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Nursing homeFAID #14563

Millbrook Healthcare and Rehabilitation Center

1850 W PLEASANT RUN RD, LANCASTER, TX, 75146
(972) 275-1900
ensignservices.net
124 licensed beds

CMS rates Millbrook Healthcare and Rehabilitation Center 2 out of 5 overall. Federal inspectors issued 30 citations across 16 inspections in the last three years, with $13,565 in fines. Listing last updated 2026-11-06.

★★★★★2/5CMS Five-Star overall2/5 health inspections1/5 staffing5/5 quality measuresSource: CMS Care Compare

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Photo of MILLBROOK HEALTHCARE AND REHABILITATION CENTER
Photo via Google · Millbrook Healthcare and Rehabilitation Center

Address

1850 W Pleasant Run Rd
Lancaster, TX 75146
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Public record summary

What we can show you for free.
Bed capacity
124
CMS facility ID
676188
Care type
Nursing home
County
Dallas
Facility name
Millbrook Healthcare and Rehabilitation Center
Street address
1850 W PLEASANT RUN RD
City / state / ZIP
Lancaster, TX 75146
Phone
(972) 275-1900
Website
ensignservices.net

About this facility — Millbrook Healthcare and Rehabilitation Center

Millbrook Healthcare and Rehabilitation Center is a Medicare/Medicaid-certified skilled nursing facility in Lancaster, Texas. It is licensed for 124 beds — close to the median for skilled nursing facilities in Texas (120 beds).

It is one of 19 senior care facilities in Lancaster and 1,179 skilled nursing facilities across Texas. Families comparing options should weigh inspection history, ownership record, and litigation — not just the tour — before deciding.

It is listed as part of The Ensign Group, a group of 347 facilities on this site.

Federal inspectors have cited Millbrook Healthcare and Rehabilitation Center 30 times across 16 inspections in the last three years, including 2 food-safety citations, and CMS has imposed $13,565 in fines. Every citation is listed, dated, and graded in the inspection record below.

This listing draws on federal CMS Nursing Home Compare records, and was last updated on November 6, 2026. Background reports are compiled from primary sources — state inspection files, federal CMS data, corporate registrations, and court records — at the time of order.

Facility background

What the public record shows.

Ownership & operator

Parent company
The Ensign Group
Ownership type
For profit - Limited Liability company

Registered owners & officers

Bluebonnet Healthcare, Inc.
Operational control · Additional disclosable party — since 2023
Burnam, Soon
Officer — since 2023
Ensign Services Inc
Additional disclosable party — since 2022
Hooper, Grady
Officer — since 2023
Keetch, Chad
Officer — since 2011
Madison, Kristen
Governing body · Operational control · Additional disclosable party — since 2023
Sharma, Neeraj
Governing body · Operational control · Additional disclosable party — since 2024

Regulatory standing

Federal court records
11 naming its parent company — view the cases (a listed case is not a finding of wrongdoing)
Licensed / certified since
2008-07-25
CMS overall rating
2 of 5 stars
Health deficiencies
13 at the last standard inspection
Federal fines
$13,565 total
Last standard inspection
2026-04-23
Nurse staffing
3.1 hours per resident per day

Cost & payer profile (FY2023 cost report)

Average billed charges
$505 per day (≈ $15,350/month). Private-pay prices typically track billed charges; Medicare and Medicaid pay set rates.
Payer mix (resident days)
72% Medicaid · 10% Medicare · 18% private/other
Occupancy
52% (fiscal year 2023)
Vs. state median
82% above the TX median of $277/day — full state cost breakdown

Services & coverage

Licensed beds
124
Medicare
Accepted
Medicaid
Accepted
Wheelchair accessible
entrance and parking
Visiting hours
Daily Open 24 hours
Compiled from CMS Nursing Home Compare; owners/officers from the CMS Ownership dataset; cost & occupancy from the facility's own CMS cost report; hours/accessibility via Google · last verified 2026-11-06. Facilities can submit a correction.

Inspection record

Every citation, dated and graded.

Kitchen & food safety

Federal surveyors inspect the kitchen at every standard visit. This facility has 2 food-safety citations on its three-year record — flagged below among the inspections.
2026-04-23Health inspection9 citations
F-0565
E · No harm found
Honor the resident's right to organize and participate in resident/family groups in the facility.
Corrected 2026-04-24
F-0609
D · No harm found
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Corrected 2026-04-24
F-0638
D · No harm found
Assure that each resident’s assessment is updated at least once every 3 months.
Corrected 2026-04-24
F-0656
E · No harm found
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Corrected 2026-04-24
F-0689
D · No harm found
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected 2026-04-24
F-0693
D · No harm found
Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube.
Corrected 2026-04-24
F-0812
E · No harm foundFood safety
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected 2026-04-24
F-0880
E · No harm found
Provide and implement an infection prevention and control program.
Corrected 2026-04-24
F-0921
E · No harm found
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
Corrected 2026-04-24
2025-12-03Health inspectionComplaint-triggered1 citation
F-0550
D · No harm foundFrom a complaint
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Corrected 2025-12-04
10 earlier / fire-safety inspections (20 citations)
2025-12-02Health inspectionComplaint-triggered2 citations
F-0656
E · No harm foundFrom a complaint
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Corrected 2025-12-03
F-0755
E · No harm foundFrom a complaint
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Corrected 2025-12-03
2025-12-01Health inspectionComplaint-triggered1 citation
F-0695
E · No harm foundFrom a complaint
Provide safe and appropriate respiratory care for a resident when needed.
Corrected 2025-12-02
2025-09-09Health inspectionComplaint-triggered1 citation
F-0628
D · No harm foundFrom a complaint
Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.
Corrected 2025-09-26
2025-05-07Health inspectionComplaint-triggered3 citations
F-0583
D · No harm foundFrom a complaint
Keep residents' personal and medical records private and confidential.
Corrected 2025-05-23
F-0755
D · No harm foundFrom a complaint
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Corrected 2025-05-23
F-0761
D · No harm foundFrom a complaint
Ensure 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.
Corrected 2025-05-23
2025-02-11Health inspection6 citations
F-0550
D · No harm found
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Corrected 2025-02-17
F-0558
E · No harm found
Reasonably accommodate the needs and preferences of each resident.
Corrected 2025-02-17
F-0641
D · No harm found
Ensure each resident receives an accurate assessment.
Corrected 2025-02-17
F-0677
D · No harm found
Provide care and assistance to perform activities of daily living for any resident who is unable.
Corrected 2025-02-17
F-0812
E · No harm foundFood safety
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected 2025-02-17
F-0880
E · No harm found
Provide and implement an infection prevention and control program.
Corrected 2025-02-17
2024-10-11Health inspectionComplaint-triggered1 citation
F-0584
D · No harm foundFrom a complaint
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.
Corrected 2024-10-14
2024-01-10Health inspectionComplaint-triggered2 citations
F-0850
E · No harm found
Hire a qualified full-time social worker in a facility with more than 120 beds.
Corrected 2024-02-05
F-0880
D · No harm foundFrom a complaint
Provide and implement an infection prevention and control program.
Corrected 2024-02-05
2023-11-29Health inspectionComplaint-triggered1 citation
F-0880
K · Immediate jeopardyFrom a complaint
Provide and implement an infection prevention and control program.
Corrected 2023-12-29
2025-02-11Fire-safety inspection1 citation
K-0324
F · No harm found
Provide properly protected cooking facilities.
Corrected 2025-02-17
2024-01-10Fire-safety inspection2 citations
K-0521
C · No harm found
Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.
Corrected 2024-01-12
K-0741
F · No harm found
Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.
Corrected 2024-01-11

Federal penalties

2023-11-29Fine$13,565
Citations and penalties from the CMS Provider Data Catalog (three-year survey window, refreshed monthly). Severity codes follow the federal scope/severity grid; “Immediate jeopardy” is the most serious grade CMS issues. CCN 676188.

Quality of care & staffing

How it compares in Texas.
Inspection citations, 3 years
30
More than 40% of nursing homes in the state
State median: 33
Federal fines, 3 years
$13,565
More than 45% of nursing homes in the state
State median: $15,642
Nurse staffing, hours per resident per day
3.1
Higher than 27% of nursing homes in the state
State median: 3.3
Nursing staff turnover, annual
67%
Higher than 88% of nursing homes in the state
State median: 50%

Resident outcomes

On 21 federal quality measures, this facility does better than the Texas average on 13 and worse on 3. Differences within 10% of the average are shown as near average.

Long-stay residentsThis facilityStateUSCompared with state
Need for help with daily activities has increased8.8%15.8%13.5%Better than state
Lose too much weight1.6%2.9%5.1%Better than state
With a catheter inserted and left in their bladder0.0%0.3%0.7%Better than state
With a urinary tract infection0.4%0.8%1.5%Better than state
Have depressive symptoms5.7%2.3%13.5%Worse than state
Were physically restrained0.0%0.0%0.1%Better than state
Experiencing one or more falls with major injury1.8%3.2%3.2%Better than state
Assessed and appropriately given the pneumococcal vaccine100.0%96.4%93.7%Near state average
Ability to walk independently worsened16.3%12.9%12.7%Worse than state
Received an antianxiety or hypnotic medication7.9%17.8%19.5%Better than state
Assessed and appropriately given the seasonal influenza vaccine98.7%97.0%95.3%Near state average
With pressure ulcers1.3%3.7%4.5%Better than state
With new or worsened bowel or bladder incontinence17.7%12.5%18.3%Worse than state
Received an antipsychotic medication0.0%9.8%15.4%Better than state
Hospitalizations per 1000 long-stay resident days1.742.051.81Better than state
Outpatient emergency department visits per 1000 long-stay resident days2.041.971.69Near state average
Short-stay residentsThis facilityStateUSCompared with state
Assessed and appropriately given the pneumococcal vaccine97.8%88.7%82.3%Better than state
Newly received an antipsychotic medication0.0%1.4%1.5%Better than state
Were assessed and appropriately given the seasonal influenza vaccine87.9%85.4%80.1%Near state average
Were rehospitalized after a nursing home admission22.9%25.5%23.4%Near state average
Had an outpatient emergency department visit6.5%12.2%11.8%Better than state
Source: CMS MDS and Medicare claims quality measures, measure period 2025Q3-2026Q2. Averages are computed from all nursing homes reporting each measure.

Cited more than once

The same rule cited at separate inspections can point to a problem that wasn't fully fixed.

  • F-0880 4 inspections. Provide and implement an infection prevention and control program.
  • F-0656 2 inspections. Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
  • F-0812 2 inspections. Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
  • F-0550 2 inspections. Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
  • F-0755 2 inspections. Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

Verify & compare

Where to check, and what's nearby.

Who to contact in Texas

  • Licensing: Texas Health and Human Services
  • File a complaint: 800-458-9858 · Online
  • Long-Term Care Ombudsman: 800-252-2412. A free advocate for residents and families.
  • Adult Protective Services: 800-252-5400. Some states send facility cases to licensing instead. In an emergency, call 911.
  • Eldercare Locator: 800-677-1116, a federal service for local aging help.

Nearest emergency hospitals

  • Methodist Charlton Medical Center, about 5.5 miles. CMS rating 3 of 5.
  • Dallas Va Medical Center (va North Texas Healthcare System), about 6.1 miles. CMS rating 3 of 5.
  • Methodist Dallas Medical Center, about 11 miles. CMS rating 3 of 5.
Source: CMS Hospital General Information. Straight-line distance.

Nearby facilities with inspection records

Visitor reviews

What people say on Google.
4.8230 ratings on Google
★★★★★Shantau Valentine · 2026-06-10 · via Google

“I recently visited Millbrook Nursing Home and Rehab and had a positive experience. The facility was clean and well-maintained, and the staff were friendly and attentive to the residents. Everyone I interacted with seemed genuinely caring and willing to help. The residents appeared comfortable and engaged, and the overall atmosphere was welcoming. Based on my visit, I would feel confident recommend…”

★★★★★Jaleesa Willis-Brice · 2026-06-10 · via Google

“I had a wonderful experience with Millbrook Healthcare and Rehab. The staff is caring, professional, and truly dedicated to providing excellent care. A special thank you to the receptionist, who was always friendly, welcoming, and helpful whenever I had questions or needed assistance. Their positive attitude made every visit a pleasant experience. I would also like to recognize the social worker …”

★★★★★Felicia Burkhalter · 2026-07-02 · via Google

“Devon is an amazing receptionist and has become a great friend. From day one, she greets me and my family with a genuine smile and assists us in any way that she can. It was a hard decision to put my parents in a nursing home, but Devon showed us around, shared information about the facility with us, and made us feel at ease. Thank you for hiring such a wondering and caring person. She’s amazing…”

Ratings and reviews are from Google and reflect visitor opinions, not our verification. See all reviews on Google

Inside your report

What unlocks when you order.

Ownership & corporate history

Primary tier
Prior operators & transfers
Corporate network & affiliates
,
Owners' other facilities
· · 2 more

Inspection citations — last 5 years

Locked
The 30 citations above are shown free. The report takes each one and explains it in plain English — what the tag requires, how serious the scope/severity grade really is, whether it recurred across surveys — plus the five-year pattern a single inspection can't show.

Civil & criminal lawsuits

Advanced tier only
Active civil suits
#
Federal dockets
CDC infection data
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Citations, owner history, lawsuits — decoded into one PDF.
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Original records

Sources we pull for this facility.
Source
CMS Nursing Home Compare
data.cms.gov Provider Data Catalog
Last verified 2026-11-06
Source
Google Business Profile
Photos, reviews & hours
Displayed with attribution · refreshed on re-run
Source
Secretary of State filings
Entity & officer search
Pulled when a report is ordered
Source
PACER federal dockets
pacer.uscourts.gov
Pulled when a report is ordered