Composite
73.7 / 100 percentile
Screener / 215168
C
LAYHILL NURSING AND REHABILITATION CENTER
snfMD
3227 BEL PRE ROAD, SILVER SPRING, MD 20906 · CCN 215168 · chain RMA EQUITY LLC
Peer group
snf n = 14,684
Evidence depth
deep
Certified beds
129
Model
v1.2
Reads as: riskier than 73.7% 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 model5ML signals1Components16CHOW radar1Distress radar1Staffing16Penalties3Deficiencies103Licensure0Ownership9Related party5Transactions1Comps12Market rent36
Composite explanation
5| Component | Percentile | Raw | Weight | Weight share | Contribution | Counts |
|---|---|---|---|---|---|---|
| regulatory risk | 97.8 | 96.7 | 0.30 | 0.2308 | 22.57 | in index |
| billing conduct | 93.1 | 63.0 | 0.30 | 0.2308 | 21.48 | in index |
| staffing risk | 58.2 | 58.2 | 0.25 | 0.1923 | 11.19 | in index |
| chow risk | 15.0 | 14.7 | 0.15 | 0.1154 | 1.73 | in index |
| financial risk | 2.8 | 10.3 | 0.30 | 0.2308 | 0.65 | 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.
ML signals — parallel engine
1| Kind | Finding | Signal | Subject | First seen |
|---|---|---|---|---|
| connection | Owner fleet enforcement cluster | 40% fined | KOHN AVROHOM | 5 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.
Component scores and registry models
16| Score type | Score | Grade | Model | Status | Registry model notes |
|---|---|---|---|---|---|
| billing conduct | 63.0 | C | v0.1-pacpuf-snf | default · in composite | R22. PAC PUF SNF 2023. PDPM coding intensity vs acuity, stay length, charge markup. |
| chow risk | 25.0 | 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. |
| chow risk | 4.5 | A | v0.6 | default · in composite | |
| financial risk | 10.3 | A | v0.5 | default · in composite | R18. |
| p adverse action 12m | 0.0 | — | 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 | 0.1 | — | 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 | 96.7 | F | v0.3 | default · in composite | Deficiency-based, SNF population. Runs alongside v0.5-pos. |
| staffing risk | 58.2 | C | v0.3 | default · in composite | Cost-report staffing, SNF population. Runs alongside v0.4-pos, which covers ICF/IID from POS. |
| financial risk | 52.9 | C | v0.1 | superseded | 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. |
| financial risk | 32.9 | B | v0.2 | superseded | 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. |
| financial risk | 34.0 | B | v0.3 | superseded | 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. |
| financial risk | 16.4 | A | v0.4 | superseded | 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. |
| regulatory risk | 96.6 | F | 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 | 96.6 | F | 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 | 58.2 | C | 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 | 58.2 | C | 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)
0.1%
model v0.1 · computed 2026-07-29
Percentile among SNFs
19.6
100 = most likely to sell
Holdout AUC
0.874
evaluated before shipping, never refit
| Driver | Value | Pull on odds | |
|---|---|---|---|
| Never sold on record | 0.00 | -1.62 | |
| Current owner tenure (years) | 7.99 | -1.07 | |
| Occupancy | 0.98 | -0.81 | |
| For-profit ownership | 1.00 | +0.69 | |
| Deficiencies, last 12 months | 26.00 | +0.46 | |
| No PBJ staffing report | 0.00 | +0.42 | |
| Ownership changes, last 5 years | 0.00 | +0.20 | |
| Contract staffing share | 0.00 | -0.10 |
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)
0.0%
model v0.1 · computed 2026-07-29
Percentile among SNFs
0.0
100 = most likely to lose certification
Holdout AUC
0.971
top decile caught 95% of actual exits
| Driver | Value | Pull on odds | |
|---|---|---|---|
| Deficiencies, last 12 months | 26.00 | -3.39 | |
| Occupancy | 0.98 | -0.96 | |
| For-profit ownership | 1.00 | -0.69 | |
| No PBJ staffing report | 0.00 | +0.39 | |
| Never sold on record | 0.00 | -0.28 | |
| Chain size (log) | 1.61 | +0.26 | |
| Fine amount, 12m (log) | 0.00 | +0.18 | |
| Current owner tenure (years) | 7.99 | -0.17 |
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 | MD median | National median | National p25–p75 |
|---|---|---|---|---|
| Total nurse | 3.16 | 3.32 | 3.28 | 2.90–3.77 |
| RN | 0.42 | 0.47 | 0.39 | 0.25–0.58 |
| Weekend total | 2.87 | 3.17 | 3.11 | — |
| Weekday total | 3.28 | 3.36 | 3.35 | — |
| Quarter | Days | Avg census | Total HPRD | RN | LPN | CNA | Weekend | Contract % |
|---|---|---|---|---|---|---|---|---|
| 2025Q4 | 92 | 125.9 | 3.16 | 0.42 | 0.87 | 1.87 | 2.87 | 0.0% |
| 2025Q3 | 92 | 123.8 | 3.08 | 0.51 | 0.77 | 1.80 | 2.78 | 0.0% |
| 2025Q2 | 91 | 126.7 | 3.09 | 0.59 | 0.70 | 1.80 | 2.76 | 0.0% |
| 2025Q1 | 90 | 126.7 | 3.00 | 0.57 | 0.77 | 1.66 | 2.72 | 0.0% |
| 2024Q4 | 92 | 128.7 | 2.92 | 0.54 | 0.66 | 1.73 | 2.69 | 0.0% |
| 2024Q3 | 92 | 128.9 | 3.00 | 0.55 | 0.68 | 1.77 | 2.69 | 0.2% |
| 2024Q2 | 91 | 132.6 | 2.92 | 0.54 | 0.77 | 1.61 | 2.66 | 3.6% |
| 2024Q1 | 91 | 132.2 | 2.82 | 0.39 | 0.78 | 1.66 | 2.63 | 6.1% |
| 2023Q4 | 92 | 132.2 | 2.89 | 0.42 | 0.72 | 1.74 | 2.74 | 8.4% |
| 2023Q3 | 92 | 129.7 | 2.90 | 0.54 | 0.66 | 1.70 | 2.70 | 10.7% |
| 2023Q2 | 91 | 125.7 | 2.85 | 0.42 | 0.78 | 1.64 | 2.62 | 12.8% |
| 2023Q1 | 90 | 125.7 | 2.97 | 0.41 | 0.83 | 1.72 | 2.83 | 11.5% |
| 2022Q4 | 92 | 125.3 | 3.02 | 0.46 | 0.84 | 1.72 | 2.79 | 14.9% |
| 2022Q3 | 92 | 124.1 | 2.36 | 0.37 | 0.81 | 1.18 | 2.28 | 19.3% |
| 2022Q2 | 91 | 120.1 | 2.38 | 0.49 | 0.87 | 1.02 | 2.21 | 12.3% |
| 2022Q1 | 90 | 120.6 | 2.72 | 0.51 | 0.88 | 1.33 | 2.43 | 5.7% |
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
3| Date | Type | Fine | Source |
|---|---|---|---|
| 2024-09-23 | Fine | $100,523 | CMS provider data |
| 2024-09-23 | Payment Denial | — | CMS provider data |
| 2024-06-18 | Fine | $53,073 | CMS provider data |
Total fines on record: $153,596
Deficiencies
103D × 72E × 21F × 7G × 2K × 1
deficiencies by survey year
| Survey | Type | Tag | Deficiency | Scope | Corrected |
|---|---|---|---|---|---|
| 2026-02-18 | Health | F0550 | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | D | 2026-04-03 |
| 2026-02-18 | Health | F0567 | Honor the resident's right to manage his or her financial affairs. | E | 2026-04-03 |
| 2026-02-18 | 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. | D | 2026-04-03 |
| 2026-02-18 | Health | F0604 | Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment. | E | 2026-04-03 |
| 2026-02-18 | Health · complaint | F0628 | Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies. | D | 2026-04-03 |
| 2026-02-18 | 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 | 2026-04-03 |
| 2026-02-18 | 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 | 2026-04-03 |
| 2026-02-18 | Health | F0658 | Ensure services provided by the nursing facility meet professional standards of quality. | D | 2026-04-03 |
| 2026-02-18 | 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 | 2026-04-03 |
| 2026-02-18 | Health | F0759 | Ensure medication error rates are not 5 percent or greater. | D | 2026-04-03 |
| 2026-02-18 | Health | F0812 | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | F | 2026-04-03 |
| 2026-02-18 | Health | F0842 | Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | D | 2026-04-03 |
| 2026-02-18 | Health | F0880 | Provide and implement an infection prevention and control program. | D | 2026-04-03 |
| 2026-02-18 | Health | F0917 | Make sure each resident has 1) at least one window to the outside in a room; 2) a room at or above ground level; 3) adequate bedding; 4) furniture that meets the resident's needs; or 5) adequate closet space. | E | 2026-04-03 |
| 2026-02-18 | Health | F0921 | Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. | D | 2026-04-03 |
| 2025-10-09 | Health · complaint | F0552 | Ensure that residents are fully informed and understand their health status, care and treatments. | D | 2025-12-10 |
| 2025-10-09 | Health · complaint | F0568 | Properly hold, secure, and manage each resident's personal money which is deposited with the nursing home. | D | 2025-12-10 |
| 2025-10-09 | Health · complaint | F0609 | Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | D | 2025-12-10 |
| 2025-10-09 | Health · complaint | F0628 | Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies. | D | 2025-12-10 |
| 2025-10-09 | Health · complaint | 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 | 2025-12-10 |
| 2025-10-09 | Health · complaint | F0658 | Ensure services provided by the nursing facility meet professional standards of quality. | E | 2025-09-06 |
| 2025-10-09 | Health · complaint | F0684 | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | D | 2025-12-10 |
| 2025-10-09 | Health · complaint | F0686 | Provide appropriate pressure ulcer care and prevent new ulcers from developing. | D | 2025-12-10 |
| 2025-10-09 | Health · complaint | F0689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | D | 2025-12-10 |
| 2025-10-09 | Health · complaint | F0711 | Ensure the resident's doctor reviews the resident's care, writes, signs and dates progress notes and orders, at each required visit. | E | 2025-12-10 |
| 2025-10-09 | Health · complaint | F0755 | Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | E | 2025-12-10 |
| 2024-09-23 | Health | F0552 | Ensure that residents are fully informed and understand their health status, care and treatments. | D | 2024-11-18 |
| 2024-09-23 | Health | F0557 | Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions. | D | 2024-11-18 |
| 2024-09-23 | Health | F0561 | Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. | E | 2024-11-18 |
| 2024-09-23 | 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. | D | 2024-11-18 |
| 2024-09-23 | Health · complaint | F0580 | Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | D | 2024-11-18 |
| 2024-09-23 | 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 | 2025-01-15 |
| 2024-09-23 | Health | F0605 | Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function. | D | 2024-11-18 |
| 2024-09-23 | Health · complaint | F0610 | Respond appropriately to all alleged violations. | D | 2024-11-18 |
| 2024-09-23 | Health · complaint | F0622 | Not transfer or discharge a resident without an adequate reason; and must provide documentation and convey specific information when a resident is transferred or discharged. | D | 2024-11-18 |
| 2024-09-23 | Health | F0623 | Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. | D | 2024-11-18 |
| 2024-09-23 | Health | F0625 | Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave. | D | 2025-01-15 |
| 2024-09-23 | Health | F0641 | Ensure each resident receives an accurate assessment. | D | 2024-11-18 |
| 2024-09-23 | Health | F0645 | PASARR screening for Mental disorders or Intellectual Disabilities | D | 2024-11-18 |
| 2024-09-23 | Health | F0655 | Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted | D | 2024-11-18 |
| 2024-09-23 | Health · complaint | F0656 | Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | E | 2024-11-18 |
| 2024-09-23 | Health · complaint | F0657 | Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. | F | 2024-11-18 |
| 2024-09-23 | Health | F0658 | Ensure services provided by the nursing facility meet professional standards of quality. | D | 2025-01-15 |
| 2024-09-23 | Health · complaint | F0676 | Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. | D | 2024-11-18 |
| 2024-09-23 | Health | F0677 | Provide care and assistance to perform activities of daily living for any resident who is unable. | D | 2024-11-18 |
| 2024-09-23 | Health | F0678 | Provide basic life support, including CPR, prior to the arrival of emergency medical personnel , subject to physician orders and the resident’s advance directives. | K | 2024-11-18 |
| 2024-09-23 | Health | F0679 | Provide activities to meet all resident's needs. | E | 2024-11-18 |
| 2024-09-23 | Health | F0686 | Provide appropriate pressure ulcer care and prevent new ulcers from developing. | D | 2024-11-18 |
| 2024-09-23 | Health | F0688 | Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. | D | 2024-11-18 |
| 2024-09-23 | Health | F0689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | D | 2024-11-18 |
| 2024-09-23 | Health | F0692 | Provide enough food/fluids to maintain a resident's health. | D | 2024-11-18 |
| 2024-09-23 | Health · complaint | F0693 | Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. | D | 2024-11-18 |
| 2024-09-23 | Health | F0697 | Provide safe, appropriate pain management for a resident who requires such services. | E | 2024-11-18 |
| 2024-09-23 | Health | F0700 | Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail. | E | 2024-11-18 |
| 2024-09-23 | Health | F0732 | Post nurse staffing information every day. | F | 2024-11-18 |
| 2024-09-23 | Health · complaint | F0740 | Ensure each resident must receive and the facility must provide necessary behavioral health care and services. | D | 2024-11-18 |
| 2024-09-23 | 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 | 2024-11-18 |
| 2024-09-23 | Health | F0757 | Ensure each resident’s drug regimen must be free from unnecessary drugs. | E | 2024-11-18 |
| 2024-09-23 | Health | F0758 | Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. | D | 2024-11-18 |
| 2024-09-23 | Health | F0759 | Ensure medication error rates are not 5 percent or greater. | D | 2025-01-15 |
| 2024-09-23 | Health | F0800 | Provide each resident with a nourishing, palatable, well-balanced diet that meets his or her daily nutritional and special dietary needs. | E | 2025-01-15 |
| 2024-09-23 | Health | F0801 | Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician. | D | 2024-11-18 |
| 2024-09-23 | Health | F0812 | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | D | 2024-11-18 |
| 2024-09-23 | Health | F0842 | Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | D | 2024-11-18 |
| 2024-09-23 | Health | F0865 | Have a plan that describes the process for conducting QAPI and QAA activities. | F | 2024-11-18 |
| 2024-09-23 | Health | F0868 | Have the Quality Assessment and Assurance group have the required members and meet at least quarterly | F | 2024-11-18 |
| 2024-09-23 | Health | F0880 | Provide and implement an infection prevention and control program. | D | 2024-11-18 |
| 2024-09-23 | Health | F0908 | Keep all essential equipment working safely. | D | 2024-11-18 |
| 2024-09-23 | Health | F0909 | Regularly inspect all bed frames, mattresses, and bed rails (if any) for safety; and all bed rails and mattresses must attach safely to the bed frame. | E | 2024-11-18 |
| 2024-09-23 | Health | F0919 | Make sure that a working call system is available in each resident's bathroom and bathing area. | D | 2025-01-15 |
| 2024-09-23 | Health | F0921 | Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. | D | 2025-01-15 |
| 2024-09-23 | Health | F0941 | Develop, implement, and/or maintain an effective training program that includes effective communications for direct care staff members. | F | 2024-11-18 |
| 2024-06-18 | Health · complaint | F0550 | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | D | 2024-07-26 |
| 2024-06-18 | Health · complaint | F0554 | Allow residents to self-administer drugs if determined clinically appropriate. | D | 2024-07-26 |
| 2024-06-18 | Health · complaint | F0558 | Reasonably accommodate the needs and preferences of each resident. | D | 2024-07-26 |
| 2024-06-18 | Health · complaint | 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. | D | 2024-07-26 |
| 2024-06-18 | Health · complaint | F0580 | Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | D | 2024-07-26 |
| 2024-06-18 | Health · complaint | F0583 | Keep residents' personal and medical records private and confidential. | G | 2024-07-26 |
| 2024-06-18 | Health · complaint | F0600 | Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | G | 2024-07-26 |
| 2024-06-18 | Health · complaint | F0609 | Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | E | 2024-07-26 |
| 2024-06-18 | Health · complaint | F0610 | Respond appropriately to all alleged violations. | E | 2024-07-26 |
| 2024-06-18 | Health · complaint | F0622 | Not transfer or discharge a resident without an adequate reason; and must provide documentation and convey specific information when a resident is transferred or discharged. | D | 2024-07-26 |
| 2024-06-18 | Health · complaint | F0641 | Ensure each resident receives an accurate assessment. | E | 2024-07-26 |
| 2024-06-18 | Health · complaint | F0656 | Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | D | 2024-07-26 |
| 2024-06-18 | Health · complaint | F0661 | Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge. | D | 2024-07-26 |
| 2024-06-18 | Health · complaint | F0684 | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | E | 2024-07-26 |
| 2024-06-18 | Health · complaint | F0686 | Provide appropriate pressure ulcer care and prevent new ulcers from developing. | D | 2024-07-26 |
| 2024-06-18 | Health · complaint | F0689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | D | 2024-07-26 |
| 2024-06-18 | Health · complaint | F0692 | Provide enough food/fluids to maintain a resident's health. | D | 2024-07-26 |
| 2024-06-18 | Health · complaint | F0711 | Ensure the resident's doctor reviews the resident's care, writes, signs and dates progress notes and orders, at each required visit. | D | 2024-07-26 |
| 2024-06-18 | Health · complaint | 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 | 2024-07-26 |
| 2024-06-18 | Health · complaint | F0740 | Ensure each resident must receive and the facility must provide necessary behavioral health care and services. | D | 2024-07-26 |
| 2024-06-18 | Health · complaint | F0760 | Ensure that residents are free from significant medication errors. | D | 2024-07-26 |
| 2024-06-18 | Health · complaint | F0790 | Provide routine and 24-hour emergency dental care for each resident. | D | 2024-07-26 |
| 2024-06-18 | Health · complaint | F0842 | Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | D | 2024-07-26 |
| 2024-06-18 | Health · complaint | F0865 | Have a plan that describes the process for conducting QAPI and QAA activities. | D | 2024-07-26 |
| 2019-09-27 | Health | F0550 | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | D | 2019-11-10 |
| 2019-09-27 | Health | F0603 | Protect each resident from separation (from other residents, his/her room, or confinement to his/her room). | D | 2019-11-10 |
| 2019-09-27 | Health | F0609 | Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | D | 2019-11-10 |
| 2019-09-27 | Health | F0656 | Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | E | 2019-11-10 |
| 2019-09-27 | Health | F0658 | Ensure services provided by the nursing facility meet professional standards of quality. | D | 2019-11-10 |
| 2019-09-27 | Health | F0689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | E | 2019-11-10 |
| 2019-09-27 | Health | F0880 | Provide and implement an infection prevention and control program. | F | 2019-11-10 |
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
9| Owner | Role | Pct | From | Status | Source |
|---|---|---|---|---|---|
| THUNDER HEALTH HOLDCO LLC | 5% OR GREATER DIRECT OWNERSHIP INTEREST | 100% | 2018-07-01 | current | pecos_ownership |
| BIRNBAUM, ISRAEL | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | 37% | 2021-05-01 | current | pecos_ownership |
| KOHN, AVROHOM | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | 11% | 2021-05-01 | current | pecos_ownership |
| RMA EQUITY LLC | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | 10% | 2023-07-13 | current | pecos_ownership |
| BIRNBAUM, ISRAEL | W-2 MANAGING EMPLOYEE | — | 2018-08-01 | current | pecos_ownership |
| ISRAEL BIRNBAUM | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | 37% | 2021-05-01 | ended 2026-05-18 | pecos_ownership |
| MICHELE NETZER | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | 37% | 2021-05-01 | ended 2026-05-18 | pecos_ownership |
| AVROHOM KOHN | 5% OR GREATER INDIRECT OWNERSHIP INTEREST | 11% | 2021-05-01 | ended 2026-05-18 | pecos_ownership |
| ISRAEL BIRNBAUM | W-2 MANAGING EMPLOYEE | — | 2018-08-01 | 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.
Transactions
1| Close date | Price | Buyer | Seller | Evidence |
|---|---|---|---|---|
| 2018-08-01 | — | LAYHILL SNF LLC | 3227 BEL PRE ROAD OPERATIONS LLC | chow |
Comparable trades — MD snf
12| Close | Facility | Price | $/bed | Cap rate | Beds | Buyer |
|---|---|---|---|---|---|---|
| 2025-03-01 | FROSTBURG REHAB CENTER | — | — | — | 122 | KAYLOR FROSTBURG LLC |
| 2025-03-01 | SOUTH MOUNTAIN REHAB CENTER | — | — | — | 157 | SM REHAB |
| 2024-12-01 | ST. ELIZABETH REHABILITATION & NURSING CENTER | — | — | — | 162 | ST. ELIZABETH OPCO LLC |
| 2024-10-01 | SNOW HILL REHABILITATION & HEALTHCARE CENTER | — | — | — | 69 | SNOW HILL SNF OPERATIONS LLC |
| 2024-10-01 | DENNETT REHAB CENTER | — | — | — | 99 | DENNETT SNF |
| 2024-09-01 | FREDERICK CROSSING OF JOURNEY | — | — | — | 120 | FREDERICK CROSSING OF JOURNEY LLC |
| 2024-07-01 | BAY HARBOR POST ACUTE HEALTHCARE CENTER | — | — | — | 305 | BAY HARBOR OPERATOR LLC |
| 2024-04-01 | GREEN ACRES NURSING AND REHAB | — | — | — | 170 | 10200 LA PLATA OPCO LLC |
| 2024-03-01 | COPPER RIDGE NURSING AND ASSISTED LIVING CENTER | — | — | — | 66 | CARROLL MD OPCO LLC |
| 2024-01-01 | RESORTS OF AUGSBURG | — | — | — | 131 | RESORTS OF AUGSBURG CORP |
| 2023-12-01 | ROSSVILLE REHABILITATION AND HEALTHCARE CENTER | — | — | — | 172 | ROSSVILLE SNF OPERATIONS LLC |
| 2023-12-01 | TOWSON REHABILITATION AND HEALTHCARE CENTER | — | — | — | 132 | TOWSON SNF OPERATIONS LLC |
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
36| Geo | Kind | BR | Amount | As of | Source |
|---|---|---|---|---|---|
| county 24031 | acs median gross | 0 | $1,685 | 2024-12-31 | CENSUS_ACS5 |
| county 24031 | fmr | 0 | $1,953 | 2025-10-01 | HUD_USER_FMR |
| county 24031 | acs median gross | 1 | $1,819 | 2024-12-31 | CENSUS_ACS5 |
| county 24031 | fmr | 1 | $2,015 | 2025-10-01 | HUD_USER_FMR |
| county 24031 | acs median gross | 2 | $2,113 | 2024-12-31 | CENSUS_ACS5 |
| county 24031 | fmr | 2 | $2,246 | 2025-10-01 | HUD_USER_FMR |
| county 24031 | acs median gross | 3 | $2,515 | 2024-12-31 | CENSUS_ACS5 |
| county 24031 | fmr | 3 | $2,835 | 2025-10-01 | HUD_USER_FMR |
| county 24031 | acs median gross | 4 | $3,095 | 2024-12-31 | CENSUS_ACS5 |
| county 24031 | fmr | 4 | $3,332 | 2025-10-01 | HUD_USER_FMR |
| county 24031 | acs median gross | 5 | $3,501 | 2024-12-31 | CENSUS_ACS5 |
| county 24031 | acs median gross | $2,068 | 2024-12-31 | CENSUS_ACS5 | |
| county 24031 | acs recent mover gross | $2,226 | 2024-12-31 | CENSUS_ACS5 | |
| zcta 20906 | acs median gross | 0 | $1,464 | 2024-12-31 | CENSUS_ACS5 |
| zcta 20906 | acs median gross | 1 | $1,710 | 2024-12-31 | CENSUS_ACS5 |
| zcta 20906 | acs median gross | 2 | $2,006 | 2024-12-31 | CENSUS_ACS5 |
| zcta 20906 | acs median gross | 3 | $2,290 | 2024-12-31 | CENSUS_ACS5 |
| zcta 20906 | acs median gross | 4 | $2,588 | 2024-12-31 | CENSUS_ACS5 |
| zcta 20906 | acs median gross | 5 | $3,000 | 2024-12-31 | CENSUS_ACS5 |
| zcta 20906 | acs median gross | $1,963 | 2024-12-31 | CENSUS_ACS5 | |
| zcta 20906 | acs recent mover gross | $1,916 | 2024-12-31 | CENSUS_ACS5 | |
| zip 20906 | payment standard 110 | 0 | $2,090 | 2025-10-01 | HUD_USER_SAFMR |
| zip 20906 | payment standard 90 | 0 | $1,710 | 2025-10-01 | HUD_USER_SAFMR |
| zip 20906 | safmr | 0 | $1,900 | 2025-10-01 | HUD_USER_SAFMR |
| zip 20906 | payment standard 110 | 1 | $2,156 | 2025-10-01 | HUD_USER_SAFMR |
| zip 20906 | payment standard 90 | 1 | $1,764 | 2025-10-01 | HUD_USER_SAFMR |
| zip 20906 | safmr | 1 | $1,960 | 2025-10-01 | HUD_USER_SAFMR |
| zip 20906 | payment standard 110 | 2 | $2,409 | 2025-10-01 | HUD_USER_SAFMR |
| zip 20906 | payment standard 90 | 2 | $1,971 | 2025-10-01 | HUD_USER_SAFMR |
| zip 20906 | safmr | 2 | $2,190 | 2025-10-01 | HUD_USER_SAFMR |
| zip 20906 | payment standard 110 | 3 | $3,036 | 2025-10-01 | HUD_USER_SAFMR |
| zip 20906 | payment standard 90 | 3 | $2,484 | 2025-10-01 | HUD_USER_SAFMR |
| zip 20906 | safmr | 3 | $2,760 | 2025-10-01 | HUD_USER_SAFMR |
| zip 20906 | payment standard 110 | 4 | $3,575 | 2025-10-01 | HUD_USER_SAFMR |
| zip 20906 | payment standard 90 | 4 | $2,925 | 2025-10-01 | HUD_USER_SAFMR |
| zip 20906 | safmr | 4 | $3,250 | 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.