203 Fourth Street NW, West Bend, IA 50597 · CCN 165444 · chain THE ENSIGN GROUP INC
Composite
17.3 / 100 percentile
Peer group
snf n = 14,684
Evidence depth
deep
Certified beds
45
Model
v1.2
Reads as: riskier than 17.3% 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.
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 spans multiple chains
18 chains
ENSIGN SERVICES INC
286 facilities
connection
Owner spans multiple chains
18 chains
CTR PARTNERSHIP LP
99 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
15 chains
CARETRUST REIT INC
96 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.
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.
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
15
2025Q3 HPRD
This facility
IA median
National median
National p25–p75
Total nurse
2.50
3.15
3.28
2.90–3.77
RN
0.42
0.46
0.39
0.25–0.58
Weekend total
2.55
2.96
3.11
—
Weekday total
2.47
3.20
3.35
—
Quarter
Days
Avg census
Total HPRD
RN
LPN
CNA
Weekend
Contract %
2025Q3
92
41.1
2.50
0.42
0.23
1.85
2.55
0.0%
2025Q2
91
39.1
2.53
0.36
0.33
1.84
2.46
0.5%
2025Q1
90
40.3
2.49
0.28
0.36
1.84
2.44
2.5%
2024Q4
92
41.5
2.53
0.32
0.45
1.76
2.40
14.9%
2024Q3
92
39.8
2.69
0.26
0.45
1.99
2.66
15.0%
2024Q2
91
42.0
2.54
0.30
0.36
1.87
2.46
16.5%
2024Q1
91
41.4
2.45
0.32
0.36
1.77
2.52
7.6%
2023Q4
92
41.3
2.65
0.40
0.35
1.91
2.71
18.4%
2023Q3
92
43.3
2.53
0.41
0.37
1.75
2.39
12.4%
2023Q2
91
43.2
2.48
0.28
0.47
1.73
2.22
10.7%
2023Q1
90
40.9
2.39
0.20
0.55
1.64
2.19
6.9%
2022Q4
92
38.5
2.47
0.26
0.56
1.66
2.38
2.4%
2022Q3
92
38.5
2.46
0.32
0.59
1.55
2.21
0.0%
2022Q2
91
35.8
2.47
0.20
0.69
1.58
2.22
2.4%
2022Q1
90
34.9
2.39
0.26
0.61
1.52
2.17
20.6%
HPRD is census-weighted: total hours over the quarter divided by total resident-days, not an average of daily ratios. Source is CMS Payroll-Based Journal daily records; only SNFs report PBJ, so other settings legitimately return zero rows.
Penalties
0
No penalties on record for this facility. Absence of a record here means the sources CII ingests contain none, not that none exists anywhere.
Deficiencies
24
D × 20E × 4
deficiencies by survey year
Survey
Type
Tag
Deficiency
Scope
Corrected
2025-05-01
Health
F0628
Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.
D
2025-05-16
2025-05-01
Health
F0644
Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.
D
2025-05-16
2025-05-01
Health
F0658
Ensure services provided by the nursing facility meet professional standards of quality.
D
2025-05-16
2025-05-01
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
2025-05-16
2025-05-01
Health
F0759
Ensure medication error rates are not 5 percent or greater.
D
2025-05-16
2025-05-01
Health
F0880
Provide and implement an infection prevention and control program.
D
2025-05-16
2024-12-16
Health · complaint
F0550
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
D
2025-01-22
2024-12-16
Health · complaint
F0658
Ensure services provided by the nursing facility meet professional standards of quality.
D
2025-01-22
2024-12-16
Health · complaint
F0677
Provide care and assistance to perform activities of daily living for any resident who is unable.
D
2025-01-22
2024-03-07
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
2024-04-03
2024-03-07
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
2024-04-03
2024-03-07
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
2024-04-03
2024-03-07
Health · complaint
F0658
Ensure services provided by the nursing facility meet professional standards of quality.
D
2024-04-03
2024-03-07
Health
F0661
Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge.
D
2024-04-03
2024-03-07
Health
F0880
Provide and implement an infection prevention and control program.
D
2024-04-03
2024-01-12
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.
E
2024-01-30
2023-07-19
Health · complaint
F0658
Ensure services provided by the nursing facility meet professional standards of quality.
D
2023-07-31
2022-12-29
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
2023-01-27
2022-12-29
Health
F0658
Ensure services provided by the nursing facility meet professional standards of quality.
D
2023-01-27
2022-12-29
Health
F0677
Provide care and assistance to perform activities of daily living for any resident who is unable.
D
2023-01-27
2022-12-29
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
2023-01-27
2022-12-29
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
2023-01-27
2022-12-29
Health
F0812
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
E
2023-01-27
2022-12-29
Health
F0880
Provide and implement an infection prevention and control program.
D
2023-01-27
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
34
Owner
Role
Pct
From
Status
Source
4TH STREET HEALTH HOLDINGS LLC
Corporation, partnership or other organization has financial interest in provider
—
2024-01-01
current
hcris_a_8_1
4TH STREET HEALTH HOLDINGS LLC
Corporation, partnership or other organization has financial interest in provider
—
2023-01-01
current
hcris_a_8_1
4TH STREET HOLDINGS LLC
ADP OF THE SNF
—
2011-07-18
current
pecos_ownership
BURNAM, SOON
CORPORATE OFFICER
—
2011-07-18
current
pecos_ownership
BURNAM, SOON
ADP OF THE SNF
—
2025-07-09
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
JORGENSEN, DAVID
CORPORATE DIRECTOR
—
2024-01-01
current
pecos_ownership
KEETCH, CHAD
CORPORATE OFFICER
—
2011-03-01
current
pecos_ownership
KLEINSTREUBER, PETER
ADP OF THE SNF
—
2025-07-09
current
pecos_ownership
KLEINSTREUBER, PETER
OPERATIONAL/MANAGERIAL CONTROL
—
2019-11-19
current
pecos_ownership
KOENIG, DEBRA
CORPORATE OFFICER
—
2020-01-01
current
pecos_ownership
OWEN, BRENT
MANAGING CONTROL - GOVERNING BODY
—
2014-05-01
current
pecos_ownership
OWEN, BRENT
ADP OF THE SNF
—
2025-07-09
current
pecos_ownership
PORT, BARRY
INDIVIDUAL IS AN OWNER, PARTNER OR TRUSTEE OF ANY ADP OF THE SNF
—
2025-07-09
current
pecos_ownership
SATO, AMI
CORPORATE OFFICER
—
2024-09-09
current
pecos_ownership
VENTURA MEDSTAFF, LLC
OPERATIONAL/MANAGERIAL CONTROL
—
2011-07-18
current
pecos_ownership
GATEWAY HEALTHCARE LLC
5% OR GREATER DIRECT OWNERSHIP INTEREST
100%
2011-07-18
ended 2026-05-18
pecos_ownership
PETER KLEINSTREUBER
OPERATIONAL/MANAGERIAL CONTROL
0%
2019-11-19
ended 2026-05-18
pecos_ownership
4TH STREET HEALTH HOLDINGS LLC
Corporation, partnership or other organization has financial interest in provider
—
2022-01-01
ended 2022-12-31
hcris_a_8_1
AMI SATO
CORPORATE OFFICER
—
2024-09-09
ended 2026-05-18
pecos_ownership
BRENT OWEN
OPERATIONAL/MANAGERIAL CONTROL
—
2014-05-01
ended 2026-05-18
pecos_ownership
BRENT OWEN
ADP OF THE SNF
—
2025-07-09
ended 2026-05-18
pecos_ownership
CHAD KEETCH
CORPORATE OFFICER
—
2011-03-01
ended 2026-05-18
pecos_ownership
DAVID JORGENSEN
CORPORATE DIRECTOR
—
2024-01-01
ended 2026-05-18
pecos_ownership
DEBRA KOENIG
CORPORATE OFFICER
—
2020-01-01
ended 2026-05-18
pecos_ownership
PETER KLEINSTREUBER
ADP OF THE SNF
—
2025-07-09
ended 2026-05-18
pecos_ownership
SOON BURNAM
CORPORATE OFFICER
—
2011-07-18
ended 2026-05-18
pecos_ownership
SOON BURNAM
ADP OF THE SNF
—
2025-07-09
ended 2026-05-18
pecos_ownership
THE ENSIGN GROUP INC
5% OR GREATER INDIRECT OWNERSHIP INTEREST
—
2006-01-30
ended 2026-05-18
pecos_ownership
THE ENSIGN GROUP INC.
Corporation, partnership or other organization has financial interest in provider
—
2020-01-01
ended 2020-12-31
hcris_a_8_1
THE ENSIGN GROUP INC.
Corporation, partnership or other organization has financial interest in provider
—
2021-01-01
ended 2021-12-31
hcris_a_8_1
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
$544,631
—
$404,543
—
—
6
propco
2023-12-31
$563,096
—
$392,599
—
—
6
propco
2022-12-31
$531,071
—
$383,844
—
—
6
propco
2021-12-31
$522,762
—
$334,815
—
—
6
propco
2020-12-31
$371,898
—
$245,206
—
$1,689
6
propco
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 19147
acs median gross
0
$557
2024-12-31
CENSUS_ACS5
county 19147
fmr
0
$682
2025-10-01
HUD_USER_FMR
county 19147
acs median gross
1
$485
2024-12-31
CENSUS_ACS5
county 19147
fmr
1
$700
2025-10-01
HUD_USER_FMR
county 19147
acs median gross
2
$669
2024-12-31
CENSUS_ACS5
county 19147
fmr
2
$919
2025-10-01
HUD_USER_FMR
county 19147
acs median gross
3
$912
2024-12-31
CENSUS_ACS5
county 19147
fmr
3
$1,222
2025-10-01
HUD_USER_FMR
county 19147
fmr
4
$1,227
2025-10-01
HUD_USER_FMR
county 19147
acs median gross
$638
2024-12-31
CENSUS_ACS5
county 19147
acs recent mover gross
$663
2024-12-31
CENSUS_ACS5
zcta 50597
acs median gross
1
$475
2024-12-31
CENSUS_ACS5
zcta 50597
acs median gross
2
$544
2024-12-31
CENSUS_ACS5
zcta 50597
acs median gross
3
$840
2024-12-31
CENSUS_ACS5
zcta 50597
acs median gross
$613
2024-12-31
CENSUS_ACS5
zip 50597
payment standard 110
0
$748
2025-10-01
HUD_USER_SAFMR
zip 50597
payment standard 90
0
$612
2025-10-01
HUD_USER_SAFMR
zip 50597
safmr
0
$680
2025-10-01
HUD_USER_SAFMR
zip 50597
payment standard 110
1
$770
2025-10-01
HUD_USER_SAFMR
zip 50597
payment standard 90
1
$630
2025-10-01
HUD_USER_SAFMR
zip 50597
safmr
1
$700
2025-10-01
HUD_USER_SAFMR
zip 50597
payment standard 110
2
$1,012
2025-10-01
HUD_USER_SAFMR
zip 50597
payment standard 90
2
$828
2025-10-01
HUD_USER_SAFMR
zip 50597
safmr
2
$920
2025-10-01
HUD_USER_SAFMR
zip 50597
payment standard 110
3
$1,320
2025-10-01
HUD_USER_SAFMR
zip 50597
payment standard 90
3
$1,080
2025-10-01
HUD_USER_SAFMR
zip 50597
safmr
3
$1,200
2025-10-01
HUD_USER_SAFMR
zip 50597
payment standard 110
4
$1,353
2025-10-01
HUD_USER_SAFMR
zip 50597
payment standard 90
4
$1,107
2025-10-01
HUD_USER_SAFMR
zip 50597
safmr
4
$1,230
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.