Cycle 1
Health 2025-03-21 · Fire 2025-03-21
1 health deficiencies
Top issue: Pharmacy Service (1 deficiency)
0 fire-safety deficiencies
No concentrated fire-safety issue counts in this cycle.
Frankfort, KY
Bradford Square Nursing and Rehabilitation Center
1-star overall rating with 2-star inspections with $13,627 in total fines with 1 recent health deficiencies
1040 US Highway 127 South, Frankfort, KY
(502) 875-5600
Overall
1 / 5
CMS overall stars
Health inspections
2 / 5
Survey and complaint cycles
Staffing
1 / 5
RN + nurse staffing
Quality measures
3 / 5
Resident outcomes and process measures
Quick facts
Facility snapshot
Beds
100
Certified beds
Average residents
89
Average occupied residents
Ownership
For-Profit
Publicly displayed owner type
Chain
Encore Health Partners
Operator or chain grouping
Approved since
1983-10-05
CMS approved date
Coverage
Medicare + Medicaid
Participation flags
Chain footprint
12 facilities
Chain averages 3 overall / 3 health / 2 staffing / 3 quality stars
Changed ownership
No
Within the last 12 months
Family council
Yes
Resident and family council reported
Sprinklers
Yes
Automatic sprinklers in all required areas
Staffing
Hours and turnover
RN hours / resident day
0.49
Registered nurse staffing · state 0.77 · national 0.68
LPN hours / resident day
0.92
Licensed practical nurse staffing · state 0.81 · national 0.87
Aide hours / resident day
2.32
Nurse aide staffing · state 2.43 · national 2.35
Total nurse hours
3.72
All reported nurse hours · state 4.01 · national 3.89
Licensed hours
1.40
RN + LPN hours · state 1.58 · national 1.54
Weekend hours
3.32
Weekend nurse staffing · state 3.50 · national 3.43
Weekend RN hours
0.27
Weekend registered nurse coverage · state 0.52 · national 0.47
Physical therapist
0.02
Reported PT staffing · state 0.06 · national 0.07
Adjusted RN hours
0.41
CMS adjusted RN staffing hours
Adjusted total hours
3.11
CMS adjusted total nurse staffing hours
Case-mix index
1.64
Higher values indicate more complex resident acuity
RN turnover
56%
Annual RN turnover · state 43% · national 45%
Total nurse turnover
50%
Annual nurse turnover · state 47% · national 46%
SNF VBP
Value-based purchasing
Program rank
10,779
Lower is better among SNFs in the FY 2026 VBP program.
Performance score
19.14
Composite VBP score used to determine payment impact.
Payment multiplier
0.9821
Above 1.000 increases Medicare payment; below 1.000 reduces it.
Program components
How the VBP score is built
Readmission
5.32
Baseline 17.88% · Performance 18.96% · Measure score 5.32 · Achievement 5.32 · Improvement 0
Healthcare-associated infections
0
Baseline 6.05% · Performance 7.74% · Measure score 0 · Achievement 0 · Improvement 0
Total nurse turnover
2.33
Baseline 65.98% · Performance 54.32% · Measure score 2.33 · Achievement 2.29 · Improvement 2.33
Adjusted total nurse staffing
0
Baseline 3.37 hours · Performance 3.18 hours · Measure score 0 · Achievement 0 · Improvement 0
SNF QRP
Medicare quality reporting measures
| Measure | Facility | National | Note |
|---|---|---|---|
| Potentially preventable 30-day readmission | 10.78% |
10.72%
0.1 pts worse
|
No Different than the National Rate · Eligible stays 64 · Observed rate 10.94% · Lower 95% interval 7.06% |
| Discharge to community | 44.88% |
50.57%
5.7 pts worse
|
No Different than the National Rate · Eligible stays 50 · Observed rate 34% · Lower 95% interval 33.75% |
| Medicare spending per beneficiary | 1.16 |
1.02
0.1 pts worse
|
|
| Drug regimen review with follow-up | 95.24% |
95.27%
About the same
|
Numerator 40 · Denominator 42 |
| Falls with major injury | 2.38% |
0.77%
1.6 pts worse
|
Numerator 1 · Denominator 42 |
| Discharge self-care score | 48.39% |
53.69%
5.3 pts worse
|
Numerator 15 · Denominator 31 |
| Discharge mobility score | 51.61% |
50.94%
0.7 pts better
|
Numerator 16 · Denominator 31 |
| Pressure ulcers or injuries, new or worsened | 2.38% |
2.29%
0.1 pts worse
|
Numerator 1 · Denominator 42 · Adjusted rate 1.94% |
| Healthcare-associated infections requiring hospitalization | 7.74% |
7.12%
0.6 pts worse
|
No Different than the National Rate · Eligible stays 37 · Observed rate 10.81% · Lower 95% interval 4.2% |
| Staff COVID-19 vaccination coverage | 1.57% |
8.2%
6.6 pts worse
|
Numerator 2 · Denominator 127 |
| Staff flu vaccination coverage | 1.54% |
42%
40.5 pts worse
|
Numerator 2 · Denominator 130 |
| Discharge function score | 58.06% |
56.45%
1.6 pts better
|
Numerator 18 · Denominator 31 |
| Transfer of health information to provider | Not Available |
95.95%
|
Numerator Not Available · Denominator 10 · Too few residents or stays to report publicly. |
| Transfer of health information to patient | Not Available |
96.28%
|
Numerator Not Available · Denominator 8 · Too few residents or stays to report publicly. |
| Resident COVID-19 vaccinations up to date | 25.93% |
25.2%
0.7 pts better
|
Numerator 7 · Denominator 27 |
Quality measures
Resident outcomes and process scores
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| Number of hospitalizations per 1000 long-stay resident days | 2.3 |
1.9
0.4 pts worse
|
1.9
0.4 pts worse
|
Long Stay · 20240701-20250630 · Adjusted 2.3 · Observed 2.9 · Expected 2.4 · Used in QM five-star |
| Number of outpatient emergency department visits per 1000 long-stay resident days | 2.3 |
2.2
0.1 pts worse
|
1.8
0.5 pts worse
|
Long Stay · 20240701-20250630 · Adjusted 2.3 · Observed 2.7 · Expected 2.0 · Used in QM five-star |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 75.7% |
94.3%
18.6 pts worse
|
93.4%
17.7 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 76.8% · Q2 78.4% · Q3 76.8% · Q4 70.6% · 4Q avg 75.7% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine | 91.3% |
96.2%
4.9 pts worse
|
95.5%
4.2 pts worse
|
Long Stay · 2024Q3-2025Q2 · 4Q avg 91.3% |
| Percentage of long-stay residents experiencing one or more falls with major injury | 2.7% |
3.8%
1.1 pts better
|
3.3%
0.6 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 2.4% · Q2 3.4% · Q3 3.7% · Q4 1.2% · 4Q avg 2.7% · Used in QM five-star |
| Percentage of long-stay residents who have depressive symptoms | 30.1% |
15.2%
14.9 pts worse
|
11.4%
18.7 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 17.1% · Q2 46.1% · Q3 28.8% · Q4 28.6% · 4Q avg 30.1% |
| Percentage of long-stay residents who lose too much weight | 9.6% |
6.7%
2.9 pts worse
|
5.4%
4.2 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 7.7% · Q2 11.4% · Q3 10.5% · Q4 9.0% · 4Q avg 9.6% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 33.8% |
29.6%
4.2 pts worse
|
19.6%
14.2 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 32.1% · Q2 30.7% · Q3 36.7% · Q4 36.1% · 4Q avg 33.8% |
| Percentage of long-stay residents who received an antipsychotic medication | 26.4% |
17.6%
8.8 pts worse
|
16.7%
9.7 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 30.5% · Q2 28.6% · Q3 25.9% · Q4 20.3% · 4Q avg 26.4% · Used in QM five-star |
| Percentage of long-stay residents who were physically restrained | 0.0% |
0.2%
0.2 pts better
|
0.1%
0.1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0% |
| Percentage of long-stay residents whose ability to walk independently worsened | 18.2% |
17.3%
0.9 pts worse
|
16.3%
1.9 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 17.5% · Q2 20.9% · Q3 10.3% · Q4 24.3% · 4Q avg 18.2% · Used in QM five-star |
| Percentage of long-stay residents whose need for help with daily activities has increased | 21.0% |
15.6%
5.4 pts worse
|
14.9%
6.1 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 15.8% · Q2 22.0% · Q3 19.7% · Q4 26.2% · 4Q avg 21.0% · Used in QM five-star |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | 0.7% |
0.7%
About the same
|
1.0%
0.3 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 1.0% · Q2 0.8% · Q3 0.9% · Q4 0.0% · 4Q avg 0.7% · Used in QM five-star |
| Percentage of long-stay residents with a urinary tract infection | 3.1% |
1.7%
1.4 pts worse
|
1.7%
1.4 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 2.5% · Q2 0.0% · Q3 6.3% · Q4 3.7% · 4Q avg 3.1% · Used in QM five-star |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | 19.3% |
19.8%
0.5 pts better
|
19.8%
0.5 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 16.9% · Q2 19.9% · Q3 16.4% · Q4 24.0% · 4Q avg 19.3% |
| Percentage of long-stay residents with pressure ulcers | 5.6% |
5.5%
0.1 pts worse
|
5.1%
0.5 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 6.5% · Q2 8.8% · Q3 2.8% · Q4 4.4% · 4Q avg 5.6% · Used in QM five-star |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 62.3% |
83.8%
21.5 pts worse
|
81.7%
19.4 pts worse
|
Short Stay · 2024Q4-2025Q3 · Q1 36.1% · Q2 55.4% · Q3 77.4% · Q4 86.0% · 4Q avg 62.3% |
| Percentage of short-stay residents who had an outpatient emergency department visit | 22.9% |
13.9%
9 pts worse
|
12.0%
10.9 pts worse
|
Short Stay · 20240701-20250630 · Adjusted 22.9% · Observed 23.2% · Expected 11.3% · Used in QM five-star |
| Percentage of short-stay residents who newly received an antipsychotic medication | 1.6% |
1.8%
0.2 pts better
|
1.6%
About the same
|
Short Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 2.9% · Q4 3.6% · 4Q avg 1.6% · Used in QM five-star |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 67.2% |
83.6%
16.4 pts worse
|
79.7%
12.5 pts worse
|
Short Stay · 2024Q3-2025Q2 · 4Q avg 67.2% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission | 13.1% |
24.5%
11.4 pts better
|
23.9%
10.8 pts better
|
Short Stay · 20240701-20250630 · Adjusted 13.1% · Observed 14.3% · Expected 26.1% · Used in QM five-star |
Survey summary
Recent inspection cycles
Cycle 2
Health 2024-04-26 · Fire 2024-04-26
15 health deficiencies
Top issue: Resident Rights (4 deficiencies)
15 fire-safety deficiencies
Top issue: Smoke (6 deficiencies)
Cycle 3
Health 2023-01-12 · Fire 2023-01-12
0 health deficiencies
No concentrated health issue counts in this cycle.
2 fire-safety deficiencies
Top issue: Smoke (2 deficiencies)
Fire safety
Fire-safety citations
F · Potential for more than minimal harm
2024-04-26
K293 · Egress Deficiencies
Fire Safety
Have properly located and lighted "Exit" signs.
Corrected 2024-05-31
F · Potential for more than minimal harm
2024-04-26
K353 · Smoke Deficiencies
Fire Safety
Inspect, test, and maintain automatic sprinkler systems.
Corrected 2024-05-31
F · Potential for more than minimal harm
2024-04-26
K712 · Miscellaneous Deficiencies
Fire Safety
Have simulated fire drills held at unexpected times.
Corrected 2024-05-31
F · Potential for more than minimal harm
2024-04-26
K741 · Miscellaneous Deficiencies
Fire Safety
Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.
Corrected 2024-05-31
F · Potential for more than minimal harm
2024-04-26
K918 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Have generator or other power source capable of supplying service within 10 seconds.
Corrected 2024-05-31
F · Potential for more than minimal harm
2024-04-26
K921 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Ensure that testing and maintenance of electrical equipment is performed.
Corrected 2024-05-31
E · Potential for more than minimal harm
2024-04-26
K222 · Egress Deficiencies
Fire Safety
Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.
Corrected 2024-05-31
E · Potential for more than minimal harm
2024-04-26
K321 · Smoke Deficiencies
Fire Safety
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
Corrected 2024-05-31
E · Potential for more than minimal harm
2024-04-26
K324 · Smoke Deficiencies
Fire Safety
Provide properly protected cooking facilities.
Corrected 2024-05-31
E · Potential for more than minimal harm
2024-04-26
K363 · Smoke Deficiencies
Fire Safety
Install corridor and hallway doors that block smoke.
Corrected 2024-05-31
E · Potential for more than minimal harm
2024-04-26
K372 · Smoke Deficiencies
Fire Safety
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
Corrected 2024-05-31
E · Potential for more than minimal harm
2024-04-26
K374 · Smoke Deficiencies
Fire Safety
Install smoke barrier doors that can resist smoke for at least 20 minutes.
Corrected 2024-05-31
E · Potential for more than minimal harm
2024-04-26
K912 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Have power receptacles that are properly grounded.
Corrected 2024-05-31
E · Potential for more than minimal harm
2024-04-26
K920 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Ensure proper usage of power strips and extension cords.
Corrected 2024-05-31
D · Potential for more than minimal harm
2024-04-26
K781 · Miscellaneous Deficiencies
Fire Safety
Have restrictions on the use of portable space heaters.
Corrected 2024-05-31
E · Potential for more than minimal harm
2023-01-12
K321 · Smoke Deficiencies
Fire Safety
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
Corrected 2023-02-14
E · Potential for more than minimal harm
2023-01-12
K372 · Smoke Deficiencies
Fire Safety
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
Corrected 2023-02-14
Inspection history
Recent health citations
D · Potential for more than minimal harm
2025-03-21
F761 · Pharmacy Service Deficiencies
Health
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.
Corrected 2025-04-10
J · Immediate jeopardy
2024-06-27
F624 · Resident Rights Deficiencies
Health
Prepare residents for a safe transfer or discharge from the nursing home.
Corrected 2024-05-31
F · Potential for more than minimal harm
2024-04-26
F802 · Nutrition and Dietary Deficiencies
Health
Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service.
Corrected 2024-05-31
E · Potential for more than minimal harm
2024-04-26
F584 · Resident Rights Deficiencies
Health
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.
Corrected 2024-05-31
E · Potential for more than minimal harm
2024-04-26
F761 · Pharmacy Service Deficiencies
Health
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.
Corrected 2024-07-19
E · Potential for more than minimal harm
2024-04-26
F812 · Nutrition and Dietary Deficiencies
Health
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected 2024-05-31
E · Potential for more than minimal harm
2024-04-26
F835 · Administration Deficiencies
Health
Administer the facility in a manner that enables it to use its resources effectively and efficiently.
Corrected 2024-07-19
E · Potential for more than minimal harm
2024-04-26
F880 · Infection Control Deficiencies
Health
Provide and implement an infection prevention and control program.
Corrected 2024-07-19
D · Potential for more than minimal harm
2024-04-26
F550 · Resident Rights Deficiencies
Health
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Corrected 2024-07-19
D · Potential for more than minimal harm
2024-04-26
F578 · Resident Rights Deficiencies
Health
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.
Corrected 2024-05-31
D · Potential for more than minimal harm
2024-04-26
F600 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Health
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Corrected 2024-05-31
D · Potential for more than minimal harm
2024-04-26
F657 · Resident Assessment and Care Planning Deficiencies
Health
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Corrected 2024-07-19
D · Potential for more than minimal harm
2024-04-26
F692 · Quality of Life and Care Deficiencies
Health
Provide enough food/fluids to maintain a resident's health.
Corrected 2024-05-31
D · Potential for more than minimal harm
2024-04-26
F695 · Quality of Life and Care Deficiencies
Health
Provide safe and appropriate respiratory care for a resident when needed.
Corrected 2024-05-31
D · Potential for more than minimal harm
2024-04-26
F887 · Infection Control Deficiencies
Health
Educate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status.
Corrected 2024-05-31
D · Potential for more than minimal harm
2024-04-26
F912 · Environmental Deficiencies
Health
Provide rooms that are at least 80 square feet per resident in multiple rooms and 100 square feet for single resident rooms.
Corrected 2024-07-19
Penalties and ownership
What sits behind the stars
$13,627
2024-04-26
Fine
Fine · fine $13,627
Fine
Ownership
Encore Investors LLC
5% Or Greater Direct Ownership Interest · Organization
Fischl, Mayer
5% Or Greater Indirect Ownership Interest · Individual
Grinspan, Eli
5% Or Greater Indirect Ownership Interest · Individual
Rubenstein, David
5% Or Greater Indirect Ownership Interest · Individual
Grinspan, Isaac
5% Or Greater Indirect Ownership Interest · Individual
Bloom, David
5% Or Greater Indirect Ownership Interest · Individual
Encore Health Partners 2 LLC
Operational/Managerial Control · Organization
Fischl, Mayer
Operational/Managerial Control · Individual
Fischl, Mayer
Corporate Officer · Individual
Gossage, James
Operational/Managerial Control · Individual
Grinspan, Eli
Operational/Managerial Control · Individual
Grinspan, Eli
Corporate Officer · Individual
Keybank National Association
5% Or Greater Mortgage Interest · Organization
Nearby options
Other facilities in reach
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2-star overall rating with 3-star inspections with 4 recent health deficiencies with 7 fire-safety deficiencies in the latest cycle
#2
Owenton Healthcare and Rehabilitation
Owenton, KY
2-star overall rating with 2-star inspections with $8,512 in total fines with 5 recent health deficiencies with 3 fire-safety deficiencies in the latest cycle
#3
The Home Place At Midway
Midway, KY
3-star overall rating with 2-star inspections with $4,147 in total fines with 4 recent health deficiencies with 5 fire-safety deficiencies in the latest cycle
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