CMS Stars
RN hrs / day
Trust Index
Bounce-back
Long-stay residents , lower is better
Source: CMS MDS Quality Measures. Updated quarterly.
⭐ Overall
3/5
🔍 Health Inspection
2/5
👩⚕️ Staffing
2/5
📊 Quality Measures
5/5
RN / Resident / Day
32 min
State avg: 47 min · US avg: 41 min
LPN hrs/day
37 min
CNA hrs/day
1h 52m
Total Nurse / Resident / Day
3h 1m
State avg: 3h 54m · US avg: 3h 53m
PT / Resident / Day
4 min
State avg: 6 min · US avg: 4 min
RN Turnover Rate
51 per 100
State avg: 47 per 100 · US avg: 46 per 100
Weekend Staffing (PBJ Q3 2024)
RN Hours Weekday
41 min
RN Hours Weekend
29 min
Weekend vs. Weekday RN
71%above avg
US avg: 64%
Total Nurse Weekend
2h 55m
Federal Penalties
9 penalties · $79,443 total
| Date | Type | Fine | Denial Days |
|---|---|---|---|
| 1/18/2024 | Fine | $8,827 | - |
| 1/18/2024 | Fine | $8,827 | - |
| 1/18/2024 | Fine | $8,827 | - |
| 1/18/2024 | Fine | $8,827 | - |
| 1/18/2024 | Fine | $8,827 |
30-Day Readmission
22.8 per 100
State avg: 23.1 · US avg: 23.9
ED Visits (no readmit)
6.1 per 100
State avg: 9.8 · US avg: 12.0
VBP Performance Score
30/100
Incentive Payment
-1.41% penalty
Risk-Std Readmission
19.8 per 100
Healthcare-Assoc. Infections
6.6 per 100
Higher performance scores lead to payment bonuses. Lower scores indicate risk of readmission penalties.
Medicare Patients/Year
75
Avg Length of Stay
31.6 days
Avg Payment / Stay
$18,164.96
Patient Complexity
2.74 × avg
Avg LOS 15-30 days is typical for short-term rehab · Patient complexity = HCC risk score (1.0 = national average; higher = sicker patient mix)
| - |
| 1/18/2024 | Fine | $8,827 | - |
| 1/18/2024 | Fine | $8,827 | - |
| 1/18/2024 | Fine | $8,827 | - |
| 1/18/2024 | Fine | $8,827 | - |
Inspection Citations
Survey: June 5, 2025(45 citations)
Survey: August 1, 2024(33 citations)
Survey: May 1, 2024(6 citations)
Survey: March 26, 2024(3 citations)
Survey: October 13, 2023(30 citations)
Falls w/ Major Injury
0.3 per 100
State avg: 3.2 · US avg: 3.3
Pressure Ulcers
5.6 per 100
State avg: 5.3 · US avg: 5.1
Antipsychotic Meds
0.0 per 100
State avg: 1.5 · US avg: 1.6
Flu Vaccination
89.3 per 100
State avg: 68.7 · US avg: 79.7
Discharge to Community
N/A
Functional Improvement
N/A
Rates shown per 100 patients · Green = better than average · Amber = average · Red = below average
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