Composite
93.3 / 100 percentile
Screener / 165245
D
Hillcrest Health Care Center
snfIA
2121 Avenue L, Hawarden, IA 51023 · CCN 165245 · chain THE ENSIGN GROUP INC
Peer group
snf n = 14,684
Evidence depth
deep
Certified beds
64
Model
v1.2
Reads as: riskier than 93.3% 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.
Score model5ML signals8Components16CHOW radar1Distress radar1Staffing16Penalties2Deficiencies70Licensure0Ownership34Related party5Transactions0Comps12Market rent33
Composite explanation
5| Component | Percentile | Raw | Weight | Weight share | Contribution | Counts |
|---|---|---|---|---|---|---|
| financial risk | 95.0 | 84.5 | 0.30 | 0.2308 | 21.92 | in index |
| regulatory risk | 89.8 | 87.4 | 0.30 | 0.2308 | 20.72 | in index |
| staffing risk | 89.7 | 89.7 | 0.25 | 0.1923 | 17.25 | in index |
| chow risk | 54.1 | 52.2 | 0.15 | 0.1154 | 6.24 | in index |
| billing conduct | 14.9 | 19.0 | 0.30 | 0.2308 | 3.44 | in index |
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
8| Kind | Finding | Signal | Subject | First seen |
|---|---|---|---|---|
| connection | Owner fleet risk far above national | +28.3 vs natl | HELPING HANDS NURSING SOLUTION INC | 5 facilities |
| connection | Owner spans multiple chains | 18 chains | CTR PARTNERSHIP LP | 99 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 spans multiple chains | 17 chains | BURNAM SOON | 335 facilities |
| connection | Owner spans multiple chains | 15 chains | CARETRUST REIT INC | 96 facilities |
| connection | Owner spans multiple chains | 12 chains | THE ENSIGN GROUP INC | 123 facilities |
| connection | Owner spans multiple chains | 11 chains | CARETRUST GP LLC | 89 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.
Component scores and registry models
16| Score type | Score | Grade | Model | Status | Registry model notes |
|---|---|---|---|---|---|
| billing conduct | 18.9 | A | v0.1-pacpuf-snf | default · in composite | R22. PAC PUF SNF 2023. PDPM coding intensity vs acuity, stay length, charge markup. |
| chow risk | 25.0 | B | v0.1-pos | default · in composite | 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. |
| chow risk | 79.5 | D | v0.6 | default · in composite | |
| financial risk | 84.5 | F | v0.5 | default · in composite | R18. |
| p adverse action 12m | 0.0 | — | v0.1 | default · in composite | 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. |
| p chow 12m | 25.7 | — | v0.1 | default · in 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. |
| regulatory risk | 87.4 | F | v0.3 | default · in composite | Deficiency-based, SNF population. Runs alongside v0.5-pos. |
| staffing risk | 89.7 | F | v0.3 | default · in composite | Cost-report staffing, SNF population. Runs alongside v0.4-pos, which covers ICF/IID from POS. |
| financial risk | 75.4 | D | v0.1 | superseded | 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. |
| financial risk | 55.4 | C | v0.2 | superseded | 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. |
| financial risk | 67.2 | D | v0.3 | superseded | 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. |
| financial risk | 84.3 | F | v0.4 | superseded | 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. |
| regulatory risk | 87.4 | F | v0.1 | superseded | 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. |
| regulatory risk | 87.4 | F | v0.2 | superseded | 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. |
| staffing risk | 89.7 | F | v0.1 | superseded | 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. |
| staffing risk | 89.7 | F | v0.2 | superseded | 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.
CHOW radar — 12-month sale probability
full board →p(CHOW, 12m)
25.7%
model v0.1 · computed 2026-07-29
Percentile among SNFs
100.0
100 = most likely to sell
Holdout AUC
0.874
evaluated before shipping, never refit
| Driver | Value | Pull on odds | |
|---|---|---|---|
| Chain size (log) | 5.46 | +0.76 | |
| For-profit ownership | 1.00 | +0.69 | |
| Never sold on record | 1.00 | +0.62 | |
| Current owner tenure (years) | 25.00 | +0.57 | |
| Contract staffing share | 0.36 | +0.46 | |
| No PBJ staffing report | 0.00 | +0.42 | |
| Deficiencies, last 12 months | 24.00 | +0.41 | |
| Ownership changes, last 5 years | 0.00 | +0.20 |
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.
Distress radar — 12-month termination probability
full board →p(termination, 12m)
0.0%
model v0.1 · computed 2026-07-29
Percentile among SNFs
0.0
100 = most likely to lose certification
Holdout AUC
0.971
top decile caught 95% of actual exits
| Driver | Value | Pull on odds | |
|---|---|---|---|
| Deficiencies, last 12 months | 24.00 | -3.02 | |
| Chain size (log) | 5.46 | -1.98 | |
| For-profit ownership | 1.00 | -0.69 | |
| No PBJ staffing report | 0.00 | +0.39 | |
| Contract staffing share | 0.36 | +0.31 | |
| Total nurse staffing (HPRD) | 2.55 | +0.28 | |
| Occupancy | 0.70 | +0.20 | |
| Fine amount, 12m (log) | 0.00 | +0.18 |
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 | 2.55 | 3.15 | 3.28 | 2.90–3.77 |
| RN | 0.45 | 0.46 | 0.39 | 0.25–0.58 |
| Weekend total | 2.26 | 2.96 | 3.11 | — |
| Weekday total | 2.66 | 3.20 | 3.35 | — |
| Quarter | Days | Avg census | Total HPRD | RN | LPN | CNA | Weekend | Contract % |
|---|---|---|---|---|---|---|---|---|
| 2025Q4 | 92 | 44.9 | 2.55 | 0.45 | 0.61 | 1.49 | 2.26 | 36.2% |
| 2025Q3 | 92 | 41.3 | 2.76 | 0.32 | 0.73 | 1.71 | 2.50 | 25.4% |
| 2025Q2 | 91 | 40.9 | 2.65 | 0.21 | 0.92 | 1.53 | 2.47 | 21.0% |
| 2025Q1 | 90 | 49.1 | 2.50 | 0.17 | 0.86 | 1.48 | 2.36 | 24.7% |
| 2024Q4 | 92 | 46.1 | 2.66 | 0.19 | 0.89 | 1.58 | 2.52 | 9.4% |
| 2024Q3 | 92 | 43.4 | 2.68 | 0.23 | 0.80 | 1.65 | 2.54 | 0.0% |
| 2024Q2 | 91 | 40.7 | 2.59 | 0.27 | 0.77 | 1.55 | 2.57 | 18.8% |
| 2024Q1 | 91 | 40.6 | 2.72 | 0.21 | 0.91 | 1.60 | 2.77 | 39.9% |
| 2023Q4 | 92 | 42.7 | 2.56 | 0.21 | 0.84 | 1.51 | 2.54 | 29.8% |
| 2023Q3 | 92 | 41.6 | 2.50 | 0.05 | 0.94 | 1.51 | 2.44 | 35.4% |
| 2023Q2 | 91 | 41.8 | 2.47 | 0.18 | 0.81 | 1.48 | 2.51 | 36.1% |
| 2023Q1 | 90 | 48.0 | 2.43 | 0.28 | 0.71 | 1.44 | 2.36 | 39.4% |
| 2022Q4 | 92 | 48.8 | 2.42 | 0.28 | 0.62 | 1.52 | 2.47 | 32.9% |
| 2022Q3 | 92 | 46.4 | 2.46 | 0.28 | 0.58 | 1.60 | 2.45 | 38.5% |
| 2022Q2 | 91 | 46.3 | 2.28 | 0.31 | 0.57 | 1.40 | 2.38 | 33.6% |
| 2022Q1 | 90 | 49.5 | 2.06 | 0.14 | 0.55 | 1.37 | 2.07 | 38.8% |
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.
Penalties
2| Date | Type | Fine | Source |
|---|---|---|---|
| 2024-07-28 | Fine | $8,649 | CMS provider data |
| 2024-01-31 | Fine | $16,801 | CMS provider data |
Total fines on record: $25,450
Deficiencies
70D × 42E × 24F × 1G × 1J × 1K × 1
deficiencies by survey year
| Survey | Type | Tag | Deficiency | Scope | Corrected |
|---|---|---|---|---|---|
| 2026-03-26 | Health · complaint | F0558 | Reasonably accommodate the needs and preferences of each resident. | D | 2026-04-08 |
| 2026-03-26 | Health | F0567 | Honor the resident's right to manage his or her financial affairs. | D | 2026-04-08 |
| 2026-03-26 | 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 | 2026-04-08 |
| 2026-03-26 | Health | F0582 | Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. | D | 2026-04-08 |
| 2026-03-26 | Health · complaint | F0584 | 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. | E | 2026-04-08 |
| 2026-03-26 | Health · complaint | F0600 | Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | G | 2026-04-08 |
| 2026-03-26 | Health | F0605 | Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function. | D | 2026-04-08 |
| 2026-03-26 | Health · complaint | F0609 | Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | D | 2026-04-08 |
| 2026-03-26 | Health | F0628 | Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies. | D | 2026-04-08 |
| 2026-03-26 | Health | F0644 | Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. | D | 2026-04-08 |
| 2026-03-26 | 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 | 2026-04-08 |
| 2026-03-26 | Health · complaint | F0677 | Provide care and assistance to perform activities of daily living for any resident who is unable. | D | 2026-04-08 |
| 2026-03-26 | Health | F0684 | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | E | 2026-04-08 |
| 2026-03-26 | Health | F0690 | Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. | D | 2026-04-08 |
| 2026-03-26 | Health | F0693 | 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. | D | 2026-04-08 |
| 2026-03-26 | Health | F0725 | Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. | E | 2026-04-08 |
| 2026-03-26 | Health | F0744 | Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia. | D | 2026-04-08 |
| 2026-03-26 | Health | F0760 | Ensure that residents are free from significant medication errors. | D | 2026-04-08 |
| 2026-03-26 | Health | F0804 | Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. | E | 2026-04-08 |
| 2026-03-26 | Health | F0842 | Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | D | 2026-04-08 |
| 2026-03-26 | Health | F0865 | Have a plan that describes the process for conducting QAPI and QAA activities. | D | 2026-04-08 |
| 2026-03-26 | Health | F0868 | Have the Quality Assessment and Assurance group have the required members and meet at least quarterly | D | 2026-04-08 |
| 2026-03-26 | Health | F0880 | Provide and implement an infection prevention and control program. | E | 2026-04-08 |
| 2025-10-08 | Health · complaint | 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 | 2025-10-13 |
| 2025-03-11 | Health | F0582 | Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. | D | 2025-03-28 |
| 2025-03-11 | Health | F0584 | 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. | D | 2025-03-28 |
| 2025-03-11 | 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. | E | 2025-03-28 |
| 2025-03-11 | 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 | 2025-03-28 |
| 2025-03-11 | Health · complaint | F0677 | Provide care and assistance to perform activities of daily living for any resident who is unable. | E | 2025-03-28 |
| 2025-03-11 | Health · complaint | F0684 | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | D | 2025-03-28 |
| 2025-03-11 | Health · complaint | F0689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | D | 2025-03-28 |
| 2025-03-11 | Health | F0758 | Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. | D | 2025-03-28 |
| 2025-03-11 | Health | F0801 | Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician. | E | 2025-03-28 |
| 2025-03-11 | Health | F0880 | Provide and implement an infection prevention and control program. | D | 2025-03-28 |
| 2024-07-28 | Health · complaint | F0550 | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | D | 2024-08-13 |
| 2024-07-28 | Health · complaint | F0558 | Reasonably accommodate the needs and preferences of each resident. | D | 2024-08-13 |
| 2024-07-28 | Health · complaint | F0689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | D | 2024-08-13 |
| 2024-07-28 | Health · complaint | F0690 | Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. | D | 2024-08-13 |
| 2024-07-28 | Health · complaint | F0725 | Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. | D | 2024-08-13 |
| 2024-07-28 | Health · complaint | 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 | 2024-08-13 |
| 2024-07-28 | Health · complaint | F0804 | Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. | E | 2024-08-13 |
| 2024-07-28 | Health · complaint | F0805 | Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. | J | 2024-08-07 |
| 2024-07-28 | Health · complaint | F0806 | Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. | D | 2024-08-13 |
| 2024-07-28 | 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 | 2024-08-13 |
| 2024-07-28 | Health · complaint | F0880 | Provide and implement an infection prevention and control program. | E | 2024-08-13 |
| 2024-01-31 | Health | F0550 | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | E | 2024-02-14 |
| 2024-01-31 | Health | F0584 | 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. | D | 2024-02-14 |
| 2024-01-31 | Health | F0585 | Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances. | E | 2024-02-14 |
| 2024-01-31 | Health | F0607 | Develop and implement policies and procedures to prevent abuse, neglect, and theft. | E | 2024-02-14 |
| 2024-01-31 | 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 | 2024-02-14 |
| 2024-01-31 | 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 | 2024-02-14 |
| 2024-01-31 | Health | F0641 | Ensure each resident receives an accurate assessment. | D | 2024-02-14 |
| 2024-01-31 | Health | F0644 | Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. | D | 2024-02-14 |
| 2024-01-31 | 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 | 2024-02-14 |
| 2024-01-31 | Health · complaint | F0658 | Ensure services provided by the nursing facility meet professional standards of quality. | D | 2024-02-14 |
| 2024-01-31 | Health | F0725 | Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. | E | 2024-02-14 |
| 2024-01-31 | Health | F0726 | Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. | E | 2024-02-14 |
| 2024-01-31 | Health · complaint | F0758 | Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. | D | 2024-02-14 |
| 2024-01-31 | Health | F0760 | Ensure that residents are free from significant medication errors. | D | 2024-02-14 |
| 2024-01-31 | Health | F0802 | Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service. | E | 2024-02-14 |
| 2024-01-31 | 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 | 2024-02-14 |
| 2024-01-31 | Health | F0804 | Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. | E | 2024-02-14 |
| 2024-01-31 | Health | F0805 | Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. | K | 2024-02-08 |
| 2024-01-31 | Health | 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 | 2024-02-14 |
| 2024-01-31 | Health | F0812 | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | E | 2024-02-14 |
| 2024-01-31 | Health | F0865 | Have a plan that describes the process for conducting QAPI and QAA activities. | E | 2024-02-14 |
| 2024-01-31 | Health | F0868 | Have the Quality Assessment and Assurance group have the required members and meet at least quarterly | E | 2024-02-14 |
| 2024-01-31 | Health | F0880 | Provide and implement an infection prevention and control program. | F | 2024-02-14 |
| 2024-01-31 | Health | F0883 | Develop and implement policies and procedures for flu and pneumonia vaccinations. | D | 2024-02-14 |
| 2023-08-17 | Health · complaint | F0689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | D | 2023-06-14 |
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
0No 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
34| Owner | Role | Pct | From | Status | Source |
|---|---|---|---|---|---|
| AEROFUND HOLDINGS INC | OPERATIONAL/MANAGERIAL CONTROL | — | 2011-07-18 | current | pecos_ownership |
| BIG SIOUX RIVER HEALTH HOLDINGS LLC | Corporation, partnership or other organization has financial interest in provider | — | 2023-01-01 | current | hcris_a_8_1 |
| BIG SIOUX RIVER HEALTH HOLDINGS LLC | Corporation, partnership or other organization has financial interest in provider | — | 2024-01-01 | current | hcris_a_8_1 |
| BLU MEDSTAFF LLC | OPERATIONAL/MANAGERIAL CONTROL | — | 2011-07-18 | current | pecos_ownership |
| BURNAM, SOON | CORPORATE OFFICER | — | 2024-09-09 | current | pecos_ownership |
| CARETRUST GP LLC | ADP OF THE SNF | — | 2011-07-18 | current | pecos_ownership |
| CARETRUST REIT INC | ADP OF THE SNF | — | 2011-07-18 | current | pecos_ownership |
| CTR PARTNERSHIP LP | ADP OF THE SNF | — | 2011-07-18 | current | pecos_ownership |
| ENSIGN SERVICES INC | ADP OF THE SNF | — | 2011-06-01 | current | pecos_ownership |
| HEART MEDICAL SOLUTIONS LLC | OPERATIONAL/MANAGERIAL CONTROL | — | 2011-07-18 | current | pecos_ownership |
| HELPING HANDS NURSING SOLUTION INC | OPERATIONAL/MANAGERIAL CONTROL | — | 2011-07-18 | current | pecos_ownership |
| JORGENSEN, DAVID | CORPORATE DIRECTOR | — | 2024-01-01 | current | pecos_ownership |
| KAMSTRA, LEE | ADP OF THE SNF | — | 2025-07-10 | current | pecos_ownership |
| KAMSTRA, LEE | OPERATIONAL/MANAGERIAL CONTROL | — | 2024-09-16 | current | pecos_ownership |
| KEETCH, CHAD | CORPORATE OFFICER | — | 2011-03-01 | current | pecos_ownership |
| KOENIG, DEBRA | CORPORATE OFFICER | — | 2020-01-01 | current | pecos_ownership |
| ONSHIFT INC | OPERATIONAL/MANAGERIAL CONTROL | — | 2011-07-18 | current | pecos_ownership |
| PORT, BARRY | CORPORATE DIRECTOR | — | 2018-07-20 | current | pecos_ownership |
| SATO, AMI | CORPORATE OFFICER | — | 2024-09-09 | current | pecos_ownership |
| THE ENSIGN GROUP INC | ADP OF THE SNF | — | 2002-07-29 | current | pecos_ownership |
| WILKINS, MELODEE | MANAGING CONTROL - GOVERNING BODY | — | 2011-07-18 | current | pecos_ownership |
| WILKINS, MELODEE | ADP OF THE SNF | — | 2025-07-10 | current | pecos_ownership |
| GATEWAY HEALTHCARE LLC | 5% OR GREATER DIRECT OWNERSHIP INTEREST | 100% | 2011-07-18 | ended 2026-05-18 | pecos_ownership |
| AMI SATO | CORPORATE OFFICER | 0% | 2024-09-09 | ended 2026-05-18 | pecos_ownership |
| BARRY PORT | CORPORATE DIRECTOR | 0% | 2018-07-20 | ended 2026-05-18 | pecos_ownership |
| CHAD KEETCH | CORPORATE OFFICER | 0% | 2011-03-01 | ended 2026-05-18 | pecos_ownership |
| DAVID JORGENSEN | CORPORATE DIRECTOR | 0% | 2024-01-01 | ended 2026-05-18 | pecos_ownership |
| DEBRA KOENIG | CORPORATE OFFICER | 0% | 2020-01-01 | ended 2026-05-18 | pecos_ownership |
| MELODEE WILKINS | OPERATIONAL/MANAGERIAL CONTROL | 0% | 2011-07-18 | ended 2026-05-18 | pecos_ownership |
| SOON BURNAM | CORPORATE OFFICER | 0% | 2024-09-09 | ended 2026-05-18 | pecos_ownership |
| BIG SIOUX RIVER HEALTH HOLDINGS LLC | Corporation, partnership or other organization has financial interest in provider | — | 2022-01-01 | ended 2022-12-31 | hcris_a_8_1 |
| LEE KAMSTRA | ADP OF THE SNF | — | 2025-07-10 | ended 2026-05-18 | pecos_ownership |
| LEE KAMSTRA | MANAGING CONTROL - GOVERNING BODY | — | 2024-09-16 | ended 2026-05-18 | pecos_ownership |
| MELODEE WILKINS | ADP OF THE SNF | — | 2025-07-10 | 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.
Transactions
0No transactions on record for this facility. Absence of a record here means the sources CII ingests contain none, not that none exists anywhere.
Comparable trades — IA snf
12| Close | Facility | Price | $/bed | Cap rate | Beds | Buyer |
|---|---|---|---|---|---|---|
| 2025-09-01 | St Luke's Regional Medical Center SNF | — | — | — | 20 | NORTHWEST IOWA HOSPITAL CORPORATION |
| 2025-08-01 | Crystal Heights Care Center | — | — | — | 72 | CANFIELD RIVER HEALTHCARE LLC |
| 2025-06-01 | AMS Memorial-Greene | — | — | — | 31 | AMS MEMORIAL-GREENE LLC |
| 2025-02-05 | Chapters Living of Council Bluffs | — | — | — | 102 | CHAPTERS COUNCIL BLUFFS OPCO LLC |
| 2025-02-01 | Osage Rehab and Health Care Center | — | — | — | 46 | OPCO OSAGE IA LLC |
| 2025-02-01 | Iowa City Rehab & Health Care | — | — | — | 89 | OPCO IOWA CITY IA LLC |
| 2025-02-01 | Accura Healthcare of Creston | — | — | — | 31 | ACCURA HEALTHCARE OF CRESTON LLC |
| 2025-02-01 | Casa De Paz Health Care Center | — | — | — | 71 | OPCO 19TH ST SIOUX CITY IA LLC |
| 2025-02-01 | Pleasant Acres Care Center | — | — | — | 46 | OPCO HULL IA LLC |
| 2025-02-01 | Cedar Falls Health Care Center | — | — | — | 70 | OPCO CEDAR FALLS IA LLC |
| 2025-02-01 | Accura Healthcare of Onawa | — | — | — | 46 | ACCURA HEALTHCARE OF ONAWA LLC |
| 2025-02-01 | Grundy Care Center | — | — | — | 40 | OPCO GRUNDY CENTER IA LLC |
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
33| Geo | Kind | BR | Amount | As of | Source |
|---|---|---|---|---|---|
| county 19167 | acs median gross | 0 | $633 | 2024-12-31 | CENSUS_ACS5 |
| county 19167 | fmr | 0 | $735 | 2025-10-01 | HUD_USER_FMR |
| county 19167 | acs median gross | 1 | $684 | 2024-12-31 | CENSUS_ACS5 |
| county 19167 | fmr | 1 | $740 | 2025-10-01 | HUD_USER_FMR |
| county 19167 | acs median gross | 2 | $923 | 2024-12-31 | CENSUS_ACS5 |
| county 19167 | fmr | 2 | $971 | 2025-10-01 | HUD_USER_FMR |
| county 19167 | acs median gross | 3 | $1,041 | 2024-12-31 | CENSUS_ACS5 |
| county 19167 | fmr | 3 | $1,246 | 2025-10-01 | HUD_USER_FMR |
| county 19167 | acs median gross | 4 | $1,191 | 2024-12-31 | CENSUS_ACS5 |
| county 19167 | fmr | 4 | $1,351 | 2025-10-01 | HUD_USER_FMR |
| county 19167 | acs median gross | 5 | $1,292 | 2024-12-31 | CENSUS_ACS5 |
| county 19167 | acs median gross | $908 | 2024-12-31 | CENSUS_ACS5 | |
| county 19167 | acs recent mover gross | $996 | 2024-12-31 | CENSUS_ACS5 | |
| zcta 51023 | acs median gross | 1 | $825 | 2024-12-31 | CENSUS_ACS5 |
| zcta 51023 | acs median gross | 2 | $910 | 2024-12-31 | CENSUS_ACS5 |
| zcta 51023 | acs median gross | 3 | $967 | 2024-12-31 | CENSUS_ACS5 |
| zcta 51023 | acs median gross | $926 | 2024-12-31 | CENSUS_ACS5 | |
| zcta 51023 | acs recent mover gross | $747 | 2024-12-31 | CENSUS_ACS5 | |
| zip 51023 | payment standard 110 | 0 | $825 | 2025-10-01 | HUD_USER_SAFMR |
| zip 51023 | payment standard 90 | 0 | $675 | 2025-10-01 | HUD_USER_SAFMR |
| zip 51023 | safmr | 0 | $750 | 2025-10-01 | HUD_USER_SAFMR |
| zip 51023 | payment standard 110 | 1 | $847 | 2025-10-01 | HUD_USER_SAFMR |
| zip 51023 | payment standard 90 | 1 | $693 | 2025-10-01 | HUD_USER_SAFMR |
| zip 51023 | safmr | 1 | $770 | 2025-10-01 | HUD_USER_SAFMR |
| zip 51023 | payment standard 110 | 2 | $1,100 | 2025-10-01 | HUD_USER_SAFMR |
| zip 51023 | payment standard 90 | 2 | $900 | 2025-10-01 | HUD_USER_SAFMR |
| zip 51023 | safmr | 2 | $1,000 | 2025-10-01 | HUD_USER_SAFMR |
| zip 51023 | payment standard 110 | 3 | $1,408 | 2025-10-01 | HUD_USER_SAFMR |
| zip 51023 | payment standard 90 | 3 | $1,152 | 2025-10-01 | HUD_USER_SAFMR |
| zip 51023 | safmr | 3 | $1,280 | 2025-10-01 | HUD_USER_SAFMR |
| zip 51023 | payment standard 110 | 4 | $1,529 | 2025-10-01 | HUD_USER_SAFMR |
| zip 51023 | payment standard 90 | 4 | $1,251 | 2025-10-01 | HUD_USER_SAFMR |
| zip 51023 | safmr | 4 | $1,390 | 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.