CMS Stars
RN hrs / day
Trust Index
Bounce-back
Long-stay residents , lower is better
Source: CMS MDS Quality Measures. Updated quarterly.
โญ Overall
2/5
๐ Health Inspection
1/5
๐ฉโโ๏ธ Staffing
2/5
๐ Quality Measures
5/5
RN / Resident / Day
11 min
State avg: 41 min ยท US avg: 41 min
LPN hrs/day
1h 12m
CNA hrs/day
1h 59m
Total Nurse / Resident / Day
3h 23m
State avg: 3h 51m ยท US avg: 3h 53m
PT / Resident / Day
6 min
State avg: 6 min ยท US avg: 4 min
RN Turnover Rate
59 per 100
State avg: 41 per 100 ยท US avg: 46 per 100
Weekend Staffing (PBJ Q3 2024)
RN Hours Weekday
27 min
RN Hours Weekend
11 min
Weekend vs. Weekday RN
41%well below avg
US avg: 64%
Total Nurse Weekend
2h 34m
Federal Penalties
9 penalties ยท $929,700 total
| Date | Type | Fine | Denial Days |
|---|---|---|---|
| 7/15/2024 | Fine | $103,300 | - |
| 7/15/2024 | Fine | $103,300 | - |
| 7/15/2024 | Fine | $103,300 | - |
| 7/15/2024 | Fine | $103,300 | - |
| 7/15/2024 | Fine | $103,300 |
30-Day Readmission
36.8 per 100
State avg: 25.4 ยท US avg: 23.9
ED Visits (no readmit)
6.0 per 100
State avg: 8.2 ยท US avg: 12.0
VBP Performance Score
29/100
Incentive Payment
-1.46% penalty
Risk-Std Readmission
17.9 per 100
Healthcare-Assoc. Infections
7.1 per 100
Higher performance scores lead to payment bonuses. Lower scores indicate risk of readmission penalties.
Medicare Patients/Year
134
Avg Length of Stay
39.7 days
Avg Payment / Stay
$20,166.82
Patient Complexity
2.96 ร avg
Avg LOS 15-30 days is typical for short-term rehab ยท Patient complexity = HCC risk score (1.0 = national average; higher = sicker patient mix)
| - |
| 7/15/2024 | Fine | $103,300 | - |
| 7/15/2024 | Fine | $103,300 | - |
| 7/15/2024 | Fine | $103,300 | - |
| 7/15/2024 | Fine | $103,300 | - |
Inspection Citations
Survey: July 15, 2024(45 citations)
Survey: June 27, 2023(9 citations)
Survey: November 10, 2022(12 citations)
Falls w/ Major Injury
0.6 per 100
State avg: 2.4 ยท US avg: 3.3
Pressure Ulcers
4.1 per 100
State avg: 6.0 ยท US avg: 5.1
Antipsychotic Meds
3.2 per 100
State avg: 1.2 ยท US avg: 1.6
Flu Vaccination
69.6 per 100
State avg: 80.1 ยท US avg: 79.7
Discharge to Community
N/A
Functional Improvement
N/A
Rates shown per 100 patients ยท Green = better than average ยท Amber = average ยท Red = below average
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