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
4/5
👩⚕️ Staffing
3/5
📊 Quality Measures
1/5
RN / Resident / Day
27 min
State avg: 47 min · US avg: 41 min
LPN hrs/day
48 min
CNA hrs/day
2h 4m
Total Nurse / Resident / Day
3h 19m
State avg: 3h 54m · US avg: 3h 53m
PT / Resident / Day
3 min
State avg: 6 min · US avg: 4 min
RN Turnover Rate
43 per 100
State avg: 47 per 100 · US avg: 46 per 100
Weekend Staffing (PBJ Q3 2024)
RN Hours Weekday
32 min
RN Hours Weekend
19 min
Weekend vs. Weekday RN
60%≈ avg
US avg: 64%
Total Nurse Weekend
2h 58m
Federal Penalties
No federal penalties in the past 3 years.
| Date | Type | Fine | Denial Days |
|---|---|---|---|
| 2/28/2023 | Fine | $3,168 | - |
| 2/28/2023 | Fine | $3,168 | - |
| 2/28/2023 | Fine | $3,168 | - |
| 2/28/2023 | Fine | $3,168 | - |
| 2/28/2023 | Fine | $3,168 |
30-Day Readmission
32.7 per 100
State avg: 23.1 · US avg: 23.9
ED Visits (no readmit)
13.0 per 100
State avg: 9.8 · US avg: 12.0
VBP Performance Score
34/100
Incentive Payment
-1.18% penalty
Risk-Std Readmission
23.3 per 100
Healthcare-Assoc. Infections
6.4 per 100
Higher performance scores lead to payment bonuses. Lower scores indicate risk of readmission penalties.
Medicare Patients/Year
189
Avg Length of Stay
18.9 days
Avg Payment / Stay
$9,063.79
Patient Complexity
2.51 × 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)
| - |
| 2/28/2023 | Fine | $3,168 | - |
| 2/28/2023 | Fine | $3,168 | - |
| 2/28/2023 | Fine | $3,168 | - |
| 2/28/2023 | Fine | $3,168 | - |
Inspection Citations
Survey: March 7, 2025(9 citations)
Survey: January 28, 2025(3 citations)
Survey: November 8, 2024(3 citations)
Survey: April 26, 2024(18 citations)
Survey: April 26, 2023(9 citations)
Falls w/ Major Injury
5.0 per 100
State avg: 3.2 · US avg: 3.3
Pressure Ulcers
6.5 per 100
State avg: 5.3 · US avg: 5.1
Antipsychotic Meds
1.0 per 100
State avg: 1.5 · US avg: 1.6
Flu Vaccination
77.5 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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