1514 High Avenue West, Oskaloosa, IA 52577 · CCN 165570 · chain THE ENSIGN GROUP INC
Composite
61.6 / 100 percentile
Peer group
snf n = 14,684
Evidence depth
deep
Certified beds
72
Model
v1.2
Reads as: riskier than 61.6% 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
6
Kind
Finding
Signal
Subject
First seen
connection
Owner fleet risk far above national
+24.0 vs natl
GATEWAY HEALTHCARE LLC
12 facilities
connection
Owner spans multiple chains
18 chains
ENSIGN SERVICES INC
286 facilities
connection
Owner spans multiple chains
17 chains
BURNAM SOON
335 facilities
connection
Owner spans multiple chains
17 chains
KEETCH CHAD
283 facilities
connection
Owner spans multiple chains
12 chains
THE ENSIGN GROUP INC
123 facilities
connection
Owner spans multiple chains
11 chains
STANDARD BEARER HEALTHCARE OP LP
83 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
2.62
3.15
3.28
2.90–3.77
RN
0.19
0.46
0.39
0.25–0.58
Weekend total
2.39
2.96
3.11
—
Weekday total
2.72
3.20
3.35
—
Quarter
Days
Avg census
Total HPRD
RN
LPN
CNA
Weekend
Contract %
2025Q4
92
67.1
2.62
0.19
0.37
2.06
2.39
7.0%
2025Q3
92
64.4
2.61
0.17
0.53
1.90
2.38
13.3%
2025Q2
91
60.8
2.36
0.11
0.47
1.78
2.22
17.7%
2025Q1
90
61.6
2.14
0.16
0.35
1.63
2.03
15.6%
2024Q4
92
56.1
2.33
0.11
0.43
1.78
2.17
16.3%
2024Q3
92
57.1
2.64
0.15
0.51
1.98
2.56
16.9%
2024Q2
91
58.0
2.38
0.13
0.54
1.71
2.31
25.3%
2024Q1
91
53.5
2.38
0.18
0.52
1.68
2.30
30.8%
2023Q4
92
53.4
2.12
0.26
0.25
1.62
2.02
22.6%
2023Q3
92
48.4
2.12
0.32
0.21
1.58
2.05
10.6%
2023Q2
91
49.5
1.92
0.36
0.21
1.35
1.83
7.2%
2023Q1
90
49.2
1.84
0.35
0.22
1.27
1.72
4.3%
2022Q4
92
47.6
2.01
0.22
0.28
1.50
1.94
11.7%
2022Q3
92
52.6
2.06
0.37
0.28
1.41
1.91
10.4%
2022Q2
91
49.2
2.16
0.26
0.46
1.44
2.06
5.9%
2022Q1
90
53.3
1.92
0.17
0.48
1.27
1.76
0.1%
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 residents are free from significant medication errors.
D
2025-12-15
2025-06-26
Health · complaint
F0550
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
D
2025-07-26
2025-06-26
Health
F0567
Honor the resident's right to manage his or her financial affairs.
D
2025-07-26
2025-06-26
Health
F0578
Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.
D
2025-07-26
2025-06-26
Health
F0641
Ensure each resident receives an accurate assessment.
D
2025-07-26
2025-06-26
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.
E
2025-07-26
2025-06-26
Health
F0679
Provide activities to meet all resident's needs.
E
2025-07-26
2025-06-26
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
2025-07-26
2025-06-26
Health
F0697
Provide safe, appropriate pain management for a resident who requires such services.
D
2025-07-26
2025-06-26
Health
F0699
Provide care or services that was trauma informed and/or culturally competent.
D
2025-07-26
2025-06-26
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
2025-07-26
2025-06-26
Health · complaint
F0880
Provide and implement an infection prevention and control program.
D
2025-07-26
2023-12-07
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
2024-01-07
2023-12-07
Health
F0658
Ensure services provided by the nursing facility meet professional standards of quality.
D
2024-01-07
2023-12-07
Health
F0677
Provide care and assistance to perform activities of daily living for any resident who is unable.
D
2024-01-07
2023-12-07
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
2024-01-07
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
23
Owner
Role
Pct
From
Status
Source
BURNAM, SOON
OPERATIONAL/MANAGERIAL CONTROL
—
2025-05-21
current
pecos_ownership
CRYSTAL PROPERTIES INC
Director, officer, administrator or key person of provider or organization
—
2024-01-01
current
hcris_a_8_1
CRYSTAL PROPERTIES INC
Director, officer, administrator or key person of provider or organization
—
2023-01-01
current
hcris_a_8_1
ENSIGN SERVICES INC
ADP OF THE SNF
—
2025-05-21
current
pecos_ownership
GATEWAY HEALTHCARE LLC
DIRECT OWNERSHIP INTEREST
—
2025-05-21
current
pecos_ownership
JORGENSEN, DAVID
INDIVIDUAL IS AN OWNER, PARTNER OR TRUSTEE OF ANY ADP OF THE SNF
—
2025-08-20
current
pecos_ownership
KEETCH, CHAD
INDIVIDUAL IS AN OWNER, PARTNER OR TRUSTEE OF ANY ADP OF THE SNF
—
2025-08-20
current
pecos_ownership
KOENIG, DEBRA
ADP OF THE SNF
—
2025-07-24
current
pecos_ownership
KOENIG, DEBRA
OPERATIONAL/MANAGERIAL CONTROL
—
2025-08-01
current
pecos_ownership
NARROWS PEAK HEALTH HOLDINGS LLC
ADP OF THE SNF
—
2025-08-01
current
pecos_ownership
NORTH, DAVID
ADP OF THE SNF
—
2025-07-24
current
pecos_ownership
NORTH, DAVID
MANAGING CONTROL - GOVERNING BODY
—
2025-08-01
current
pecos_ownership
PORT, BARRY
INDIVIDUAL IS AN OWNER, PARTNER OR TRUSTEE OF ANY ADP OF THE SNF
—
2025-07-24
current
pecos_ownership
STANDARD BEARER HEALTHCARE OP, LP
ADP OF THE SNF
—
2025-08-01
current
pecos_ownership
THE ENSIGN GROUP INC
INDIRECT OWNERSHIP INTEREST
—
2025-05-21
current
pecos_ownership
CRYSTAL PROPERTIES INC
Director, officer, administrator or key person of provider or organization
—
2021-01-01
ended 2021-12-31
hcris_a_8_1
CRYSTAL PROPERTIES INC
Director, officer, administrator or key person of provider or organization
—
2020-01-01
ended 2020-12-31
hcris_a_8_1
CRYSTAL PROPERTIES INC
Director, officer, administrator or key person of provider or organization
—
2022-01-01
ended 2022-12-31
hcris_a_8_1
DAVID NORTH
MANAGING CONTROL - GOVERNING BODY
—
2025-08-01
ended 2026-05-18
pecos_ownership
DAVID NORTH
ADP OF THE SNF
—
2025-07-24
ended 2026-05-18
pecos_ownership
DEBRA KOENIG
OPERATIONAL/MANAGERIAL CONTROL
—
2025-08-01
ended 2026-05-18
pecos_ownership
DEBRA KOENIG
ADP OF THE SNF
—
2025-07-24
ended 2026-05-18
pecos_ownership
SOON BURNAM
OPERATIONAL/MANAGERIAL CONTROL
—
2025-05-21
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
$266,895
$180,000
—
—
—
3
propco
2023-12-31
$363,147
$267,518
—
—
—
3
propco
2022-12-31
$456,240
$317,036
—
—
—
4
propco
2021-12-31
$509,779
$369,491
—
—
$140,288
4
propco
2020-12-31
$511,122
$382,759
—
—
$51,715
4
propco
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 19123
acs median gross
0
$905
2024-12-31
CENSUS_ACS5
county 19123
fmr
0
$717
2025-10-01
HUD_USER_FMR
county 19123
acs median gross
1
$453
2024-12-31
CENSUS_ACS5
county 19123
fmr
1
$722
2025-10-01
HUD_USER_FMR
county 19123
acs median gross
2
$810
2024-12-31
CENSUS_ACS5
county 19123
fmr
2
$947
2025-10-01
HUD_USER_FMR
county 19123
acs median gross
3
$992
2024-12-31
CENSUS_ACS5
county 19123
fmr
3
$1,135
2025-10-01
HUD_USER_FMR
county 19123
acs median gross
4
$816
2024-12-31
CENSUS_ACS5
county 19123
fmr
4
$1,254
2025-10-01
HUD_USER_FMR
county 19123
acs median gross
5
$1,061
2024-12-31
CENSUS_ACS5
county 19123
acs median gross
$793
2024-12-31
CENSUS_ACS5
county 19123
acs recent mover gross
$816
2024-12-31
CENSUS_ACS5
zcta 52577
acs median gross
0
$912
2024-12-31
CENSUS_ACS5
zcta 52577
acs median gross
1
$427
2024-12-31
CENSUS_ACS5
zcta 52577
acs median gross
2
$855
2024-12-31
CENSUS_ACS5
zcta 52577
acs median gross
3
$1,010
2024-12-31
CENSUS_ACS5
zcta 52577
acs median gross
4
$880
2024-12-31
CENSUS_ACS5
zcta 52577
acs median gross
5
$1,063
2024-12-31
CENSUS_ACS5
zcta 52577
acs median gross
$825
2024-12-31
CENSUS_ACS5
zip 52577
payment standard 110
0
$825
2025-10-01
HUD_USER_SAFMR
zip 52577
payment standard 90
0
$675
2025-10-01
HUD_USER_SAFMR
zip 52577
safmr
0
$750
2025-10-01
HUD_USER_SAFMR
zip 52577
payment standard 110
1
$825
2025-10-01
HUD_USER_SAFMR
zip 52577
payment standard 90
1
$675
2025-10-01
HUD_USER_SAFMR
zip 52577
safmr
1
$750
2025-10-01
HUD_USER_SAFMR
zip 52577
payment standard 110
2
$1,089
2025-10-01
HUD_USER_SAFMR
zip 52577
payment standard 90
2
$891
2025-10-01
HUD_USER_SAFMR
zip 52577
safmr
2
$990
2025-10-01
HUD_USER_SAFMR
zip 52577
payment standard 110
3
$1,309
2025-10-01
HUD_USER_SAFMR
zip 52577
payment standard 90
3
$1,071
2025-10-01
HUD_USER_SAFMR
zip 52577
safmr
3
$1,190
2025-10-01
HUD_USER_SAFMR
zip 52577
payment standard 110
4
$1,441
2025-10-01
HUD_USER_SAFMR
zip 52577
payment standard 90
4
$1,179
2025-10-01
HUD_USER_SAFMR
zip 52577
safmr
4
$1,310
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.