Reads as: riskier than 74.8% 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.
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.
ML signals — parallel engine
3
Kind
Finding
Signal
Subject
First seen
connection
Owner fleet risk far above national
+35.4 vs natl
BELL BILLIE
7 facilities
connection
Owner fleet risk far above national
+33.6 vs natl
MEDINA COUNTY HOSPITAL DISTRICT
6 facilities
connection
Owner fleet enforcement cluster
43% fined
BELL BILLIE
7 facilities
Findings from the always-on scanning layer: anomalies on this facility, connections through its current owners and past buyers. Runs beside the deterministic composite, never inside it. Full board on the ML Lab page.
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.
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.
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.
Pre-registry model iteration, superseded by a later financial_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.
Pre-registry model iteration, superseded by a later financial_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.
Pre-registry model iteration, superseded by a later financial_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.
Pre-registry model iteration, superseded by a later financial_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.
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.
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.
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.
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.
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.
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
16
2025Q4 HPRD
This facility
TX median
National median
National p25–p75
Total nurse
2.25
2.67
3.28
2.90–3.77
RN
0.21
0.24
0.39
0.25–0.58
Weekend total
1.87
2.56
3.11
—
Weekday total
2.40
2.72
3.35
—
Quarter
Days
Avg census
Total HPRD
RN
LPN
CNA
Weekend
Contract %
2025Q4
92
87.0
2.25
0.21
0.79
1.26
1.87
0.0%
2025Q3
92
85.3
2.64
0.24
0.88
1.52
2.24
0.0%
2025Q2
91
89.2
2.73
0.35
0.87
1.51
2.35
0.0%
2025Q1
90
88.4
2.72
0.35
0.90
1.47
2.22
0.0%
2024Q4
92
91.8
2.50
0.25
0.97
1.28
2.22
0.0%
2024Q3
92
91.8
2.25
0.30
0.81
1.14
1.91
0.0%
2024Q2
91
89.5
2.26
0.31
0.80
1.15
1.80
0.0%
2024Q1
91
88.9
2.11
0.24
0.81
1.06
1.66
0.0%
2023Q4
92
91.2
2.17
0.17
0.85
1.15
1.69
8.2%
2023Q3
92
91.5
2.09
0.23
0.81
1.05
1.70
2.5%
2023Q2
91
90.5
2.06
0.18
1.00
0.88
1.59
0.0%
2023Q1
90
87.5
2.01
0.14
0.97
0.89
1.54
0.2%
2022Q4
92
81.7
2.36
0.17
1.04
1.15
1.98
2.4%
2022Q3
92
83.5
2.31
0.13
0.97
1.20
1.94
14.5%
2022Q2
91
83.3
2.07
0.13
0.92
1.02
1.66
0.0%
2022Q1
90
82.9
2.06
0.16
0.85
1.05
1.87
0.0%
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
0
No penalties on record for this facility. Absence of a record here means the sources CII ingests contain none, not that none exists anywhere.
Deficiencies
36
B × 2D × 28E × 6
deficiencies by survey year
Survey
Type
Tag
Deficiency
Scope
Corrected
2026-02-27
Health
F0638
Assure that each resident’s assessment is updated at least once every 3 months.
B
2026-03-27
2026-02-27
Health
F0641
Ensure each resident receives an accurate assessment.
E
2026-03-27
2026-02-27
Health
F0686
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
D
2026-03-27
2026-02-27
Health
F0727
Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis.
D
2026-03-27
2026-02-27
Health
F0842
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
D
2026-03-27
2026-02-27
Health
F0880
Provide and implement an infection prevention and control program.
E
2026-03-27
2026-02-27
Health
F0908
Keep all essential equipment working safely.
D
2026-03-27
2024-11-15
Health
F0580
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
D
2024-12-18
2024-11-15
Health
F0641
Ensure each resident receives an accurate assessment.
D
2024-12-18
2024-11-15
Health
F0644
Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.
D
2024-12-18
2024-11-15
Health
F0645
PASARR screening for Mental disorders or Intellectual Disabilities
D
2024-12-18
2024-11-15
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.
D
2024-12-18
2024-11-15
Health
F0677
Provide care and assistance to perform activities of daily living for any resident who is unable.
D
2024-12-18
2024-11-15
Health
F0690
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
D
2024-12-18
2024-11-15
Health
F0755
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
D
2024-12-18
2024-11-15
Health
F0761
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
D
2024-12-18
2024-11-15
Health
F0812
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
E
2024-12-18
2024-11-15
Health
F0814
Dispose of garbage and refuse properly.
B
2024-12-18
2024-11-15
Health
F0842
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
D
2024-12-18
2024-11-15
Health
F0849
Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services.
D
2024-12-18
2024-11-15
Health
F0880
Provide and implement an infection prevention and control program.
D
2024-12-18
2024-11-15
Health
F0908
Keep all essential equipment working safely.
D
2024-12-17
2024-10-30
Health · complaint
F0609
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
D
2024-11-14
2024-10-30
Health · complaint
F0689
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
D
2023-12-11
2024-10-30
Health · complaint
F0690
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
D
2024-11-14
2024-09-21
Health · complaint
F0761
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
D
2024-10-01
2024-07-26
Health · complaint
F0609
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
D
2024-09-02
2023-11-15
Health · complaint
F0842
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
D
2023-12-11
2023-09-22
Health
F0604
Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment.
E
2023-10-25
2023-09-22
Health
F0690
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
D
2023-10-25
2023-09-22
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.
D
2023-10-25
2023-09-22
Health
F0759
Ensure medication error rates are not 5 percent or greater.
D
2023-10-25
2023-09-22
Health
F0760
Ensure that residents are free from significant medication errors.
D
2023-10-25
2023-09-22
Health
F0812
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
E
2023-10-25
2023-09-22
Health
F0814
Dispose of garbage and refuse properly.
D
2023-10-25
2023-09-22
Health
F0880
Provide and implement an infection prevention and control program.
E
2023-10-25
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
0
No 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
19
Owner
Role
Pct
From
Status
Source
MEDINA COUNTY HOSPITAL DISTRICT
5% OR GREATER DIRECT OWNERSHIP INTEREST
100%
2014-08-01
current
pecos_ownership
BELL, BILLIE
CORPORATE OFFICER
—
2023-06-03
current
pecos_ownership
CASCADE HEALTH SERVICES, LLC
OPERATIONAL/MANAGERIAL CONTROL
—
2014-08-01
current
pecos_ownership
CASCADE MEDINA HEALTH SERVICES, LTD
OPERATIONAL/MANAGERIAL CONTROL
—
2014-08-01
current
pecos_ownership
CASCADEMEDINA HEALTH SERVICES LTD
—
—
2024-08-01
current
tx_hhsc_directory
CASTROVILLE CARE CENTER, LTD
ADP OF THE SNF
—
2014-08-01
current
pecos_ownership
DORROW, MARJORIE
INDIVIDUAL IS AN OWNER, PARTNER OR TRUSTEE OF ANY ADP OF THE SNF
—
2025-05-08
current
pecos_ownership
GREGORY, PATRICE
ADP OF THE SNF
—
2020-11-30
current
pecos_ownership
HANEY, MAX
ADP OF THE SNF
—
2014-08-01
current
pecos_ownership
HANEY, RONALD
ADP OF THE SNF
—
2014-08-01
current
pecos_ownership
JAAFAR, SALEH
ADP OF THE SNF
—
2024-08-01
current
pecos_ownership
KUBIK, DARLENE
ADP OF THE SNF
—
2014-08-01
current
pecos_ownership
MEDINA COUNTY HOSPITAL DISTRICT
—
—
2024-08-01
current
tx_hhsc_directory
BILLIE BELL
CORPORATE OFFICER
—
2023-06-03
ended 2026-05-18
pecos_ownership
DARLENE KUBIK
ADP OF THE SNF
—
2014-08-01
ended 2026-05-18
pecos_ownership
MAX HANEY
ADP OF THE SNF
—
2014-08-01
ended 2026-05-18
pecos_ownership
PATRICE GREGORY
ADP OF THE SNF
—
2020-11-30
ended 2026-05-18
pecos_ownership
RONALD HANEY
OPERATIONAL/MANAGERIAL CONTROL
—
2014-08-01
ended 2026-05-18
pecos_ownership
SALEH JAAFAR
ADP OF THE SNF
—
2024-08-01
ended 2026-05-18
pecos_ownership
PECOS ownership and managing-control associations. Current edges have no end date in the source; historical edges are retained.
Related-party costs
5
FY end
Total allowable
Rent
Home office
Therapy
Staffing
Counterparties
PropCo
2024-09-30
$24,312
—
—
—
—
1
—
2023-09-30
$24,732
—
—
—
—
1
—
2022-09-30
$24,011
—
—
—
—
1
—
2021-09-30
$16,939
—
—
—
—
1
—
2020-09-30
$18,966
—
—
—
—
1
—
Cost-report related-party spend by fiscal year. has_propco flags real-estate counterparties.
Transactions
0
No transactions on record for this facility. Absence of a record here means the sources CII ingests contain none, not that none exists anywhere.
Most recent same-state, same-setting trades. Most CHOW-derived trades carry no disclosed consideration, so price, $/bed, and cap rate show only where a sale price was resolved from a deed or filing — blanks are honest, not missing data.
Market rent context
33
Geo
Kind
BR
Amount
As of
Source
county 48029
acs median gross
0
$1,088
2024-12-31
CENSUS_ACS5
county 48029
fmr
0
$1,077
2025-10-01
HUD_USER_FMR
county 48029
acs median gross
1
$1,145
2024-12-31
CENSUS_ACS5
county 48029
fmr
1
$1,177
2025-10-01
HUD_USER_FMR
county 48029
acs median gross
2
$1,389
2024-12-31
CENSUS_ACS5
county 48029
fmr
2
$1,426
2025-10-01
HUD_USER_FMR
county 48029
acs median gross
3
$1,668
2024-12-31
CENSUS_ACS5
county 48029
fmr
3
$1,830
2025-10-01
HUD_USER_FMR
county 48029
acs median gross
4
$1,909
2024-12-31
CENSUS_ACS5
county 48029
fmr
4
$2,132
2025-10-01
HUD_USER_FMR
county 48029
acs median gross
5
$2,324
2024-12-31
CENSUS_ACS5
county 48029
acs median gross
$1,354
2024-12-31
CENSUS_ACS5
county 48029
acs recent mover gross
$1,427
2024-12-31
CENSUS_ACS5
zcta 78009
acs median gross
1
$1,109
2024-12-31
CENSUS_ACS5
zcta 78009
acs median gross
2
$1,293
2024-12-31
CENSUS_ACS5
zcta 78009
acs median gross
3
$1,313
2024-12-31
CENSUS_ACS5
zcta 78009
acs median gross
$1,250
2024-12-31
CENSUS_ACS5
zcta 78009
acs recent mover gross
$1,116
2024-12-31
CENSUS_ACS5
zip 78009
payment standard 110
0
$1,111
2025-10-01
HUD_USER_SAFMR
zip 78009
payment standard 90
0
$909
2025-10-01
HUD_USER_SAFMR
zip 78009
safmr
0
$1,010
2025-10-01
HUD_USER_SAFMR
zip 78009
payment standard 110
1
$1,111
2025-10-01
HUD_USER_SAFMR
zip 78009
payment standard 90
1
$909
2025-10-01
HUD_USER_SAFMR
zip 78009
safmr
1
$1,010
2025-10-01
HUD_USER_SAFMR
zip 78009
payment standard 110
2
$1,463
2025-10-01
HUD_USER_SAFMR
zip 78009
payment standard 90
2
$1,197
2025-10-01
HUD_USER_SAFMR
zip 78009
safmr
2
$1,330
2025-10-01
HUD_USER_SAFMR
zip 78009
payment standard 110
3
$1,925
2025-10-01
HUD_USER_SAFMR
zip 78009
payment standard 90
3
$1,575
2025-10-01
HUD_USER_SAFMR
zip 78009
safmr
3
$1,750
2025-10-01
HUD_USER_SAFMR
zip 78009
payment standard 110
4
$1,936
2025-10-01
HUD_USER_SAFMR
zip 78009
payment standard 90
4
$1,584
2025-10-01
HUD_USER_SAFMR
zip 78009
safmr
4
$1,760
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.