inspection · Deficient, Provider has date of correction (Jul 11, 2025)

DAssist a resident in gaining access to vision and hearing services.

Potential for more than minimal harm · Quality of Life and Care Deficiencies · Tag F0685 · Deficient, Provider has date of correction (Jul 11, 2025)

DEnsure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Potential for more than minimal harm · Quality of Life and Care Deficiencies · Tag F0689 · Deficient, Provider has date of correction (Jul 11, 2025)

DEnsure that residents are free from significant medication errors.

Potential for more than minimal harm · Pharmacy Service Deficiencies · Tag F0760 · Deficient, Provider has date of correction (Jul 11, 2025)

DHave a policy regarding use and storage of foods brought to residents by family and other visitors.

Potential for more than minimal harm · Nutrition and Dietary Deficiencies · Tag F0813 · Deficient, Provider has date of correction (Jul 11, 2025)

DProvide and implement an infection prevention and control program.

Potential for more than minimal harm · Infection Control Deficiencies · Tag F0880 · Deficient, Provider has date of correction (Jul 11, 2025)

May 13, 2025 · 2 citations · includes complaint inspection

EReasonably accommodate the needs and preferences of each resident.

Potential for more than minimal harm · Resident Rights Deficiencies · Tag F0558 · Complaint inspection · Deficient, Provider has date of correction (Jun 3, 2025)

DEnsure each resident receives an accurate assessment.

Potential for more than minimal harm · Resident Assessment and Care Planning Deficiencies · Tag F0641 · Complaint inspection · Deficient, Provider has date of correction (Jun 3, 2025)

February 8, 2025 · 4 citations, includes immediate jeopardy · includes complaint inspection

JProvide appropriate treatment and care according to orders, resident’s preferences and goals.

Immediate jeopardy · Quality of Life and Care Deficiencies · Tag F0684 · Complaint inspection · Deficient, Provider has date of correction (Feb 9, 2025)

JProvide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

Immediate jeopardy · Pharmacy Service Deficiencies · Tag F0755 · Complaint inspection · Deficient, Provider has date of correction (Feb 9, 2025)

JEnsure that residents are free from significant medication errors.

Immediate jeopardy · Pharmacy Service Deficiencies · Tag F0760 · Complaint inspection · Deficient, Provider has date of correction (Feb 9, 2025)

DProvide timely, quality laboratory services/tests to meet the needs of residents.

Potential for more than minimal harm · Administration Deficiencies · Tag F0770 · Complaint inspection · Deficient, Provider has date of correction (Feb 9, 2025)

December 21, 2024 · 5 citations, includes immediate jeopardy · includes complaint inspection

JEnsure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Immediate jeopardy · Quality of Life and Care Deficiencies · Tag F0689 · Complaint inspection · Deficient, Provider has date of correction (Dec 22, 2024)

FHave 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.

Potential for more than minimal harm · Nursing and Physician Services Deficiencies · Tag F0727 · Complaint inspection · Deficient, Provider has date of correction (Dec 22, 2024)

DCreate and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted

Potential for more than minimal harm · Resident Assessment and Care Planning Deficiencies · Tag F0655 · Complaint inspection · Deficient, Provider has date of correction (Dec 22, 2024)

DDevelop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

Potential for more than minimal harm · Resident Assessment and Care Planning Deficiencies · Tag F0656 · Complaint inspection · Deficient, Provider has date of correction (Dec 22, 2024)

DDevelop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.

Potential for more than minimal harm · Resident Assessment and Care Planning Deficiencies · Tag F0657 · Complaint inspection · Deficient, Provider has date of correction (Dec 22, 2024)

September 9, 2024 · 4 citations · includes complaint inspection

EDevelop and implement policies and procedures to prevent abuse, neglect, and theft.

Potential for more than minimal harm · Freedom from Abuse, Neglect, and Exploitation Deficiencies · Tag F0607 · Complaint inspection · Deficient, Provider has date of correction (Sep 30, 2024)

ETimely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

Potential for more than minimal harm · Freedom from Abuse, Neglect, and Exploitation Deficiencies · Tag F0609 · Complaint inspection · Deficient, Provider has date of correction (Sep 30, 2024)

DProvide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

Potential for more than minimal harm · Pharmacy Service Deficiencies · Tag F0755 · Complaint inspection · Deficient, Provider has date of correction (Sep 30, 2024)

DEmploy staff that are licensed, certified, or registered in accordance with state laws.

Potential for more than minimal harm · Administration Deficiencies · Tag F0839 · Complaint inspection · Deficient, Provider has date of correction (Sep 30, 2024)

April 19, 2024 · 11 citations

FProcure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

Potential for more than minimal harm · Nutrition and Dietary Deficiencies · Tag F0812 · Deficient, Provider has date of correction (May 31, 2024)

EKeep residents' personal and medical records private and confidential.

Potential for more than minimal harm · Resident Rights Deficiencies · Tag F0583 · Deficient, Provider has date of correction (May 31, 2024)

EEmploy sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician.

Potential for more than minimal harm · Nutrition and Dietary Deficiencies · Tag F0801 · Deficient, Provider has date of correction (May 31, 2024)

EArrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services.

Potential for more than minimal harm · Administration Deficiencies · Tag F0849 · Deficient, Provider has date of correction (May 31, 2024)

EProvide and implement an infection prevention and control program.

Potential for more than minimal harm · Infection Control Deficiencies · Tag F0880 · Deficient, Provider has date of correction (May 31, 2024)

EMake sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.

Potential for more than minimal harm · Environmental Deficiencies · Tag F0921 · Deficient, Provider has date of correction (May 31, 2024)

DEnsure each resident receives an accurate assessment.

Potential for more than minimal harm · Resident Assessment and Care Planning Deficiencies · Tag F0641 · Deficient, Provider has date of correction (May 31, 2024)

DDevelop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

Potential for more than minimal harm · Resident Assessment and Care Planning Deficiencies · Tag F0656 · Deficient, Provider has date of correction (May 31, 2024)

DImplement 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.

Potential for more than minimal harm · Pharmacy Service Deficiencies · Tag F0758 · Deficient, Provider has date of correction (May 31, 2024)

DEnsure medication error rates are not 5 percent or greater.

Potential for more than minimal harm · Pharmacy Service Deficiencies · Tag F0759 · Deficient, Provider has date of correction (May 31, 2024)

DHave a policy regarding use and storage of foods brought to residents by family and other visitors.

Potential for more than minimal harm · Nutrition and Dietary Deficiencies · Tag F0813 · Deficient, Provider has date of correction (May 31, 2024)

January 10, 2024 · 2 citations, includes immediate jeopardy · includes complaint inspection

JImmediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.

Immediate jeopardy · Resident Rights Deficiencies · Tag F0580 · Complaint inspection · Deficient, Provider has date of correction (Jan 29, 2024)

JProvide appropriate treatment and care according to orders, resident’s preferences and goals.

Immediate jeopardy · Quality of Life and Care Deficiencies · Tag F0684 · Complaint inspection · Deficient, Provider has date of correction (Jan 29, 2024)

Questions to ask on a tour of River Hills Health and Rehabilitation Center

  1. Inspectors cited the home at the immediate-jeopardy level on February 8, 2025 under the rule on quality of life and care. What changed afterwards, and can I see the plan of correction?
  2. CMS cited the home under its abuse and neglect rules on May 7, 2026. How are staff trained, and how are concerns reported?
  3. CMS rates staffing 1 out of 5. How many residents does each nurse aide care for on day, evening and night shifts?
  4. Nursing staff turnover was 72.5% a year. How many of the staff come from agencies?
  5. CMS rates short-stay quality 2 out of 5. How often do rehab patients go back to the hospital, and how many therapy sessions a week are typical?
  6. Do you have a Medicaid bed open now, and will you admit someone whose Medicaid application is still pending?
  7. When is the first care-plan meeting, and can family attend?

Questions come from this home's CMS data: its inspections, staffing and ownership record.

Fines and payment denials

3 penalties in the last three years, including $112,133 in fines.

DateTypeAmount or length
Feb 8, 2025 Fine $49,392
Dec 21, 2024 Fine $47,467
Jan 10, 2024 Fine $15,274

Rating history

CMS monthOverallInspectionStaffingQuality
October 2026 1/5 1/5 1/5 4/5
August 2026 1/5 1/5 1/5 4/5
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Location

Hospitals near River Hills Health and Rehabilitation Center

The Medicare-certified hospitals closest to this nursing home, with their CMS data. Ask the home which hospital it usually sends residents to.

  • 2.5 mi
    Peterson Regional Medical Center Kerrville
    Emergency room ★★★★☆ Medicare overall 4 of 5
    Median ER visit 2h 42m for patients treated and sent home
  • 22.5 mi
    Hill Country Memorial Hospital INC Fredericksburg
    Emergency room ★★★★☆ Medicare overall 4 of 5
    Median ER visit 2h 36m for patients treated and sent home

Hospital ratings, ER visit times and more at Hospitals In Each State
Source: CMS Care Compare. Distances are approximate.

Nearby nursing homes

Avir at Kerrville Kerrville · 1.0 mi away ★☆☆☆☆ Inspection 1/5 · Staffing 1/5 130 beds · Medicaid
Arbor View Nursing & Rehabilitation Kerrville · 1.8 mi away ★☆☆☆☆ Inspection 1/5 · Staffing 1/5 179 beds · Medicaid
Hilltop Village Nursing and Rehabilitation Kerrville · 4.6 mi away ★★☆☆☆ Inspection 3/5 · Staffing 1/5 150 beds · Medicaid
Avir at Comfort Comfort · 13.5 mi away ★★★★☆ Inspection 4/5 · Staffing 3/5 76 beds · Medicaid
Cedar Creek Nursing and Rehabilitation Center Bandera · 19.8 mi away ★★☆☆☆ Inspection 3/5 · Staffing 1/5 62 beds · Medicaid

More nursing homes near River Hills Health and Rehabilitation Center ›   All nursing homes in Kerrville ›

Compare River Hills Health and Rehabilitation Center with the 3 closest homes side by side ›

Higher-rated nursing homes within 10 miles

Source: CMS Provider Data Catalog (provider information, health deficiencies, penalties), October 2026. Inspection citations and penalties cover the last three years. Nursing Homes In Each State is independent and not affiliated with CMS or Medicare. About the data · Report a problem with this listing. Is this your nursing home? Feature it here.

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https://www.nursinghomesineachstate.com/texas/kerrville/river-hills-health-and-rehabilitation-center/ · Data: CMS, October 2026 · Nursing Homes In Each State, not affiliated with CMS or Medicare.