Staffing
CMS publishes a 1-star staffing rating for this facility.
RN staffing was 0.73 hours per resident day in 2026Q1, calculated from CMS PBJ records.
View staffing evidenceAsk Trust Hub Network
SPOKANE VALLEY, WA
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 0.73 hours per resident day in 2026Q1, calculated from CMS PBJ records.
View staffing evidenceThe latest standard inspection on Nov 24, 2025 cited 6 deficiencies.
View inspection evidenceCMS-published records list 40 ownership or control parties.
CMS records show an ownership change effective July 2023.
View ownership evidenceCMS groups this facility with a chain covering 45 facilities across 5 states or territories.
View chain evidenceCMS records show a $3,529 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:
44 currently connected nursing homes share this CMS organization identity with CASCADIA HEALTHCARE 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.
Organization · 5% OR GREATER SECURITY INTEREST
Association date reported to CMS: Jun 5, 2025
Other facilities connected through this exact CMS organization identity: 0 across WA.
Organization · 5% OR GREATER SECURITY INTEREST
Association date reported to CMS: Aug 11, 2022
Other facilities connected through this exact CMS organization identity: 0 across WA.
Individual · ADP OF THE SNF
Association date reported to CMS: Oct 16, 2025
Organization · ADP OF THE SNF
Association date reported to CMS: Feb 12, 2025
Other facilities connected through this exact CMS organization identity: 0 across WA.
Individual · ADP OF THE SNF
Association date reported to CMS: Feb 12, 2025
Organization · ADP OF THE SNF
Association date reported to CMS: Jun 5, 2025
Other facilities connected through this exact CMS organization identity: 0 across WA.
Organization · DIRECT OWNERSHIP INTEREST
Association date reported to CMS: Jul 1, 2023
Other facilities connected through this exact CMS organization identity: 0 across WA.
Organization · INDIRECT OWNERSHIP INTEREST
Association date reported to CMS: Jun 5, 2025
Other facilities connected through this exact CMS organization identity: 0 across WA.
Organization · INDIRECT OWNERSHIP INTEREST
Association date reported to CMS: Jul 1, 2023
Other facilities connected through this exact CMS organization identity: 0 across WA.
Organization · INDIRECT OWNERSHIP INTEREST
Association date reported to CMS: Jun 5, 2025
Other facilities connected through this exact CMS organization identity: 0 across WA.
Individual · INDIRECT OWNERSHIP INTEREST
Association date reported to CMS: Jul 1, 2023
Individual · INDIRECT OWNERSHIP INTEREST
Association date reported to CMS: Jun 5, 2025
Individual · INDIRECT OWNERSHIP INTEREST
Association date reported to CMS: Jun 5, 2025
Individual · OPERATIONAL/MANAGERIAL CONTROL
Association date reported to CMS: Sep 1, 2025
Organization · OPERATIONAL/MANAGERIAL CONTROL
Association date reported to CMS: Nov 30, 2022
Other facilities connected through this exact CMS organization identity: 0 across WA.
Individual · OPERATIONAL/MANAGERIAL CONTROL
Association date reported to CMS: Jul 1, 2023
Individual · OPERATIONAL/MANAGERIAL CONTROL
Association date reported to CMS: Jun 5, 2025
Individual · OPERATIONAL/MANAGERIAL CONTROL
Association date reported to CMS: Nov 30, 2022
Individual · OPERATIONAL/MANAGERIAL CONTROL
Association date reported to CMS: Jun 5, 2025
Organization · 5% OR GREATER INDIRECT OWNERSHIP INTEREST
Association date reported to CMS: Nov 30, 2022
CMS classifications: Parent company
Other facilities connected through this exact CMS organization identity: 43 across ID, MT, OR, WA.
Organization · 5% OR GREATER SECURITY INTEREST
Published ownership percentage: 100%
Association date reported to CMS: Jun 5, 2025
Other facilities connected through this exact CMS organization identity: 0 across WA.
Organization · 5% OR GREATER SECURITY INTEREST
Association date reported to CMS: Aug 11, 2022
Other facilities connected through this exact CMS organization identity: 43 across CA, ID, MT, OR, WA.
Individual · ADP OF THE SNF
Association date reported to CMS: Oct 16, 2025
Organization · ADP OF THE SNF
Association date reported to CMS: Feb 12, 2025
Other facilities connected through this exact CMS organization identity: 42 across ID, MT, OR, WA.
Individual · ADP OF THE SNF
Association date reported to CMS: Feb 12, 2025
Organization · ADP OF THE SNF
Association date reported to CMS: Jun 5, 2025
Other facilities connected through this exact CMS organization identity: 0 across WA.
Organization · DIRECT OWNERSHIP INTEREST
Published ownership percentage: 100%
Association date reported to CMS: Jul 1, 2023
Other facilities connected through this exact CMS organization identity: 9 across WA.
Organization · INDIRECT OWNERSHIP INTEREST
Published ownership percentage: 100%
Association date reported to CMS: Jun 5, 2025
Other facilities connected through this exact CMS organization identity: 41 across ID, MT, OR, WA.
Organization · INDIRECT OWNERSHIP INTEREST
Published ownership percentage: 100%
Association date reported to CMS: Jul 1, 2023
Other facilities connected through this exact CMS organization identity: 43 across ID, MT, OR, WA.
Organization · INDIRECT OWNERSHIP INTEREST
Published ownership percentage: 100%
Association date reported to CMS: Jun 5, 2025
Other facilities connected through this exact CMS organization identity: 41 across ID, MT, OR, WA.
Individual · INDIRECT OWNERSHIP INTEREST
Published ownership percentage: 33.34%
Association date reported to CMS: Jul 1, 2023
Individual · INDIRECT OWNERSHIP INTEREST
Published ownership percentage: 33.33%
Association date reported to CMS: Jun 5, 2025
Individual · INDIRECT OWNERSHIP INTEREST
Published ownership percentage: 33.33%
Association date reported to CMS: Jun 5, 2025
Individual · OPERATIONAL/MANAGERIAL CONTROL
Association date reported to CMS: Sep 1, 2025
Organization · OPERATIONAL/MANAGERIAL CONTROL
Association date reported to CMS: Nov 30, 2022
Other facilities connected through this exact CMS organization identity: 42 across ID, MT, OR, WA.
Individual · OPERATIONAL/MANAGERIAL CONTROL
Association date reported to CMS: Jul 1, 2023
Individual · OPERATIONAL/MANAGERIAL CONTROL
Association date reported to CMS: Jun 5, 2025
Individual · OPERATIONAL/MANAGERIAL CONTROL
Association date reported to CMS: Nov 30, 2022
Individual · OPERATIONAL/MANAGERIAL CONTROL
Association date reported to CMS: Jun 5, 2025
Organization · Medicare-enrolled legal organization
Other facilities connected through this exact CMS organization identity: 0 across WA.
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 118 is a grouping identifier, not a legal organization.
| Month | Facilities | Overall rating | Staffing rating |
|---|---|---|---|
| Wed Jul | 45 | 3.1 | 2.7 |
| Mon Jun | 44 | 3.2 | 2.8 |
| Fri May | 44 | 3.2 | 2.8 |
| Wed Apr | 44 | 3.2 | 2.8 |
| Sun Mar | 44 | 3.2 | 2.9 |
| Sun Feb | 44 | 3.3 | 2.9 |
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.
Electronically submit to CMS complete and accurate direct care staffing information, based on payroll and other verifiable and auditable data.
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 12, 2026)
No health-deficiency rows were deterministically linked to this inspection.
No health-deficiency rows were deterministically linked to this inspection.
Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.
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 30, 2025)
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
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 30, 2025)
Provide safe, appropriate dialysis care/services for a resident who requires such services.
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 30, 2025)
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 (Dec 30, 2025)
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
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 30, 2025)
Provide and implement an infection prevention and control program.
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 30, 2025)
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, 2025)
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 (Dec 12, 2025)
Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.
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, 2025)
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 (Apr 10, 2025)
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
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 (Apr 10, 2025)
Ensure that residents are free from significant medication errors.
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 (Apr 10, 2025)
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
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 2, 2024)
Electronically submit to CMS complete and accurate direct care staffing information, based on payroll and other verifiable and auditable data.
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 2, 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 (Sep 24, 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 (Sep 24, 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 (Sep 24, 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 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 (Sep 24, 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 (Sep 24, 2024)
Provide care and assistance to perform activities of daily living for any resident who is unable.
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 (Sep 24, 2024)
Provide activities to meet all resident's needs.
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 (Sep 24, 2024)
Provide safe, appropriate dialysis care/services for a resident who requires such services.
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 (Sep 24, 2024)
Ensure that the resident and his/her doctor meet face-to-face at all required visits.
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 (Sep 24, 2024)
Observe each nurse aide's job performance and give regular training.
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 (Sep 24, 2024)
Ensure each resident must receive and the facility must provide necessary behavioral health care and services.
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 (Sep 24, 2024)
Ensure medication error rates are not 5 percent or greater.
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 (Sep 24, 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 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 (Sep 24, 2024)
Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service.
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 (Sep 24, 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 (Sep 24, 2024)
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
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 (Sep 24, 2024)
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 (Sep 24, 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 (Sep 24, 2024)
Educate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status.
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 (Sep 24, 2024)
Ensure services provided by the nursing facility meet professional standards of quality.
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 (Aug 22, 2024)
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
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 (Aug 22, 2024)
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
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 (Aug 22, 2024)
Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs.
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 (Jul 24, 2024)
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 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 17, 2024)
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
CMS scope/severity G: Isolated; Actual harm that is not immediate jeopardy.
Correction status: Deficient, Provider has date of correction (Nov 8, 2023)
No health-deficiency rows were deterministically linked to this inspection.
Provide care and assistance to perform activities of daily living for any resident who is unable.
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 16, 2023)
Provide activities to meet all resident's needs.
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 16, 2023)
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
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 16, 2023)
Provide enough food/fluids to maintain a resident's health.
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 16, 2023)
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 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 16, 2023)
Ensure medication error rates are not 5 percent or greater.
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 16, 2023)
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 (May 16, 2023)
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 (May 16, 2023)
Penalties & enforcement
Published fine amount: $3,529.00
Published fine amount: $18,233.00
Published fine amount: $2,098.00
Published fine amount: $3,174.00
Questions to ask
Facility history
20 historical events available. Dates and values come from published CMS and official state regulator evidence, not a score.
1 deficiency was recorded.
CMS · Recorded event date · View related evidence
No linked health-deficiency findings were recorded for this survey.
CMS · Recorded event date · View related evidence
6 deficiencies were recorded.
CMS · Recorded event date · View related evidence
3 deficiencies were recorded.
CMS · Recorded event date · View related evidence
RN staffing increased from 0.56 to 0.81 hours per resident day between 2025Q2 and 2025Q3. Staffing improved across those reported periods.
0.56 → 0.81
CMS · Reported in a source release · View related evidence
Total nurse staffing increased from 3.19 to 3.75 hours per resident day between 2025Q2 and 2025Q3. Staffing improved across those reported periods.
3.19 → 3.75
CMS · Reported in a source release · View related evidence
3 deficiencies were recorded.
CMS · Recorded event date · View related evidence
2 deficiencies were recorded.
CMS · Recorded event date · View related evidence
19 deficiencies were recorded.
CMS · Recorded event date · View related evidence
No linked health-deficiency findings were recorded for this survey.
CMS · Recorded event date · View related evidence
3 deficiencies were recorded.
CMS · Recorded event date · View related evidence
1 deficiency was 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 | 3.668 | 3.105 |
| RN categories | 0.791 | 0.575 |
Contract staff accounted for 6.2% of reported nursing hours included in this quarter calculation.
Reported RN-category hours per resident day were 0.095 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 | 3.191 | 0.562 | 0.749 | 1.874 | 11.9% | 91 |
| 2025Q3 | 3.751 | 0.811 | 0.845 | 2.025 | 12.2% | 92 |
| 2025Q4 | 3.591 | 0.823 | 0.766 | 1.891 | 8.6% | 92 |
| 2026Q1 | 3.505 | 0.729 | 0.744 | 1.867 | 6.2% | 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.