Cycle 1
Health 2025-04-02 · Fire 2025-04-02
4 health deficiencies
Top issue: Nutrition and Dietary (2 deficiencies)
0 fire-safety deficiencies
No concentrated fire-safety issue counts in this cycle.
Hot Springs, AR
The Pines Nursing And Rehabilitation Center
3-star overall rating with 3-star inspections with $13,863 in total fines with 4 recent health deficiencies
524 Carpenter Dam Road, Hot Springs, AR
(501) 262-4124
Overall
3 / 5
CMS overall stars
Health inspections
3 / 5
Survey and complaint cycles
Staffing
2 / 5
RN + nurse staffing
Quality measures
3 / 5
Resident outcomes and process measures
Quick facts
Facility snapshot
Beds
125
Certified beds
Average residents
73
Average occupied residents
Ownership
For-Profit
Publicly displayed owner type
Chain
Southern Administrative Services
Operator or chain grouping
Approved since
1994-09-01
CMS approved date
Coverage
Medicare + Medicaid
Participation flags
Chain footprint
35 facilities
Chain averages 4 overall / 3 health / 4 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
0.51
Registered nurse staffing · state 0.40 · national 0.68
LPN hours / resident day
0.77
Licensed practical nurse staffing · state 0.95 · national 0.87
Aide hours / resident day
2.64
Nurse aide staffing · state 2.72 · national 2.35
Total nurse hours
3.92
All reported nurse hours · state 4.07 · national 3.89
Licensed hours
1.28
RN + LPN hours · state 1.35 · national 1.54
Weekend hours
3.34
Weekend nurse staffing · state 3.48 · national 3.43
Weekend RN hours
0.15
Weekend registered nurse coverage · state 0.27 · national 0.47
Physical therapist
0.06
Reported PT staffing · state 0.03 · national 0.07
Adjusted RN hours
0.50
CMS adjusted RN staffing hours
Adjusted total hours
3.87
CMS adjusted total nurse staffing hours
Case-mix index
1.39
Higher values indicate more complex resident acuity
RN turnover
70%
Annual RN turnover · state 48% · national 45%
Total nurse turnover
60%
Annual nurse turnover · state 51% · national 46%
SNF VBP
Value-based purchasing
Program rank
13,252
Lower is better among SNFs in the FY 2026 VBP program.
Performance score
7.16
Composite VBP score used to determine payment impact.
Payment multiplier
0.9807
Above 1.000 increases Medicare payment; below 1.000 reduces it.
Program components
How the VBP score is built
Readmission
0
Baseline 21.04% · Performance 22.69% · Measure score 0 · Achievement 0 · Improvement 0
Healthcare-associated infections
0
Baseline 7.08% · Performance 9.68% · Measure score 0 · Achievement 0 · Improvement 0
Total nurse turnover
0
Baseline 62.77% · Performance 66.30% · Measure score 0 · Achievement 0 · Improvement 0
Adjusted total nurse staffing
2.86
Baseline 3.77 hours · Performance 3.89 hours · Measure score 2.86 · Achievement 2.86 · Improvement 0.11
SNF QRP
Medicare quality reporting measures
| Measure | Facility | National | Note |
|---|---|---|---|
| Potentially preventable 30-day readmission | 11.99% |
10.72%
1.3 pts worse
|
No Different than the National Rate · Eligible stays 67 · Observed rate 17.91% · Lower 95% interval 8.39% |
| Discharge to community | 43.04% |
50.57%
7.5 pts worse
|
No Different than the National Rate · Eligible stays 45 · Observed rate 33.33% · Lower 95% interval 31.53% |
| Medicare spending per beneficiary | 1.17 |
1.02
0.1 pts worse
|
|
| Drug regimen review with follow-up | 100% |
95.27%
4.7 pts better
|
Numerator 45 · Denominator 45 |
| Falls with major injury | 0% |
0.77%
0.8 pts better
|
Numerator 0 · Denominator 45 |
| Discharge self-care score | 68% |
53.69%
14.3 pts better
|
Numerator 17 · Denominator 25 |
| Discharge mobility score | 32% |
50.94%
18.9 pts worse
|
Numerator 8 · Denominator 25 |
| Pressure ulcers or injuries, new or worsened | 4.44% |
2.29%
2.2 pts worse
|
Numerator 2 · Denominator 45 · Adjusted rate 3.12% |
| Healthcare-associated infections requiring hospitalization | 9.68% |
7.12%
2.6 pts worse
|
No Different than the National Rate · Eligible stays 41 · Observed rate 19.51% · Lower 95% interval 5.5% |
| Staff COVID-19 vaccination coverage | 0% |
8.2%
8.2 pts worse
|
Numerator 0 · Denominator 79 |
| Staff flu vaccination coverage | 94.57% |
42%
52.6 pts better
|
Numerator 87 · Denominator 92 |
| Discharge function score | 56% |
56.45%
0.5 pts worse
|
Numerator 14 · Denominator 25 |
| Transfer of health information to provider | 100% |
95.95%
4 pts better
|
Numerator 21 · Denominator 21 |
| Transfer of health information to patient | Not Available |
96.28%
|
Numerator Not Available · Denominator 7 · Too few residents or stays to report publicly. |
| Resident COVID-19 vaccinations up to date | 3.85% |
25.2%
21.3 pts worse
|
Numerator 1 · Denominator 26 |
Quality measures
Resident outcomes and process scores
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 97.8% |
94.9%
2.9 pts better
|
93.4%
4.4 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 98.5% · Q2 98.6% · Q3 98.5% · Q4 95.5% · 4Q avg 97.8% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine | 98.7% |
96.1%
2.6 pts better
|
95.5%
3.2 pts better
|
Long Stay · 2024Q3-2025Q2 · 4Q avg 98.7% |
| Percentage of long-stay residents experiencing one or more falls with major injury | 2.2% |
3.9%
1.7 pts better
|
3.3%
1.1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 2.9% · Q2 2.9% · Q3 1.5% · Q4 1.5% · 4Q avg 2.2% · 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 | 3.6% |
4.9%
1.3 pts better
|
5.4%
1.8 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 4.8% · Q2 3.2% · Q3 3.3% · Q4 3.3% · 4Q avg 3.6% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 26.5% |
21.8%
4.7 pts worse
|
19.6%
6.9 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 25.0% · Q2 23.8% · Q3 27.9% · Q4 29.5% · 4Q avg 26.5% |
| Percentage of long-stay residents who received an antipsychotic medication | 4.3% |
12.5%
8.2 pts better
|
16.7%
12.4 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 4.1% · Q2 6.7% · Q3 6.4% · Q4 0.0% · 4Q avg 4.3% · 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 | 1.9% |
11.4%
9.5 pts better
|
16.3%
14.4 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 4.8% · Q2 0.0% · Q3 0.0% · Q4 3.2% · 4Q avg 1.9% · Used in QM five-star |
| Percentage of long-stay residents whose need for help with daily activities has increased | 2.9% |
10.4%
7.5 pts better
|
14.9%
12 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 1.6% · Q2 5.0% · Q3 1.7% · Q4 3.4% · 4Q avg 2.9% · Used in QM five-star |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | 0.6% |
0.7%
0.1 pts better
|
1.0%
0.4 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 1.3% · Q2 1.1% · Q3 0.0% · Q4 0.0% · 4Q avg 0.6% · 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 | 8.7% |
14.6%
5.9 pts better
|
19.8%
11.1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 12.5% · Q2 10.9% · Q3 4.3% · Q4 7.1% · 4Q avg 8.7% |
| Percentage of long-stay residents with pressure ulcers | 8.8% |
4.6%
4.2 pts worse
|
5.1%
3.7 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 11.3% · Q2 8.1% · Q3 7.2% · Q4 8.6% · 4Q avg 8.8% · Used in QM five-star |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 83.0% |
81.8%
1.2 pts better
|
81.7%
1.3 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 79.3% · Q2 81.6% · Q3 86.6% · Q4 86.2% · 4Q avg 83.0% |
| Percentage of short-stay residents who had an outpatient emergency department visit | 24.2% |
13.8%
10.4 pts worse
|
12.0%
12.2 pts worse
|
Short Stay · 20240701-20250630 · Adjusted 24.2% · Observed 25.0% · Expected 11.6% · 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 | 86.7% |
77.9%
8.8 pts better
|
79.7%
7 pts better
|
Short Stay · 2024Q3-2025Q2 · 4Q avg 86.7% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission | 29.3% |
25.2%
4.1 pts worse
|
23.9%
5.4 pts worse
|
Short Stay · 20240701-20250630 · Adjusted 29.3% · Observed 37.5% · Expected 30.5% · Used in QM five-star |
Survey summary
Recent inspection cycles
Cycle 2
Health 2024-02-23 · Fire 2024-02-23
7 health deficiencies
Top issue: Nutrition and Dietary (2 deficiencies)
2 fire-safety deficiencies
Top issue: Smoke (2 deficiencies)
Cycle 3
Health 2022-12-09 · Fire 2022-12-09
4 health deficiencies
Top issue: Pharmacy Service (2 deficiencies)
3 fire-safety deficiencies
Top issue: Gas and Vacuum and Electrical Systems (1 deficiency)
Fire safety
Fire-safety citations
F · Potential for more than minimal harm
2024-02-23
K347 · Smoke Deficiencies
Fire Safety
Properly provide smoke detection systems in areas open to corridors.
Corrected 2024-04-12
F · Potential for more than minimal harm
2024-02-23
K363 · Smoke Deficiencies
Fire Safety
Install corridor and hallway doors that block smoke.
Corrected 2024-04-12
F · Potential for more than minimal harm
2022-12-09
K345 · Smoke Deficiencies
Fire Safety
Have approved installation, maintenance and testing program for fire alarm systems.
Corrected 2023-01-05
F · Potential for more than minimal harm
2022-12-09
K918 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Have generator or other power source capable of supplying service within 10 seconds.
Corrected 2023-01-05
E · Potential for more than minimal harm
2022-12-09
K712 · Miscellaneous Deficiencies
Fire Safety
Have simulated fire drills held at unexpected times.
Corrected 2023-01-05
Inspection history
Recent health citations
F · Potential for more than minimal harm
2025-04-02
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 2025-05-02
E · Potential for more than minimal harm
2025-04-02
F759 · Pharmacy Service Deficiencies
Health
Ensure medication error rates are not 5 percent or greater.
Corrected 2025-05-02
E · Potential for more than minimal harm
2025-04-02
F803 · Nutrition and Dietary Deficiencies
Health
Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.
Corrected 2025-05-02
D · Potential for more than minimal harm
2025-04-02
F880 · Infection Control Deficiencies
Health
Provide and implement an infection prevention and control program.
Corrected 2025-05-02
J · Immediate jeopardy
2024-08-29
F760 · Pharmacy Service Deficiencies
Health
Ensure that residents are free from significant medication errors.
Corrected 2024-08-20
E · Potential for more than minimal harm
2024-08-29
F580 · Resident Rights Deficiencies
Health
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
Corrected 2024-09-28
E · Potential for more than minimal harm
2024-08-29
F686 · Quality of Life and Care Deficiencies
Health
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Corrected 2024-09-28
F · Potential for more than minimal harm
2024-02-23
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 2024-04-12
E · Potential for more than minimal harm
2024-02-23
F623 · Resident Rights Deficiencies
Health
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
Corrected 2024-04-12
E · Potential for more than minimal harm
2024-02-23
F803 · Nutrition and Dietary Deficiencies
Health
Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.
Corrected 2024-04-12
D · Potential for more than minimal harm
2024-02-23
F641 · Resident Assessment and Care Planning Deficiencies
Health
Ensure each resident receives an accurate assessment.
Corrected 2024-04-12
E · Potential for more than minimal harm
2022-12-09
F689 · Quality of Life and Care Deficiencies
Health
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected 2023-01-05
E · Potential for more than minimal harm
2022-12-09
F760 · Pharmacy Service Deficiencies
Health
Ensure that residents are free from significant medication errors.
Corrected 2023-01-05
E · Potential for more than minimal harm
2022-12-09
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 2023-01-05
D · Potential for more than minimal harm
2022-12-09
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 2023-01-05
Penalties and ownership
What sits behind the stars
$13,863
2024-08-29
Fine
Fine · fine $13,863
Fine
Ownership
4p2t1 Ops Holding LP
5% Or Greater Direct Ownership Interest · Organization
Alexark1 LLC
Operational/Managerial Control · Organization
Higgs, John
Operational/Managerial Control · Individual
Jej Assets LP
5% Or Greater Indirect Ownership Interest · Organization
Jej Management, LLC
Operational/Managerial Control · Organization
Ponthie, John
5% Or Greater Indirect Ownership Interest · Individual
Ponthie, John
Corporate Director · Individual
Ponthie, John
Corporate Officer · Individual
Ponthie, Sharlot
5% Or Greater Indirect Ownership Interest · Individual
Nearby options
Other facilities in reach
#1
The Springs Of Red Oak
Hot Springs, AR
3-star overall rating with 3-star inspections with $14,935 in total fines with 8 recent health deficiencies
#2
The Blossoms At Hot Springs Rehab And Nursing Cent
Hot Springs, AR
4-star overall rating with 4-star inspections with 1 recent health deficiencies with 2 fire-safety deficiencies in the latest cycle
#3
Quapaw Care And Rehabilitation Center LLC
Hot Springs, AR
4-star overall rating with 3-star inspections with 5 recent health deficiencies with 2 fire-safety deficiencies in the latest cycle
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