1500 W 38TH ST, SIOUX FALLS, SD 57105 · CCN 435044 · chain SANFORD
Composite
90.2 / 100 percentile
Peer group
snf n = 14,684
Evidence depth
deep
Certified beds
92
Model
v1.2
Reads as: riskier than 90.2% 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
1
Kind
Finding
Signal
Subject
First seen
connection
Owner spans multiple chains
6 chains
GRAPE TREE MEDICAL STAFFING LLC
55 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
SD median
National median
National p25–p75
Total nurse
2.84
2.96
3.28
2.90–3.77
RN
0.58
0.52
0.39
0.25–0.58
Weekend total
2.61
2.75
3.11
—
Weekday total
2.93
3.06
3.35
—
Quarter
Days
Avg census
Total HPRD
RN
LPN
CNA
Weekend
Contract %
2025Q4
92
83.8
2.84
0.58
0.53
1.73
2.61
0.6%
2025Q3
92
84.3
3.13
0.55
0.55
2.03
2.84
0.8%
2025Q2
91
83.2
3.48
0.52
0.60
2.35
3.16
3.5%
2025Q1
90
80.3
3.52
0.57
0.71
2.24
3.21
5.2%
2024Q4
92
80.8
3.34
0.44
0.66
2.23
2.94
4.5%
2024Q3
92
80.0
3.48
0.67
0.46
2.36
3.18
4.7%
2024Q2
91
81.9
3.30
0.65
0.36
2.29
2.85
0.9%
2024Q1
91
80.1
3.45
0.69
0.53
2.23
3.33
8.1%
2023Q4
92
80.2
3.30
0.76
0.42
2.13
3.07
4.6%
2023Q3
92
86.9
3.14
0.73
0.36
2.05
2.92
1.1%
2023Q2
91
80.1
3.37
0.87
0.33
2.17
3.09
0.3%
2023Q1
90
77.1
3.46
1.13
0.22
2.12
3.11
0.0%
2022Q4
92
75.9
3.61
0.94
0.23
2.43
3.44
0.0%
2022Q3
92
74.2
3.49
0.91
0.25
2.33
3.22
1.2%
2022Q2
91
67.1
3.33
1.01
0.26
2.05
2.92
0.3%
2022Q1
90
65.0
3.51
0.96
0.31
2.25
3.15
2.6%
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.
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
E
2026-04-24
2026-04-01
Health · complaint
F0760
Ensure that residents are free from significant medication errors.
G
2026-03-23
2026-03-05
Health
F0554
Allow residents to self-administer drugs if determined clinically appropriate.
D
2026-04-01
2026-03-05
Health · complaint
F0609
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
D
2026-04-01
2026-03-05
Health
F0641
Ensure each resident receives an accurate assessment.
D
2026-04-01
2026-03-05
Health
F0657
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
D
2026-04-01
2026-03-05
Health
F0686
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
G
2026-04-01
2026-03-05
Health · complaint
F0689
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
G
2026-04-01
2026-03-05
Health
F0699
Provide care or services that was trauma informed and/or culturally competent.
D
2026-04-01
2026-03-05
Health · complaint
F0755
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
E
2026-04-01
2025-07-23
Health · complaint
F0684
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
D
2025-08-15
2025-06-18
Health · complaint
F0684
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
D
2025-07-18
2025-06-18
Health · complaint
F0689
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
G
2025-07-18
2025-01-23
Health · complaint
F0684
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
D
2025-02-15
2024-10-17
Health
F0657
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
D
2024-11-12
2024-10-17
Health
F0689
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
G
2024-11-12
2024-10-17
Health
F0812
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
E
2024-11-12
2023-09-08
Health
F0582
Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.
E
2023-10-26
2023-09-08
Health
F0676
Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason.
E
2023-10-26
2023-09-08
Health
F0686
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
D
2023-10-26
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
49
Owner
Role
Pct
From
Status
Source
SANFORD
5% OR GREATER DIRECT OWNERSHIP INTEREST
100%
2019-01-01
current
pecos_ownership
THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
5% OR GREATER INDIRECT OWNERSHIP INTEREST
100%
2019-01-01
current
pecos_ownership
BROWN, GEORGE
CORPORATE DIRECTOR
—
2025-01-01
current
pecos_ownership
DTN STAFFING INC
ADP OF THE SNF
—
2024-03-04
current
pecos_ownership
DYKHOUSE, DANA
CORPORATE DIRECTOR
—
2024-05-30
current
pecos_ownership
ENGBRECHT, WESLEY
ADP OF THE SNF
—
2024-05-30
current
pecos_ownership
FLUIT, JOEL
ADP OF THE SNF
—
2022-10-01
current
pecos_ownership
FOCUSONE SOLUTIONS
ADP OF THE SNF
—
2024-03-04
current
pecos_ownership
FRASER, THOMAS
ADP OF THE SNF
—
2022-04-25
current
pecos_ownership
GASSEN, WILLIAM
CORPORATE OFFICER
—
2024-05-30
current
pecos_ownership
GRAPE TREE MEDICAL STAFFING LLC
ADP OF THE SNF
—
2018-04-13
current
pecos_ownership
GULSVIG, NEIL
ADP OF THE SNF
—
2024-05-30
current
pecos_ownership
HERSETH SANDLIN, STEPHANIE
CORPORATE DIRECTOR
—
2024-05-30
current
pecos_ownership
LUNDEEN, MARK
ADP OF THE SNF
—
2024-05-30
current
pecos_ownership
MCCAUSLAND, MAUREEN
ADP OF THE SNF
—
2025-01-01
current
pecos_ownership
MIDDLETON, AIMEE
CORPORATE OFFICER
—
2022-01-27
current
pecos_ownership
MOLBERT, LAURIS
ADP OF THE SNF
—
2024-05-30
current
pecos_ownership
MORRISON, TONY
OPERATIONAL/MANAGERIAL CONTROL
—
2019-01-01
current
pecos_ownership
NORTH, ANDREW
ADP OF THE SNF
—
2024-05-30
current
pecos_ownership
OLSON, NICHOLAS
ADP OF THE SNF
—
2024-04-08
current
pecos_ownership
ORSTAD, KERI
ADP OF THE SNF
—
2020-03-01
current
pecos_ownership
SANDGREN, DEEANDRA
ADP OF THE SNF
—
2023-07-16
current
pecos_ownership
SANFORD
ADP OF THE SNF
—
2025-11-28
current
pecos_ownership
SCHEMA, NATHAN
CORPORATE OFFICER
—
2022-01-01
current
pecos_ownership
SCHIEFFER, KEVIN
ADP OF THE SNF
—
2025-01-01
current
pecos_ownership
SHULKIN, DAVID
CORPORATE DIRECTOR
—
2024-05-30
current
pecos_ownership
TEIKEN, BRENT
ADP OF THE SNF
—
2024-05-30
current
pecos_ownership
VENTLING-HERRMANN, MARNIE
CORPORATE DIRECTOR
—
2024-05-30
current
pecos_ownership
WENZEL, THOMAS
ADP OF THE SNF
—
2025-01-01
current
pecos_ownership
AIMEE MIDDLETON
CORPORATE OFFICER
0%
2022-01-27
ended 2026-05-18
pecos_ownership
ANDREW NORTH
CORPORATE DIRECTOR
0%
2024-05-30
ended 2026-05-18
pecos_ownership
BRENT TEIKEN
CORPORATE DIRECTOR
0%
2024-05-30
ended 2026-05-18
pecos_ownership
DANA DYKHOUSE
CORPORATE DIRECTOR
0%
2024-05-30
ended 2026-05-18
pecos_ownership
DAVID SHULKIN
CORPORATE DIRECTOR
0%
2024-05-30
ended 2026-05-18
pecos_ownership
JAMES CAIN
CORPORATE DIRECTOR
0%
2024-05-30
ended 2026-05-18
pecos_ownership
JOEL FLUIT
CORPORATE OFFICER
0%
2022-10-01
ended 2026-05-18
pecos_ownership
KELLI GUYSE
W-2 MANAGING EMPLOYEE
0%
2022-04-10
ended 2026-05-18
pecos_ownership
KERI ORSTAD
CONTRACTED MANAGING EMPLOYEE
0%
2020-03-01
ended 2026-05-18
pecos_ownership
LAURIS MOLBERT
CORPORATE DIRECTOR
0%
2024-05-30
ended 2026-05-18
pecos_ownership
MARK LUNDEEN
CORPORATE DIRECTOR
0%
2024-05-30
ended 2026-05-18
pecos_ownership
MARNIE VENTLING-HERRMANN
CORPORATE DIRECTOR
0%
2024-05-30
ended 2026-05-18
pecos_ownership
MICHAEL ROGERS
CORPORATE OFFICER
0%
2022-06-13
ended 2026-05-18
pecos_ownership
NATHAN SCHEMA
CORPORATE OFFICER
0%
2022-01-01
ended 2026-05-18
pecos_ownership
NEIL GULSVIG
CORPORATE DIRECTOR
0%
2024-05-30
ended 2026-05-18
pecos_ownership
NICHOLAS OLSON
CORPORATE OFFICER
0%
2024-04-08
ended 2026-05-18
pecos_ownership
STEPHANIE HERSETH-SANDLIN
CORPORATE DIRECTOR
0%
2024-05-30
ended 2026-05-18
pecos_ownership
TONY MORRISON
W-2 MANAGING EMPLOYEE
0%
2019-01-01
ended 2026-05-18
pecos_ownership
WESLEY ENGBRECHT
CORPORATE DIRECTOR
0%
2024-05-30
ended 2026-05-18
pecos_ownership
WILLIAM GASSEN
CORPORATE OFFICER
0%
2024-05-30
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
5
FY end
Total allowable
Rent
Home office
Therapy
Staffing
Counterparties
PropCo
2024-09-30
$1,458,387
—
—
—
$1
2
—
2023-09-30
$1,315,658
—
—
—
$62
2
—
2022-09-30
$1,970,221
—
—
—
$580
2
—
2021-09-30
$2,197,170
—
—
—
—
2
—
2020-09-30
$1,779,674
—
—
—
$8,655
1
—
Cost-report related-party spend by fiscal year. has_propco flags real-estate counterparties.
Transactions
0
No transactions on record for this facility. Absence of a record here means the sources CII ingests contain none, not that none exists anywhere.
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
36
Geo
Kind
BR
Amount
As of
Source
county 46099
acs median gross
0
$840
2024-12-31
CENSUS_ACS5
county 46099
fmr
0
$865
2025-10-01
HUD_USER_FMR
county 46099
acs median gross
1
$854
2024-12-31
CENSUS_ACS5
county 46099
fmr
1
$986
2025-10-01
HUD_USER_FMR
county 46099
acs median gross
2
$995
2024-12-31
CENSUS_ACS5
county 46099
fmr
2
$1,156
2025-10-01
HUD_USER_FMR
county 46099
acs median gross
3
$1,291
2024-12-31
CENSUS_ACS5
county 46099
fmr
3
$1,586
2025-10-01
HUD_USER_FMR
county 46099
acs median gross
4
$1,755
2024-12-31
CENSUS_ACS5
county 46099
fmr
4
$1,939
2025-10-01
HUD_USER_FMR
county 46099
acs median gross
5
$1,368
2024-12-31
CENSUS_ACS5
county 46099
acs median gross
$978
2024-12-31
CENSUS_ACS5
county 46099
acs recent mover gross
$1,149
2024-12-31
CENSUS_ACS5
zcta 57105
acs median gross
0
$779
2024-12-31
CENSUS_ACS5
zcta 57105
acs median gross
1
$784
2024-12-31
CENSUS_ACS5
zcta 57105
acs median gross
2
$960
2024-12-31
CENSUS_ACS5
zcta 57105
acs median gross
3
$1,361
2024-12-31
CENSUS_ACS5
zcta 57105
acs median gross
4
$1,859
2024-12-31
CENSUS_ACS5
zcta 57105
acs median gross
5
$1,109
2024-12-31
CENSUS_ACS5
zcta 57105
acs median gross
$953
2024-12-31
CENSUS_ACS5
zcta 57105
acs recent mover gross
$996
2024-12-31
CENSUS_ACS5
zip 57105
payment standard 110
0
$913
2025-10-01
HUD_USER_SAFMR
zip 57105
payment standard 90
0
$747
2025-10-01
HUD_USER_SAFMR
zip 57105
safmr
0
$830
2025-10-01
HUD_USER_SAFMR
zip 57105
payment standard 110
1
$1,045
2025-10-01
HUD_USER_SAFMR
zip 57105
payment standard 90
1
$855
2025-10-01
HUD_USER_SAFMR
zip 57105
safmr
1
$950
2025-10-01
HUD_USER_SAFMR
zip 57105
payment standard 110
2
$1,221
2025-10-01
HUD_USER_SAFMR
zip 57105
payment standard 90
2
$999
2025-10-01
HUD_USER_SAFMR
zip 57105
safmr
2
$1,110
2025-10-01
HUD_USER_SAFMR
zip 57105
payment standard 110
3
$1,672
2025-10-01
HUD_USER_SAFMR
zip 57105
payment standard 90
3
$1,368
2025-10-01
HUD_USER_SAFMR
zip 57105
safmr
3
$1,520
2025-10-01
HUD_USER_SAFMR
zip 57105
payment standard 110
4
$2,046
2025-10-01
HUD_USER_SAFMR
zip 57105
payment standard 90
4
$1,674
2025-10-01
HUD_USER_SAFMR
zip 57105
safmr
4
$1,860
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.