The Evergreen at Pahrump Health and Rehabilitation Center received only one star, the lowest in a five-star rating system released by the Nevada Bureau of Licensure and Certification last month.

The rating system was devised by the federal Centers for Medicare and Medicaid Services in cooperation with the states.

The CMMS said it is being made available to provide patients and their families an easy-to-understand assessment of nursing home quality.

Five stars means a facility is much above average, four stars means above average, three stars means average, two stars means below average and one star means much below average.

The report pointed out, however, "Although some nursing homes are categorized as one star, they still meet federal health and safety requirements."

Jason Smith, general counsel for Evergreen Health Care Management, operator of 52 skilled nursing facilities nationwide from its base in Vancouver, Wash., said the rating system was suitable for things like food and entertainment but not for a nursing facility.

Evergreen at Pahrump received one star for staffing, two stars for registered nurse staffing, two stars for its health inspection and four stars for its material data sheets, a reporting system that deals with things like billing.

"Unfortunately, the data used in the health inspections and quality measures categories has been determined to be outdated by the time it is worked into the program. It is an unreliable set of data upon which to base a snapshot of information of this importance," Smith said in a prepared statement.

The requirements for staffing were identified in a 2001 study, which aren't provided for in the reimbursement and are not mandated by the federal government, he said. Evergreen Health Care concedes few facilities would achieve a five-star rating.

In Nevada, seven nursing homes earned five-star ratings, including Battle Mountain General Hospital, the TLC Care Center in Henderson, Nevada State Veterans Home in Boulder City, the Plaza Regency at Sun Mountain in Las Vegas, Grover C. Dils Medical Center Skilled Nursing Facility in Caliente, Harmon Medical and Rehabilitation Hospital Skilled Nursing Facility in Las Vegas and Gaye Haven Intermediate Care Facility in Las Vegas.

Nine other facilities earned four stars: South Lyon Medical Center, Highland Manor in Mesquite, Life Care Center of Las Vegas, Mountain View Care Center at Boulder City, Care Meridian, Boulder City Hospital Skilled Nursing Facility, El Jen Convalescent Hospital Skilled Nursing Facility in Las Vegas, Highland Manor of Fallon and Evergreen Mountainview Health in Carson City.

Nye Regional Medical Center in Tonopah received a two-star rating overall. Nye Regional got good marks, four stars, for staffing and RN staffing but only one star for the MDS quality measures and two stars on its health inspection.

Nye Regional Assistant Administrator Jennifer McMullen said their extended care facility typically had an LPN and an RN along with two certified nursing assistant's on duty in the day and an LPN or RN along with a CNA on duty at night, for an average of 19 to 20 residents at a time.

The one star for material data sheets McMullen attributed to the lack of a nursing director for some time and an attempt to comply with constantly changing reporting standards.

Smith, with Evergreen Healthcare, said in his prepared statement its better to investigate a nursing facility in person than rely on the ratings.

"Unfortunately, this program is no substitute for evaluating a healthcare facility in person and getting to know the residents and staff that live and work within that facility. Additionally, the services and quality of those services is most easily determined by meeting with the facility staff and having them address your questions and concerns and/or questioning other residents about their experience living at the facility and using its services."

In an annual survey, Smith said Evergreen at Pahrump had great results which concluded the facility's care and services were approprirate in quality and delivery.

"The highest deficiency that was issued was one 'F,' which indicates that no harm occurred as a result of the condition that gave rise to that 'F' deficiency," he said. "No harm occurred as a result of this deficiency. Most likely these surveys are not yet reflected in the facility's overall quality and health inspections ratings."

A March 2007 survey at Evergreen at Pahrump showed the number of registered nurses and licensed practical nurses at the facility divided by the number of residents worked out to 31 minutes per patient, below the state and national average of 48 minutes. Evergreen Pahrump however had two hours and 25 minutes of certified nursing assistants per resident.

The state average is two hours; the national average is two hours and 18 minutes.

That survey reported Evergreen Pahrump had 12 quality care deficiencies, more than the state average of nine. The ratings ranged from one to four, with one having the least potential for harm and four the most potential.

Eleven deficiencies Medicare rated as No. 2, which had the chance of causing minimal harm or the potential for actual harm, involved procedures like offering flu shots, giving catheters only when necessary, developing plans with the family for care after they leave the nursing home, informing doctors and family members of a change in the patient's health, preparing good food, closely monitoring a patient's drug use, keeping accurate medical records and keeping safe, clean and homelike surroundings.

One deficiency that could cause actual harm, the study noted, a No. 3, concerned giving patients proper treatment to prevent bed sores or heal existing ones, which the study conceded would affect few residents.

Smith added, "The team at Evergreen Pahrump is confident that the facility is a five-star facility in their opinion. Only by touring the facility and getting to know what services are available and what the environment is like will you know if Evergreen Pahrump is a suitable place for you or your loved one to call home."

The latest study concludes, "The ratings are intended to provide a first step for evaluating long-term options for a family member. It should be a guide, not a substitute, for talking with physicians and vistiing nursing homes."

The five-star rating report is available on-line at www.medicare.gov/nhcompare or by calling 1-800-Medicare.