Composite
20.4 / 100 percentile
Screener / 405000
A
ALTERNATIVE HEALTHCARE SOLUTIONS LLC
snfPR
SEPTIMO PISO DOCTORS CENTER HOSPITAL, SAN JUAN, PR 00910 · CCN 405000
Peer group
snf n = 14,684
Evidence depth
moderate
Certified beds
22
Model
v1.2
Reads as: riskier than 20.4% 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.
Score model3Components9CHOW radar1Distress radar1Staffing11Penalties0Deficiencies33Licensure0Ownership0Related party0Transactions0Market rent28
Composite explanation
3| Component | Percentile | Raw | Weight | Weight share | Contribution | Counts |
|---|---|---|---|---|---|---|
| chow risk | 82.6 | 35.0 | 0.15 | 0.2143 | 17.70 | in index |
| regulatory risk | 33.2 | 23.1 | 0.30 | 0.4286 | 14.23 | in index |
| staffing risk | 12.0 | 12.1 | 0.25 | 0.3571 | 4.29 | in index |
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.
Component scores and registry models
9| Score type | Score | Grade | Model | Status | Registry model notes |
|---|---|---|---|---|---|
| chow risk | 35.0 | B | v0.1-pos | default · in composite | 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. |
| p adverse action 12m | 0.1 | — | v0.1 | default · in composite | 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. |
| p chow 12m | 2.7 | — | v0.1 | default · in 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. |
| regulatory risk | 23.1 | A | v0.3 | default · in composite | Deficiency-based, SNF population. Runs alongside v0.5-pos. |
| staffing risk | 12.1 | A | v0.3 | default · in composite | Cost-report staffing, SNF population. Runs alongside v0.4-pos, which covers ICF/IID from POS. |
| regulatory risk | 23.0 | A | v0.1 | superseded | 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. |
| regulatory risk | 23.0 | A | v0.2 | superseded | 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. |
| staffing risk | 12.1 | A | v0.1 | superseded | Pre-registry model iteration, superseded by a later staffing_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. |
| staffing risk | 12.1 | A | v0.2 | superseded | Pre-registry model iteration, superseded by a later staffing_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.
CHOW radar — 12-month sale probability
full board →p(CHOW, 12m)
2.7%
model v0.1 · computed 2026-07-29
Percentile among SNFs
75.1
100 = most likely to sell
Holdout AUC
0.874
evaluated before shipping, never refit
| Driver | Value | Pull on odds | |
|---|---|---|---|
| For-profit ownership | 1.00 | +0.69 | |
| Never sold on record | 1.00 | +0.62 | |
| Current owner tenure (years) | 25.00 | +0.57 | |
| No PBJ staffing report | 0.00 | +0.42 | |
| Chain size (log) | 0.00 | -0.40 | |
| Occupancy | 0.82 | -0.35 | |
| Total nurse staffing (HPRD) | 4.25 | -0.24 | |
| Ownership changes, last 5 years | 0.00 | +0.20 |
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.
Distress radar — 12-month termination probability
full board →p(termination, 12m)
0.1%
model v0.1 · computed 2026-07-29
Percentile among SNFs
49.0
100 = most likely to lose certification
Holdout AUC
0.971
top decile caught 95% of actual exits
| Driver | Value | Pull on odds | |
|---|---|---|---|
| Staffing trend, last 4 quarters | -3.67 | -1.73 | |
| Deficiencies, last 12 months | 0.00 | +1.43 | |
| Chain size (log) | 0.00 | +1.20 | |
| For-profit ownership | 1.00 | -0.69 | |
| Total nurse staffing (HPRD) | 4.25 | -0.43 | |
| No PBJ staffing report | 0.00 | +0.39 | |
| Occupancy | 0.82 | -0.29 | |
| Facility size (log beds) | 3.14 | +0.25 |
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
11| 2025Q4 HPRD | This facility | PR median | National median | National p25–p75 |
|---|---|---|---|---|
| Total nurse | 4.25 | 3.15 | 3.28 | 2.90–3.77 |
| RN | 3.43 | 2.52 | 0.39 | 0.25–0.58 |
| Weekend total | 4.11 | 2.85 | 3.11 | — |
| Weekday total | 4.30 | 3.27 | 3.35 | — |
| Quarter | Days | Avg census | Total HPRD | RN | LPN | CNA | Weekend | Contract % |
|---|---|---|---|---|---|---|---|---|
| 2025Q4 | 92 | 18.0 | 4.25 | 3.43 | 0.82 | 0.00 | 4.11 | 14.9% |
| 2025Q3 | 92 | 15.1 | 5.54 | 4.74 | 0.79 | 0.00 | 4.90 | 9.7% |
| 2025Q2 | 91 | 12.6 | 6.05 | 4.70 | 1.34 | 0.00 | 6.35 | 12.7% |
| 2025Q1 | 90 | 13.4 | 5.84 | 4.36 | 1.48 | 0.00 | 5.87 | 14.7% |
| 2024Q4 | 92 | 11.3 | 7.92 | 5.73 | 2.18 | 0.00 | 7.77 | 9.3% |
| 2024Q3 | 92 | 16.3 | 5.35 | 3.43 | 1.92 | 0.00 | 5.11 | 7.3% |
| 2024Q2 | 91 | 11.3 | 7.02 | 5.37 | 1.66 | 0.00 | 6.14 | 2.1% |
| 2024Q1 | 91 | 8.9 | 8.80 | 6.49 | 2.31 | 0.00 | 7.64 | 0.1% |
| 2023Q4 | 92 | 12.9 | 7.43 | 5.43 | 2.01 | 0.00 | 6.36 | 0.0% |
| 2023Q3 | 92 | 12.6 | 7.32 | 5.22 | 2.10 | 0.00 | 6.10 | 0.0% |
| 2023Q2 | 91 | 11.8 | 7.90 | 5.60 | 2.30 | 0.00 | 7.00 | 4.8% |
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
0No penalties on record for this facility. Absence of a record here means the sources CII ingests contain none, not that none exists anywhere.
Deficiencies
33C × 5D × 4E × 7F × 17
deficiencies by survey year
| Survey | Type | Tag | Deficiency | Scope | Corrected |
|---|---|---|---|---|---|
| 2024-12-03 | Health | F0584 | Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. | E | 2025-01-09 |
| 2024-12-03 | Health | F0732 | Post nurse staffing information every day. | C | 2025-05-02 |
| 2024-12-03 | Health | F0802 | Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service. | F | 2025-06-12 |
| 2024-12-03 | Health | F0804 | Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. | F | 2025-05-02 |
| 2024-12-03 | Health | F0806 | Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. | D | 2025-05-02 |
| 2024-12-03 | Health | F0812 | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | F | 2025-06-12 |
| 2024-12-03 | Health | F0880 | Provide and implement an infection prevention and control program. | F | 2025-05-02 |
| 2024-12-03 | Health | F0883 | Develop and implement policies and procedures for flu and pneumonia vaccinations. | C | 2025-05-02 |
| 2024-12-03 | Health | F0921 | Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. | F | 2025-05-02 |
| 2024-04-18 | Health | F0584 | Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. | E | 2024-05-13 |
| 2024-04-18 | Health | F0655 | Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted | E | 2024-05-13 |
| 2024-04-18 | Health | F0694 | Provide for the safe, appropriate administration of IV fluids for a resident when needed. | E | 2024-05-15 |
| 2024-04-18 | Health | F0726 | Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. | F | 2024-05-15 |
| 2024-04-18 | Health | F0802 | Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service. | F | 2024-05-14 |
| 2024-04-18 | Health | F0812 | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | F | 2024-05-13 |
| 2024-04-18 | Health | F0813 | Have a policy regarding use and storage of foods brought to residents by family and other visitors. | F | 2024-04-20 |
| 2024-04-18 | Health | F0908 | Keep all essential equipment working safely. | F | 2024-05-15 |
| 2023-05-02 | Health | F0578 | Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. | E | 2023-05-15 |
| 2023-05-02 | Health | F0582 | Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. | F | 2023-05-15 |
| 2023-05-02 | Health | F0584 | Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. | E | 2023-05-05 |
| 2023-05-02 | Health | F0655 | Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted | F | 2023-05-15 |
| 2023-05-02 | 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 | 2023-05-15 |
| 2023-05-02 | 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 | 2023-05-15 |
| 2023-05-02 | Health | F0677 | Provide care and assistance to perform activities of daily living for any resident who is unable. | D | 2023-05-15 |
| 2023-05-02 | Health | F0732 | Post nurse staffing information every day. | C | 2023-05-17 |
| 2023-05-02 | Health | F0740 | Ensure each resident must receive and the facility must provide necessary behavioral health care and services. | C | 2023-05-18 |
| 2023-05-02 | Health | F0741 | Ensure that the facility has sufficient staff members who possess the competencies and skills to meet the behavioral health needs of residents. | C | 2023-06-01 |
| 2023-05-02 | Health | F0756 | Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. | D | 2023-06-12 |
| 2023-05-02 | Health | F0812 | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | F | 2023-05-26 |
| 2023-05-02 | Health | F0865 | Have a plan that describes the process for conducting QAPI and QAA activities. | F | 2023-05-26 |
| 2023-05-02 | Health | F0868 | Have the Quality Assessment and Assurance group have the required members and meet at least quarterly | F | 2023-05-15 |
| 2023-05-02 | Health | F0880 | Provide and implement an infection prevention and control program. | F | 2023-05-15 |
| 2023-05-02 | Health | F0882 | Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home. | F | 2023-05-17 |
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
0No 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
0No ownership edges on record for this facility. Absence of a record here means the sources CII ingests contain none, not that none exists anywhere.
PECOS ownership and managing-control associations. Current edges have no end date in the source; historical edges are retained.
Transactions
0No transactions on record for this facility. Absence of a record here means the sources CII ingests contain none, not that none exists anywhere.
Market rent context
28| Geo | Kind | BR | Amount | As of | Source |
|---|---|---|---|---|---|
| county 72127 | acs median gross | 0 | $502 | 2024-12-31 | CENSUS_ACS5 |
| county 72127 | fmr | 0 | $559 | 2025-10-01 | HUD_USER_FMR |
| county 72127 | acs median gross | 1 | $448 | 2024-12-31 | CENSUS_ACS5 |
| county 72127 | fmr | 1 | $572 | 2025-10-01 | HUD_USER_FMR |
| county 72127 | acs median gross | 2 | $611 | 2024-12-31 | CENSUS_ACS5 |
| county 72127 | fmr | 2 | $663 | 2025-10-01 | HUD_USER_FMR |
| county 72127 | acs median gross | 3 | $718 | 2024-12-31 | CENSUS_ACS5 |
| county 72127 | fmr | 3 | $868 | 2025-10-01 | HUD_USER_FMR |
| county 72127 | acs median gross | 4 | $772 | 2024-12-31 | CENSUS_ACS5 |
| county 72127 | fmr | 4 | $1,046 | 2025-10-01 | HUD_USER_FMR |
| county 72127 | acs median gross | 5 | $580 | 2024-12-31 | CENSUS_ACS5 |
| county 72127 | acs median gross | $611 | 2024-12-31 | CENSUS_ACS5 | |
| county 72127 | acs recent mover gross | $803 | 2024-12-31 | CENSUS_ACS5 | |
| zip 00910 | payment standard 110 | 0 | $616 | 2025-10-01 | HUD_USER_SAFMR |
| zip 00910 | payment standard 90 | 0 | $504 | 2025-10-01 | HUD_USER_SAFMR |
| zip 00910 | safmr | 0 | $560 | 2025-10-01 | HUD_USER_SAFMR |
| zip 00910 | payment standard 110 | 1 | $638 | 2025-10-01 | HUD_USER_SAFMR |
| zip 00910 | payment standard 90 | 1 | $522 | 2025-10-01 | HUD_USER_SAFMR |
| zip 00910 | safmr | 1 | $580 | 2025-10-01 | HUD_USER_SAFMR |
| zip 00910 | payment standard 110 | 2 | $737 | 2025-10-01 | HUD_USER_SAFMR |
| zip 00910 | payment standard 90 | 2 | $603 | 2025-10-01 | HUD_USER_SAFMR |
| zip 00910 | safmr | 2 | $670 | 2025-10-01 | HUD_USER_SAFMR |
| zip 00910 | payment standard 110 | 3 | $968 | 2025-10-01 | HUD_USER_SAFMR |
| zip 00910 | payment standard 90 | 3 | $792 | 2025-10-01 | HUD_USER_SAFMR |
| zip 00910 | safmr | 3 | $880 | 2025-10-01 | HUD_USER_SAFMR |
| zip 00910 | payment standard 110 | 4 | $1,166 | 2025-10-01 | HUD_USER_SAFMR |
| zip 00910 | payment standard 90 | 4 | $954 | 2025-10-01 | HUD_USER_SAFMR |
| zip 00910 | safmr | 4 | $1,060 | 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.