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CMS (the Centers for Medicare & Medicaid Services) is the federal agency that rates nursing home quality. Its Overall Rating runs from 1 to 5 stars, combining health inspections, staffing, and quality measures, with inspections weighted most heavily.
CMS (the Centers for Medicare & Medicaid Services) is the federal agency that rates nursing home quality. Its Overall Rating runs from 1 to 5 stars, combining health inspections, staffing, and quality measures, with inspections weighted most heavily.
Shepherd of the Hills Living Center is a skilled nursing home in Branson, Missouri, operated by N & R Of Branson, LLC and administered by Jeremy Osenga. The home is located on State Highway 248 in a very walkable area with a Walk Score of 72. Most daily errands can be completed on foot. The facility accepts Medicare, Medicaid, and private pay, giving families several options to cover short-term rehabilitation stays and longer-term nursing care.
The 100-bed community has an occupancy rate of 78%. Residents stay an average of 85 days, including residents in post-acute rehabilitation and those needing ongoing skilled nursing support. Daily nurse staffing averages 4 hours and 19 minutes per resident. Additional staffing is provided by registered nurses, nurse aides, and licensed practical nurses throughout the day and night to support residents’ medical and personal care needs.
Clinical services include rehabilitation, skilled nursing care, and specialized behavioral and Alzheimer’s care. Residents have access to on-site physicians, physical and occupational therapists, and dietitians. Hospice services are available for residents in their final stages of care, making it a practical setting for a range of health needs.
State inspections identified areas for improvement related to documentation, medication management protocols, and staff training. Families touring the home can ask how the home handles physician coordination, medication oversight, and grievance resolution.
Residents receive complete meal service tailored to dietary preferences and restrictions. Transportation is available for medical appointments and errands, and the home also provides housekeeping and laundry services. Rehabilitation programs support residents working toward recovery.
With professional medical care available around the clock, the facility’s nursing oversight and therapeutic services make it suitable for residents transitioning from the hospital or managing ongoing complex care needs.
The Overall CMS Rating combines results from health inspections, staffing levels and quality measures. Health inspections carry the most weight. Staffing and quality scores can increase or decrease the final rating based on performance compared to state and national standards.
Based on the results of the facility's three most recent standard inspections and any complaint investigations. CMS reviews the number, scope, and severity of deficiencies, with more recent findings weighted more heavily.
Measures average nursing staff hours per resident per day, including Registered Nurses (RNs) and total nursing staff. Ratings are adjusted based on the level of care residents require and are compared to state and national benchmarks.
Based on clinical and physical health indicators reported to CMS, such as hospital readmissions, falls, pressure ulcers, and improvements in mobility. These measures reflect how well residents' health needs are being managed.
Daily nursing hours per resident by staff type, reported to CMS. Higher is generally better — compare this facility to state and national averages to see where staffing stands.
This home is ranked 66th out of 276 homes in Missouri for nurse hours. Total adjusted nursing hours per resident per day, combining RN, LPN, and aide time. CMS adjusts this for case-mix so facilities can be fairly compared.
| Staff type | Hours / Day / Resident | vs state avg |
|---|---|---|
|
Registered Nurse (RN)
RNs hold the highest nursing license and can assess residents, interpret test results, and direct care plans. More RN hours per day often signals stronger clinical oversight and faster response to health changes.
| 8m per day | ▼ 71% State avg: 28m per day · National avg: 41m per day |
|
LPN / LVN
Licensed Practical Nurses (LPNs) or Licensed Vocational Nurses (LVNs) deliver routine hands-on care — medication administration, wound dressing, and monitoring vital signs. They work under RN supervision and make up a large share of daily bedside care.
| 44m per day | ▲ 8% State avg: 41m per day · National avg: 52m per day |
|
Nurse Aide
Certified Nurse Aides (CNAs) provide the most direct day-to-day assistance: bathing, dressing, feeding, and mobility. Nurse aide hours are typically the largest staffing category and directly affect residents' quality of life.
| 1h 59m per day | ▼ 14% State avg: 2h 19m per day · National avg: 2h 20m per day |
|
Weekend Total Nursing
Combined nursing hours (RN + LPN + Nurse Aide) per resident per day on weekends. Staffing often drops on weekends — this figure reveals whether the facility maintains adequate coverage outside of weekday hours.
| 2h 32m per day | ▼ 17% State avg: 3h 3m per day · National avg: 3h 26m per day |
|
Physical Therapist
Hours per resident per day provided by licensed Physical Therapists (PTs) or PT Assistants. PT services help residents recover mobility after injury or illness and are especially important for post-acute (short-stay) rehabilitation.
| 3m per day | ▲ 48% State avg: 2m per day · National avg: 4m per day |
|
Weekend RN
Registered nurse hours specifically on weekends. Facilities sometimes reduce RN presence on Saturdays and Sundays — a low weekend RN figure compared to weekday hours can indicate reduced clinical oversight when most administrative staff are absent.
| 2m per day | ▼ 89% State avg: 20m per day · National avg: 28m per day |
Higher than the Missouri average: 66.6%Shepherd of the Hills Living Center is legally operated by N & R Of Branson, Llc, and administrated by Jeremy Osenga.
In Missouri, the Department of Health and Senior Services, Division of Regulation and Licensure performs the inspections and unannounced surveys required for all long-term care providers.
This scorecard compares key inspection, citation, and complaint metrics at this facility against the Missouri state average. Metrics rated ≥15% worse than average are highlighted in red; those ≥15% better are highlighted in green.
Deficiencies
| This Facility | MO Average | vs. MO Avg |
|---|---|---|---|
|
Total deficiencies
Formal regulatory issues recorded by inspectors across all inspection types.
| 88 | 35 | This facility has 151% more total deficiencies than a typical Missouri nursing home (88 vs. MO avg 35).↑ 151% worse |
|
Deficiencies per year
Average deficiencies per year since 2018.
| 11 | 4.4 | This facility has 150% more deficiencies per year than a typical Missouri nursing home (11 vs. MO avg 4.4).↑ 150% worse |
|
Deficiencies per inspection
Average deficiencies per inspection.
| 5.5 | 5 | This facility has 10% more deficiencies per inspection than a typical Missouri nursing home (5.5 vs. MO avg 5).↑ 10% worse |
Inspections
| This Facility | MO Average | vs. MO Avg |
|---|---|---|---|
|
Total inspections
Combined count of all routine and focused inspections. Excludes complaint investigations.
| 16 | 7 | This facility has 129% more total inspections than a typical Missouri nursing home (16 vs. MO avg 7).↑ 129% worse |
An editor-reviewed summary of the themes and findings across this facility's recent inspection reports.
Missouri average 6.6
Last Health inspection on Jul 2025
Missouri average 36.5
Missouri average 5.67
Health citations are formal notices following inspections when they fail to comply with safety and care standards.
21 of 25 citations resulted from standard inspections; 3 of 25 resulted from complaint investigations; and 1 of 25 came from combined inspections (standard and complaint).
100% better than Missouri averageMissouri average: 0.7
In line with Missouri averageMissouri average: 1
Corrected
Corrected
Corrected
Corrected
Reporting period: October 1 – December 31, 2025 (Q4 2025). Source: CMS Payroll-Based Journal report.
28% fewer staff per resident than Missouri average
6% worse than Missouri average
This data comes from the CMS Payroll-Based Journal report covering October 1 – December 31, 2025.
Manages medical care and health needs.
All 4 RN Staff are full-time employees. No contractors work on this role.
4
Average shift length. Calculated as total hours divided by days worked and average staff per day.
7.5 hoursAssists with medical care and medications.
All 13 LPN Staff are full-time employees. No contractors work on this role.
13
Average shift length. Calculated as total hours divided by days worked and average staff per day.
8.2 hoursHelps with daily care and mobility.
All 28 CNA Staff are full-time employees. No contractors work on this role.
28
Average shift length. Calculated as total hours divided by days worked and average staff per day.
7.6 hours
This data comes from the CMS Payroll-Based Journal report covering October 1 – December 31, 2025.
Total hours from contractors
2,317 contractor hours this quarter
This data comes from the CMS Payroll-Based Journal report covering October 1 – December 31, 2025.
| Certified Nursing Assistant | 28 | 0 | 28 | 9,384 | 92 | 100% | 7.6 |
| Medication Aide/Technician | 12 | 0 | 12 | 4,313 | 92 | 100% | 7.8 |
| Licensed Practical Nurse | 13 | 0 | 13 | 4,309 | 92 | 100% | 8.2 |
| RN Director of Nursing | 2 | 0 | 2 | 940 | 72 | 78% | 7.8 |
| Dental Services Staff | 1 | 0 | 1 | 530 | 65 | 71% | 8.1 |
| Registered Nurse | 4 | 0 | 4 | 517 | 53 | 58% | 7.5 |
| Dietitian | 1 | 0 | 1 | 515 | 64 | 70% | 8.1 |
| Administrator | 1 | 0 | 1 | 486 | 63 | 68% | 7.7 |
| Speech Language Pathologist | 0 | 4 | 4 | 479 | 66 | 72% | 6.8 |
| Nurse Aide in Training | 6 | 0 | 6 | 466 | 57 | 62% | 7.2 |
| Nurse Practitioner | 0 | 1 | 1 | 438 | 60 | 65% | 7.3 |
| Physical Therapy Aide | 0 | 4 | 4 | 373 | 55 | 60% | 6.5 |
| Physical Therapy Assistant | 0 | 2 | 2 | 372 | 67 | 73% | 5.3 |
| Respiratory Therapy Technician | 0 | 2 | 2 | 352 | 64 | 70% | 5.4 |
| Qualified Social Worker | 0 | 3 | 3 | 209 | 57 | 62% | 3.7 |
| Occupational Therapy Aide | 0 | 2 | 2 | 46 | 6 | 7% | 7.7 |
| Occupational Therapy Assistant | 0 | 1 | 1 | 25 | 6 | 7% | 4.1 |
| Clinical Nurse Specialist | 0 | 1 | 1 | 23 | 3 | 3% | 7.5 |
| Medical Director | 0 | 1 | 1 | 1 | 1 | 1% | 0.8 |
Federal penalties imposed by CMS for regulatory violations, including civil money penalties (fines) and denials of payment for new Medicare/Medicaid admissions.
Source: CMS Penalties Database
No penalties in the past 3 years
No civil money penalties or payment denials were reported in the last 3 years.
These measures show how residents usually do over time at this home, based on health outcomes and preventive care.
A composite score based on pressure ulcers, falls with injury, weight loss, walking ability decline, and activities of daily living decline.
15.0
37% worse than Missouri averageMissouri average: 10.9
A composite score based on activities of daily living decline, walking ability decline, and incontinence.
27.6
42% worse than Missouri averageMissouri average: 19.5
CMS star rating based on long-stay quality measure performance. 5 stars = significantly above average, 1 star = significantly below average.
Percent of long-stay residents whose need for help with daily activities has increased
25.0%
27% worse than Missouri averageMissouri average: 19.8%
Percent of long-stay residents whose ability to move independently worsened
40.0%
94% worse than Missouri averageMissouri average: 20.6%
Percent of low risk long-stay residents who lose control of their bowels or bladder
17.6%
In line with Missouri averageMissouri average: 18.1%
Percent of long-stay residents experiencing one or more falls with major injury
2.6%
35% better than Missouri averageMissouri average: 4.0%
Percent of long-stay high risk residents with pressure ulcers
3.4%
32% better than Missouri averageMissouri average: 5.0%
Percent of long-stay residents with a urinary tract infection
9.3%
240% worse than Missouri averageMissouri average: 2.7%
Percent of long-stay residents who lose too much weight
3.8%
32% better than Missouri averageMissouri average: 5.6%
Percent of long-stay residents who have depressive symptoms
0.9%
93% better than Missouri averageMissouri average: 12.8%
Percent of long-stay residents who received an antipsychotic medication
12.0%
46% better than Missouri averageMissouri average: 22.0%
Percent of long-stay residents assessed and appropriately given the pneumococcal vaccine
43.2%
49% worse than Missouri averageMissouri average: 85.2%
Percent of long-stay residents assessed and appropriately given the seasonal influenza vaccine
68.3%
25% worse than Missouri averageMissouri average: 90.9%
Number of hospitalizations per 1,000 long-stay resident days.
1.54
26% better than Missouri averageMissouri average: 2.08
Number of outpatient emergency department visits per 1,000 long-stay resident days.
0.39
83% better than Missouri averageMissouri average: 2.35
CMS star rating based on short-stay quality measure performance. 5 stars = much above average, 1 star = much below average.
Percent of short-stay residents assessed and appropriately given the pneumococcal vaccine
31.6%
53% worse than Missouri averageMissouri average: 66.6%
Percent of short-stay residents who newly received an antipsychotic medication
0.4%
82% better than Missouri averageMissouri average: 2.2%
Percent of short-stay residents assessed and appropriately given the seasonal influenza vaccine
43.0%
32% worse than Missouri averageMissouri average: 63.5%
Percentage of short-stay residents who were re-hospitalized after their nursing home admission.
20.8%
18% better than Missouri averageMissouri average: 25.3%
Percentage of short-stay residents who had an outpatient emergency department visit.
12.0%
10% better than Missouri averageMissouri average: 13.4%
Percentage of SNF residents who experience falls with major injury during their stay.
0.0%
100% better than Missouri averageMissouri average: 0.8%
Percentage of residents at or above expected ability to care for themselves at discharge.
60.0%
12% better than Missouri averageMissouri average: 53.7%
Rate of successful return to home or community from a skilled nursing facility.
59.2%
17% better than Missouri averageMissouri average: 50.6%
Quality measures are calculated from Minimum Data Set (MDS) assessments. For most measures, lower percentages indicate better care quality.
31% of new residents, usually for short-term rehab.
51% of new residents, often for short stays.
18% of new residents, often for long-term daily care.
Source: CMS Long-Term Care Facility Characteristics (Data as of Jan 2026)
Total residents
73Residents meet regularly to discuss policies, care quality, and activities
Organized group of residents that meets regularly to discuss facility policies, quality of life, and activities.
Data sourced from CMS Long-Term Care Facility Characteristics quarterly report. Payer mix reflects the current resident census by primary payment source.
Historical financial and operational data for Shepherd of the Hills Living Center based on CMS SNF Cost Reports.
The portion of the home's budget spent on staff, including nurses, caregivers, and other employees who support care and operations.
Rank #127 / 286Payroll — State benchmarkedThis home is ranked 127th out of 286 homes in Missouri. Shows total annual staff payroll benchmarked to the Missouri average. Higher payroll investment relative to peers often signals better staffing and less reliance on cheaper contract labor.Click the rank badge to see the full State ranking.Click here to see the full State ranking.
All remaining costs needed to run the home, such as food, utilities, building maintenance, supplies and administrative expenses.
This home supports both short-term rehab and long-term care, with residents staying for a wide range of durations.
0.0 miles from city center
Estimated distance in miles from Branson's city center to Shepherd of the Hills Living Center's address, calculated via Google Maps.
Add your location
Shepherd of the Hills Living Center is located in BRANSON, Missouri.
Here are the financial assistance programs available to residents in Missouri.
The information below is reported by the Missouri Department of Health and Senior Services, Division of Regulation and Licensure.
| Breeze Park – Lutheran Senior Services |
NH Nursing Home Licensed facility providing 24/7 skilled nursing care for residents with complex, ongoing medical needs. Staffed by RNs, LPNs, and CNAs. Inspected and star-rated annually by CMS. Accepts Medicare (short-term rehab) and Medicaid (long-term care).
AL Assisted Living A licensed, long-term care setting for seniors or individuals with disabilities who need help with daily activities — like bathing, dressing, and medication management — but not 24-hour skilled nursing. Offers housing, meals, and around-the-clock support while aiming to maximize resident independence.
IL Independent Living Lifestyle-focused communities for older adults offering dining, activities, and transportation with minimal personal care. Best for active, independent seniors who want community without medical support.
MC Memory Care Secured, specialized care for people living with Alzheimer's or dementia. Staff trained in cognitive impairment, with higher staff-to-resident ratios and an environment designed to reduce confusion and wandering risk. | Weldon Spring | 50
Facility
50
MO AVG
97
Rank
#390 / 454 | - | - | 5.01
Facility
5.01
MO AVG
3.74
Rank
#31 / 276 | -16% | +34% | $41.3k
Facility
$41.3k
MO AVG
$76.9k
Rank
#222 / 283 | 16
Facility
16
MO AVG
36.5
Rank
#55 / 281 | 4.0
Facility
4.0
MO AVG
5.7
Rank
#75 / 281 | 2 | 46 | A+ |
2
Facility
2
MO AVG
45
Rank
#545 / 563 | Holly Stevens | $20.9M
Facility
$20.9M
MO AVG
$8.4M
Rank
#17 / 286 | $12.2M
Facility
$12.2M
MO AVG
$3.3M
Rank
#6 / 286 | 58.6%
Facility
58.6%
MO AVG
45.6%
Rank
#105 / 286 | 265767 | ||||
| Farmington Presbyterian Manor |
NH Nursing Home Licensed facility providing 24/7 skilled nursing care for residents with complex, ongoing medical needs. Staffed by RNs, LPNs, and CNAs. Inspected and star-rated annually by CMS. Accepts Medicare (short-term rehab) and Medicaid (long-term care).
AL Assisted Living A licensed, long-term care setting for seniors or individuals with disabilities who need help with daily activities — like bathing, dressing, and medication management — but not 24-hour skilled nursing. Offers housing, meals, and around-the-clock support while aiming to maximize resident independence.
IL Independent Living Lifestyle-focused communities for older adults offering dining, activities, and transportation with minimal personal care. Best for active, independent seniors who want community without medical support.
MC Memory Care Secured, specialized care for people living with Alzheimer's or dementia. Staff trained in cognitive impairment, with higher staff-to-resident ratios and an environment designed to reduce confusion and wandering risk. | Farmington | 90
Facility
90
MO AVG
97
Rank
#227 / 454 |
74.4%
Facility
74.4%
MO AVG
66.6%
Rank
#150 / 428 | +12% | 4.58
Facility
4.58
MO AVG
3.74
Rank
#43 / 276 | +49% | +23% | $12.6k
Facility
$12.6k
MO AVG
$76.9k
Rank
#167 / 283 | 9
Facility
9
MO AVG
36.5
Rank
#11 / 281 | 2.3
Facility
2.3
MO AVG
5.7
Rank
#11 / 281 | 1 | 70 | A+ |
66
Facility
66
MO AVG
45
Rank
#113 / 563 | Jane Hull | $9.9M
Facility
$9.9M
MO AVG
$8.4M
Rank
#73 / 286 | $6.3M
Facility
$6.3M
MO AVG
$3.3M
Rank
#52 / 286 | 63%
Facility
63%
MO AVG
45.6%
Rank
#74 / 286 | 265583 | ||||
| Shepherd of the Hills Living Center |
NH Nursing Home Licensed facility providing 24/7 skilled nursing care for residents with complex, ongoing medical needs. Staffed by RNs, LPNs, and CNAs. Inspected and star-rated annually by CMS. Accepts Medicare (short-term rehab) and Medicaid (long-term care).
AL Assisted Living A licensed, long-term care setting for seniors or individuals with disabilities who need help with daily activities — like bathing, dressing, and medication management — but not 24-hour skilled nursing. Offers housing, meals, and around-the-clock support while aiming to maximize resident independence. | Branson (Downtown Branson) | 100
Facility
100
MO AVG
97
Rank
#177 / 454 |
78.0%
Facility
78.0%
MO AVG
66.6%
Rank
#128 / 428 | +17% | 4.32
Facility
4.32
MO AVG
3.74
Rank
#66 / 276 | -42% | +16% | $0
Facility
$0
MO AVG
$76.9k
Rank
#1 / 283 | 25
Facility
25
MO AVG
36.5
Rank
#108 / 281 | 4.2
Facility
4.2
MO AVG
5.7
Rank
#92 / 281 | 1 | 78 | - |
72
Facility
72
MO AVG
45
Rank
#79 / 563 | N & R Of Branson, LLC | $7.0M
Facility
$7.0M
MO AVG
$8.4M
Rank
#125 / 286 | $3.9M
Facility
$3.9M
MO AVG
$3.3M
Rank
#127 / 286 | 56.1%
Facility
56.1%
MO AVG
45.6%
Rank
#122 / 286 | 265393 | ||||
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NH Nursing Home Licensed facility providing 24/7 skilled nursing care for residents with complex, ongoing medical needs. Staffed by RNs, LPNs, and CNAs. Inspected and star-rated annually by CMS. Accepts Medicare (short-term rehab) and Medicaid (long-term care).
AL Assisted Living A licensed, long-term care setting for seniors or individuals with disabilities who need help with daily activities — like bathing, dressing, and medication management — but not 24-hour skilled nursing. Offers housing, meals, and around-the-clock support while aiming to maximize resident independence.
IL Independent Living Lifestyle-focused communities for older adults offering dining, activities, and transportation with minimal personal care. Best for active, independent seniors who want community without medical support.
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Facility
38
MO AVG
97
Rank
#424 / 454 |
100.0%
Facility
100.0%
MO AVG
66.6%
Rank
#1 / 428 | +50% | 3.03
Facility
3.03
MO AVG
3.74
Rank
#230 / 276 | -27% | -19% | $0
Facility
$0
MO AVG
$76.9k
Rank
#1 / 283 | 39
Facility
39
MO AVG
36.5
Rank
#183 / 281 | 6.5
Facility
6.5
MO AVG
5.7
Rank
#200 / 281 | - | 100 | A+ |
73
Facility
73
MO AVG
45
Rank
#70 / 563 | Womens Christian Association Of Kansas City Missouri | $2.9M
Facility
$2.9M
MO AVG
$8.4M
Rank
#264 / 286 | $2.4M
Facility
$2.4M
MO AVG
$3.3M
Rank
#221 / 286 | 81.6%
Facility
81.6%
MO AVG
45.6%
Rank
#13 / 286 | 265802 | ||||
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NH Nursing Home Licensed facility providing 24/7 skilled nursing care for residents with complex, ongoing medical needs. Staffed by RNs, LPNs, and CNAs. Inspected and star-rated annually by CMS. Accepts Medicare (short-term rehab) and Medicaid (long-term care).
AL Assisted Living A licensed, long-term care setting for seniors or individuals with disabilities who need help with daily activities — like bathing, dressing, and medication management — but not 24-hour skilled nursing. Offers housing, meals, and around-the-clock support while aiming to maximize resident independence.
IL Independent Living Lifestyle-focused communities for older adults offering dining, activities, and transportation with minimal personal care. Best for active, independent seniors who want community without medical support.
MC Memory Care Secured, specialized care for people living with Alzheimer's or dementia. Staff trained in cognitive impairment, with higher staff-to-resident ratios and an environment designed to reduce confusion and wandering risk. | Des Peres | 102
Facility
102
MO AVG
97
Rank
#169 / 454 |
72.5%
Facility
72.5%
MO AVG
66.6%
Rank
#166 / 428 | +9% | 3.50
Facility
3.50
MO AVG
3.74
Rank
#168 / 276 | +4% | -6% | $334.9k
Facility
$334.9k
MO AVG
$76.9k
Rank
#277 / 283 | 87
Facility
87
MO AVG
36.5
Rank
#272 / 281 | 7.9
Facility
7.9
MO AVG
5.7
Rank
#243 / 281 | 13 | 74 | A+ |
50
Facility
50
MO AVG
45
Rank
#244 / 563 | Mary Grodeon | $15.6M
Facility
$15.6M
MO AVG
$8.4M
Rank
#32 / 286 | $7.7M
Facility
$7.7M
MO AVG
$3.3M
Rank
#31 / 286 | 49.2%
Facility
49.2%
MO AVG
45.6%
Rank
#186 / 286 | 265834 |
Shepherd of the Hills Living Center is in the Downtown Branson neighborhood of BRANSON.
The legal owner and operator of Shepherd of the Hills Living Center is N & R Of Branson, Llc.
Shepherd of the Hills Living Center has a walk score of 72. Very walkable. Most errands can be accomplished on foot, and many essentials are within a short walk.
According to MO state health department records, Shepherd of the Hills Living Center's license number is 053355.
According to MO state health department records, Shepherd of the Hills Living Center's license expires on January 31, 2028.
Shepherd of the Hills Living Center's occupancy is 78%.
Jeremy Osenga is the administrator of Shepherd of the Hills Living Center.
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