Reads as: riskier than 87.6% of the 14,684 facilities in the snf peer group. percentile within peer group, 100 = highest risk. Grade bands are fixed percentile cuts (F is the top 5% of peer risk), so a grade is a position, not an absolute level.
weighted_contribution sums to pre_rank_index over rows where counts_toward_index is true. The composite is the facility's percentile position of that index within its peer group, so contributions explain the input, and the rank explains the score.
ML signals — parallel engine
5
Kind
Finding
Signal
Subject
First seen
connection
Owner fleet risk far above national
+22.3 vs natl
PRICE LARRY
26 facilities
connection
Owner spans multiple chains
18 chains
ENSIGN SERVICES INC
286 facilities
connection
Owner spans multiple chains
17 chains
KEETCH CHAD
283 facilities
connection
Owner fleet enforcement cluster
42% fined
PRICE LARRY
26 facilities
connection
Owner fleet enforcement cluster
42% fined
SOUTH LIMESTONE HOSPITAL DISTRICT
26 facilities
Findings from the always-on scanning layer: anomalies on this facility, connections through its current owners and past buyers. Runs beside the deterministic composite, never inside it. Full board on the ML Lab page.
Change-of-ownership footprint in the CMS Provider of Services file: control-family, legal-name and address deltas across quarterly snapshots, plus certification reset recency and Medicare tenure.
R23/W4-3. Deterministic logistic p(Medicare termination within 12m), SNF only. Label = first POS termination date (any code: voluntary closure, involuntary termination, merger exit); facilities already terminated by the panel date are excluded, not counted as safe. Trained on panels 2024-07/2024-10/2025-01 (n=46,466, 283 positives), evaluated on the held-out later panel 2025-04 BEFORE shipping: AUC 0.971, top-decile lift 9.5x, top-decile capture 95.4% of the 65 terminations that followed. Separability is high because closures announce themselves in the data: collapsing occupancy is the strongest signal, and the learned NEGATIVE weight on 12m deficiency counts is the surveys-stop signature of a facility winding down, not a claim that clean inspections are dangerous. Same 15 as-of-date features and anti-leakage chassis as p_chow_12m; SFF entry rejected as a label (only one month of SFF history exists, so as-of transitions cannot be reconstructed). Score = probability x 100; grade NULL. Not in any composite.
R22/W4-2. Deterministic logistic p(CHOW within 12m), SNF only. Trained on panels 2024-07/2024-10/2025-01 (n=50,700, 1,207 positives), evaluated on the held-out later panel 2025-04 BEFORE shipping: AUC 0.874, top-decile lift 5.0x (top 10% of predictions captured 49.6% of the CHOWs that actually closed in the next 12 months). Shipped coefficients are the evaluated ones; no post-holdout refit. Caveat: holdout positives (133) run below the training base rate because recent CHOWs surface in public records with a lag, so measured lift is conservative. Features are as-of-date public records: PBJ staffing level/trend/contract share (quarterly history to 2022Q1), deficiency and CMP counts (12m), ownership tenure and churn from CHOW-evidenced transactions, beds, occupancy, ownership type, chain size. Chain membership and ownership type are current-state (history not published). SFF and star ratings deliberately excluded (no as-of history). Notable learned direction: long ownership tenure RAISES sale odds and a recent prior CHOW lowers them. Score = probability x 100; grade is NULL because a probability is not a quality letter. Not in any composite.
Pre-registry model iteration, superseded by a later financial_risk rebuild. Rows retained for audit per project convention (see regulatory_risk v0.4-pos); never consumed because v_cii_api_facility_score and the composite eligibility join both require status = default. Backfilled 2026-07-26 by alert triage on model_registry_integrity.
Pre-registry model iteration, superseded by a later financial_risk rebuild. Rows retained for audit per project convention (see regulatory_risk v0.4-pos); never consumed because v_cii_api_facility_score and the composite eligibility join both require status = default. Backfilled 2026-07-26 by alert triage on model_registry_integrity.
Pre-registry model iteration, superseded by a later financial_risk rebuild. Rows retained for audit per project convention (see regulatory_risk v0.4-pos); never consumed because v_cii_api_facility_score and the composite eligibility join both require status = default. Backfilled 2026-07-26 by alert triage on model_registry_integrity.
Pre-registry model iteration, superseded by a later financial_risk rebuild. Rows retained for audit per project convention (see regulatory_risk v0.4-pos); never consumed because v_cii_api_facility_score and the composite eligibility join both require status = default. Backfilled 2026-07-26 by alert triage on model_registry_integrity.
Pre-registry model iteration, superseded by a later regulatory_risk rebuild. Rows retained for audit per project convention (see regulatory_risk v0.4-pos); never consumed because v_cii_api_facility_score and the composite eligibility join both require status = default. Backfilled 2026-07-26 by alert triage on model_registry_integrity.
Pre-registry model iteration, superseded by a later regulatory_risk rebuild. Rows retained for audit per project convention (see regulatory_risk v0.4-pos); never consumed because v_cii_api_facility_score and the composite eligibility join both require status = default. Backfilled 2026-07-26 by alert triage on model_registry_integrity.
Pre-registry model iteration, superseded by a later staffing_risk rebuild. Rows retained for audit per project convention (see regulatory_risk v0.4-pos); never consumed because v_cii_api_facility_score and the composite eligibility join both require status = default. Backfilled 2026-07-26 by alert triage on model_registry_integrity.
Pre-registry model iteration, superseded by a later staffing_risk rebuild. Rows retained for audit per project convention (see regulatory_risk v0.4-pos); never consumed because v_cii_api_facility_score and the composite eligibility join both require status = default. Backfilled 2026-07-26 by alert triage on model_registry_integrity.
Rows with counts_toward_composite false come from models that are addressable or retracted rather than default. They exist and may be informative, but they did not enter the published composite and must not be summed as though they had.
p_adverse_action_12m: probability the facility's Medicare participation terminates within 12 months (any POS termination code; already-terminated facilities are excluded, not scored safe). Deterministic logistic over as-of-date public records, SNF only. Holdout (2025-04 panel, evaluated before shipping): AUC 0.971, top-decile lift 9.5x. Closures announce themselves: collapsing occupancy dominates, and fewer recent surveys is a winding-down signature. inputs.features holds raw feature values, inputs.contributions each feature's standardized pull on the log-odds. Predictions never enter the composite. See /v1/models. | p_chow_12m: probability of a change of ownership within 12 months. Deterministic logistic over as-of-date public records, SNF only. Holdout (2025-04 panel, evaluated before shipping): AUC 0.874, top-decile lift 5.0x. inputs.features holds raw feature values, inputs.contributions each feature's standardized pull on the log-odds. Predictions never enter the composite. See /v1/models for full notes.
Probability the facility's Medicare participation ends within 12 months, from public records only. Red bars raise exit odds. A negative pull from deficiencies is the winding-down signature — surveys stop as a facility empties — not evidence that clean inspections are dangerous.
Staffing vs peers
16
2025Q4 HPRD
This facility
TX median
National median
National p25–p75
Total nurse
2.57
2.67
3.28
2.90–3.77
RN
0.33
0.24
0.39
0.25–0.58
Weekend total
2.48
2.56
3.11
—
Weekday total
2.61
2.72
3.35
—
Quarter
Days
Avg census
Total HPRD
RN
LPN
CNA
Weekend
Contract %
2025Q4
92
64.4
2.57
0.33
0.53
1.72
2.48
34.0%
2025Q3
92
63.5
2.26
0.22
0.54
1.50
2.06
30.9%
2025Q2
91
62.2
2.80
0.16
0.73
1.90
2.59
37.4%
2025Q1
90
62.3
2.50
0.26
0.65
1.59
2.25
35.9%
2024Q4
92
57.8
2.46
0.34
0.61
1.51
2.41
18.7%
2024Q3
92
60.6
2.21
0.24
0.65
1.32
2.18
11.0%
2024Q2
91
60.8
2.40
0.11
0.89
1.40
2.35
18.8%
2024Q1
91
60.8
2.22
0.16
0.73
1.33
2.13
16.7%
2023Q4
92
55.4
2.61
0.09
0.95
1.57
2.51
27.9%
2023Q3
92
56.6
2.21
0.05
0.91
1.25
2.08
27.7%
2023Q2
91
62.6
2.43
0.02
1.06
1.34
2.34
38.3%
2023Q1
90
66.5
2.54
0.05
1.01
1.48
2.44
25.8%
2022Q4
92
58.7
2.70
0.08
0.90
1.72
2.63
10.7%
2022Q3
92
58.9
2.98
0.19
0.93
1.86
2.84
14.8%
2022Q2
91
51.8
2.88
0.14
0.95
1.79
2.64
20.8%
2022Q1
90
52.4
2.73
0.25
0.83
1.66
2.70
27.8%
HPRD is census-weighted: total hours over the quarter divided by total resident-days, not an average of daily ratios. Source is CMS Payroll-Based Journal daily records; only SNFs report PBJ, so other settings legitimately return zero rows.
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
D
2026-04-19
2026-03-19
Health
F0812
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
E
2026-04-19
2026-03-19
Health
F0880
Provide and implement an infection prevention and control program.
D
2026-04-19
2026-01-23
Health · complaint
F0842
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
D
2026-02-23
2025-09-26
Health · complaint
F0760
Ensure that residents are free from significant medication errors.
J
2025-09-20
2025-08-28
Health · complaint
F0580
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
D
2025-08-29
2025-08-28
Health · complaint
F0689
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
J
2025-08-29
2025-07-30
Health · complaint
F0627
Ensure the transfer/discharge meets the resident's needs/preferences and that the resident is prepared for a safe transfer/discharge.
D
2025-07-31
2025-07-01
Health · complaint
F0644
Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.
D
2025-07-09
2025-03-20
Health · complaint
F0580
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
K
2025-03-21
2025-03-20
Health · complaint
F0684
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
K
2025-03-21
2025-02-27
Health · complaint
F0656
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
D
2025-03-19
2025-02-27
Health · complaint
F0695
Provide safe and appropriate respiratory care for a resident when needed.
J
2025-03-19
2025-01-08
Health · complaint
F0684
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
E
2025-01-28
2025-01-08
Health · complaint
F0695
Provide safe and appropriate respiratory care for a resident when needed.
E
2025-01-28
2025-01-08
Health · complaint
F0880
Provide and implement an infection prevention and control program.
E
2025-01-28
2024-12-18
Health
F0641
Ensure each resident receives an accurate assessment.
D
2025-01-10
2024-12-18
Health
F0656
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
E
2025-01-10
2024-12-18
Health
F0677
Provide care and assistance to perform activities of daily living for any resident who is unable.
E
2025-01-10
2024-12-18
Health
F0686
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
E
2025-01-10
2024-12-18
Health
F0761
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.
D
2025-01-10
2024-11-24
Health · complaint
F0689
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
J
2024-11-23
2024-02-28
Health · complaint
F0623
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
D
2024-03-19
2024-02-28
Health · complaint
F0809
Ensure meals and snacks are served at times in accordance with resident’s needs, preferences, and requests. Suitable and nourishing alternative meals and snacks must be provided for residents who want to eat at non-traditional times or outside of scheduled meal times.
E
2024-03-19
2024-02-28
Health · complaint
F0810
Provide special eating equipment and utensils for residents who need them and appropriate assistance.
E
2024-03-19
2024-02-28
Health · complaint
F0880
Provide and implement an infection prevention and control program.
E
2024-03-19
2024-01-16
Health · complaint
F0755
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
E
2024-02-13
2023-10-26
Health
F0656
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
E
2023-11-16
2023-10-26
Health
F0689
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
D
2023-11-16
2023-10-26
Health
F0812
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
F
2023-11-16
2023-09-01
Health · complaint
F0656
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
E
2023-09-21
2023-07-14
Health · complaint
F0550
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
D
2023-07-15
2023-07-14
Health · complaint
F0600
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
D
2023-07-15
scope_severity uses the CMS letter grid: A is least serious, L most. J, K and L are immediate jeopardy. Rows are the surveyor's findings of record, not the model's opinion.
Licensure actions
0
No licensure actions on record for this facility. Absence of a record here means the sources CII ingests contain none, not that none exists anywhere.
Ownership
15
Owner
Role
Pct
From
Status
Source
SOUTH LIMESTONE HOSPITAL DISTRICT
5% OR GREATER DIRECT OWNERSHIP INTEREST
100%
2025-06-01
current
pecos_ownership
ENSIGN SERVICES INC
ADP OF THE SNF
—
2026-02-01
current
pecos_ownership
FLOWERS, ADAM
ADP OF THE SNF
—
2022-07-05
current
pecos_ownership
HICKS, HEATHER
ADP OF THE SNF
—
2026-02-01
current
pecos_ownership
KEETCH, CHAD
CORPORATE OFFICER
—
2011-03-01
current
pecos_ownership
KENDRICK HEALTHCARE LLC
OPERATIONAL/MANAGERIAL CONTROL
—
2026-02-01
current
pecos_ownership
KENDRICK HEALTHCARE LLC
—
—
2026-01-27
current
tx_hhsc_directory
KENDRICK HEALTHCARE LLC
ADP OF THE SNF
—
2026-02-12
current
pecos_ownership
LAKE WACO HEALTH HOLDINGS LLC
ADP OF THE SNF
—
2026-02-01
current
pecos_ownership
PRICE, LARRY
CORPORATE OFFICER
—
2025-06-01
current
pecos_ownership
SOUTH LIMESTONE HOSPITAL DISTRICT
—
—
2026-01-27
current
tx_hhsc_directory
CHAD KEETCH
CORPORATE OFFICER
0%
2011-03-01
ended 2026-05-18
pecos_ownership
ADAM FLOWERS
ADP OF THE SNF
—
2022-07-05
ended 2026-05-18
pecos_ownership
HEATHER HICKS
OPERATIONAL/MANAGERIAL CONTROL
—
2026-02-01
ended 2026-05-18
pecos_ownership
LARRY PRICE
CORPORATE OFFICER
—
2025-06-01
ended 2026-05-18
pecos_ownership
PECOS ownership and managing-control associations. Current edges have no end date in the source; historical edges are retained.
Related-party costs
2
FY end
Total allowable
Rent
Home office
Therapy
Staffing
Counterparties
PropCo
2022-05-31
$340,451
—
—
—
$52,829
1
—
2021-05-31
$355,671
—
—
—
$51,142
1
—
Cost-report related-party spend by fiscal year. has_propco flags real-estate counterparties.
Most recent same-state, same-setting trades. Most CHOW-derived trades carry no disclosed consideration, so price, $/bed, and cap rate show only where a sale price was resolved from a deed or filing — blanks are honest, not missing data.
Market rent context
35
Geo
Kind
BR
Amount
As of
Source
county 48309
acs median gross
0
$861
2024-12-31
CENSUS_ACS5
county 48309
fmr
0
$850
2025-10-01
HUD_USER_FMR
county 48309
acs median gross
1
$936
2024-12-31
CENSUS_ACS5
county 48309
fmr
1
$996
2025-10-01
HUD_USER_FMR
county 48309
acs median gross
2
$1,171
2024-12-31
CENSUS_ACS5
county 48309
fmr
2
$1,240
2025-10-01
HUD_USER_FMR
county 48309
acs median gross
3
$1,452
2024-12-31
CENSUS_ACS5
county 48309
fmr
3
$1,599
2025-10-01
HUD_USER_FMR
county 48309
acs median gross
4
$1,492
2024-12-31
CENSUS_ACS5
county 48309
fmr
4
$1,644
2025-10-01
HUD_USER_FMR
county 48309
acs median gross
5
$1,715
2024-12-31
CENSUS_ACS5
county 48309
acs median gross
$1,173
2024-12-31
CENSUS_ACS5
county 48309
acs recent mover gross
$1,295
2024-12-31
CENSUS_ACS5
zcta 76711
acs median gross
0
$1,505
2024-12-31
CENSUS_ACS5
zcta 76711
acs median gross
1
$1,310
2024-12-31
CENSUS_ACS5
zcta 76711
acs median gross
2
$1,605
2024-12-31
CENSUS_ACS5
zcta 76711
acs median gross
3
$1,210
2024-12-31
CENSUS_ACS5
zcta 76711
acs median gross
4
$1,266
2024-12-31
CENSUS_ACS5
zcta 76711
acs median gross
$1,391
2024-12-31
CENSUS_ACS5
zcta 76711
acs recent mover gross
$1,649
2024-12-31
CENSUS_ACS5
zip 76711
payment standard 110
0
$1,166
2025-10-01
HUD_USER_SAFMR
zip 76711
payment standard 90
0
$954
2025-10-01
HUD_USER_SAFMR
zip 76711
safmr
0
$1,060
2025-10-01
HUD_USER_SAFMR
zip 76711
payment standard 110
1
$1,364
2025-10-01
HUD_USER_SAFMR
zip 76711
payment standard 90
1
$1,116
2025-10-01
HUD_USER_SAFMR
zip 76711
safmr
1
$1,240
2025-10-01
HUD_USER_SAFMR
zip 76711
payment standard 110
2
$1,683
2025-10-01
HUD_USER_SAFMR
zip 76711
payment standard 90
2
$1,377
2025-10-01
HUD_USER_SAFMR
zip 76711
safmr
2
$1,530
2025-10-01
HUD_USER_SAFMR
zip 76711
payment standard 110
3
$2,178
2025-10-01
HUD_USER_SAFMR
zip 76711
payment standard 90
3
$1,782
2025-10-01
HUD_USER_SAFMR
zip 76711
safmr
3
$1,980
2025-10-01
HUD_USER_SAFMR
zip 76711
payment standard 110
4
$2,233
2025-10-01
HUD_USER_SAFMR
zip 76711
payment standard 90
4
$1,827
2025-10-01
HUD_USER_SAFMR
zip 76711
safmr
4
$2,030
2025-10-01
HUD_USER_SAFMR
ACS median gross rents and HUD FMR/SAFMR for the facility's county and ZIP. Context for underwriting, not facility pricing.