CMS Stars
RN hrs / day
Trust Index
Bounce-back
Long-stay residents , lower is better
Source: CMS MDS Quality Measures. Updated quarterly.
โญ Overall
4/5
๐ Health Inspection
4/5
๐ฉโโ๏ธ Staffing
3/5
๐ Quality Measures
4/5
RN / Resident / Day
41 min
State avg: 47 min ยท US avg: 41 min
LPN hrs/day
52 min
CNA hrs/day
1h 53m
Total Nurse / Resident / Day
3h 26m
State avg: 3h 54m ยท US avg: 3h 53m
PT / Resident / Day
2 min
State avg: 6 min ยท US avg: 4 min
RN Turnover Rate
35 per 100
State avg: 47 per 100 ยท US avg: 46 per 100
Weekend Staffing (PBJ Q3 2024)
RN Hours Weekday
49 min
RN Hours Weekend
31 min
Weekend vs. Weekday RN
65%โ avg
US avg: 64%
Total Nurse Weekend
3h 21m
Federal Penalties
No federal penalties in the past 3 years.
โ No penalty records on file
Inspection Citations
Survey: August 21, 2025(15 citations)
30-Day Readmission
20.5 per 100
State avg: 23.1 ยท US avg: 23.9
ED Visits (no readmit)
9.8 per 100
State avg: 9.8 ยท US avg: 12.0
VBP Performance Score
42/100
Incentive Payment
-0.53% penalty
Risk-Std Readmission
22.5 per 100
Healthcare-Assoc. Infections
5.5 per 100
Higher performance scores lead to payment bonuses. Lower scores indicate risk of readmission penalties.
Medicare Patients/Year
184
Avg Length of Stay
17.7 days
Avg Payment / Stay
$9,535.78
Patient Complexity
2.53 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)
Survey: October 26, 2024(3 citations)
Survey: July 12, 2024(15 citations)
Falls w/ Major Injury
3.9 per 100
State avg: 3.2 ยท US avg: 3.3
Pressure Ulcers
3.6 per 100
State avg: 5.3 ยท US avg: 5.1
Antipsychotic Meds
1.8 per 100
State avg: 1.5 ยท US avg: 1.6
Flu Vaccination
87.1 per 100
State avg: 68.7 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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