About the Facility
- CMS Certification Number (CCN)
- 45T644
- Ownership Type
- For Profit
- CMS Region
- Dallas
- Certification Date
- Address
12141 Richmond Ave
- Phone Number
- (281) 558-3444
Facility Medical Condition Statistics
- All other conditions
- 111
- Brain disease or condition (non-traumatic)
- 32
- Brain injury (traumatic)
- Data not available for this reporting period.
- Hip or femur fracture
- 34
- Hip or knee replacement, amputation or other bone or joint condition
- 32
- Nervous system disorder (excluding stroke)
- 35
- Spinal cord disease or condition (non-traumatic)
- 19
- Spinal cord injury (traumatic)
- -
- Stroke
- 54
Facility Quality of Patient Care Measures
- Catheter-associated urinary tract infections (CAUTI)
- Standardized infection ratio (SIR) 95% confidence interval - lower limit
- Not Available
- SIR 95% confidence interval - upper limit
- Not Available
- Comparative performance category
- Not Available
- Catheter days
- 387
- Predicted number of infections (B)
- 0.619
- Number of infections reported (A)
- 1
- SIR (A/B)
- Not Available
- Percentage of patients whose functional abilities were assessed and functional goals were included in their treatment plan
- Numerator
- 256
- Denominator
- 256
- Facility rate
- 100.0
- Change in patients ability to care for themselves
- Average risk-adjusted change score
- 15.3
- Denominator
- 229
- Average observed change score
- 16.5
- Change in patients ability to move around
- Average risk-adjusted change score
- 37.9
- Denominator
- 229
- Average observed change score
- 36.7
- Percentage of patients who are at or above an expected ability to care for themselves at discharge
- Numerator
- 195
- Denominator
- 229
- Facility rate
- 85.2
- Percentage of patients who are at or above an expected ability to move around at discharge
- Numerator
- 192
- Denominator
- 229
- Facility rate
- 83.8
- Percentage of IRF patients who experience one or more falls with major injury during their IRF stay
- Numerator
- 0
- Denominator
- 256
- Facility rate
- 0.0
- Clostridium difficile Infection (CDI)
- Standardized infection ratio (SIR) 95% confidence interval - lower limit
- Not Available
- SIR 95% confidence interval - upper limit
- 1.403
- Comparative performance category
- No Different than the National Benchmark
- Patient days
- 5,858
- Predicted number of infections (B)
- 2.136
- Number of infections reported (A)
- 0
- SIR (A/B)
- 0.000
- Percentage of healthcare personnel who got a flu shot for the current season
- Number of health care workers vaccinated
- 35
- Number of health care workers
- 61
- Rate of flu vaccination
- 57.4
- Rate of potentially preventable hospital readmissions 30 days after discharge from an IRF
- Number of potentially preventable readmissions following discharge
- 19
- Number of eligible stays
- 193
- Unadjusted potentially preventable readmission rate
- 9.84
- Risk-standardized potentially preventable readmission rate (RSRR)
- 8.77
- Lower limit of the 95% confidence interval on the RSRR
- 7.00
- Upper limit of the 95% confidence interval on the RSRR
- 10.92
- Comparative performance category
- No Different than the National Rate
- Rate of potentially preventable hospital readmissions during the IRF stay
- Number of potentially preventable readmissions
- 8
- Number of eligible stays
- 208
- Unadjusted potentially preventable readmission rate
- 3.85
- Risk-standardized potentially preventable readmission rate (RSRR)
- 4.43
- Lower limit of the 95% confidence interval on the RSRR
- 3.20
- Upper limit of the 95% confidence interval on the RSRR
- 6.65
- Comparative performance category
- No Different than the National Rate
- Rate of successful return to home or community from an IRF
- Observed number of discharges to community (DTC)
- 99
- Number of eligible stays
- 157
- Observed discharge to community rate
- 63.06
- Risk-standardized discharge to community rate
- 65.99
- Lower limit of the 95% confidence interval on the risk-standardized discharge to community rate
- 58.86
- Upper limit of the 95% confidence interval on the risk-standardized discharge to community rate
- 72.37
- Comparative performance category
- No Different than the National Rate
- Medicare Spending Per Beneficiary (MSPB) for patients in IRFs
- MSPB score
- 1.20
- Number of eligible episodes
- 184
- Percentage of patients whose medications were reviewed and who received follow-up care when medication issues were identified
- Numerator
- 244
- Denominator
- 256
- Facility rate
- 95.3
- Percentage of patients with pressure ulcers/pressure injuries that are new or worsened
- Numerator
- 6
- Denominator
- 255
- Facility observed rate
- 2.4
- Facility risk-adjusted rate
- 1.8
- Percentage of IRF healthcare personnel who completed COVID-19 primary vaccination series
- Number of health care workers vaccinated
- 51
- Number of health care workers
- 65
- Rate of COVID-19 vaccination
- 78.5