Cycle 1
Health 2025-03-27 · Fire 2025-03-27
0 health deficiencies
No concentrated health issue counts in this cycle.
4 fire-safety deficiencies
Top issue: Smoke (3 deficiencies)
Seneca, SC
Lila Doyle Post Acute
4-star overall rating with 3-star inspections with $9,318 in total fines with 4 fire-safety deficiencies in the latest cycle
101 Lila Doyle Drive, Seneca, SC
(864) 885-7675
Overall
4 / 5
CMS overall stars
Health inspections
3 / 5
Survey and complaint cycles
Staffing
4 / 5
RN + nurse staffing
Quality measures
5 / 5
Resident outcomes and process measures
Quick facts
Facility snapshot
Beds
120
Certified beds
Average residents
87
Average occupied residents
Ownership
For-Profit
Publicly displayed owner type
Chain
The Ensign Group
Operator or chain grouping
Approved since
1971-01-01
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
0.82
Registered nurse staffing · state 0.63 · national 0.68
LPN hours / resident day
1.11
Licensed practical nurse staffing · state 1.01 · national 0.87
Aide hours / resident day
2.14
Nurse aide staffing · state 2.22 · national 2.35
Total nurse hours
4.08
All reported nurse hours · state 3.86 · national 3.89
Licensed hours
1.93
RN + LPN hours · state 1.65 · national 1.54
Weekend hours
3.51
Weekend nurse staffing · state 3.34 · national 3.43
Weekend RN hours
0.51
Weekend registered nurse coverage · state 0.40 · national 0.47
Physical therapist
0.10
Reported PT staffing · state 0.09 · national 0.07
Adjusted RN hours
0.81
CMS adjusted RN staffing hours
Adjusted total hours
4.03
CMS adjusted total nurse staffing hours
Case-mix index
1.38
Higher values indicate more complex resident acuity
RN turnover
39%
Annual RN turnover · state 44% · national 45%
Total nurse turnover
59%
Annual nurse turnover · state 47% · national 46%
SNF VBP
Value-based purchasing
Program rank
13,039
Lower is better among SNFs in the FY 2026 VBP program.
Performance score
8.86
Composite VBP score used to determine payment impact.
Payment multiplier
0.9808
Above 1.000 increases Medicare payment; below 1.000 reduces it.
Program components
How the VBP score is built
Readmission
0
Baseline 18.95% · Performance 22.37% · Measure score 0 · Achievement 0 · Improvement 0
Healthcare-associated infections
1.53
Baseline 7.02% · Performance 7.38% · Measure score 1.53 · Achievement 1.53 · Improvement 0
Total nurse turnover
0
Baseline 61.77% · Performance 62.83% · Measure score 0 · Achievement 0 · Improvement 0
Adjusted total nurse staffing
2.01
Baseline 4.03 hours · Performance 3.65 hours · Measure score 2.01 · Achievement 2.01 · Improvement 0
SNF QRP
Medicare quality reporting measures
| Measure | Facility | National | Note |
|---|---|---|---|
| Potentially preventable 30-day readmission | 11.37% |
10.72%
0.6 pts worse
|
No Different than the National Rate · Eligible stays 397 · Observed rate 11.08% · Lower 95% interval 8.96% |
| Discharge to community | 66.42% |
50.57%
15.9 pts better
|
Better than the National Rate · Eligible stays 412 · Observed rate 61.41% · Lower 95% interval 60.72% |
| Medicare spending per beneficiary | 0.98 |
1.02
About the same
|
|
| Drug regimen review with follow-up | 96.13% |
95.27%
0.9 pts better
|
Numerator 273 · Denominator 284 |
| Falls with major injury | 0.35% |
0.77%
0.4 pts better
|
Numerator 1 · Denominator 284 |
| Discharge self-care score | 59.7% |
53.69%
6 pts better
|
Numerator 120 · Denominator 201 |
| Discharge mobility score | 54.23% |
50.94%
3.3 pts better
|
Numerator 109 · Denominator 201 |
| Pressure ulcers or injuries, new or worsened | 1.41% |
2.29%
0.9 pts better
|
Numerator 4 · Denominator 284 · Adjusted rate 1.64% |
| Healthcare-associated infections requiring hospitalization | 7.38% |
7.12%
0.3 pts worse
|
No Different than the National Rate · Eligible stays 287 · Observed rate 6.97% · Lower 95% interval 5.51% |
| Staff COVID-19 vaccination coverage | 0% |
8.2%
8.2 pts worse
|
Numerator 0 · Denominator 129 |
| Staff flu vaccination coverage | 24.39% |
42%
17.6 pts worse
|
Numerator 40 · Denominator 164 |
| Discharge function score | 62.19% |
56.45%
5.7 pts better
|
Numerator 125 · Denominator 201 |
| Transfer of health information to provider | 98.56% |
95.95%
2.6 pts better
|
Numerator 206 · Denominator 209 |
| Transfer of health information to patient | 100% |
96.28%
3.7 pts better
|
Numerator 54 · Denominator 54 |
| Resident COVID-19 vaccinations up to date | 1.34% |
25.2%
23.9 pts worse
|
Numerator 2 · Denominator 149 |
Quality measures
Resident outcomes and process scores
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| Number of hospitalizations per 1000 long-stay resident days | 1.0 |
2.0
1 pts better
|
1.9
0.9 pts better
|
Long Stay · 20240701-20250630 · Adjusted 1.0 · Observed 0.6 · Expected 1.2 · Used in QM five-star |
| Number of outpatient emergency department visits per 1000 long-stay resident days | 0.4 |
1.9
1.5 pts better
|
1.8
1.4 pts better
|
Long Stay · 20240701-20250630 · Adjusted 0.4 · Observed 0.3 · Expected 1.2 · Used in QM five-star |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 95.0% |
90.5%
4.5 pts better
|
93.4%
1.6 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 81.8% · Q2 100.0% · Q3 100.0% · Q4 98.2% · 4Q avg 95.0% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine | 89.3% |
90.6%
1.3 pts worse
|
95.5%
6.2 pts worse
|
Long Stay · 2024Q3-2025Q2 · 4Q avg 89.3% |
| Percentage of long-stay residents experiencing one or more falls with major injury | 1.4% |
3.0%
1.6 pts better
|
3.3%
1.9 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 3.6% · Q2 1.9% · Q3 0.0% · Q4 0.0% · 4Q avg 1.4% · Used in QM five-star |
| Percentage of long-stay residents who have depressive symptoms | 2.4% |
2.9%
0.5 pts better
|
11.4%
9 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 5.7% · Q3 1.9% · Q4 1.9% · 4Q avg 2.4% |
| Percentage of long-stay residents who lose too much weight | 4.3% |
6.2%
1.9 pts better
|
5.4%
1.1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 7.3% · Q2 4.5% · Q3 4.1% · Q4 2.0% · 4Q avg 4.3% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 20.7% |
20.4%
0.3 pts worse
|
19.6%
1.1 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 16.7% · Q2 22.7% · Q3 23.5% · Q4 19.6% · 4Q avg 20.7% |
| Percentage of long-stay residents who received an antipsychotic medication | 11.9% |
16.3%
4.4 pts better
|
16.7%
4.8 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 11.1% · Q2 12.8% · Q3 12.2% · Q4 11.4% · 4Q avg 11.9% · 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 | 12.3% |
14.9%
2.6 pts better
|
16.3%
4 pts better
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 12.3% · Used in QM five-star |
| Percentage of long-stay residents whose need for help with daily activities has increased | 14.9% |
12.4%
2.5 pts worse
|
14.9%
About the same
|
Long Stay · 2024Q4-2025Q3 · Q1 13.5% · Q2 12.8% · Q3 19.5% · Q4 13.6% · 4Q avg 14.9% · 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 | 0.5% |
1.6%
1.1 pts better
|
1.7%
1.2 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 1.9% · Q3 0.0% · Q4 0.0% · 4Q avg 0.5% · Used in QM five-star |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | 28.4% |
17.2%
11.2 pts worse
|
19.8%
8.6 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 28.8% · Q2 28.2% · Q3 34.8% · Q4 22.0% · 4Q avg 28.4% |
| Percentage of long-stay residents with pressure ulcers | 4.1% |
5.8%
1.7 pts better
|
5.1%
1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 4.7% · Q2 5.6% · Q3 3.3% · Q4 3.0% · 4Q avg 4.1% · Used in QM five-star |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 86.7% |
79.8%
6.9 pts better
|
81.7%
5 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 66.9% · Q2 91.0% · Q3 95.5% · Q4 93.6% · 4Q avg 86.7% |
| Percentage of short-stay residents who had an outpatient emergency department visit | 12.7% |
14.1%
1.4 pts better
|
12.0%
0.7 pts worse
|
Short Stay · 20240701-20250630 · Adjusted 12.7% · Observed 12.1% · Expected 10.6% · Used in QM five-star |
| Percentage of short-stay residents who newly received an antipsychotic medication | 1.1% |
1.6%
0.5 pts better
|
1.6%
0.5 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 2.2% · Q2 0.5% · Q3 1.1% · Q4 0.5% · 4Q avg 1.1% · Used in QM five-star |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 90.3% |
78.0%
12.3 pts better
|
79.7%
10.6 pts better
|
Short Stay · 2024Q3-2025Q2 · 4Q avg 90.3% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission | 30.1% |
24.7%
5.4 pts worse
|
23.9%
6.2 pts worse
|
Short Stay · 20240701-20250630 · Adjusted 30.1% · Observed 28.6% · Expected 22.6% · Used in QM five-star |
Survey summary
Recent inspection cycles
Cycle 2
Health 2023-07-13 · Fire 2023-07-13
5 health deficiencies
Top issue: Resident Assessment and Care Planning (2 deficiencies)
0 fire-safety deficiencies
No concentrated fire-safety issue counts in this cycle.
Cycle 3
Health 2021-12-02 · Fire 2021-12-02
2 health deficiencies
Top issue: Freedom from Abuse and Neglect and Exploitation (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
2025-03-27
K363 · Smoke Deficiencies
Fire Safety
Install corridor and hallway doors that block smoke.
Corrected 2025-03-26
D · Potential for more than minimal harm
2025-03-27
K211 · Egress Deficiencies
Fire Safety
Keep aisles, corridors, and exits free of obstruction in case of emergency.
Corrected 2025-03-26
D · Potential for more than minimal harm
2025-03-27
K324 · Smoke Deficiencies
Fire Safety
Provide properly protected cooking facilities.
Corrected 2025-03-26
D · Potential for more than minimal harm
2025-03-27
K353 · Smoke Deficiencies
Fire Safety
Inspect, test, and maintain automatic sprinkler systems.
Corrected 2025-03-26
Inspection history
Recent health citations
J · Immediate jeopardy
2023-11-05
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 2023-11-24
D · Potential for more than minimal harm
2023-11-05
F610 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Health
Respond appropriately to all alleged violations.
Corrected 2023-11-24
D · Potential for more than minimal harm
2023-07-13
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 2023-07-25
D · Potential for more than minimal harm
2023-07-13
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 2023-07-25
D · Potential for more than minimal harm
2023-07-13
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 2023-07-25
D · Potential for more than minimal harm
2023-07-13
F684 · Quality of Life and Care Deficiencies
Health
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected 2023-07-25
D · Potential for more than minimal harm
2023-07-13
F883 · Infection Control Deficiencies
Health
Develop and implement policies and procedures for flu and pneumonia vaccinations.
Corrected 2023-07-25
Penalties and ownership
What sits behind the stars
$9,318
2023-11-05
Fine
Fine · fine $9,318
Fine
Ownership
Hopewell Healthcare, Inc.
5% Or Greater Direct Ownership Interest · Organization
The Ensign Group Inc
5% Or Greater Indirect Ownership Interest · Organization
Burnam, Soon
Corporate Officer · Individual
Peterson, Forrest
Corporate Officer · Individual
Sato, Ami
Corporate Officer · Individual
Thatcher, Brent
Operational/Managerial Control · Individual
Thatcher, Brent
Corporate Officer · Individual
Nearby options
Other facilities in reach
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Seneca Health & Rehabilitation Center
Seneca, SC
2-star overall rating with 2-star inspections with $4,893 in total fines with 9 recent health deficiencies
#2
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SIX Mile, SC
3-star overall rating with 2-star inspections with $6,570 in total fines with 4 recent health deficiencies with 3 fire-safety deficiencies in the latest cycle
#3
Manna Post Acute
Pickens, SC
4-star overall rating with 4-star inspections with 5 recent health deficiencies
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