Cycle 1
Health 2024-11-07 · Fire 2024-11-07
2 health deficiencies
Top issue: Infection Control (1 deficiency)
0 fire-safety deficiencies
No concentrated fire-safety issue counts in this cycle.
Springdale, AR
Edgewood Health And Rehab
5-star overall rating with 4-star inspections with 2 recent health deficiencies
1393 E Don Tyson Parkway, Springdale, AR
(479) 751-2390
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
100
Certified beds
Average residents
83
Average occupied residents
Ownership
For-Profit
Publicly displayed owner type
Chain
Anthony & Bryan Adams
Operator or chain grouping
Approved since
2008-06-19
CMS approved date
Coverage
Medicare + Medicaid
Participation flags
Chain footprint
38 facilities
Chain averages 4 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
0.26
Registered nurse staffing · state 0.40 · national 0.68
LPN hours / resident day
1.16
Licensed practical nurse staffing · state 0.95 · national 0.87
Aide hours / resident day
2.83
Nurse aide staffing · state 2.72 · national 2.35
Total nurse hours
4.26
All reported nurse hours · state 4.07 · national 3.89
Licensed hours
1.42
RN + LPN hours · state 1.35 · national 1.54
Weekend hours
3.52
Weekend nurse staffing · state 3.48 · national 3.43
Weekend RN hours
0.21
Weekend registered nurse coverage · state 0.27 · national 0.47
Physical therapist
0.02
Reported PT staffing · state 0.03 · national 0.07
Adjusted RN hours
0.29
CMS adjusted RN staffing hours
Adjusted total hours
4.70
CMS adjusted total nurse staffing hours
Case-mix index
1.24
Higher values indicate more complex resident acuity
RN turnover
60%
Annual RN turnover · state 48% · national 45%
Total nurse turnover
46%
Annual nurse turnover · state 51% · national 46%
SNF VBP
Value-based purchasing
Program rank
5,556
Lower is better among SNFs in the FY 2026 VBP program.
Performance score
35.77
Composite VBP score used to determine payment impact.
Payment multiplier
0.9893
Above 1.000 increases Medicare payment; below 1.000 reduces it.
Program components
How the VBP score is built
Readmission
4.60
Baseline 20.16% · Performance 19.30% · Measure score 4.60 · Achievement 4.60 · Improvement 2.23
Healthcare-associated infections
4.09
Baseline 8.03% · Performance 6.64% · Measure score 4.09 · Achievement 4.01 · Improvement 4.09
Total nurse turnover
0
Baseline 61.36% · Performance 63.06% · Measure score 0 · Achievement 0 · Improvement 0
Adjusted total nurse staffing
5.62
Baseline 4.23 hours · Performance 4.68 hours · Measure score 5.62 · Achievement 5.62 · Improvement 2.39
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 128 · Observed rate 10.16% · Lower 95% interval 7.12% |
| Discharge to community | 48.32% |
50.57%
2.2 pts worse
|
No Different than the National Rate · Eligible stays 94 · Observed rate 44.68% · Lower 95% interval 38.96% |
| Medicare spending per beneficiary | 0.93 |
1.02
0.1 pts better
|
|
| Drug regimen review with follow-up | 98.81% |
95.27%
3.5 pts better
|
Numerator 83 · Denominator 84 |
| Falls with major injury | 1.19% |
0.77%
0.4 pts worse
|
Numerator 1 · Denominator 84 |
| Discharge self-care score | 41.79% |
53.69%
11.9 pts worse
|
Numerator 28 · Denominator 67 |
| Discharge mobility score | 64.18% |
50.94%
13.2 pts better
|
Numerator 43 · Denominator 67 |
| Pressure ulcers or injuries, new or worsened | 3.57% |
2.29%
1.3 pts worse
|
Numerator 3 · Denominator 84 · Adjusted rate 3.55% |
| Healthcare-associated infections requiring hospitalization | 6.64% |
7.12%
0.5 pts better
|
No Different than the National Rate · Eligible stays 64 · Observed rate 4.69% · Lower 95% interval 3.53% |
| Staff COVID-19 vaccination coverage | 1.56% |
8.2%
6.6 pts worse
|
Numerator 2 · Denominator 128 |
| Staff flu vaccination coverage | 81.32% |
42%
39.3 pts better
|
Numerator 148 · Denominator 182 |
| Discharge function score | 68.66% |
56.45%
12.2 pts better
|
Numerator 46 · Denominator 67 |
| Transfer of health information to provider | 96.97% |
95.95%
1 pts better
|
Numerator 32 · Denominator 33 |
| Transfer of health information to patient | Not Available |
96.28%
|
Numerator Not Available · Denominator 19 · Too few residents or stays to report publicly. |
| Resident COVID-19 vaccinations up to date | 38.78% |
25.2%
13.6 pts better
|
Numerator 19 · Denominator 49 |
Quality measures
Resident outcomes and process scores
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| Number of hospitalizations per 1000 long-stay resident days | 2.1 |
2.0
0.1 pts worse
|
1.9
0.2 pts worse
|
Long Stay · 20240701-20250630 · Adjusted 2.1 · Observed 2.1 · Expected 1.8 · Used in QM five-star |
| Number of outpatient emergency department visits per 1000 long-stay resident days | 1.6 |
2.2
0.6 pts better
|
1.8
0.2 pts better
|
Long Stay · 20240701-20250630 · Adjusted 1.6 · Observed 1.5 · Expected 1.5 · Used in QM five-star |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 100.0% |
94.9%
5.1 pts better
|
93.4%
6.6 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 100.0% · Q2 100.0% · Q3 100.0% · Q4 100.0% · 4Q avg 100.0% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine | 100.0% |
96.1%
3.9 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 | 4.9% |
3.9%
1 pts worse
|
3.3%
1.6 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 5.3% · Q2 9.1% · Q3 2.7% · Q4 2.9% · 4Q avg 4.9% · Used in QM five-star |
| Percentage of long-stay residents who have depressive symptoms | 0.0% |
1.4%
1.4 pts better
|
11.4%
11.4 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 who lose too much weight | 1.6% |
4.9%
3.3 pts better
|
5.4%
3.8 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 1.6% · Q2 1.7% · Q3 1.5% · Q4 1.7% · 4Q avg 1.6% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 12.5% |
21.8%
9.3 pts better
|
19.6%
7.1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 18.8% · Q2 13.3% · Q3 9.2% · Q4 8.5% · 4Q avg 12.5% |
| Percentage of long-stay residents who received an antipsychotic medication | 3.8% |
12.5%
8.7 pts better
|
16.7%
12.9 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 3.7% · Q2 4.1% · Q3 3.4% · Q4 4.1% · 4Q avg 3.8% · Used in QM five-star |
| Percentage of long-stay residents who were physically restrained | 0.0% |
0.1%
0.1 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 | 10.4% |
11.4%
1 pts better
|
16.3%
5.9 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 16.4% · Q2 13.2% · Q3 2.6% · Q4 9.5% · 4Q avg 10.4% · Used in QM five-star |
| Percentage of long-stay residents whose need for help with daily activities has increased | 6.1% |
10.4%
4.3 pts better
|
14.9%
8.8 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 6.3% · Q2 8.5% · Q3 4.7% · Q4 5.1% · 4Q avg 6.1% · Used in QM five-star |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | 0.0% |
0.7%
0.7 pts better
|
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% · Used in QM five-star |
| Percentage of long-stay residents with a urinary tract infection | 0.0% |
1.1%
1.1 pts better
|
1.7%
1.7 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0% · Used in QM five-star |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | 11.9% |
14.6%
2.7 pts better
|
19.8%
7.9 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 7.9% · Q2 12.0% · Q3 12.4% · Q4 15.4% · 4Q avg 11.9% |
| Percentage of long-stay residents with pressure ulcers | 2.1% |
4.6%
2.5 pts better
|
5.1%
3 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 3.3% · Q2 3.8% · Q3 0.0% · Q4 1.3% · 4Q avg 2.1% · Used in QM five-star |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 98.4% |
81.8%
16.6 pts better
|
81.7%
16.7 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 96.4% · Q2 97.9% · Q3 99.3% · Q4 100.0% · 4Q avg 98.4% |
| Percentage of short-stay residents who had an outpatient emergency department visit | 12.4% |
13.8%
1.4 pts better
|
12.0%
0.4 pts worse
|
Short Stay · 20240701-20250630 · Adjusted 12.4% · Observed 12.5% · Expected 11.3% · Used in QM five-star |
| Percentage of short-stay residents who newly received an antipsychotic medication | 0.0% |
1.4%
1.4 pts better
|
1.6%
1.6 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0% · Used in QM five-star |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 91.6% |
77.9%
13.7 pts better
|
79.7%
11.9 pts better
|
Short Stay · 2024Q3-2025Q2 · 4Q avg 91.6% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission | 22.3% |
25.2%
2.9 pts better
|
23.9%
1.6 pts better
|
Short Stay · 20240701-20250630 · Adjusted 22.3% · Observed 21.4% · Expected 22.9% · Used in QM five-star |
Survey summary
Recent inspection cycles
Cycle 2
Health 2023-09-08 · Fire 2023-09-08
5 health deficiencies
Top issue: Resident Rights (2 deficiencies)
1 fire-safety deficiencies
Top issue: Smoke (1 deficiency)
Cycle 3
Health 2022-06-10 · Fire 2022-06-10
5 health deficiencies
Top issue: Nutrition and Dietary (2 deficiencies)
0 fire-safety deficiencies
No concentrated fire-safety issue counts in this cycle.
Fire safety
Fire-safety citations
E · Potential for more than minimal harm
2023-09-08
K363 · Smoke Deficiencies
Fire Safety
Install corridor and hallway doors that block smoke.
Corrected 2023-10-06
Inspection history
Recent health citations
E · Potential for more than minimal harm
2024-11-07
F727 · Nursing and Physician Services Deficiencies
Health
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.
Corrected 2024-12-05
E · Potential for more than minimal harm
2024-11-07
F880 · Infection Control Deficiencies
Health
Provide and implement an infection prevention and control program.
Corrected 2024-12-05
F · Potential for more than minimal harm
2023-09-08
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 2023-10-06
E · Potential for more than minimal harm
2023-09-08
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 2023-10-06
E · Potential for more than minimal harm
2023-09-08
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 2023-10-06
D · Potential for more than minimal harm
2023-09-08
F583 · Resident Rights Deficiencies
Health
Keep residents' personal and medical records private and confidential.
Corrected 2023-10-06
D · Potential for more than minimal harm
2023-09-08
F880 · Infection Control Deficiencies
Health
Provide and implement an infection prevention and control program.
Corrected 2023-10-06
F · Potential for more than minimal harm
2022-06-10
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 2022-07-11
E · Potential for more than minimal harm
2022-06-10
F676 · Quality of Life and Care Deficiencies
Health
Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason.
Corrected 2022-07-11
E · Potential for more than minimal harm
2022-06-10
F805 · Nutrition and Dietary Deficiencies
Health
Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs.
Corrected 2022-07-11
D · Potential for more than minimal harm
2022-06-10
F641 · Resident Assessment and Care Planning Deficiencies
Health
Ensure each resident receives an accurate assessment.
Corrected 2022-07-11
D · Potential for more than minimal harm
2022-06-10
F656 · Resident Assessment and Care Planning Deficiencies
Health
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Corrected 2022-07-11
Penalties and ownership
What sits behind the stars
Ownership
Ovation Health Systems, Inc
5% Or Greater Direct Ownership Interest · Organization
Adams, Anthony
5% Or Greater Indirect Ownership Interest · Individual
Adams, Bryan
5% Or Greater Indirect Ownership Interest · Individual
Adams, Anthony
Corporate Officer · Individual
Adams, Bryan
Corporate Officer · Individual
Centennial Bank
5% Or Greater Mortgage Interest · Organization
Ellis, John
Corporate Officer · Individual
Jones, Tracie
Operational/Managerial Control · Individual
Koehler, Tobey
Corporate Officer · Individual
Thomas, Darryl
Corporate Director · Individual
Nearby options
Other facilities in reach
#1
Butterfield Trail Village
Fayetteville, AR
2-star overall rating with 2-star inspections with $58,006 in total fines with 2 recent health deficiencies with 3 fire-safety deficiencies in the latest cycle
#2
Westwood Health And Rehab, Inc
Springdale, AR
2-star overall rating with 1-star inspections with $13,871 in total fines with 6 recent health deficiencies with 2 fire-safety deficiencies in the latest cycle
#3
Fayetteville Health And Rehabilitation Center
Fayetteville, AR
3-star overall rating with 3-star inspections with 4 recent health deficiencies with 3 fire-safety deficiencies in the latest cycle
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