How to check nursing home ratings in Dallas County against the Texas HHSC inspection record, and what the five-star score quietly leaves out.
By Dallas Senior Advisor Care Team · August 7, 2026
Families who want to check nursing home ratings in Dallas County almost always start with the star score, and almost always stop there. That is a mistake, because the Texas HHSC inspection record and the federal star rating are two different documents produced by two different processes, and only one of them tells you what a surveyor actually walked in and saw. Nursing facilities in Texas are licensed by the Texas Health and Human Services Commission under Texas Health and Safety Code Chapter 242, and HHSC's Long-Term Care Regulation division conducts the on-site surveys — including, for facilities that participate in Medicare or Medicaid, the federal certification survey done on behalf of the Centers for Medicare and Medicaid Services. Those survey findings then feed the five-star rating you see on Medicare's Care Compare site. So the star is a summary of the inspection, not a substitute for it. The practical workflow for a DFW family is to open two tabs: the HHSC Long-Term Care Provider Search at apps.hhs.texas.gov, which shows license status, ownership, and enforcement history, and Medicare Care Compare, which shows the star breakdown. Read them side by side before you drive out to tour anything in Richardson, Garland, or Duncanville.
The reason this matters more in Dallas County than a family might expect is inventory age and ownership churn. Nursing facilities across Dallas County range from mid-century buildings near Oak Cliff and Pleasant Grove that have been through multiple ownership groups to newer post-acute buildings that opened alongside suburban hospital expansion. Ownership changes show up on the HHSC record before they show up in the star rating, because the star rating is built on a rolling window of prior surveys — meaning a facility that changed hands eighteen months ago may still be carrying the inspection history of an operator who no longer runs it, in either direction. If the HHSC provider search shows a recent change of ownership, treat the star score as a lagging indicator and weight the most recent survey far more heavily than the composite.
The overall five-star rating on Care Compare is assembled from three separate ratings, and understanding which one you are reacting to changes how you read a Dallas County facility. The health inspection rating is built from the facility's three most recent standard surveys plus complaint investigations from roughly the past three years, weighted so the most recent survey counts most. The staffing rating draws on payroll-based journal data submitted by the facility — actual hours worked, not self-reported estimates — and looks at registered nurse hours per resident day, total nurse staffing, and staff turnover. The quality measures rating comes from resident assessment data and Medicare claims, covering things like the share of long-stay residents with pressure ulcers, falls with major injury, antipsychotic use, or unplanned hospital readmissions. Those three are not interchangeable. A facility can post four stars overall while carrying a two-star staffing rating, and for a resident with dementia who needs a hands-on aide at 3 a.m., staffing is the number that will define daily life.
The bigger limitation is that the health inspection star is curved within the state. Facilities are scored against other Texas facilities, not against a fixed national standard — the top tier of Texas facilities earns five stars, the bottom tier earns one, and everyone else is distributed in between. That means a four-star health inspection score in Dallas County tells you a facility is doing well relative to Texas peers, not that it cleared some absolute bar. It also means comparing a Texas star rating to a rating you saw on a facility in another state is not an apples-to-apples comparison, which trips up families relocating a parent to DFW from out of state. Read the underlying deficiency list, not the curve.
When a surveyor cites a deficiency, it is graded on a grid that combines how widespread the problem was with how much harm it caused or risked, and the result is a letter from A through L. Letters at the low end describe an isolated issue with no actual harm and minimal risk — a documentation gap, a labeling problem. The letters at the high end describe immediate jeopardy, meaning the facility's practices placed residents at risk of serious injury, impairment, or death, and those require the facility to act before the surveyor leaves the building. Between those poles sits the large middle band that most citations fall into: actual harm that is not immediate jeopardy, or the potential for more than minimal harm. Two Dallas County facilities can each show, say, nine deficiencies on their last standard survey and be in completely different condition — nine low-letter paperwork findings is a different building than three low-letter findings plus one at the harm level involving medication administration.
So read the letters, then read the narrative. The survey report describes what happened in plain language: what the surveyor observed, which resident was affected (de-identified), what the record showed, and what the facility said. Then look at the plan of correction, which is the facility's own written commitment about how it fixed the problem and how it will monitor to keep it fixed. A serious citation followed by a specific, dated, well-staffed correction plan and a clean follow-up visit is a facility that responded. The same citation repeated across two consecutive survey cycles is a pattern, and that pattern is the single most useful thing on the entire record. Bring the printout with you on the tour and ask the administrator about the highest-severity item by name.
Most Dallas County families do not begin this research calmly at a kitchen table. They begin it in a hallway at Parkland Health, Baylor University Medical Center, Methodist Dallas Medical Center, Medical City Dallas, Texas Health Presbyterian Dallas, or UT Southwestern Medical Center, holding a printed list of skilled nursing facilities with beds available, and a case manager explaining that the discharge is scheduled for tomorrow. That list is not a ranking. Under federal patient-choice rules a discharge planner gives you options; it is not an endorsement of quality, and the ordering usually reflects bed availability and network participation rather than inspection history. You are allowed to say the list is not enough and ask for the survey information, and you are allowed to ask for a short extension while you check. Case managers at the large Dallas systems field this request constantly and are not offended by it.
Do the fast version of the research rather than none. For each facility on the list, pull the HHSC provider record to confirm the license is active and see whether enforcement action appears, then pull Care Compare and look at three things: the health inspection star, the staffing star, and the date of the most recent standard survey. If a facility's most recent survey is unusually old, you are looking at a thinner evidence base than the star implies. Fifteen minutes of this will usually separate a five-name list into two you would consider and three you would not — which is exactly the decision the hospital is asking you to make on a compressed timeline.
DFW is a four-county metro built around freeways, and the honest constraint on a nursing home choice here is not the star rating — it is who is going to drive there, and how often. A facility in Denton or McKinney with a stronger inspection record than one in Lake Highlands is the better building on paper and the worse choice in practice if the adult child doing the visiting works in Uptown and the drive is fifty minutes each way at 5:30 p.m. Residents whose families visit frequently get noticed more, get advocated for more, and get problems escalated faster. That is not a criticism of any operator; it is how institutions work. Weigh the drive as a real variable alongside the survey record, especially if the spouse doing most of the visiting has already stopped driving at night — a common turning point in this metro, where giving up the car removes the last independent way to get across town.
County lines matter for who helps you, too. Dallas County residents are served by the Dallas Area Agency on Aging, operated by The Senior Source; Collin, Denton, and Rockwall counties fall under the Area Agency on Aging of North Central Texas at NCTCOG; Arlington and the rest of Tarrant County are covered by the Area Agency on Aging of Tarrant County. Each one can connect you to a benefits counselor and to the Texas Long-Term Care Ombudsman Program, whose ombudsmen visit facilities regularly and can tell you things no database contains. Texas 2-1-1 and the HHSC Aging and Disability Resource Center are the general front doors. If you suspect abuse, neglect, or exploitation, call Texas Adult Protective Services at 1-800-252-5400, which is staffed around the clock; to report a regulatory problem at the facility itself, HHSC Complaint and Incident Intake is 1-800-458-9858. Nursing home care across DFW generally runs about $6,500 to $9,500 a month in 2026 depending on level of care and location, so this is both a safety decision and one of the largest recurring expenses most families will ever sign for.
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