Market Deployment Report

State 1 / State 2 / State 3

3,033 facilities • 333,006 beds • Top 50 opportunities ranked • MDR-TX-FL-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

Multi-state market overview for staffing deployment planning

3,033

Total Facilities

333,006

Total Beds

69.4%

With Compliance Gaps

High Contract Dependency

Across 3 states, 3,033 nursing facilities operate 333,006 certified beds. 69.4% of facilities have at least one compliance gap heading into the industry staffing benchmarks. 12 facilities are in the HIGH or CRITICAL contract dependency tier, representing the most agency-dependent facilities across these markets. Average contract staffing utilization is 2.0%.

2 State Comparison

Side-by-side market metrics across selected states

Non-Compliance Rate by State

Contract Dependency by State

State	Fac	Beds	Avg Rating	Medicaid	Private	Stability	%NC	Contract	High Dep	Avg Viol
S1	1,177	133,557	2.8	59.8%	31.6%	81.3	65.1%	2.1%	5	5.5
S3	1,162	114,992	3.1	23.8%	57.0%	84.5	7.5%	2.4%	5	8.6
S2	694	84,457	3.2	54.8%	28.5%	86.0	18.1%	1.2%	2	2.8

3 Compliance Landscape

Combined compliance status across all 3 states

912

Compliant

1111

At Risk

801

Non-Compliant

160

Critical

Compliance Trend — Selected States vs National (11 Quarters)

4 County Market Rankings

Top 30 counties across selected states, ranked by facility count

Private Pay % by County (Top 15)

Contract Dependency % by County (Top 15)

County	State	Fac	Beds	Private	%NC	Contract	Avg Viol	IJ (3yr)
County 1	S3	371	37,670	59.4%	6.0%	1.8%	12.5	276
County 2	S1	97	11,672	33.2%	60.8%	2.1%	4.7	262
County 3	S1	82	10,770	32.6%	60.5%	1.5%	5.8	180
County 4	S3	81	8,791	57.5%	11.1%	2.8%	7.1	2
County 5	S3	72	7,730	49.5%	5.6%	1.6%	13.7	1
County 6	S1	71	8,972	35.3%	62.9%	1.3%	6.6	199
County 7	S3	69	5,522	48.8%	4.3%	4.2%	2.9	8
County 8	S2	65	7,485	22.2%	33.8%	2.3%	3.2	67
County 9	S1	62	7,679	34.4%	66.1%	1.5%	9.5	120
County 10	S3	54	5,123	57.5%	5.6%	1.4%	8.6	19
County 11	S2	54	8,281	26.5%	0.0%	2.1%	2.7	29
County 12	S3	54	4,996	56.6%	13.0%	2.6%	4.6	12
County 13	S2	54	6,163	34.8%	3.7%	0.4%	4.3	14
County 14	S3	50	5,114	61.3%	4.1%	2.1%	7.7	7
County 15	S3	37	3,915	71.1%	0.0%	0.4%	6.9	4
County 5	S2	36	4,559	28.6%	11.8%	1.3%	3.3	36
County 16	S2	34	4,400	25.7%	29.4%	1.1%	1.2	6
County 17	S2	33	4,314	28.4%	6.1%	0.6%	2.8	2
County 18	S3	31	2,778	53.6%	13.3%	0.3%	3.7	1
County 19	S2	30	3,943	26.6%	16.7%	0.5%	3.1	16
County 20	S2	30	3,086	34.8%	23.3%	3.3%	1.9	30
County 21	S3	30	2,916	59.4%	6.7%	2.8%	4.5	3
County 22	S2	29	3,427	28.7%	27.6%	2.8%	1.0	11
County 23	S1	28	3,203	33.8%	57.1%	1.5%	5.2	75
County 24	S2	25	3,174	31.2%	24.0%	0.1%	3.9	27
County 25	S3	24	2,629	57.2%	4.2%	0.1%	10.0	0
County 26	S1	22	2,772	21.2%	72.7%	0.3%	5.5	38
County 27	S1	22	2,640	42.9%	63.6%	0.4%	4.5	16
County 28	S1	22	2,585	34.4%	54.5%	0.2%	7.3	32
County 29	S2	21	2,803	27.6%	19.0%	0.5%	2.7	29

5 Top 50 Deployment Targets

Facilities ranked by SeniorIndex Staffing Need Score (0–100)

Opportunity Map: Staffing Need vs Revenue Quality

#	Facility	City	State	Beds	Rating	RN Hrs	Private	Compliance	Contract	Score
1	Facility 1	City 1	S3	391	★☆☆☆☆	0.28	78.8%	AT RISK	0.0%	96
2	Facility 2	City 2	S3	130	★☆☆☆☆	0.34	86.8%	AT RISK	0.0%	86
3	Facility 3	City 3	S3	87	★☆☆☆☆	0.26	79.9%	AT RISK	0.0%	83
4	Facility 4	City 4	S3	99	★☆☆☆☆	0.29	81.2%	AT RISK	0.0%	82
5	Facility 5	City 5	S3	59	★☆☆☆☆	0.25	77.8%	NON COMPLIANT	0.1%	81
6	Facility 6	City 6	S1	222	★☆☆☆☆	0.30	24.5%	CRITICAL	0.0%	80
7	Facility 7	City 7	S3	154	★☆☆☆☆	0.39	93.8%	AT RISK	1.0%	79
8	Facility 8	City 8	S3	99	★☆☆☆☆	0.33	78.6%	AT RISK	0.0%	78
9	Facility 9	City 9	S1	214	★☆☆☆☆	0.16	17.6%	CRITICAL	0.0%	77
10	Facility 10	City 10	S1	180	★☆☆☆☆	0.28	29.2%	NON COMPLIANT	3.9%	77
11	Facility 11	City 11	S3	59	★☆☆☆☆	0.29	67.6%	AT RISK	0.0%	76
12	Facility 12	City 12	S3	99	★☆☆☆☆	0.33	69.5%	AT RISK	0.3%	76
13	Facility 13	City 13	S1	154	★☆☆☆☆	0.22	25.0%	CRITICAL	11.8%	75
14	Facility 14	City 6	S1	237	★☆☆☆☆	0.21	17.5%	CRITICAL	0.0%	75
15	Facility 15	City 14	S1	124	★☆☆☆☆	0.14	26.6%	NON COMPLIANT	0.0%	73
16	Facility 16	City 15	S1	124	★☆☆☆☆	0.27	32.7%	NON COMPLIANT	2.8%	73
17	Facility 17	City 16	S1	172	★☆☆☆☆	0.32	12.4%	NON COMPLIANT	0.0%	73
18	Facility 18	City 17	S1	186	★☆☆☆☆	0.33	35.4%	NON COMPLIANT	0.0%	73
19	Facility 19	City 18	S2	120	★☆☆☆☆	0.33	31.0%	NON COMPLIANT	0.0%	73
20	Facility 20	County 3	S1	184	★☆☆☆☆	0.27	11.5%	NON COMPLIANT	0.0%	71
21	Facility 21	City 20	S1	152	★☆☆☆☆	0.19	8.0%	CRITICAL	0.0%	71
22	Facility 22	City 21	S2	103	★☆☆☆☆	N/A	29.2%	AT RISK	0.0%	70
23	Facility 23	City 22	S3	253	★☆☆☆☆	0.32	7.7%	AT RISK	23.6%	69
24	Facility 24	City 23	S1	68	★☆☆☆☆	N/A	41.9%	NON COMPLIANT	0.0%	67
25	Facility 25	City 24	S3	126	★☆☆☆☆	0.35	64.8%	AT RISK	0.0%	66
26	Facility 26	City 25	S3	99	★☆☆☆☆	0.43	74.8%	AT RISK	0.0%	66
27	Facility 27	City 6	S1	106	★☆☆☆☆	0.35	31.2%	NON COMPLIANT	12.6%	64
28	Facility 28	City 26	S1	155	★☆☆☆☆	0.31	23.8%	NON COMPLIANT	2.6%	64
29	Facility 29	City 27	S1	163	★☆☆☆☆	0.40	34.7%	NON COMPLIANT	0.0%	64
30	Facility 30	City 28	S1	143	★☆☆☆☆	0.35	19.8%	NON COMPLIANT	0.1%	63
31	Facility 31	City 29	S1	234	★☆☆☆☆	0.40	17.4%	NON COMPLIANT	0.0%	63
32	Facility 32	City 30	S3	145	★☆☆☆☆	0.32	0.7%	AT RISK	4.8%	63
33	Facility 33	City 31	S3	99	★☆☆☆☆	0.40	87.2%	AT RISK	2.4%	62
34	Facility 34	City 11	S3	99	★☆☆☆☆	0.30	1.9%	AT RISK	0.0%	62
35	Facility 35	City 32	S3	99	★☆☆☆☆	0.23	8.1%	NON COMPLIANT	40.6%	61
36	Facility 36	City 33	S3	133	★☆☆☆☆	0.35	12.0%	AT RISK	0.0%	61
37	Facility 37	County 28	S1	187	★☆☆☆☆	0.43	20.3%	NON COMPLIANT	0.0%	60
38	Facility 38	City 35	S3	92	★☆☆☆☆	0.37	70.7%	AT RISK	0.0%	60
39	Facility 39	City 36	S1	104	★☆☆☆☆	0.39	29.7%	NON COMPLIANT	1.6%	59
40	Facility 40	City 37	S3	99	★☆☆☆☆	0.35	9.5%	AT RISK	0.0%	59
41	Facility 41	City 30	S3	99	★☆☆☆☆	0.42	40.0%	AT RISK	0.9%	59
42	Facility 42	City 12	S3	148	★☆☆☆☆	0.38	7.3%	AT RISK	2.1%	58
43	Facility 43	City 38	S1	204	★☆☆☆☆	0.47	23.6%	NON COMPLIANT	0.0%	57
44	Facility 44	City 39	S1	179	★☆☆☆☆	0.47	30.5%	NON COMPLIANT	0.0%	56
45	Facility 45	City 40	S2	104	★☆☆☆☆	0.36	23.8%	NON COMPLIANT	0.4%	56
46	Facility 46	City 41	S2	185	★☆☆☆☆	0.45	20.1%	AT RISK	0.0%	56
47	Facility 47	City 42	S1	122	★☆☆☆☆	0.34	24.1%	CRITICAL	2.1%	55
48	Facility 48	City 43	S2	59	★☆☆☆☆	N/A	15.8%	NON COMPLIANT	33.1%	55
49	Facility 49	City 44	S2	120	★☆☆☆☆	0.42	15.2%	NON COMPLIANT	0.1%	54
50	Facility 50	City 37	S3	119	★☆☆☆☆	0.38	3.7%	AT RISK	0.0%	54

Staffing Need Score combines: Staffing Gap (30pts), Revenue Quality (25pts), Regulatory Pressure (20pts), Facility Size (15pts), and Violation Signal (10pts).

6 Deployment Strategy Insights

Data-driven recommendations for market entry

Highest urgency market: State 1 with 65.1% non-compliance rate across 1,177 facilities. Facilities here have the widest staffing gaps and highest deployment opportunity.

Highest existing agency market: State 3 at 2.4% average contract utilization with 5 high-dependency facilities. Established demand for agency staff.

Strongest revenue market: State 3 with 57.0% average private pay. Facilities in this state have the strongest capacity to sustain premium contract rates.

Top county for deployment: County 1, CA with 371 facilities and 37,670 beds. Geographic density enables efficient multi-facility coverage from a single base.

7 Penalty Intelligence

Enforcement actions and fines across selected states

$115,617,509

Total Fines (3yr)

4,383

Penalty Actions

481

Payment Denials

1,666

Facilities Penalized

Penalty Fines by State

Enforcement intensity varies significantly across markets. States with higher penalty volumes signal active regulatory pressure, creating urgency-driven demand for contract staffing and compliance consulting.

8 Ownership Landscape

Chain operators and market consolidation across selected states

76.2%%

Chain-Affiliated

234

High-Risk Facilities

1,775

Acquisition Targets

Top Chain Operators	Facilities (Selected States)	Total Nationwide	Avg Rating
Chain Operator 1	155	329	3.2 ★
Chain Operator 2	149	149	2.7 ★
Chain Operator 3	132	264	2.9 ★
Chain Operator 4	90	90	2.3 ★
Chain Operator 5	67	67	2.8 ★
Chain Operator 6	52	52	2.2 ★
Chain Operator 7	46	46	3.1 ★
Chain Operator 8	45	45	3.2 ★
Chain Operator 9	38	38	2.2 ★
Chain Operator 10	37	38	3.1 ★

Chain-affiliated facilities often have centralized staffing contracts, while independent facilities represent direct sales opportunities for staffing agencies. Markets with high acquisition target counts signal potential ownership transitions that frequently trigger staffing contract renegotiation.

9 Financial Health by Market

CMS HCRIS Cost Reports (Form 2540-10) — Cross-State Comparison

State	Avg Revenue	Avg Margin	Rev/Day	Cost/Day	Unprofitable
S1	$9,214,082	-12.9%%	$1,218,649	$1,054,226	633 (61%%)
S2	$17,823,229	-13.2%%	$231,128	$203,571	385 (57%%)
S3	$20,178,975	-5.1%%	$45,775	$43,808	377 (37%%)

Financial data from CMS HCRIS cost reports. Margin = (revenue - expenses) / revenue. National avg: -9.1% (FY2024).

Source: CMS Cost Report Filings (HCRIS, Form 2540-10)

10 Methodology & Data Sources

Report ID: MDR-TX-FL-CA-202604 • Generated April 06, 2026

This report aggregates data from CMS Provider Data Catalog (facility profiles, star ratings, quality measures), CMS Payroll-Based Journal (PBJ) daily nurse staffing records (14.5 million records across 11 quarters), facility financial filings (payer mix), and CMS health inspection and enforcement records (419,452 deficiencies).

Staffing Need Score (0–100): Staffing Gap (30pts) + Revenue Quality (25pts) + Regulatory Pressure (20pts) + Facility Size (15pts) + Violation Signal (10pts).

Staffing Assessment: COMPLIANT = meets all 3 industry benchmarks. AT_RISK = meets 2 of 3. NON_COMPLIANT = meets 0–1. CRITICAL = fails all 3 or 10+ zero-RN days.

Limitations: Proprietary analytical products. Not CMS endorsements or regulatory determinations. Compliance projections are estimates and should not be construed as legal advice.