Villages Of Lake Highlands has received an F grade based on CMS data, with a score of 35/100 — placing it among the lowest-rated nursing facilities in Texas. Families considering this Dallas facility should carefully review its inspection history and quality metrics.
Villages Of Lake Highlands provides above-average staffing with 4.39 total nurse hours per resident per day. Higher staffing levels are generally associated with better care outcomes and more attentive staff.
Recent CMS inspections identified 14 deficiencies at Villages Of Lake Highlands, including 4 classified as serious — among the most concerning citation levels. The most notable finding involved: develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured..
Score Breakdown
🏥 Staffing Details
| Staff Type | Hours/Resident/Day | National Avg | Comparison |
|---|---|---|---|
| Total Nursing | 4.39 | 3.8 | Above Average |
| Registered Nurses (RN) | 0.52 | 0.7 | Below Average |
| Licensed Practical Nurses (LPN) | 1.67 | 0.7 | Above Average |
| Certified Nursing Assistants (CNA) | 2.20 | 2.4 | Average |
| Weekend Total Nursing | 3.79 | 3.8 | Average |
| Weekend RN Hours | 0.48 | 0.7 | Below Average |
🔍 Inspection & Deficiency History
View recent deficiencies (5 shown)
- Tag 0656 Severity DDevelop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.Nov 30, 2025 · Resident Assessment and Care Planning Deficiencies
- Tag 0684 Severity JProvide appropriate treatment and care according to orders, resident’s preferences and goals.Sep 12, 2025 · Quality of Life and Care Deficiencies
- Tag 0842 Severity ESafeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standarSep 12, 2025 · Resident Assessment and Care Planning Deficiencies
- Tag 0684 Severity KProvide appropriate treatment and care according to orders, resident’s preferences and goals.Aug 27, 2025 · Quality of Life and Care Deficiencies
- Tag 0695 Severity KProvide safe and appropriate respiratory care for a resident when needed.May 15, 2025 · Quality of Life and Care Deficiencies
📊 Resident Outcome Measures
Based on CMS quality measure data. Lower percentages are better for most metrics.
| Measure | This Facility | Nat'l Avg | |
|---|---|---|---|
| Residents with pressure ulcers | 6.9% | 4.5% | Worse |
| Falls with major injury | 4.1% | 3.0% | Worse |
| On antipsychotic medication | 5.5% | 14.5% | Better |
| Urinary tract infections | 0.0% | 2.5% | Better |
| ADL decline (daily activities) | 17.5% | 14.0% | Worse |
| Excessive weight loss | 5.1% | 7.5% | Better |
| New/worsened incontinence | 17.2% | 45.0% | Better |
⚠️ Penalties & Fines
3 penalties recorded by CMS
Total fines: $28,814
How This Grade Was Calculated
This facility's grade of F is based on a score of 35 out of 100, calculated from official CMS Nursing Home Compare data:
- Overall CMS Rating: 2★ → 16 pts (max 40)
- Health Inspection Rating: 1★ → 5 pts (max 25)
- Staffing Rating: 4★ → 16 pts (max 20)
- Quality Measures Rating: 5★ → 15 pts (max 15)
- Penalty deductions: -15 pts
- Fine deductions: -2 pts
Grades: A=85+, B=70–84, C=55–69, D=40–54, F=below 40
Facility Details
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