Staffing
CMS publishes a 1-star staffing rating for this facility.
RN staffing was 0.37 hours per resident day in 2026Q1, calculated from CMS PBJ records.
View staffing evidenceAsk Trust Hub Network
CMS overview
No proprietary TrustHub score. These ratings are published separately by CMS.
Facility information
CMS remains the primary federal record. Public website and additional contact details appear only when independently verified.
Decision guide
Factual evidence to examine before you decide. These summaries are not a score or recommendation.
CMS publishes a 1-star staffing rating for this facility.
RN staffing was 0.37 hours per resident day in 2026Q1, calculated from CMS PBJ records.
View staffing evidenceThe latest standard inspection on Apr 18, 2024 cited 27 deficiencies.
View inspection evidenceCMS-published records list 31 ownership or control parties.
CMS records show an ownership change effective January 2025.
View ownership evidenceCMS groups this facility with a chain covering 33 facilities across 2 states or territories.
View chain evidenceCMS records show a $15,143 fine in the loaded enforcement dataset.
View enforcement evidence →Ownership & operation
Operator, licensee, owner, manager, and chain stay separate. A connected organization is not automatically the party that runs daily operations.
SeniorTrustHub found evidence connecting this facility to:
29 currently connected nursing homes share this CMS organization identity with RELIANT CARE GROUP LLC.
These figures summarize currently connected CMS-certified nursing homes. Some facilities have incomplete measures; missing values are omitted, not treated as zero. Ownership structures can change. State operator or licensee evidence may differ from CMS ownership disclosures.
Ownership
These are CMS-published ownership disclosures. Medicare enrollment ownership and managerial-control information is reported by enrolled providers through CMS forms; it is not an independent determination of beneficial ownership.
Individual · ADP OF THE SNF
Association date reported to CMS: Jan 25, 2025
Organization · ADP OF THE SNF
Association date reported to CMS: Jan 25, 2025
Other facilities connected through this exact CMS organization identity: 0 across MO.
Individual · ADP OF THE SNF
Association date reported to CMS: Jan 25, 2025
Individual · ADP OF THE SNF
Association date reported to CMS: Jan 25, 2025
Organization · ADP OF THE SNF
Association date reported to CMS: Jan 30, 2025
Other facilities connected through this exact CMS organization identity: 0 across MO.
Organization · ADP OF THE SNF
Association date reported to CMS: Apr 1, 2025
Other facilities connected through this exact CMS organization identity: 0 across MO.
Organization · ADP OF THE SNF
Association date reported to CMS: Jan 25, 2025
Other facilities connected through this exact CMS organization identity: 0 across MO.
Individual · CORPORATE OFFICER
Association date reported to CMS: Jan 25, 2025
Organization · DIRECT OWNERSHIP INTEREST
Association date reported to CMS: Jan 25, 2025
Other facilities connected through this exact CMS organization identity: 0 across MO.
Individual · INDIRECT OWNERSHIP INTEREST
Association date reported to CMS: Jan 25, 2025
Organization · INDIRECT OWNERSHIP INTEREST
Association date reported to CMS: Jan 25, 2025
Other facilities connected through this exact CMS organization identity: 0 across MO.
Organization · INDIRECT OWNERSHIP INTEREST
Association date reported to CMS: Apr 1, 2025
Other facilities connected through this exact CMS organization identity: 0 across MO.
Individual · OPERATIONAL/MANAGERIAL CONTROL
Association date reported to CMS: Jan 25, 2025
Individual · OPERATIONAL/MANAGERIAL CONTROL
Association date reported to CMS: Jan 25, 2025
Organization · OPERATIONAL/MANAGERIAL CONTROL
Association date reported to CMS: Jan 25, 2025
Other facilities connected through this exact CMS organization identity: 0 across MO.
Individual · ADP OF THE SNF
Association date reported to CMS: Jan 25, 2025
Organization · ADP OF THE SNF
Association date reported to CMS: Jan 25, 2025
Other facilities connected through this exact CMS organization identity: 0 across MO.
Individual · ADP OF THE SNF
Association date reported to CMS: Jan 25, 2025
Individual · ADP OF THE SNF
Association date reported to CMS: Jan 25, 2025
Organization · ADP OF THE SNF
Association date reported to CMS: Jan 30, 2025
CMS classifications: Chain / home office, Management services company
Other facilities connected through this exact CMS organization identity: 33 across KS, MO.
Organization · ADP OF THE SNF
Association date reported to CMS: Apr 1, 2025
Other facilities connected through this exact CMS organization identity: 23 across KS, MO.
Organization · ADP OF THE SNF
Association date reported to CMS: Jan 25, 2025
CMS classifications: Holding company
Other facilities connected through this exact CMS organization identity: 17 across KS, MO.
Individual · CORPORATE OFFICER
Published ownership percentage: 100%
Association date reported to CMS: Jan 25, 2025
Organization · DIRECT OWNERSHIP INTEREST
Published ownership percentage: 100%
Association date reported to CMS: Jan 25, 2025
CMS classifications: Parent company, Holding company
Other facilities connected through this exact CMS organization identity: 28 across KS, MO.
Individual · INDIRECT OWNERSHIP INTEREST
Published ownership percentage: 100%
Association date reported to CMS: Jan 25, 2025
Organization · INDIRECT OWNERSHIP INTEREST
Published ownership percentage: 0.01%
Association date reported to CMS: Jan 25, 2025
CMS classifications: Holding company
Other facilities connected through this exact CMS organization identity: 22 across KS, MO.
Organization · INDIRECT OWNERSHIP INTEREST
Published ownership percentage: 100%
Association date reported to CMS: Apr 1, 2025
Other facilities connected through this exact CMS organization identity: 23 across KS, MO.
Individual · OPERATIONAL/MANAGERIAL CONTROL
Association date reported to CMS: Jan 25, 2025
Individual · OPERATIONAL/MANAGERIAL CONTROL
Association date reported to CMS: Jan 25, 2025
Organization · OPERATIONAL/MANAGERIAL CONTROL
Association date reported to CMS: Jan 25, 2025
CMS classifications: Chain / home office, Management services company
Other facilities connected through this exact CMS organization identity: 33 across KS, MO.
Organization · Medicare-enrolled legal organization
Other facilities connected through this exact CMS organization identity: 0 across MO.
Roles are shown as CMS publishes them. Different CMS sources can describe different enrollment, ownership, and control concepts, so TrustHub keeps each source-specific disclosure distinct.
Chain context
Chain-level values describe this CMS-defined group, not any one facility. CMS Chain ID 446 is a grouping identifier, not a legal organization.
| Month | Facilities | Overall rating | Staffing rating |
|---|---|---|---|
| Wed Jul | 33 | 1.2 | 1 |
| Mon Jun | 32 | 1.2 | 1 |
| Fri May | 32 | 1.2 | 1 |
| Wed Apr | 31 | 1.2 | 1 |
| Sun Mar | 29 | 1.1 | 1 |
| Sun Feb | 30 | 1.2 | 1 |
Nursing Home Chain Performance Measures, fixed version da2db00a-0f3d-40a9-a535-588ff1220c55. Membership comes separately from CMS Skilled Nursing Facility Enrollments.
View official CMS sourceInspections & deficiencies
Scope and severity terms below are CMS classifications. They are not a TrustHub score.
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.
CMS scope/severity F: Widespread; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Sep 1, 2025)
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
CMS scope/severity J: Isolated; Immediate jeopardy to resident health or safety.
Correction status: Past Non-Compliance (Mar 31, 2025)
Ensure that the facility has sufficient staff members who possess the competencies and skills to meet the behavioral health needs of residents.
CMS scope/severity E: Pattern; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (May 20, 2025)
Provide the appropriate treatment and services to a resident who displays or is diagnosed with mental disorder or psychosocial adjustment difficulty, or who has a history of trauma and/or post-traumatic stress disorder.
CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (May 20, 2025)
Provide basic life support, including CPR, prior to the arrival of emergency medical personnel , subject to physician orders and the resident’s advance directives.
CMS scope/severity E: Pattern; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Dec 9, 2024)
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.
CMS scope/severity E: Pattern; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Dec 9, 2024)
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.
CMS scope/severity E: Pattern; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Oct 18, 2024)
Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.
CMS scope/severity G: Isolated; Actual harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Jul 23, 2024)
No health-deficiency rows were deterministically linked to this inspection.
No health-deficiency rows were deterministically linked to this inspection.
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Jun 1, 2024)
Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.
CMS scope/severity E: Pattern; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Jun 1, 2024)
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Jun 1, 2024)
Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.
CMS scope/severity B: Pattern; No actual harm with potential for minimal harm.
Correction status: Deficient, Provider has date of correction (Jun 1, 2024)
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.
CMS scope/severity E: Pattern; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Jun 1, 2024)
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
CMS scope/severity E: Pattern; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Jun 1, 2024)
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Jun 1, 2024)
Assess the resident when there is a significant change in condition
CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Jun 1, 2024)
Ensure each resident receives an accurate assessment.
CMS scope/severity B: Pattern; No actual harm with potential for minimal harm.
Correction status: Deficient, Provider has date of correction (Jun 1, 2024)
PASARR screening for Mental disorders or Intellectual Disabilities
CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Jun 1, 2024)
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
CMS scope/severity E: Pattern; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Jun 1, 2024)
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
CMS scope/severity E: Pattern; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Jun 1, 2024)
Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge.
CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Jun 1, 2024)
Provide care and assistance to perform activities of daily living for any resident who is unable.
CMS scope/severity E: Pattern; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Jun 1, 2024)
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
CMS scope/severity E: Pattern; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Jun 1, 2024)
Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail.
CMS scope/severity E: Pattern; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Jun 1, 2024)
Ensure that nurse aides who have worked more than 4 months, are trained and competent; and nurse aides who have worked less than 4 months are enrolled in appropriate training.
CMS scope/severity E: Pattern; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Jun 1, 2024)
Post nurse staffing information every day.
CMS scope/severity C: Widespread; No actual harm with potential for minimal harm.
Correction status: Deficient, Provider has date of correction (Jun 1, 2024)
Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.
CMS scope/severity E: Pattern; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Jun 1, 2024)
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.
CMS scope/severity E: Pattern; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Jun 1, 2024)
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
CMS scope/severity E: Pattern; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Jun 1, 2024)
Ensure that residents are assessed for appropriateness for a feeding assistant program, receive services as per their plan of care, and feeding assistants are trained and supervised.
CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Jun 1, 2024)
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
CMS scope/severity F: Widespread; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Jun 1, 2024)
Provide and implement an infection prevention and control program.
CMS scope/severity F: Widespread; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Jul 23, 2024)
Implement a program that monitors antibiotic use.
CMS scope/severity E: Pattern; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Jul 23, 2024)
Develop and implement policies and procedures for flu and pneumonia vaccinations.
CMS scope/severity E: Pattern; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Jun 1, 2024)
Regularly inspect all bed frames, mattresses, and bed rails (if any) for safety; and all bed rails and mattresses must attach safely to the bed frame.
CMS scope/severity E: Pattern; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Jun 1, 2024)
Respond appropriately to all alleged violations.
CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Dec 12, 2023)
No health-deficiency rows were deterministically linked to this inspection.
Honor the resident's right to manage his or her financial affairs.
CMS scope/severity E: Pattern; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Nov 2, 2022)
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
CMS scope/severity B: Pattern; No actual harm with potential for minimal harm.
Correction status: Deficient, Provider has date of correction (Nov 2, 2022)
Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave.
CMS scope/severity B: Pattern; No actual harm with potential for minimal harm.
Correction status: Deficient, Provider has date of correction (Nov 2, 2022)
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Nov 2, 2022)
Ensure services provided by the nursing facility meet professional standards of quality.
CMS scope/severity E: Pattern; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Nov 2, 2022)
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
CMS scope/severity E: Pattern; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Nov 2, 2022)
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Nov 2, 2022)
Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail.
CMS scope/severity E: Pattern; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Nov 14, 2022)
Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.
CMS scope/severity E: Pattern; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Nov 2, 2022)
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.
CMS scope/severity D: Isolated; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Nov 2, 2022)
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.
CMS scope/severity E: Pattern; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Nov 2, 2022)
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
CMS scope/severity E: Pattern; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Nov 2, 2022)
Provide and implement an infection prevention and control program.
CMS scope/severity E: Pattern; No actual harm with potential for more than minimal harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Nov 2, 2022)
Develop and implement policies and procedures for flu and pneumonia vaccinations.
CMS scope/severity H: Pattern; Actual harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Nov 2, 2022)
No health-deficiency rows were deterministically linked to this inspection.
No health-deficiency rows were deterministically linked to this inspection.
Penalties & enforcement
Published fine amount: $15,143.00
Payment denial length: 5 days
Questions to ask
Facility history
16 historical events available. Dates and values come from published CMS and official state regulator evidence, not a score.
Total nurse staffing increased from 3.48 to 3.77 hours per resident day between 2025Q4 and 2026Q1. Staffing improved across those reported periods.
3.48 → 3.77
CMS · Reported in a source release · View related evidence
RN staffing decreased from 0.46 to 0.34 hours per resident day between 2025Q2 and 2025Q3. Staffing declined across those reported periods.
0.46 → 0.34
CMS · Reported in a source release · View related evidence
Total nurse staffing increased from 3.13 to 3.36 hours per resident day between 2025Q2 and 2025Q3. Staffing improved across those reported periods.
3.13 → 3.36
CMS · Reported in a source release · View related evidence
1 deficiency was recorded.
CMS · Recorded event date · View related evidence
3 deficiencies were recorded. That includes 1 higher-severity deficiency.
CMS · Recorded event date · View related evidence
CMS recorded a $15,143 civil monetary penalty.
CMS · Recorded event date · View related evidence
An ownership change was recorded. New organization: BRUNSWICK HEALTH CARE CENTER LLC.
ANEW HEALTHCARE OPERATIONS - BRUNSWICK LLC → BRUNSWICK HEALTH CARE CENTER LLC
CMS · Recorded event date · View related evidence
2 deficiencies were recorded.
CMS · Recorded event date · View related evidence
1 deficiency was recorded.
CMS · Recorded event date · View related evidence
1 deficiencies were recorded. That includes 1 higher-severity deficiency.
CMS · Recorded event date · View related evidence
CMS recorded a Medicare payment denial lasting 5 days.
CMS · Recorded event date · View related evidence
27 deficiencies were recorded.
CMS · Recorded event date · View related evidence
Staffing
CMS staffing rating: 1 of 5 stars. CMS calculates that rating separately using its published methodology. The values below are calculations from daily PBJ records for 2026Q1 (current source quarter).
| Measure | Monday–Friday | Saturday–Sunday |
|---|---|---|
| Total nursing | 3.867 | 3.522 |
| RN categories | 0.391 | 0.334 |
Contract staff accounted for 0% of reported nursing hours included in this quarter calculation.
Reported RN-category hours per resident day were 0.068 lower than the prior loaded quarter.
Solid bar: Total nursing · Outlined bar: RN categories
| Quarter | Total nursing | RN categories | LPN/LVN | CNA | Contract share | Days |
|---|---|---|---|---|---|---|
| 2025Q2 | 3.128 | 0.458 | 0.87 | 1.792 | 0% | 91 |
| 2025Q3 | 3.357 | 0.345 | 0.813 | 2.193 | 0% | 92 |
| 2025Q4 | 3.484 | 0.442 | 1.046 | 1.785 | 0% | 92 |
| 2026Q1 | 3.767 | 0.374 | 1.129 | 1.873 | 0% | 90 |
Hours-per-resident-day values are calculated by this platform from CMS-published daily PBJ hours and MDS census. For each displayed period, included hours are summed and divided by the summed census for days with a positive census. They are not CMS case-mix-adjusted staffing measures or a staffing rating.
View official CMS PBJ sourceWhat we can verify today
These measures come from the current successfully ingested CMS Nursing Home Provider Information release.
Planned evidence layers
These areas require separate authoritative CMS datasets. No findings are shown until those sources are ingested and reviewed.
Trust participation
Claims, corrections, and factual context are free. Submissions never replace CMS evidence or affect ranking.
Source register
No paid placements. Facilities cannot pay to rank higher. We cite. You decide.