STATE ACQUISITION INTELLIGENCE REPORT
Sample State
1,162 facilities • 114,992 beds • 610 acquisition targets • Report ID: SAIR-CA-202604
Data vintage
Staffing (PBJ)Q3 2025 (PBJ)
Health inspectionsthrough Apr 2026
Federal penaltiesthrough Apr 2026
Quality measuresthrough Apr 2026
Ownership recordsthrough Apr 2026
Fire safetythrough Apr 2026
Facility financialsFY2024 HCRIS
Local demographics2023 ACS 5-year estimates
Each layer refreshed at the fastest cadence CMS publishes. PBJ staffing is released quarterly approximately 45 days after each collection period; deficiencies, penalties, and ownership records update continuously as agencies post them.
1 Executive Summary
Sample State acquisition landscape • 2025-Q3 data
58.8
Avg Acquisition Score
Sample State has 1,162 Medicare-certified nursing facilities with 114,992 beds.
610 facilities score 60+ on the SeniorIndex Acquisition Attractiveness Score, indicating strong acquisition potential.
36 facilities have compliance risk scores above 70, signaling operational distress.
Average turnaround potential across the state is 70.9 out of 100.
MARKET SIGNAL: HIGH ACQUISITION OPPORTUNITY
62.2%% of Sample State facilities have compliance gaps. Markets with widespread non-compliance see higher ownership turnover and more acquisition opportunities.
2 Compliance Risk Landscape
Facility readiness against May 2026 federal staffing thresholds
82
Non-Compliant + Critical
Compliance Trend — CA vs National (11 Quarters)
Non-compliant facilities face regulatory pressure that accelerates ownership transitions. States with rising non-compliance
rates present expanding acquisition pipelines as operators seek exits before enforcement actions escalate.
3 Revenue Quality
Payer mix as a valuation signal • Higher private pay = stronger cash flow
19.2%%
Medicare (highest margin)
Private Pay % by County (Top 12 Markets)
Private pay concentration is the strongest public signal of a facility's cash flow health. Counties with high
private pay averages support premium valuations, while Medicaid-heavy markets may offer turnaround opportunities
where payer mix optimization can drive margin expansion post-acquisition.
4 Ownership & Consolidation
Chain concentration, independent targets, and market structure
352
Independent Facilities
| Chain Operator | State Facilities | Total Nationwide | Avg Rating |
|---|
| Chain Operator 1 | 132 | 264 | 2.9 ★ |
| Chain Operator 2 | 71 | 329 | 3.2 ★ |
| Chain Operator 3 | 45 | 45 | 3.2 ★ |
| Chain Operator 4 | 38 | 38 | 2.2 ★ |
| Chain Operator 5 | 33 | 34 | 3.5 ★ |
| Chain Operator 6 | 32 | 32 | 2.7 ★ |
| Chain Operator 7 | 25 | 33 | 3.8 ★ |
| Chain Operator 8 | 24 | 31 | 2.8 ★ |
| Chain Operator 9 | 21 | 24 | 2.8 ★ |
| Chain Operator 10 | 21 | 193 | 2.4 ★ |
Ownership Type Distribution
5 Penalty & Enforcement Exposure
Regulatory risk profile • Fines, denials, and enforcement trends
$31,162,180
Total Fines (3yr)
Facilities with significant penalty exposure often face capital constraints, making them more receptive to acquisition offers.
Rising penalty trends indicate tightening regulatory environments that accelerate market turnover.
6 Quality Benchmarks
Clinical outcomes • State vs national • Improvement upside
Long-Stay Quality Measures: State vs National Average
Quality measures where the state significantly underperforms national averages represent improvement upside post-acquisition.
Facilities with poor outcomes on falls, pressure ulcers, and antipsychotic use are common turnaround targets where
operational improvements can drive star rating gains within 12–18 months.
7 County Acquisition Rankings
Markets ranked by acquisition opportunity density
Non-Compliance vs Private Pay by County (Top 12)
| County | Fac | Beds | Avg Rating | Medicaid | Private | %NC | Avg Viol | IJ (3yr) |
|---|
| County 1 | 6 | 577 | ★★★☆☆ | 19.6% | 68.8% | 16.7% | 8.5 | 0 |
| County 2 | 17 | 1,755 | ★☆☆☆☆ | 19.6% | 63.1% | 17.6% | 8.6 | 1 |
| County 3 | 10 | 1,055 | ★★★☆☆ | 20.3% | 52.2% | 20.0% | 4.1 | 1 |
| County 4 | 14 | 1,657 | ★★★☆☆ | 13.9% | 66.1% | 14.3% | 4.8 | 3 |
| County 5 | 17 | 1,795 | ★★★☆☆ | 19.7% | 65.5% | 11.8% | 6.5 | 2 |
| County 6 | 54 | 4,996 | ★★★☆☆ | 25.5% | 56.6% | 13.0% | 4.6 | 12 |
| County 7 | 31 | 2,778 | ★★★☆☆ | 32.6% | 53.6% | 13.3% | 3.7 | 1 |
| County 8 | 14 | 1,277 | ★★★★☆ | 28.1% | 49.7% | 14.3% | 2.6 | 1 |
| County 9 | 16 | 1,552 | ★★★☆☆ | 32.0% | 54.5% | 12.5% | 6.8 | 0 |
| County 10 | 81 | 8,791 | ★★★☆☆ | 22.9% | 57.5% | 11.1% | 7.1 | 2 |
| County 11 | 10 | 781 | ★★★☆☆ | 31.2% | 54.1% | 10.0% | 5.1 | 0 |
| County 12 | 19 | 1,862 | ★★★★☆ | 27.9% | 48.2% | 10.5% | 5.8 | 1 |
| County 13 | 30 | 2,916 | ★★★★☆ | 21.8% | 59.4% | 6.7% | 4.5 | 3 |
| County 14 | 371 | 37,670 | ★★☆☆☆ | 20.4% | 59.4% | 6.0% | 12.5 | 276 |
| County 15 | 14 | 994 | ★★★☆☆ | 25.1% | 48.4% | 7.1% | 4.5 | 1 |
| County 16 | 54 | 5,123 | ★★★☆☆ | 21.5% | 57.5% | 5.6% | 8.6 | 19 |
| County 17 | 72 | 7,730 | ★★★☆☆ | 25.6% | 49.5% | 5.6% | 13.7 | 1 |
| County 18 | 50 | 5,114 | ★★★☆☆ | 20.8% | 61.3% | 4.1% | 7.7 | 7 |
| County 19 | 24 | 2,629 | ★★☆☆☆ | 30.2% | 57.2% | 4.2% | 10.0 | 0 |
| County 20 | 69 | 5,522 | ★★★☆☆ | 34.7% | 48.8% | 4.3% | 2.9 | 8 |
| County 21 | 37 | 3,915 | ★★★☆☆ | 13.5% | 71.1% | 0.0% | 6.9 | 4 |
| County 22 | 18 | 2,322 | ★★★★☆ | 3.5% | 74.1% | 0.0% | 1.7 | 1 |
| County 23 | 18 | 1,506 | ★★★☆☆ | 20.1% | 59.7% | 0.0% | 6.8 | 3 |
| County 24 | 11 | 948 | ★★☆☆☆ | 29.5% | 54.3% | 0.0% | 12.7 | 0 |
| County 25 | 10 | 1,125 | ★★★☆☆ | 17.6% | 67.7% | 0.0% | 5.6 | 0 |
| County 26 | 9 | 910 | ★★☆☆☆ | 39.1% | 36.9% | 0.0% | 7.3 | 3 |
| County 27 | 8 | 747 | ★★★☆☆ | 49.1% | 33.9% | 0.0% | 5.4 | 0 |
| County 28 | 7 | 725 | ★★★☆☆ | 26.4% | 55.6% | 0.0% | 3.3 | 0 |
| County 29 | 7 | 755 | ★★★★★ | 3.2% | 70.2% | 0.0% | 3.0 | 0 |
| County 30 | 6 | 678 | ★★★☆☆ | 16.1% | 72.7% | 0.0% | 5.3 | 0 |
8 Top 25 Acquisition Targets
Facilities ranked by SeniorIndex Acquisition Opportunity Score
Opportunity Map: Acquisition Score vs Revenue Quality
| # | Facility | City | Beds | Rating | Private | Medicaid | Compliance | Score |
|---|
| 1 | Facility 1 | City 1 | 99 | ★☆☆☆☆ | 87.2% | 3.9% | AT RISK | 86 |
| 2 | Facility 2 | City 2 | 130 | ★☆☆☆☆ | 86.8% | 5.4% | AT RISK | 88 |
| 3 | Facility 3 | City 3 | 59 | ★☆☆☆☆ | 77.8% | 4.8% | NON COMPLIANT | 77 |
| 4 | Facility 4 | City 4 | 104 | ★☆☆☆☆ | 82.9% | 3.7% | COMPLIANT | 86 |
| 5 | Facility 5 | City 5 | 75 | ★☆☆☆☆ | 81.8% | 6.8% | COMPLIANT | 86 |
| 6 | Facility 6 | City 6 | 99 | ★☆☆☆☆ | 81.2% | 9.4% | AT RISK | 86 |
| 7 | Facility 7 | City 7 | 87 | ★☆☆☆☆ | 79.9% | 7.3% | AT RISK | 88 |
| 8 | Facility 8 | City 8 | 391 | ★☆☆☆☆ | 78.8% | 6.3% | AT RISK | 88 |
| 9 | Facility 9 | City 9 | 99 | ★☆☆☆☆ | 78.6% | 2.6% | AT RISK | 89 |
| 10 | Facility 10 | City 10 | 99 | ★☆☆☆☆ | 74.8% | 2.5% | AT RISK | 86 |
| 11 | Facility 11 | City 11 | 92 | ★☆☆☆☆ | 70.7% | 5.7% | AT RISK | 85 |
| 12 | Facility 12 | City 12 | 99 | ★☆☆☆☆ | 69.5% | 3.0% | AT RISK | 84 |
| 13 | Facility 13 | City 13 | 59 | ★☆☆☆☆ | 67.6% | 12.1% | AT RISK | 86 |
| 14 | Facility 14 | City 14 | 126 | ★☆☆☆☆ | 64.8% | 3.9% | AT RISK | 84 |
| 15 | Facility 15 | City 15 | 99 | ★☆☆☆☆ | 40.0% | 10.6% | AT RISK | 85 |
| 16 | Facility 16 | City 16 | 99 | ★☆☆☆☆ | 19.2% | 71.3% | AT RISK | 85 |
| 17 | Facility 17 | City 17 | 99 | ★☆☆☆☆ | 8.1% | 77.1% | NON COMPLIANT | 77 |
| 18 | Facility 18 | City 18 | 133 | ★☆☆☆☆ | 12.0% | 77.7% | AT RISK | 85 |
| 19 | Facility 19 | City 12 | 148 | ★☆☆☆☆ | 7.3% | 80.8% | AT RISK | 83 |
| 20 | Facility 20 | City 19 | 99 | ★☆☆☆☆ | 9.5% | 84.7% | AT RISK | 88 |
| 21 | Facility 21 | City 20 | 253 | ★☆☆☆☆ | 7.7% | 87.0% | AT RISK | 85 |
| 22 | Facility 22 | City 19 | 119 | ★☆☆☆☆ | 3.7% | 93.7% | AT RISK | 85 |
| 23 | Facility 23 | City 21 | 117 | ★☆☆☆☆ | 2.2% | 83.6% | COMPLIANT | 86 |
| 24 | Facility 24 | City 13 | 99 | ★☆☆☆☆ | 1.9% | 75.9% | AT RISK | 86 |
| 25 | Facility 25 | City 15 | 145 | ★☆☆☆☆ | 0.7% | 78.6% | AT RISK | 87 |
Acquisition Opportunity Score combines: Staffing Gap (30pts), Revenue Quality (25pts),
Regulatory Pressure (20pts), Facility Size (15pts), and Violation Signal (10pts). Higher scores indicate
facilities with both operational need and financial capacity to support acquisition economics.
9 Investment Signals
Data-driven acquisition intelligence for Sample State
Highest regulatory pressure: County 3 with 20.0% non-compliance rate across 10 facilities. Distressed facilities in high-pressure markets are more likely to transact.
Strongest revenue market: County 22 with 74.1% average private pay. Higher private pay mix supports premium valuations and stronger cash flow post-acquisition.
Largest market: County 14 with 371 facilities and 37,670 beds. Geographic density enables multi-facility platform acquisitions and operational synergies.
Independent facility opportunity: 352 facilities (30.3%) are not chain-affiliated, representing direct acquisition targets without chain-level negotiation complexity.
10 Methodology & Data Sources
Report ID: SAIR-CA-202604 • Generated April 06, 2026
This report is generated from the SeniorIndex.ai database, which aggregates multiple federal and state
data sources into a unified intelligence platform. Primary data sources include federal provider data
(facility profiles, star ratings, quality measures), mandatory payroll-based daily nurse staffing records
(14.5 million records across 11 quarters), facility financial filings (payer mix), federal health inspection
and enforcement records (419,452 deficiencies), and ownership/chain affiliation data (160,373 records).
Acquisition Attractiveness Score (0–100): Combines compliance risk trajectory, payer mix quality,
star ratings, facility size, occupancy, demographic demand, and ownership stability. Higher scores indicate
facilities more likely to be available and economically attractive for acquisition.
Turnaround Potential (0–100): Measures the gap between current performance and market opportunity.
Facilities with low ratings but strong demographics and revenue quality score highest.
Compliance Risk (0–100): Algorithmic risk scoring combining deficiency severity, penalty history,
staffing volatility, inspection patterns, and SFF status. Higher = riskier.
Limitations: PBJ data reflects paid hours only. Payer mix is based on most recent cost report filing.
Acquisition scores are proprietary analytical products and do not represent CMS endorsements.
This report is for informational purposes only and should not be construed as investment advice.