Composite
97.0 / 100 percentile
| Component | Percentile | Raw | Weight | Weight share | Contribution | Counts |
|---|---|---|---|---|---|---|
| regulatory risk | 90.0 | 87.6 | 0.30 | 0.2308 | 20.77 | in index |
| billing conduct | 88.3 | 58.4 | 0.30 | 0.2308 | 20.38 | in index |
| staffing risk | 80.7 | 80.7 | 0.25 | 0.1923 | 15.52 | in index |
| financial risk | 60.0 | 52.3 | 0.30 | 0.2308 | 13.85 | in index |
| chow risk | 33.2 | 31.9 | 0.15 | 0.1154 | 3.83 | in index |
| Kind | Finding | Signal | Subject | First seen |
|---|---|---|---|---|
| connection | Owner fleet risk far above national | +39.6 vs natl | RAMOS BRIAN | 8 facilities |
| connection | Owner fleet risk far above national | +28.1 vs natl | EDURO HEALTHCARE LLC | 10 facilities |
| connection | Owner fleet risk far above national | +23.4 vs natl | THOMPSON CHRISTOPHER | 11 facilities |
| connection | Owner fleet risk far above national | +20.2 vs natl | BEWSEY MICHAEL | 31 facilities |
| connection | Owner spans multiple chains | 6 chains | BEWSEY MICHAEL | 29 facilities |
| connection | Owner fleet enforcement cluster | 88% fined | RAMOS BRIAN | 8 facilities |
| connection | Owner fleet enforcement cluster | 50% fined | EDURO HEALTHCARE LLC | 10 facilities |
| connection | Owner fleet enforcement cluster | 48% fined | BEWSEY MICHAEL | 31 facilities |
| connection | Owner fleet enforcement cluster | 46% fined | THOMPSON CHRISTOPHER | 11 facilities |
| Score type | Score | Grade | Model | Status | Registry model notes |
|---|---|---|---|---|---|
| billing conduct | 58.4 | C | 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 | 38.7 | B | v0.6 | default · in composite | |
| financial risk | 52.3 | C | 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 | 0.2 | — | 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 | 87.6 | F | v0.3 | default · in composite | Deficiency-based, SNF population. Runs alongside v0.5-pos. |
| staffing risk | 80.7 | F | v0.3 | default · in composite | Cost-report staffing, SNF population. Runs alongside v0.4-pos, which covers ICF/IID from POS. |
| financial risk | 55.4 | C | 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 | 35.4 | B | 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 | 45.2 | C | 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 | 57.2 | C | 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 | 87.5 | 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 | 87.5 | 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 | 80.7 | 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 | 80.7 | 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. |
| Driver | Value | Pull on odds | |
|---|---|---|---|
| Never sold on record | 0.00 | -1.62 | |
| Current owner tenure (years) | 7.49 | -1.12 | |
| For-profit ownership | 1.00 | +0.69 | |
| No PBJ staffing report | 0.00 | +0.42 | |
| Ownership changes, last 5 years | 0.00 | +0.20 | |
| Chain size (log) | 2.71 | +0.17 | |
| Deficiencies, last 12 months | 12.00 | +0.12 | |
| Occupancy | 0.66 | +0.12 |
| Driver | Value | Pull on odds | |
|---|---|---|---|
| Deficiencies, last 12 months | 12.00 | -0.80 | |
| For-profit ownership | 1.00 | -0.69 | |
| Fine amount, 12m (log) | 10.58 | -0.60 | |
| No PBJ staffing report | 0.00 | +0.39 | |
| Occupancy | 0.66 | +0.39 | |
| Chain size (log) | 2.71 | -0.37 | |
| Staffing trend, last 4 quarters | 0.69 | +0.30 | |
| Never sold on record | 0.00 | -0.28 |
| 2025Q4 HPRD | This facility | SD median | National median | National p25–p75 |
|---|---|---|---|---|
| Total nurse | 2.78 | 2.96 | 3.28 | 2.90–3.77 |
| RN | 0.33 | 0.52 | 0.39 | 0.25–0.58 |
| Weekend total | 2.24 | 2.75 | 3.11 | — |
| Weekday total | 3.00 | 3.06 | 3.35 | — |
| Quarter | Days | Avg census | Total HPRD | RN | LPN | CNA | Weekend | Contract % |
|---|---|---|---|---|---|---|---|---|
| 2025Q4 | 92 | 54.5 | 2.78 | 0.33 | 0.51 | 1.95 | 2.24 | 9.0% |
| 2025Q3 | 92 | 52.7 | 2.13 | 0.17 | 0.48 | 1.48 | 1.94 | 2.7% |
| 2025Q2 | 91 | 47.8 | 2.00 | 0.24 | 0.31 | 1.45 | 1.85 | 25.1% |
| 2025Q1 | 90 | 47.5 | 1.92 | 0.34 | 0.14 | 1.44 | 1.75 | 16.7% |
| 2024Q4 | 92 | 48.6 | 2.09 | 0.45 | 0.20 | 1.44 | 1.97 | 0.0% |
| 2024Q3 | 92 | 50.0 | 2.13 | 0.37 | 0.22 | 1.54 | 1.95 | 0.0% |
| 2024Q2 | 91 | 52.6 | 2.07 | 0.24 | 0.38 | 1.46 | 1.73 | 0.0% |
| 2024Q1 | 91 | 51.3 | 2.28 | 0.40 | 0.35 | 1.53 | 1.90 | 0.0% |
| 2023Q4 | 92 | 51.3 | 2.26 | 0.38 | 0.43 | 1.45 | 2.00 | 0.3% |
| 2023Q3 | 92 | 52.9 | 2.23 | 0.28 | 0.48 | 1.46 | 2.00 | 4.5% |
| 2023Q2 | 91 | 51.7 | 2.38 | 0.44 | 0.34 | 1.60 | 2.29 | 39.3% |
| 2023Q1 | 90 | 52.4 | 2.51 | 0.42 | 0.45 | 1.64 | 2.48 | 38.3% |
| 2022Q4 | 92 | 52.5 | 2.58 | 0.28 | 0.47 | 1.82 | 2.51 | 36.4% |
| 2022Q3 | 92 | 52.3 | 2.29 | 0.33 | 0.48 | 1.47 | 2.03 | 26.5% |
| 2022Q2 | 91 | 53.8 | 2.17 | 0.30 | 0.39 | 1.48 | 1.89 | 8.0% |
| 2022Q1 | 90 | 57.4 | 2.56 | 0.47 | 0.31 | 1.77 | 2.17 | 0.0% |
| Date | Type | Fine | Source |
|---|---|---|---|
| 2025-09-29 | Fine | $39,215 | CMS provider data |
| 2025-01-28 | Fine | $7,008 | CMS provider data |
| 2024-10-17 | Fine | $16,656 | CMS provider data |
| 2024-09-04 | Fine | $31,480 | CMS provider data |
| Survey | Type | Tag | Deficiency | Scope | Corrected |
|---|---|---|---|---|---|
| 2026-02-12 | Health | F0554 | Allow residents to self-administer drugs if determined clinically appropriate. | D | 2026-03-17 |
| 2026-02-12 | 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 | 2026-03-17 |
| 2026-02-12 | Health | F0655 | Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted | D | 2026-03-17 |
| 2026-02-12 | Health | F0658 | Ensure services provided by the nursing facility meet professional standards of quality. | D | 2026-03-17 |
| 2026-02-12 | Health | F0686 | Provide appropriate pressure ulcer care and prevent new ulcers from developing. | G | 2026-03-17 |
| 2026-02-12 | Health | F0695 | Provide safe and appropriate respiratory care for a resident when needed. | E | 2026-03-17 |
| 2026-02-12 | Health | F0727 | Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis. | F | 2026-03-17 |
| 2026-02-12 | 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. | E | 2026-03-17 |
| 2026-02-12 | Health | F0880 | Provide and implement an infection prevention and control program. | E | 2026-03-17 |
| 2025-09-29 | Health · complaint | F0689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | G | 2025-10-22 |
| 2025-09-29 | Health · complaint | F0699 | Provide care or services that was trauma informed and/or culturally competent. | D | 2025-10-22 |
| 2025-09-29 | Health · complaint | F0755 | Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | D | 2025-10-22 |
| 2025-06-03 | Health · complaint | F0550 | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | E | 2025-07-05 |
| 2025-01-28 | Health · complaint | F0600 | Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | G | 2025-01-24 |
| 2024-10-17 | Health | F0550 | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | E | 2024-11-09 |
| 2024-10-17 | 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 | 2024-11-09 |
| 2024-10-17 | Health | F0610 | Respond appropriately to all alleged violations. | D | 2024-11-09 |
| 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 | 2024-11-09 |
| 2024-10-17 | Health | F0658 | Ensure services provided by the nursing facility meet professional standards of quality. | D | 2024-11-09 |
| 2024-10-17 | Health | F0686 | Provide appropriate pressure ulcer care and prevent new ulcers from developing. | G | 2024-11-09 |
| 2024-10-17 | Health · complaint | F0804 | Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. | F | 2024-11-09 |
| 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 | 2024-11-09 |
| 2024-09-04 | Health · complaint | 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. | D | 2024-09-23 |
| 2024-09-04 | Health · complaint | F0812 | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | L | 2024-09-23 |
| 2024-09-04 | Health · complaint | F0880 | Provide and implement an infection prevention and control program. | D | 2024-09-23 |
| 2024-06-27 | Health · complaint | F0600 | Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | D | 2024-05-21 |
| 2024-06-27 | Health · complaint | F0658 | Ensure services provided by the nursing facility meet professional standards of quality. | D | 2024-08-02 |
| 2023-09-27 | Health | F0558 | Reasonably accommodate the needs and preferences of each resident. | D | 2023-10-31 |
| 2023-09-27 | Health | F0561 | Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. | D | 2023-10-31 |
| 2023-09-27 | 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. | E | 2023-10-31 |
| 2023-09-27 | Health | F0684 | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | E | 2023-10-31 |
| 2023-09-27 | 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 | 2023-10-31 |
| 2023-09-27 | Health | F0812 | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | D | 2023-10-31 |
| 2023-09-27 | Health | F0880 | Provide and implement an infection prevention and control program. | D | 2023-10-31 |
| Owner | Role | Pct | From | Status | Source |
|---|---|---|---|---|---|
| RAMOS, BRIAN | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | 50% | 2019-02-01 | current | pecos_ownership |
| BEWSEY, MICHAEL | CORPORATE OFFICER | — | 2019-02-01 | current | pecos_ownership |
| EDURO HEALTHCARE LLC | OPERATIONAL/MANAGERIAL CONTROL | — | 2019-02-01 | current | pecos_ownership |
| THOMPSON, CHRISTOPHER | CORPORATE OFFICER | — | 2019-02-01 | current | pecos_ownership |
| BRIAN RAMOS | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | 50% | 2019-02-01 | ended 2026-05-18 | pecos_ownership |
| MICHAEL BEWSEY | CORPORATE OFFICER | 50% | 2019-02-01 | ended 2026-05-18 | pecos_ownership |
| CHRISTOPHER THOMPSON | CORPORATE OFFICER | 0% | 2019-02-01 | ended 2026-05-18 | pecos_ownership |
| Close date | Price | Buyer | Seller | Evidence |
|---|---|---|---|---|
| 2019-02-01 | — | BELLE FOURCHE NURSING AND REHAB CENTER LLC | BELLE FOURCHE HEALTHCARE, LLC | chow |
| Close | Facility | Price | $/bed | Cap rate | Beds | Buyer |
|---|---|---|---|---|---|---|
| 2023-08-31 | RIVERVIEW HEALTHCARE CENTER | — | — | — | 63 | RIVERVIEW SNF OPERATIONS, LLC |
| 2023-08-31 | Wheatcrest Hills Healthcare Center | — | — | — | 60 | WHEATCREST HILLS SNF OPERATIONS, LLC |
| 2023-08-31 | PALISADE HEALTHCARE CENTER | — | — | — | 55 | PALISADE SNF OPERATIONS, LLC |
| 2023-08-31 | PRAIRIE VIEW HEALTHCARE CENTER | — | — | — | 42 | PRAIRIE VIEW SNF OPERATIONS, LLC |
| 2023-08-31 | FIRESTEEL HEALTHCARE CENTER | — | — | — | 125 | FIRESTEEL SNF OPERATIONS, LLC |
| 2023-08-31 | Fountain Springs Healthcare | — | — | — | 90 | FOUNTAIN SPRINGS SNF OPERATIONS, LLC |
| 2019-10-02 | AVANTARA NORTON | — | — | — | 110 | NORTON SD SKILLED NURSING FACILITY LLC |
| 2019-10-02 | AVANTARA HURON | — | — | — | 119 | HURON SD SKILLED NURSING FACILITY, LLC |
| 2019-10-01 | DIAMOND CARE CENTER | — | — | — | 36 | BRIDGEWATER NURSING HOME CORPORATION |
| 2019-07-01 | AVANTARA SAINT CLOUD | — | — | — | 78 | SAINT CLOUD SD SKILLED NURSING FACILITY, LLC |
| 2019-07-01 | AVANTARA WATERTOWN | — | — | — | 51 | WATERTOWN SD SKILLED NURSING FACILITY, LLC |
| 2019-07-01 | AVANTARA CLARK CITY | — | — | — | 35 | CLARK CITY SD SKILLED NURSING FACILITY LLC |
| Geo | Kind | BR | Amount | As of | Source |
|---|---|---|---|---|---|
| county 46019 | acs median gross | 0 | $277 | 2024-12-31 | CENSUS_ACS5 |
| county 46019 | fmr | 0 | $758 | 2025-10-01 | HUD_USER_FMR |
| county 46019 | acs median gross | 1 | $580 | 2024-12-31 | CENSUS_ACS5 |
| county 46019 | fmr | 1 | $838 | 2025-10-01 | HUD_USER_FMR |
| county 46019 | acs median gross | 2 | $1,140 | 2024-12-31 | CENSUS_ACS5 |
| county 46019 | fmr | 2 | $1,099 | 2025-10-01 | HUD_USER_FMR |
| county 46019 | acs median gross | 3 | $1,060 | 2024-12-31 | CENSUS_ACS5 |
| county 46019 | fmr | 3 | $1,318 | 2025-10-01 | HUD_USER_FMR |
| county 46019 | fmr | 4 | $1,701 | 2025-10-01 | HUD_USER_FMR |
| county 46019 | acs median gross | $972 | 2024-12-31 | CENSUS_ACS5 | |
| county 46019 | acs recent mover gross | $1,142 | 2024-12-31 | CENSUS_ACS5 | |
| zcta 57717 | acs median gross | 1 | $583 | 2024-12-31 | CENSUS_ACS5 |
| zcta 57717 | acs median gross | 2 | $1,153 | 2024-12-31 | CENSUS_ACS5 |
| zcta 57717 | acs median gross | 3 | $1,068 | 2024-12-31 | CENSUS_ACS5 |
| zcta 57717 | acs median gross | $973 | 2024-12-31 | CENSUS_ACS5 | |
| zcta 57717 | acs recent mover gross | $1,125 | 2024-12-31 | CENSUS_ACS5 | |
| zip 57717 | payment standard 110 | 0 | $880 | 2025-10-01 | HUD_USER_SAFMR |
| zip 57717 | payment standard 90 | 0 | $720 | 2025-10-01 | HUD_USER_SAFMR |
| zip 57717 | safmr | 0 | $800 | 2025-10-01 | HUD_USER_SAFMR |
| zip 57717 | payment standard 110 | 1 | $990 | 2025-10-01 | HUD_USER_SAFMR |
| zip 57717 | payment standard 90 | 1 | $810 | 2025-10-01 | HUD_USER_SAFMR |
| zip 57717 | safmr | 1 | $900 | 2025-10-01 | HUD_USER_SAFMR |
| zip 57717 | payment standard 110 | 2 | $1,199 | 2025-10-01 | HUD_USER_SAFMR |
| zip 57717 | payment standard 90 | 2 | $981 | 2025-10-01 | HUD_USER_SAFMR |
| zip 57717 | safmr | 2 | $1,090 | 2025-10-01 | HUD_USER_SAFMR |
| zip 57717 | payment standard 110 | 3 | $1,441 | 2025-10-01 | HUD_USER_SAFMR |
| zip 57717 | payment standard 90 | 3 | $1,179 | 2025-10-01 | HUD_USER_SAFMR |
| zip 57717 | safmr | 3 | $1,310 | 2025-10-01 | HUD_USER_SAFMR |
| zip 57717 | payment standard 110 | 4 | $1,903 | 2025-10-01 | HUD_USER_SAFMR |
| zip 57717 | payment standard 90 | 4 | $1,557 | 2025-10-01 | HUD_USER_SAFMR |
| zip 57717 | safmr | 4 | $1,730 | 2025-10-01 | HUD_USER_SAFMR |