Ankeny, IA

Mill-Pond

5-star overall rating with 4-star inspections with 2 recent health deficiencies with 2 fire-safety deficiencies in the latest cycle

1201 SE Mill Pond Court, Ankeny, IA

(515) 964-2273

Compare this facility

Overall

5 / 5

CMS overall stars

Health inspections

4 / 5

Survey and complaint cycles

Staffing

5 / 5

RN + nurse staffing

Quality measures

4 / 5

Resident outcomes and process measures

Quick facts

Facility snapshot

Beds

60

Certified beds

Average residents

56

Average occupied residents

Ownership

Non-Profit

Publicly displayed owner type

Chain

Presbyterian Homes & Services

Operator or chain grouping

Approved since

1995-09-19

CMS approved date

Coverage

Medicare + Medicaid

Participation flags

Chain footprint

20 facilities

Chain averages 4 overall / 3 health / 5 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

0.89

Registered nurse staffing · state 0.73 · national 0.68

LPN hours / resident day

0.31

Licensed practical nurse staffing · state 0.57 · national 0.87

Aide hours / resident day

3.14

Nurse aide staffing · state 2.53 · national 2.35

Total nurse hours

4.33

All reported nurse hours · state 3.83 · national 3.89

Licensed hours

1.19

RN + LPN hours · state 1.30 · national 1.54

Weekend hours

3.94

Weekend nurse staffing · state 3.35 · national 3.43

Weekend RN hours

0.67

Weekend registered nurse coverage · state 0.50 · national 0.47

Physical therapist

0.12

Reported PT staffing · state 0.04 · national 0.07

Adjusted RN hours

1.00

CMS adjusted RN staffing hours

Adjusted total hours

4.87

CMS adjusted total nurse staffing hours

Case-mix index

1.22

Higher values indicate more complex resident acuity

RN turnover

46%

Annual RN turnover · state 44% · national 45%

Total nurse turnover

37%

Annual nurse turnover · state 44% · national 46%

SNF VBP

Value-based purchasing

Program rank

1,966

Lower is better among SNFs in the FY 2026 VBP program.

Performance score

52.63

Composite VBP score used to determine payment impact.

Payment multiplier

1.0072

Above 1.000 increases Medicare payment; below 1.000 reduces it.

Program components

How the VBP score is built

Readmission

4.11

Baseline 18.18% · Performance 19.53% · Measure score 4.11 · Achievement 4.11 · Improvement 0

Healthcare-associated infections

3.45

Baseline 6.16% · Performance 6.80% · Measure score 3.45 · Achievement 3.45 · Improvement 0

Total nurse turnover

7.07

Baseline 46.67% · Performance 34.78% · Measure score 7.07 · Achievement 7.07 · Improvement 4.95

Adjusted total nurse staffing

6.42

Baseline 4.70 hours · Performance 4.91 hours · Measure score 6.42 · Achievement 6.42 · Improvement 1.44

SNF QRP

Medicare quality reporting measures

Measure	Facility	National	Note
Potentially preventable 30-day readmission	9.78%	10.72% 0.9 pts better	No Different than the National Rate · Eligible stays 95 · Observed rate 5.26% · Lower 95% interval 6.07%
Discharge to community	42.67%	50.57% 7.9 pts worse	No Different than the National Rate · Eligible stays 69 · Observed rate 39.13% · Lower 95% interval 34.23%
Medicare spending per beneficiary	0.6	1.02 0.4 pts better
Drug regimen review with follow-up	95.65%	95.27% 0.4 pts better	Numerator 44 · Denominator 46
Falls with major injury	2.17%	0.77% 1.4 pts worse	Numerator 1 · Denominator 46
Discharge self-care score	24.39%	53.69% 29.3 pts worse	Numerator 10 · Denominator 41
Discharge mobility score	36.59%	50.94% 14.3 pts worse	Numerator 15 · Denominator 41
Pressure ulcers or injuries, new or worsened	4.35%	2.29% 2.1 pts worse	Numerator 2 · Denominator 46 · Adjusted rate 4.06%
Healthcare-associated infections requiring hospitalization	6.8%	7.12% 0.3 pts better	No Different than the National Rate · Eligible stays 47 · Observed rate 4.26% · Lower 95% interval 3.66%
Staff COVID-19 vaccination coverage	11.61%	8.2% 3.4 pts better	Numerator 18 · Denominator 155
Staff flu vaccination coverage	17.76%	42% 24.2 pts worse	Numerator 57 · Denominator 321
Discharge function score	43.9%	56.45% 12.6 pts worse	Numerator 18 · Denominator 41
Transfer of health information to provider	Not Available	95.95%	Numerator Not Available · Denominator 8 · 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	59.09%	25.2% 33.9 pts better	Numerator 13 · Denominator 22

Quality measures

Resident outcomes and process scores

Measure	Facility	State	National	Note
Number of hospitalizations per 1000 long-stay resident days	1.5	1.5 About the same	1.9 0.4 pts better	Long Stay · 20240701-20250630 · Adjusted 1.5 · Observed 1.2 · Expected 1.6 · Used in QM five-star
Number of outpatient emergency department visits per 1000 long-stay resident days	0.9	2.1 1.2 pts better	1.8 0.9 pts better	Long Stay · 20240701-20250630 · Adjusted 0.9 · Observed 0.8 · Expected 1.4 · Used in QM five-star
Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine	92.1%	94.0% 1.9 pts worse	93.4% 1.3 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 90.6% · Q2 94.6% · Q3 90.7% · Q4 92.2% · 4Q avg 92.1%
Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine	86.7%	95.2% 8.5 pts worse	95.5% 8.8 pts worse	Long Stay · 2024Q3-2025Q2 · 4Q avg 86.7%
Percentage of long-stay residents experiencing one or more falls with major injury	2.8%	3.7% 0.9 pts better	3.3% 0.5 pts better	Long Stay · 2024Q4-2025Q3 · Q1 1.9% · Q2 3.6% · Q3 1.9% · Q4 3.9% · 4Q avg 2.8% · Used in QM five-star
Percentage of long-stay residents who have depressive symptoms	2.9%	4.0% 1.1 pts better	11.4% 8.5 pts better	Long Stay · 2024Q4-2025Q3 · Q1 2.0% · Q2 1.8% · Q3 3.8% · Q4 4.2% · 4Q avg 2.9%
Percentage of long-stay residents who lose too much weight	5.3%	4.9% 0.4 pts worse	5.4% 0.1 pts better	Long Stay · 2024Q4-2025Q3 · Q1 5.3% · Q2 7.0% · Q3 2.3% · Q4 6.8% · 4Q avg 5.3%
Percentage of long-stay residents who received an antianxiety or hypnotic medication	18.3%	20.6% 2.3 pts better	19.6% 1.3 pts better	Long Stay · 2024Q4-2025Q3 · Q1 14.6% · Q2 17.4% · Q3 18.2% · Q4 22.7% · 4Q avg 18.3%
Percentage of long-stay residents who received an antipsychotic medication	11.2%	19.8% 8.6 pts better	16.7% 5.5 pts better	Long Stay · 2024Q4-2025Q3 · Q1 8.6% · Q2 10.8% · Q3 13.5% · Q4 11.8% · 4Q avg 11.2% · 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	30.2%	18.5% 11.7 pts worse	16.3% 13.9 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 22.9% · Q3 34.1% · Q4 29.8% · 4Q avg 30.2% · Used in QM five-star
Percentage of long-stay residents whose need for help with daily activities has increased	13.6%	18.3% 4.7 pts better	14.9% 1.3 pts better	Long Stay · 2024Q4-2025Q3 · Q1 7.7% · Q2 16.7% · Q3 18.2% · Q4 11.4% · 4Q avg 13.6% · Used in QM five-star
Percentage of long-stay residents with a catheter inserted and left in their bladder	1.6%	1.7% 0.1 pts better	1.0% 0.6 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 1.1% · Q3 2.4% · Q4 2.9% · 4Q avg 1.6% · Used in QM five-star
Percentage of long-stay residents with a urinary tract infection	3.4%	2.5% 0.9 pts worse	1.7% 1.7 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 6.0% · Q2 1.9% · Q3 3.7% · Q4 2.0% · 4Q avg 3.4% · Used in QM five-star
Percentage of long-stay residents with new or worsened bowel or bladder incontinence	34.0%	26.0% 8 pts worse	19.8% 14.2 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 30.1% · Q2 25.1% · Q3 22.6% · Q4 58.9% · 4Q avg 34.0%
Percentage of long-stay residents with pressure ulcers	10.1%	4.3% 5.8 pts worse	5.1% 5 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 10.9% · Q2 12.3% · Q3 9.4% · Q4 7.8% · 4Q avg 10.1% · Used in QM five-star
Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine	79.6%	84.3% 4.7 pts worse	81.7% 2.1 pts worse	Short Stay · 2024Q4-2025Q3 · Q1 76.9% · Q2 82.6% · Q3 78.3% · Q4 80.8% · 4Q avg 79.6%
Percentage of short-stay residents who had an outpatient emergency department visit	3.5%	13.1% 9.6 pts better	12.0% 8.5 pts better	Short Stay · 20240701-20250630 · Adjusted 3.5% · Observed 3.0% · Expected 9.6% · Used in QM five-star
Percentage of short-stay residents who newly received an antipsychotic medication	1.9%	1.9% About the same	1.6% 0.3 pts worse	Short Stay · 2024Q4-2025Q3 · 4Q avg 1.9% · Used in QM five-star
Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine	64.0%	73.3% 9.3 pts worse	79.7% 15.7 pts worse	Short Stay · 2024Q3-2025Q2 · 4Q avg 64.0%
Percentage of short-stay residents who were rehospitalized after a nursing home admission	15.2%	21.3% 6.1 pts better	23.9% 8.7 pts better	Short Stay · 20240701-20250630 · Adjusted 15.2% · Observed 12.1% · Expected 19.0% · Used in QM five-star

Survey summary

Recent inspection cycles

Cycle 1 Health 2025-03-06 · Fire 2025-03-06

2 health deficiencies

Top issue: Nutrition and Dietary (1 deficiency)

2 fire-safety deficiencies

Top issue: Gas and Vacuum and Electrical Systems (1 deficiency)

Cycle 2 Health 2024-04-15 · Fire 2024-04-15

5 health deficiencies

Top issue: Freedom from Abuse and Neglect and Exploitation (2 deficiencies)

2 fire-safety deficiencies

Top issue: Emergency Preparedness (1 deficiency)

Cycle 3 Health 2023-02-23 · Fire 2023-02-23

2 health deficiencies

Top issue: Nursing and Physician Services (1 deficiency)

6 fire-safety deficiencies

Top issue: Smoke (3 deficiencies)

Fire safety

Fire-safety citations

E · Potential for more than minimal harm 2025-03-06

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 2025-03-19

E · Potential for more than minimal harm 2025-03-06

K923 · Gas, Vacuum, and Electrical Systems Deficiencies

Fire Safety

Have proper medical gas storage and administration areas.

Corrected 2025-03-19

F · Potential for more than minimal harm 2024-04-15

E39 · Emergency Preparedness Deficiencies

Fire Safety

Conduct testing and exercise requirements.

Corrected 2024-04-19

F · Potential for more than minimal harm 2024-04-15

K918 · Gas, Vacuum, and Electrical Systems Deficiencies

Fire Safety

Have generator or other power source capable of supplying service within 10 seconds.

Corrected 2024-05-12

F · Potential for more than minimal harm 2023-02-23

E39 · Emergency Preparedness Deficiencies

Fire Safety

Conduct testing and exercise requirements.

Corrected 2023-03-10

F · Potential for more than minimal harm 2023-02-23

K353 · Smoke Deficiencies

Fire Safety

Inspect, test, and maintain automatic sprinkler systems.

Corrected 2023-03-06

F · Potential for more than minimal harm 2023-02-23

K712 · Miscellaneous Deficiencies

Fire Safety

Have simulated fire drills held at unexpected times.

Corrected 2023-04-01

F · Potential for more than minimal harm 2023-02-23

K918 · Gas, Vacuum, and Electrical Systems Deficiencies

Fire Safety

Have generator or other power source capable of supplying service within 10 seconds.

Corrected 2023-04-01

E · Potential for more than minimal harm 2023-02-23

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 2023-03-07

E · Potential for more than minimal harm 2023-02-23

K343 · Smoke Deficiencies

Fire Safety

Have a fire alarm with audible and visual signals that transmits the alarm automatically to notify emergency forces in event of fire.

Corrected 2023-03-06

Inspection history

Recent health citations

D · Potential for more than minimal harm 2025-03-06

F800 · Nutrition and Dietary Deficiencies

Health

Provide each resident with a nourishing, palatable, well-balanced diet that meets his or her daily nutritional and special dietary needs.

Corrected 2025-03-26

D · Potential for more than minimal harm 2025-03-06

F842 · Resident Assessment and Care Planning Deficiencies

Health

Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.

Corrected 2025-03-26