Cycle 1
Health 2025-09-10 · Fire 2025-09-10
3 health deficiencies
Top issue: Administration (2 deficiencies)
0 fire-safety deficiencies
No concentrated fire-safety issue counts in this cycle.
West Jordan, UT
Copper Ridge Health Care
5-star overall rating with 4-star inspections with 3 recent health deficiencies
3706 West 9000 South, West Jordan, UT
(801) 280-2273
Overall
5 / 5
CMS overall stars
Health inspections
4 / 5
Survey and complaint cycles
Staffing
3 / 5
RN + nurse staffing
Quality measures
5 / 5
Resident outcomes and process measures
Quick facts
Facility snapshot
Beds
120
Certified beds
Average residents
84
Average occupied residents
Ownership
For-Profit
Publicly displayed owner type
Chain
The Ensign Group
Operator or chain grouping
Approved since
1987-02-09
CMS approved date
Coverage
Medicare + Medicaid
Participation flags
Chain footprint
329 facilities
Chain averages 3 overall / 3 health / 3 staffing / 4 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
0.80
Registered nurse staffing · state 1.19 · national 0.68
LPN hours / resident day
0.62
Licensed practical nurse staffing · state 0.51 · national 0.87
Aide hours / resident day
2.25
Nurse aide staffing · state 2.37 · national 2.35
Total nurse hours
3.67
All reported nurse hours · state 4.06 · national 3.89
Licensed hours
1.42
RN + LPN hours · state 1.69 · national 1.54
Weekend hours
3.17
Weekend nurse staffing · state 3.52 · national 3.43
Weekend RN hours
0.54
Weekend registered nurse coverage · state 0.84 · national 0.47
Physical therapist
0.19
Reported PT staffing · state 0.12 · national 0.07
Adjusted RN hours
0.80
CMS adjusted RN staffing hours
Adjusted total hours
3.67
CMS adjusted total nurse staffing hours
Case-mix index
1.37
Higher values indicate more complex resident acuity
RN turnover
31%
Annual RN turnover · state 43% · national 45%
Total nurse turnover
51%
Annual nurse turnover · state 52% · national 46%
SNF VBP
Value-based purchasing
Program rank
3,828
Lower is better among SNFs in the FY 2026 VBP program.
Performance score
42.51
Composite VBP score used to determine payment impact.
Payment multiplier
0.9955
Above 1.000 increases Medicare payment; below 1.000 reduces it.
Program components
How the VBP score is built
Readmission
6.42
Baseline 19.79% · Performance 18.46% · Measure score 6.42 · Achievement 6.42 · Improvement 4.33
Healthcare-associated infections
6.10
Baseline 6.32% · Performance 6.01% · Measure score 6.10 · Achievement 6.10 · Improvement 1.81
Total nurse turnover
3.88
Baseline 45.57% · Performance 47.83% · Measure score 3.88 · Achievement 3.88 · Improvement 0
Adjusted total nurse staffing
0.61
Baseline 3.36 hours · Performance 3.25 hours · Measure score 0.61 · Achievement 0.61 · Improvement 0
SNF QRP
Medicare quality reporting measures
| Measure | Facility | National | Note |
|---|---|---|---|
| Potentially preventable 30-day readmission | 9.71% |
10.72%
1 pts better
|
No Different than the National Rate · Eligible stays 160 · Observed rate 7.5% · Lower 95% interval 6.69% |
| Discharge to community | 68.55% |
50.57%
18 pts better
|
Better than the National Rate · Eligible stays 115 · Observed rate 70.43% · Lower 95% interval 60.5% |
| Medicare spending per beneficiary | 0.8 |
1.02
0.2 pts better
|
|
| Drug regimen review with follow-up | 92.55% |
95.27%
2.7 pts worse
|
Numerator 87 · Denominator 94 |
| Falls with major injury | 1.06% |
0.77%
0.3 pts worse
|
Numerator 1 · Denominator 94 |
| Discharge self-care score | 74.67% |
53.69%
21 pts better
|
Numerator 56 · Denominator 75 |
| Discharge mobility score | 54.67% |
50.94%
3.7 pts better
|
Numerator 41 · Denominator 75 |
| Pressure ulcers or injuries, new or worsened | 1.06% |
2.29%
1.2 pts better
|
Numerator 1 · Denominator 94 · Adjusted rate 1.07% |
| Healthcare-associated infections requiring hospitalization | 6.01% |
7.12%
1.1 pts better
|
No Different than the National Rate · Eligible stays 75 · Observed rate 2.67% · Lower 95% interval 3.46% |
| Staff COVID-19 vaccination coverage | 0% |
8.2%
8.2 pts worse
|
Numerator 0 · Denominator 133 |
| Staff flu vaccination coverage | 24.7% |
42%
17.3 pts worse
|
Numerator 41 · Denominator 166 |
| Discharge function score | 61.33% |
56.45%
4.9 pts better
|
Numerator 46 · Denominator 75 |
| Transfer of health information to provider | 100% |
95.95%
4 pts better
|
Numerator 58 · Denominator 58 |
| Transfer of health information to patient | Not Available |
96.28%
|
Numerator Not Available · Denominator 15 · Too few residents or stays to report publicly. |
| Resident COVID-19 vaccinations up to date | 81.13% |
25.2%
55.9 pts better
|
Numerator 43 · Denominator 53 |
Quality measures
Resident outcomes and process scores
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| Number of hospitalizations per 1000 long-stay resident days | 0.8 |
1.2
0.4 pts better
|
1.9
1.1 pts better
|
Long Stay · 20240701-20250630 · Adjusted 0.8 · Observed 1.0 · Expected 2.4 · Used in QM five-star |
| Number of outpatient emergency department visits per 1000 long-stay resident days | 0.7 |
1.5
0.8 pts better
|
1.8
1.1 pts better
|
Long Stay · 20240701-20250630 · Adjusted 0.7 · Observed 0.8 · Expected 1.7 · Used in QM five-star |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 99.6% |
96.8%
2.8 pts better
|
93.4%
6.2 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 100.0% · Q2 100.0% · Q3 98.0% · Q4 100.0% · 4Q avg 99.6% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine | 100.0% |
98.0%
2 pts better
|
95.5%
4.5 pts better
|
Long Stay · 2024Q3-2025Q2 · 4Q avg 100.0% |
| Percentage of long-stay residents experiencing one or more falls with major injury | 0.4% |
2.6%
2.2 pts better
|
3.3%
2.9 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 1.6% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.4% · Used in QM five-star |
| Percentage of long-stay residents who have depressive symptoms | 5.0% |
16.1%
11.1 pts better
|
11.4%
6.4 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 4.9% · Q2 1.8% · Q3 2.0% · Q4 11.8% · 4Q avg 5.0% |
| Percentage of long-stay residents who lose too much weight | 4.4% |
3.8%
0.6 pts worse
|
5.4%
1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 1.7% · Q2 5.6% · Q3 6.4% · Q4 4.3% · 4Q avg 4.4% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 17.4% |
24.1%
6.7 pts better
|
19.6%
2.2 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 16.9% · Q2 16.7% · Q3 17.0% · Q4 19.1% · 4Q avg 17.4% |
| Percentage of long-stay residents who received an antipsychotic medication | 13.6% |
15.4%
1.8 pts better
|
16.7%
3.1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 15.2% · Q2 13.5% · Q3 11.8% · Q4 13.3% · 4Q avg 13.6% · Used in QM five-star |
| Percentage of long-stay residents who were physically restrained | 0.4% |
0.1%
0.3 pts worse
|
0.1%
0.3 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 2.0% · Q4 0.0% · 4Q avg 0.4% |
| Percentage of long-stay residents whose ability to walk independently worsened | 8.4% |
18.3%
9.9 pts better
|
16.3%
7.9 pts better
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 8.4% · Used in QM five-star |
| Percentage of long-stay residents whose need for help with daily activities has increased | 11.5% |
13.6%
2.1 pts better
|
14.9%
3.4 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 25.0% · Q2 4.0% · Q3 11.9% · Q4 2.3% · 4Q avg 11.5% · Used in QM five-star |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | 0.6% |
0.9%
0.3 pts better
|
1.0%
0.4 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 1.4% · Q4 1.4% · 4Q avg 0.6% · Used in QM five-star |
| Percentage of long-stay residents with a urinary tract infection | 1.8% |
1.8%
About the same
|
1.7%
0.1 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 1.6% · Q2 1.7% · Q3 0.0% · Q4 3.8% · 4Q avg 1.8% · Used in QM five-star |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | 33.9% |
22.4%
11.5 pts worse
|
19.8%
14.1 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 40.5% · Q2 28.9% · Q3 30.9% · Q4 35.0% · 4Q avg 33.9% |
| Percentage of long-stay residents with pressure ulcers | 2.5% |
4.1%
1.6 pts better
|
5.1%
2.6 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 1.2% · Q2 2.6% · Q3 4.2% · Q4 2.1% · 4Q avg 2.5% · Used in QM five-star |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 100.0% |
93.3%
6.7 pts better
|
81.7%
18.3 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 100.0% · Q2 100.0% · Q3 100.0% · Q4 100.0% · 4Q avg 100.0% |
| Percentage of short-stay residents who had an outpatient emergency department visit | 11.4% |
11.8%
0.4 pts better
|
12.0%
0.6 pts better
|
Short Stay · 20240701-20250630 · Adjusted 11.4% · Observed 11.5% · Expected 11.3% · Used in QM five-star |
| Percentage of short-stay residents who newly received an antipsychotic medication | 1.0% |
0.9%
0.1 pts worse
|
1.6%
0.6 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 1.2% · Q3 1.1% · Q4 1.6% · 4Q avg 1.0% · Used in QM five-star |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 98.9% |
91.0%
7.9 pts better
|
79.7%
19.2 pts better
|
Short Stay · 2024Q3-2025Q2 · 4Q avg 98.9% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission | 18.5% |
17.4%
1.1 pts worse
|
23.9%
5.4 pts better
|
Short Stay · 20240701-20250630 · Adjusted 18.5% · Observed 18.4% · Expected 23.7% · Used in QM five-star |
Survey summary
Recent inspection cycles
Cycle 2
Health 2023-11-02 · Fire 2023-11-02
7 health deficiencies
Top issue: Pharmacy Service (7 deficiencies)
0 fire-safety deficiencies
No concentrated fire-safety issue counts in this cycle.
Cycle 3
Health 2022-01-12 · Fire 2022-01-12
6 health deficiencies
Top issue: Environmental (2 deficiencies)
1 fire-safety deficiencies
Top issue: Emergency Preparedness (1 deficiency)
Fire safety
Fire-safety citations
D · Potential for more than minimal harm
2022-01-12
E39 · Emergency Preparedness Deficiencies
Fire Safety
Conduct testing and exercise requirements.
Corrected 2022-02-25
Inspection history
Recent health citations
D · Potential for more than minimal harm
2025-09-10
F695 · Quality of Life and Care Deficiencies
Health
Provide safe and appropriate respiratory care for a resident when needed.
Corrected 2025-10-06
D · Potential for more than minimal harm
2025-09-10
F775 · Administration Deficiencies
Health
Keep complete, dated laboratory records in the resident's record.
Corrected 2025-10-06
D · Potential for more than minimal harm
2025-09-10
F840 · Administration Deficiencies
Health
Employ or obtain outside professional resources to provide services in the nursing home when the facility does not employ a qualified professional to furnish a required service.
Corrected 2025-10-06
E · Potential for more than minimal harm
2023-11-02
F759 · Pharmacy Service Deficiencies
Health
Ensure medication error rates are not 5 percent or greater.
Corrected 2023-12-01
E · Potential for more than minimal harm
2023-11-02
F760 · Pharmacy Service Deficiencies
Health
Ensure that residents are free from significant medication errors.
Corrected 2023-12-01
D · Potential for more than minimal harm
2023-11-02
F755 · Pharmacy Service Deficiencies
Health
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Corrected 2023-12-01
D · Potential for more than minimal harm
2023-11-02
F756 · Pharmacy Service Deficiencies
Health
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
Corrected 2023-12-01
D · Potential for more than minimal harm
2023-11-02
F757 · Pharmacy Service Deficiencies
Health
Ensure each resident’s drug regimen must be free from unnecessary drugs.
Corrected 2023-12-01
D · Potential for more than minimal harm
2023-11-02
F758 · Pharmacy Service Deficiencies
Health
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.
Corrected 2023-12-01
D · Potential for more than minimal harm
2023-11-02
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 2023-12-01
E · Potential for more than minimal harm
2022-01-12
F804 · Nutrition and Dietary Deficiencies
Health
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Corrected 2022-02-25
E · Potential for more than minimal harm
2022-01-12
F880 · Infection Control Deficiencies
Health
Provide and implement an infection prevention and control program.
Corrected 2022-02-25
E · Potential for more than minimal harm
2022-01-12
F886 · Infection Control Deficiencies
Health
Perform COVID19 testing on residents and staff.
Corrected 2022-02-25
E · Potential for more than minimal harm
2022-01-12
F923 · Environmental Deficiencies
Health
Have enough outside ventilation via a window or mechanical ventilation, or both.
Corrected 2022-02-25
D · Potential for more than minimal harm
2022-01-12
F636 · Resident Assessment and Care Planning Deficiencies
Health
Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months.
Corrected 2022-02-25
D · Potential for more than minimal harm
2022-01-12
F924 · Environmental Deficiencies
Health
Put firmly secured handrails on each side of hallways.
Corrected 2022-02-25
Penalties and ownership
What sits behind the stars
Ownership
Beaver Valley Hospital
5% Or Greater Direct Ownership Interest · Organization
Burnam, Soon
Operational/Managerial Control · Individual
Burnam, Soon
Corporate Officer · Individual
Hymas, Mark
Operational/Managerial Control · Individual
Hymas, Mark
Contracted Managing Employee · Individual
Jordan Health Associates, Inc.
Operational/Managerial Control · Organization
Moss, Tyler
Corporate Officer · Individual
Nearby options
Other facilities in reach
#1
Stonehenge of South Jordan
South Jordan, UT
5-star overall rating with 5-star inspections with 2 recent health deficiencies with 2 fire-safety deficiencies in the latest cycle
#2
Cascades at Riverwalk
Midvale, UT
4-star overall rating with 3-star inspections with $23,829 in total fines with 7 recent health deficiencies with 7 fire-safety deficiencies in the latest cycle
#3
Monument Healthcare Taylorsville
Salt Lake City, UT
4-star overall rating with 3-star inspections with $7,525 in total fines with 8 recent health deficiencies
Jump out