324 First Avenue North, George, IA 51237 · CCN 165247 · chain SANFORD
Composite
88.5 / 100 percentile
Peer group
snf n = 14,684
Evidence depth
deep
Certified beds
36
Model
v1.2
Reads as: riskier than 88.5% 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
IA median
National median
National p25–p75
Total nurse
2.38
3.15
3.28
2.90–3.77
RN
0.76
0.46
0.39
0.25–0.58
Weekend total
2.25
2.96
3.11
—
Weekday total
2.44
3.20
3.35
—
Quarter
Days
Avg census
Total HPRD
RN
LPN
CNA
Weekend
Contract %
2025Q4
92
32.0
2.38
0.76
0.22
1.41
2.25
0.0%
2025Q3
92
30.3
2.65
0.79
0.25
1.62
2.47
1.1%
2025Q2
91
31.9
2.63
0.81
0.20
1.62
2.44
0.3%
2025Q1
90
29.7
2.78
0.95
0.17
1.66
2.62
0.0%
2024Q4
92
26.2
2.99
1.07
0.18
1.74
2.75
0.0%
2024Q3
92
26.3
2.90
0.90
0.27
1.74
2.61
0.9%
2024Q2
91
26.6
2.53
0.71
0.30
1.52
2.42
4.3%
2024Q1
91
30.0
2.09
0.69
0.20
1.21
2.04
4.9%
2023Q4
92
30.5
2.54
0.84
0.23
1.47
2.41
8.9%
2023Q3
92
34.2
2.45
0.78
0.24
1.42
2.34
9.6%
2023Q2
91
33.8
2.49
0.65
0.29
1.54
2.39
4.4%
2023Q1
90
32.6
2.28
0.57
0.36
1.35
2.16
0.0%
2022Q4
92
31.3
2.44
0.51
0.35
1.57
2.27
0.0%
2022Q3
92
30.6
2.43
0.37
0.42
1.64
2.37
0.2%
2022Q2
91
30.4
2.71
0.63
0.30
1.78
2.64
1.4%
2022Q1
90
29.4
2.82
0.62
0.30
1.91
2.72
3.9%
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.
Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.
D
2025-09-16
2025-08-21
Health
F0695
Provide safe and appropriate respiratory care for a resident when needed.
D
2025-09-16
2025-08-21
Health
F0803
Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.
E
2025-09-16
2025-08-21
Health
F0812
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
E
2025-09-16
2025-08-21
Health
F0851
Electronically submit to CMS complete and accurate direct care staffing information, based on payroll and other verifiable and auditable data.
F
2025-09-16
2024-08-29
Health · complaint
F0600
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
D
2024-09-25
2024-08-29
Health · complaint
F0609
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
D
2024-09-25
2024-08-29
Health · complaint
F0610
Respond appropriately to all alleged violations.
J
2024-06-27
2024-08-29
Health
F0812
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
E
2024-09-25
2024-08-29
Health
F0851
Electronically submit to CMS complete and accurate direct care staffing information, based on payroll and other verifiable and auditable data.
E
2024-09-25
2024-08-29
Health
F0880
Provide and implement an infection prevention and control program.
D
2024-09-25
2023-09-21
Health
F0623
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
D
2023-10-14
2023-09-21
Health
F0625
Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave.
D
2023-10-14
2023-09-21
Health
F0644
Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.
D
2023-10-14
2023-09-21
Health
F0656
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
D
2023-10-14
2023-09-21
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.
E
2023-10-14
2023-09-21
Health
F0658
Ensure services provided by the nursing facility meet professional standards of quality.
D
2023-10-14
2023-09-21
Health
F0661
Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge.
D
2023-10-14
2023-09-21
Health
F0686
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
D
2023-10-14
2023-09-21
Health
F0689
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
J
2023-05-03
2023-09-21
Health
F0880
Provide and implement an infection prevention and control program.
E
2023-10-14
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
54
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
ADP OF THE SNF
—
2025-01-01
current
pecos_ownership
CHAUDHARY, IKRAM
ADP OF THE SNF
—
2024-04-07
current
pecos_ownership
DEJONG, CHESTER
OPERATIONAL/MANAGERIAL CONTROL
—
2018-02-02
current
pecos_ownership
DTN STAFFING INC
ADP OF THE SNF
—
2024-08-02
current
pecos_ownership
DYKHOUSE, DANA
CORPORATE DIRECTOR
—
2024-05-30
current
pecos_ownership
ENGBRECHT, WESLEY
CORPORATE DIRECTOR
—
2024-05-30
current
pecos_ownership
FLUIT, JOEL
CORPORATE OFFICER
—
2022-10-01
current
pecos_ownership
FOCUSONE SOLUTIONS
ADP OF THE SNF
—
2024-03-04
current
pecos_ownership
GASSEN, WILLIAM
CORPORATE OFFICER
—
2024-05-30
current
pecos_ownership
GRAPE TREE MEDICAL STAFFING LLC
ADP OF THE SNF
—
2014-04-13
current
pecos_ownership
GULSVIG, NEIL
CORPORATE DIRECTOR
—
2024-05-30
current
pecos_ownership
HERSETH SANDLIN, STEPHANIE
ADP OF THE SNF
—
2024-05-30
current
pecos_ownership
LUNDEEN, MARK
CORPORATE DIRECTOR
—
2024-05-30
current
pecos_ownership
MCCAUSLAND, MAUREEN
CORPORATE DIRECTOR
—
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
ADP OF THE SNF
—
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
SANDGREN, DEEANDRA
ADP OF THE SNF
—
2020-07-16
current
pecos_ownership
SANDGREN, DEEANDRA
OPERATIONAL/MANAGERIAL CONTROL
—
2023-07-16
current
pecos_ownership
SANFORD
ADP OF THE SNF
—
2025-11-25
current
pecos_ownership
SCHEMA, NATHAN
CORPORATE OFFICER
—
2022-01-01
current
pecos_ownership
SCHIEFFER, KEVIN
CORPORATE DIRECTOR
—
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
ADP OF THE SNF
—
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
GEORGE BROWN
CORPORATE DIRECTOR
0%
2025-01-01
ended 2026-05-18
pecos_ownership
JOEL FLUIT
CORPORATE OFFICER
0%
2022-10-01
ended 2026-05-18
pecos_ownership
KEVIN SCHIEFFER
CORPORATE DIRECTOR
0%
2025-01-01
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
MAUREEN MCCAUSLAND
CORPORATE DIRECTOR
0%
2025-01-01
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
THOMAS WENZEL
CORPORATE DIRECTOR
0%
2025-01-01
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
CHESTER DEJONG
OPERATIONAL/MANAGERIAL CONTROL
—
2018-02-02
ended 2026-05-18
pecos_ownership
DEEANDRA SANDGREN
OPERATIONAL/MANAGERIAL CONTROL
—
2023-07-16
ended 2026-05-18
pecos_ownership
DEEANDRA SANDGREN
ADP OF THE SNF
—
2020-07-16
ended 2026-05-18
pecos_ownership
IKRAM CHAUDHARY
OPERATIONAL/MANAGERIAL CONTROL
—
2024-04-07
ended 2026-05-18
pecos_ownership
TONY MORRISON
OPERATIONAL/MANAGERIAL CONTROL
—
2019-01-01
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
5
FY end
Total allowable
Rent
Home office
Therapy
Staffing
Counterparties
PropCo
2024-12-31
$568,646
—
—
—
$1,746
2
—
2023-12-31
$575,237
—
—
—
—
2
—
2022-12-31
$536,160
—
—
—
—
2
—
2021-12-31
$577,188
—
—
—
—
2
—
2020-12-31
$502,818
—
—
—
—
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
30
Geo
Kind
BR
Amount
As of
Source
county 19119
fmr
0
$682
2025-10-01
HUD_USER_FMR
county 19119
acs median gross
1
$522
2024-12-31
CENSUS_ACS5
county 19119
fmr
1
$700
2025-10-01
HUD_USER_FMR
county 19119
acs median gross
2
$849
2024-12-31
CENSUS_ACS5
county 19119
fmr
2
$919
2025-10-01
HUD_USER_FMR
county 19119
acs median gross
3
$853
2024-12-31
CENSUS_ACS5
county 19119
fmr
3
$1,102
2025-10-01
HUD_USER_FMR
county 19119
acs median gross
4
$880
2024-12-31
CENSUS_ACS5
county 19119
fmr
4
$1,217
2025-10-01
HUD_USER_FMR
county 19119
acs median gross
$843
2024-12-31
CENSUS_ACS5
county 19119
acs recent mover gross
$862
2024-12-31
CENSUS_ACS5
zcta 51237
acs median gross
2
$832
2024-12-31
CENSUS_ACS5
zcta 51237
acs median gross
3
$859
2024-12-31
CENSUS_ACS5
zcta 51237
acs median gross
4
$669
2024-12-31
CENSUS_ACS5
zcta 51237
acs median gross
$822
2024-12-31
CENSUS_ACS5
zip 51237
payment standard 110
0
$748
2025-10-01
HUD_USER_SAFMR
zip 51237
payment standard 90
0
$612
2025-10-01
HUD_USER_SAFMR
zip 51237
safmr
0
$680
2025-10-01
HUD_USER_SAFMR
zip 51237
payment standard 110
1
$770
2025-10-01
HUD_USER_SAFMR
zip 51237
payment standard 90
1
$630
2025-10-01
HUD_USER_SAFMR
zip 51237
safmr
1
$700
2025-10-01
HUD_USER_SAFMR
zip 51237
payment standard 110
2
$1,012
2025-10-01
HUD_USER_SAFMR
zip 51237
payment standard 90
2
$828
2025-10-01
HUD_USER_SAFMR
zip 51237
safmr
2
$920
2025-10-01
HUD_USER_SAFMR
zip 51237
payment standard 110
3
$1,210
2025-10-01
HUD_USER_SAFMR
zip 51237
payment standard 90
3
$990
2025-10-01
HUD_USER_SAFMR
zip 51237
safmr
3
$1,100
2025-10-01
HUD_USER_SAFMR
zip 51237
payment standard 110
4
$1,342
2025-10-01
HUD_USER_SAFMR
zip 51237
payment standard 90
4
$1,098
2025-10-01
HUD_USER_SAFMR
zip 51237
safmr
4
$1,220
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.