Cycle 1
Health 2024-07-12 · Fire 2024-07-12
4 health deficiencies
Top issue: Nutrition and Dietary (2 deficiencies)
6 fire-safety deficiencies
Top issue: Gas and Vacuum and Electrical Systems (3 deficiencies)
Lancaster, KY
Landmark Of Lancaster Rehabilitation And Nursing C
2-star overall rating with 2-star inspections with 4 recent health deficiencies with 6 fire-safety deficiencies in the latest cycle
308 West Maple Avenue, Lancaster, KY
(859) 792-6844
Overall
2 / 5
CMS overall stars
Health inspections
2 / 5
Survey and complaint cycles
Staffing
2 / 5
RN + nurse staffing
Quality measures
4 / 5
Resident outcomes and process measures
Quick facts
Facility snapshot
Beds
96
Certified beds
Average residents
94
Average occupied residents
Ownership
For-Profit
Publicly displayed owner type
Chain
Lyon Healthcare
Operator or chain grouping
Approved since
1968-06-20
CMS approved date
Coverage
Medicare + Medicaid
Participation flags
Chain footprint
14 facilities
Chain averages 2 overall / 2 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
0.35
Registered nurse staffing · state 0.77 · national 0.68
LPN hours / resident day
0.76
Licensed practical nurse staffing · state 0.81 · national 0.87
Aide hours / resident day
2.15
Nurse aide staffing · state 2.43 · national 2.35
Total nurse hours
3.26
All reported nurse hours · state 4.01 · national 3.89
Licensed hours
1.11
RN + LPN hours · state 1.58 · national 1.54
Weekend hours
2.94
Weekend nurse staffing · state 3.50 · national 3.43
Weekend RN hours
0.21
Weekend registered nurse coverage · state 0.52 · national 0.47
Physical therapist
0.03
Reported PT staffing · state 0.06 · national 0.07
Adjusted RN hours
0.29
CMS adjusted RN staffing hours
Adjusted total hours
2.73
CMS adjusted total nurse staffing hours
Case-mix index
1.63
Higher values indicate more complex resident acuity
RN turnover
50%
Annual RN turnover · state 43% · national 45%
Total nurse turnover
30%
Annual nurse turnover · state 47% · national 46%
SNF VBP
Value-based purchasing
Program rank
10,959
Lower is better among SNFs in the FY 2026 VBP program.
Performance score
18.51
Composite VBP score used to determine payment impact.
Payment multiplier
0.9820
Above 1.000 increases Medicare payment; below 1.000 reduces it.
Program components
How the VBP score is built
Readmission
1.73
Baseline 19.19% · Performance 20.63% · Measure score 1.73 · Achievement 1.73 · Improvement 0
Healthcare-associated infections
1.08
Baseline 6.40% · Performance 7.51% · Measure score 1.08 · Achievement 1.08 · Improvement 0
Total nurse turnover
4.59
Baseline 58.89% · Performance 44.93% · Measure score 4.59 · Achievement 4.59 · Improvement 3.60
Adjusted total nurse staffing
0
Baseline 3.65 hours · Performance 2.98 hours · Measure score 0 · Achievement 0 · Improvement 0
SNF QRP
Medicare quality reporting measures
| Measure | Facility | National | Note |
|---|---|---|---|
| Potentially preventable 30-day readmission | 10.17% |
10.72%
0.6 pts better
|
No Different than the National Rate · Eligible stays 53 · Observed rate 7.55% · Lower 95% interval 6.58% |
| Discharge to community | 29.21% |
50.57%
21.4 pts worse
|
Worse than the National Rate · Eligible stays 34 · Observed rate 14.71% · Lower 95% interval 20.3% |
| Medicare spending per beneficiary | 1.42 |
1.02
0.4 pts worse
|
|
| Drug regimen review with follow-up | 100% |
95.27%
4.7 pts better
|
Numerator 38 · Denominator 38 |
| Falls with major injury | 2.63% |
0.77%
1.9 pts worse
|
Numerator 1 · Denominator 38 |
| Discharge self-care score | 21.74% |
53.69%
31.9 pts worse
|
Numerator 5 · Denominator 23 |
| Discharge mobility score | 26.09% |
50.94%
24.8 pts worse
|
Numerator 6 · Denominator 23 |
| Pressure ulcers or injuries, new or worsened | 0% |
2.29%
2.3 pts better
|
Numerator 0 · Denominator 38 · Adjusted rate 0% |
| Healthcare-associated infections requiring hospitalization | 7.51% |
7.12%
0.4 pts worse
|
No Different than the National Rate · Eligible stays 38 · Observed rate 7.89% · Lower 95% interval 3.74% |
| Staff COVID-19 vaccination coverage | 0% |
8.2%
8.2 pts worse
|
Numerator 0 · Denominator 104 |
| Staff flu vaccination coverage | 36.92% |
42%
5.1 pts worse
|
Numerator 48 · Denominator 130 |
| Discharge function score | 21.74% |
56.45%
34.7 pts worse
|
Numerator 5 · Denominator 23 |
| Transfer of health information to provider | Not Available |
95.95%
|
Numerator Not Available · Denominator 13 · Too few residents or stays to report publicly. |
| Transfer of health information to patient | Not Available |
96.28%
|
Numerator Not Available · Denominator 2 · Too few residents or stays to report publicly. |
| Resident COVID-19 vaccinations up to date | Not Available |
25.2%
|
Numerator Not Available · Denominator 15 · Too few residents or stays to report publicly. |
Quality measures
Resident outcomes and process scores
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| Number of hospitalizations per 1000 long-stay resident days | 2.6 |
1.9
0.7 pts worse
|
1.9
0.7 pts worse
|
Long Stay · 20240701-20250630 · Adjusted 2.6 · Observed 2.2 · Expected 1.6 · Used in QM five-star |
| Number of outpatient emergency department visits per 1000 long-stay resident days | 4.9 |
2.2
2.7 pts worse
|
1.8
3.1 pts worse
|
Long Stay · 20240701-20250630 · Adjusted 4.9 · Observed 4.5 · Expected 1.5 · Used in QM five-star |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 100.0% |
94.3%
5.7 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% |
96.2%
3.8 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 | 3.2% |
3.8%
0.6 pts better
|
3.3%
0.1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 3.6% · Q2 2.4% · Q3 3.6% · Q4 3.3% · 4Q avg 3.2% · Used in QM five-star |
| Percentage of long-stay residents who have depressive symptoms | 28.2% |
15.2%
13 pts worse
|
11.4%
16.8 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 17.5% · Q2 20.7% · Q3 34.3% · Q4 36.4% · 4Q avg 28.2% |
| Percentage of long-stay residents who lose too much weight | 5.3% |
6.7%
1.4 pts better
|
5.4%
0.1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 8.6% · Q2 7.8% · Q3 2.8% · Q4 2.4% · 4Q avg 5.3% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 39.7% |
29.6%
10.1 pts worse
|
19.6%
20.1 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 41.9% · Q2 38.5% · Q3 38.8% · Q4 39.8% · 4Q avg 39.7% |
| Percentage of long-stay residents who received an antipsychotic medication | 24.0% |
17.6%
6.4 pts worse
|
16.7%
7.3 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 33.3% · Q2 25.0% · Q3 26.4% · Q4 14.1% · 4Q avg 24.0% · Used in QM five-star |
| Percentage of long-stay residents who were physically restrained | 0.6% |
0.2%
0.4 pts worse
|
0.1%
0.5 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 1.2% · Q2 1.2% · Q3 0.0% · Q4 0.0% · 4Q avg 0.6% |
| Percentage of long-stay residents whose ability to walk independently worsened | 14.0% |
17.3%
3.3 pts better
|
16.3%
2.3 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 21.9% · Q2 13.9% · Q3 5.5% · Q4 15.0% · 4Q avg 14.0% · Used in QM five-star |
| Percentage of long-stay residents whose need for help with daily activities has increased | 4.6% |
15.6%
11 pts better
|
14.9%
10.3 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 4.7% · Q2 2.9% · Q3 10.0% · Q4 1.2% · 4Q avg 4.6% · Used in QM five-star |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | 1.5% |
0.7%
0.8 pts worse
|
1.0%
0.5 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 2.7% · Q2 2.1% · Q3 1.4% · Q4 0.0% · 4Q avg 1.5% · Used in QM five-star |
| Percentage of long-stay residents with a urinary tract infection | 0.6% |
1.7%
1.1 pts better
|
1.7%
1.1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 1.3% · Q2 0.0% · Q3 0.0% · Q4 1.2% · 4Q avg 0.6% · Used in QM five-star |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | 15.0% |
19.8%
4.8 pts better
|
19.8%
4.8 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 16.3% · Q2 10.9% · Q3 12.7% · Q4 19.8% · 4Q avg 15.0% |
| Percentage of long-stay residents with pressure ulcers | 1.8% |
5.5%
3.7 pts better
|
5.1%
3.3 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.9% · Q2 2.6% · Q3 3.0% · Q4 0.7% · 4Q avg 1.8% · Used in QM five-star |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 97.3% |
83.8%
13.5 pts better
|
81.7%
15.6 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 93.3% · Q2 96.7% · Q3 100.0% · 4Q avg 97.3% |
| Percentage of short-stay residents who had an outpatient emergency department visit | 9.8% |
13.9%
4.1 pts better
|
12.0%
2.2 pts better
|
Short Stay · 20240701-20250630 · Adjusted 9.8% · Observed 9.1% · Expected 10.3% · Used in QM five-star |
| Percentage of short-stay residents who newly received an antipsychotic medication | 0.0% |
1.8%
1.8 pts better
|
1.6%
1.6 pts better
|
Short Stay · 2024Q4-2025Q3 · 4Q avg 0.0% · Used in QM five-star |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 96.8% |
83.6%
13.2 pts better
|
79.7%
17.1 pts better
|
Short Stay · 2024Q3-2025Q2 · 4Q avg 96.8% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission | 9.9% |
24.5%
14.6 pts better
|
23.9%
14 pts better
|
Short Stay · 20240701-20250630 · Adjusted 9.9% · Observed 9.1% · Expected 21.8% · Used in QM five-star |
Survey summary
Recent inspection cycles
Cycle 2
Health 2019-05-30 · Fire 2019-05-30
3 health deficiencies
Top issue: Nursing and Physician Services (1 deficiency)
0 fire-safety deficiencies
No concentrated fire-safety issue counts in this cycle.
Cycle 3
Health 2018-03-29 · Fire 2018-03-29
0 health deficiencies
No concentrated health issue counts in this cycle.
0 fire-safety deficiencies
No concentrated fire-safety issue counts in this cycle.
Fire safety
Fire-safety citations
F · Potential for more than minimal harm
2024-07-12
K918 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Have generator or other power source capable of supplying service within 10 seconds.
Corrected 2024-08-02
F · Potential for more than minimal harm
2024-07-12
K921 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Ensure that testing and maintenance of electrical equipment is performed.
Corrected 2024-08-02
E · Potential for more than minimal harm
2024-07-12
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 2024-08-02
E · Potential for more than minimal harm
2024-07-12
K351 · Smoke Deficiencies
Fire Safety
Install an approved automatic sprinkler system.
Corrected 2024-08-02
E · Potential for more than minimal harm
2024-07-12
K363 · Smoke Deficiencies
Fire Safety
Install corridor and hallway doors that block smoke.
Corrected 2024-08-02
D · Potential for more than minimal harm
2024-07-12
K912 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Have power receptacles that are properly grounded.
Corrected 2024-08-02
Inspection history
Recent health citations
F · Potential for more than minimal harm
2024-07-12
F804 · Nutrition and Dietary Deficiencies
Health
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Corrected 2024-08-03
F · Potential for more than minimal harm
2024-07-12
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 2024-08-07
E · Potential for more than minimal harm
2024-07-12
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 2024-08-03
D · Potential for more than minimal harm
2024-07-12
F880 · Infection Control Deficiencies
Health
Provide and implement an infection prevention and control program.
Corrected 2024-08-07
D · Potential for more than minimal harm
2024-03-15
F806 · Nutrition and Dietary Deficiencies
Health
Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options.
Corrected 2024-04-26
D · Potential for more than minimal harm
2019-05-30
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 2019-06-24
D · Potential for more than minimal harm
2019-05-30
F732 · Nursing and Physician Services Deficiencies
Health
Post nurse staffing information every day.
Corrected 2019-06-24
Penalties and ownership
What sits behind the stars
Ownership
A&M Healthcare Investments LLC
5% Or Greater Direct Ownership Interest · Organization
Carr, Laura
W-2 Managing Employee · Individual
Meisels, Joseph
W-2 Managing Employee · Individual
Nearby options
Other facilities in reach
#1
Stanford Crossing
Stanford, KY
1-star overall rating with 1-star inspections with Special Focus status with $272,373 in total fines with 9 recent health deficiencies with 17 fire-safety deficiencies in the latest cycle
#2
Henson Park Health & Rehabilitation
Danville, KY
1-star overall rating with 1-star inspections with $369,133 in total fines with 3 recent health deficiencies with 3 fire-safety deficiencies in the latest cycle
#3
Danville Centre for Health & Rehabilitation
Danville, KY
2-star overall rating with 1-star inspections with $12,444 in total fines with 2 recent health deficiencies with 1 fire-safety deficiencies in the latest cycle
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