Federal nursing home survey record · CMS-certified nursing home· Not a state assisted-living licensing record

Treemont Healthcare and Rehabilitation Center

Dallas, TX · 130 certified beds · Last Life Safety survey July 17, 2025

CMS Certification Number 455823 · first certified June 1989

Ownership

Operated by CREATIVE SOLUTIONS IN HEALTHCARE · For profit - Limited Liability company

  • Ownership changed February 1, 2023 (change of ownership)from DIVERSICARE TREEMONT LLC
25
Citations on file
Rolling three-year window
3
Life Safety surveys
In the same window
6
Tags cited more than once
Across separate surveys
14
Inspection & testing records
Of the citations on file

Position within TX

25 citations — more than 97% of the 1,177 certified nursing homes in TX. Compared within TX rather than nationally because which state a facility is in explains about 30% of the variation in citation counts between facilities, while bed count explains under 1%. State survey agencies differ far more than the buildings do. How this is calculated

Slippingmore citations at the latest survey than at its earlier surveys in the window.

The latest survey found 10 citations; the earlier surveys in the window averaged 7.5. With 3 surveys on file this is a direction of travel, not a conclusion.

When is the next survey likely?

The window is open now: August 2026 to September 2026. This facility’s last Life Safety survey was July 2025. Facilities in TX are typically surveyed 13–14 months after the last one (median 14), measured over 1,905 consecutive surveys in the last two years of CMS records.

A range the record supports, not a prediction of a date. State agencies vary widely — from about 11 months in Pennsylvania to three years in Maryland. How the window is measured

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Which alerts

5 inspection-and-testing tags have been cited here at more than one survey. Nationally, that pattern is common: about three quarters of cited facilities have at least one repeated tag, and half of the facilities ever cited for sprinkler inspection and testing are cited for it again. A repeat is usually a recordkeeping gap rather than a new hazard.

Emergency preparedness

3 of the 25 citations on file are Emergency Preparedness E-tags. E-tags are cited under 42 CFR §483.73 and concern the emergency plan, training, drills, communications and supplies. Nationally about half of certified facilities have at least one. The Emergency Preparedness Index

Physical environment (health survey)

16 physical-environment citations on the health survey. Cited by the health surveyors under Appendix PP, not the Life Safety Code surveyor: equipment in safe operating condition, the call system, bed rails, pest control, hazards, the environment. Counted separately from the 25 Life Safety citations above. The Physical Environment Index

  • F-0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
  • F-0880 Provide and implement an infection prevention and control program.
  • F-0921 Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
  • F-0584 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.
  • F-0908 Keep all essential equipment working safely.
  • F-0925 Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.
  • F-0909 Regularly inspect all bed frames, mattresses, and bed rails (if any) for safety; and all bed rails and mattresses must attach safely to the bed frame.

How that compares

Citations on file over three years

Compared with the median facility in TX, and nationally. Surveyors differ markedly between states, so the TX figure is the meaningful one.

This facility25TX median7National median11
Citations on file over three years, compared
MeasureCitations
This facility25
Median facility in TX7
Median facility nationally11

Survey history

Citations at each Life Safety survey
72023-0682024-07102025-07
Citations at each Life Safety survey
Survey dateCitations
June 1, 20237
July 23, 20248
July 17, 202510

Most-cited tags

Most-cited tags at this facility
K-09183K-03532K-03722K-07122K-03632K-07412E-00391K-02221
Most-cited tags at this facility
TagWhat the surveyor checksTimes citedLast cited
K-0918Have generator or other power source capable of supplying service within 10 seconds.32025-07-17
K-0353Inspect, test, and maintain automatic sprinkler systems.22025-07-17
K-0372Ensure smoke barriers are constructed to a 1 hour fire resistance rating.22024-07-23
K-0712Have simulated fire drills held at unexpected times.22024-07-23
K-0363Install corridor and hallway doors that block smoke.22024-07-23
K-0741Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.22025-07-17
E-0039Conduct testing and exercise requirements.12024-07-23
K-0222Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.12024-07-23

What the citations cover

Citations by CMS category
  • Smoke Deficiencies 10
  • Miscellaneous Deficiencies 5
  • Emergency Preparedness Deficiencies 3
  • Egress Deficiencies 3
  • Other 4
Citations by CMS category
CategoryCitations
Smoke Deficiencies10
Miscellaneous Deficiencies5
Emergency Preparedness Deficiencies3
Egress Deficiencies3
Gas, Vacuum, and Electrical Systems Deficiencies3
Services Deficiencies1

Every citation on file

As published by CMS, newest survey first. Descriptions are CMS’s own wording.

July 17, 2025 — 10 citations

Citations issued on July 17, 2025
TagWhat the surveyor checksStatus
E-0009Include a process for Emergency Preparedness collaboration.Deficient, Provider has date of correction (August 5, 2025)
E-0037Establish staff and initial training requirements.Deficient, Provider has date of correction (August 5, 2025)
K-0341Install a fire alarm system that can be heard throughout the facility.Deficient, Provider has date of correction (August 5, 2025)
K-0347Properly provide smoke detection systems in areas open to corridors.Deficient, Provider has date of correction (August 5, 2025)
K-0353Inspect, test, and maintain automatic sprinkler systems.Deficient, Provider has date of correction (August 5, 2025)
K-0355Properly select, install, inspect, or maintain portable fire extinguishes.Deficient, Provider has date of correction (August 5, 2025)
K-0362Ensure that corridors are separated from use areas by walls constructed to limit the passage of smoke.Deficient, Provider has date of correction (August 5, 2025)
K-0741Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.Deficient, Provider has date of correction (August 5, 2025)
K-0761To conduct inspection, testing and maintenance of fire doors by qualified individuals.Deficient, Provider has date of correction (August 5, 2025)
K-0918Have generator or other power source capable of supplying service within 10 seconds.Deficient, Provider has date of correction (August 25, 2025)

July 23, 2024 — 8 citations

Citations issued on July 23, 2024
TagWhat the surveyor checksStatus
E-0039Conduct testing and exercise requirements.Deficient, Provider has date of correction (August 20, 2024)
K-0222Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.Deficient, Provider has date of correction (July 25, 2024)
K-0353Inspect, test, and maintain automatic sprinkler systems.Deficient, Provider has date of correction (August 16, 2024)
K-0363Install corridor and hallway doors that block smoke.Deficient, Provider has date of correction (August 15, 2024)
K-0372Ensure smoke barriers are constructed to a 1 hour fire resistance rating.Deficient, Provider has date of correction (August 15, 2024)
K-0712Have simulated fire drills held at unexpected times.Deficient, Provider has date of correction (August 16, 2024)
K-0741Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.Deficient, Provider has date of correction (August 16, 2024)
K-0918Have generator or other power source capable of supplying service within 10 seconds.Deficient, Provider has date of correction (August 16, 2024)

June 1, 2023 — 7 citations

Citations issued on June 1, 2023
TagWhat the surveyor checksStatus
K-0200Meet other general requirements.Deficient, Provider has date of correction (June 26, 2023)
K-0211Keep aisles, corridors, and exits free of obstruction in case of emergency.Deficient, Provider has date of correction (June 26, 2023)
K-0363Install corridor and hallway doors that block smoke.Deficient, Provider has date of correction (June 26, 2023)
K-0372Ensure smoke barriers are constructed to a 1 hour fire resistance rating.Deficient, Provider has date of correction (June 26, 2023)
K-0511Have properly installed electrical wiring and gas equipment.Deficient, Provider has date of correction (June 26, 2023)
K-0712Have simulated fire drills held at unexpected times.Deficient, Provider has date of correction (June 26, 2023)
K-0918Have generator or other power source capable of supplying service within 10 seconds.Deficient, Provider has date of correction (June 26, 2023)

Reflects the CMS posting of August 1, 2026. Surveys conducted in the last few months may not appear yet.