| General |
| City |
| Watertown |
Manitowoc |
| State attribute explanation |
| Wi |
Wi |
| Street |
| 121 Hospital Dr |
960 S Rapids Rd |
| Zip Code |
| 53,098 |
54,220 |
| Phone |
| 9,202,619,220 |
9,206,841,144 |
|
Overall Star Rating |
| 2 |
3 |
|
Health Inspections Star Rating |
| 1 |
2 |
|
Nurse Staffing Star Rating |
| 4 |
4 |
|
Quality Measures Star Rating |
| 4 |
4 |
|
RN Only Star Rating |
| 5 |
5 |
|
Number of Certified Beds |
| 112 |
124 |
|
Total Number of Residents |
| 99 |
88 |
|
Percent of Occupied Beds |
| 88 % |
71 % |
| Health Survey Date |
| 10/18/2011 |
2/6/2012 |
| Fire Survey Date |
| 10/19/2011 |
2/6/2012 |
| Sprinkler Status |
| Fully Sprinklered |
Fully Sprinklered |
| Program Participation |
| Medicare And Medicaid |
Medicare And Medicaid |
| Type of Ownership |
| For Profit - Corporation |
For Profit - Corporation |
| Located Within a Hospital? |
| No |
No |
| Multi Nursing Home Ownership? |
| Yes |
Yes |
| Resident and Family Councils |
| Both |
Resident |
| Continuing Care Retirement Community? |
| No |
No |
| Quality Indicator Survey? |
| No |
No |
| Special Focus Facility? |
| No |
No |
| Civil Money Penalty Count |
| 75.2 |
75.2 |
| Total Enforcement Actions Count |
| 1 |
75.2 |
| # of deficiencies |
| 17 |
5 |
|
| Staff Information |
| Number of Residents |
| 99 |
88 |
| Number of RN Hours Per Resident Per Day |
| 1.05 |
1.22 |
| Number of LPN/LVN Hours Per Resident Per Day |
| 0.24 |
0.48 |
| Total Number of Licensed Staff Hours Per Resident Per Day |
| 1.29 |
1.7 |
| Number of CNA Hours Per Resident Per Day |
| 0.05 |
0.09 |
| Number Therapy Hours Per Resident Per Day |
| 0.05 |
0.09 |
| Environmental Deficiencies |
| Deficiency #1 |
| Scope: Fewlevel Of Harm: 3deficiency: Make Sure That The Nursing Home Area Is Free From Accident Hazards And Risks And Provides Supervision To Prevent Avoidable Accidents.survey Date: 02/06/2012date Of Correction: 03/06/2012 |
Scope: Fewlevel Of Harm: 2deficiency: Make Sure That The Nursing Home Area Is Free From Accident Hazards And Risks And Provides Supervision To Prevent Avoidable Accidents.survey Date: 04/29/2012date Of Correction: 05/28/2012 |
| Deficiency #2 |
| Scope: Fewlevel Of Harm: 3deficiency: Make Sure That The Nursing Home Area Is Free From Accident Hazards And Risks And Provides Supervision To Prevent Avoidable Accidents.survey Date: 06/01/2011date Of Correction: 07/22/2011 |
Scope: Fewlevel Of Harm: 2deficiency: Make Sure That The Nursing Home Area Is Free From Accident Hazards And Risks And Provides Supervision To Prevent Avoidable Accidents.survey Date: 04/21/2011date Of Correction: 05/21/2011 |
| Deficiency #3 |
|
Scope: Somelevel Of Harm: 2deficiency: Have A Program That Investigates, Controls And Keeps Infection From Spreading.survey Date: 01/27/2011date Of Correction: 02/27/2011 |
| Mistreatment Deficiencies |
| Deficiency #1 |
| Scope: Fewlevel Of Harm: 2deficiency: Develop Policies That Prevent Mistreatment, Neglect, Or Abuse Of Residents Or Theft Of Resident Property.survey Date: 02/01/2010date Of Correction: 03/01/2010 |
Scope: Fewlevel Of Harm: 2deficiency: 1) Hire Only People With No Legal History Of Abusing, Neglecting Or Mistreating Residents; Or 2) Report And Investigate Any Acts Or Reports Of Abuse, Neglect Or Mistreatment Of Residents.survey Date: 09/30/2009date Of Correction: 10/30/2009 |
| Deficiency #2 |
| Scope: Fewlevel Of Harm: 2deficiency: 1) Hire Only People With No Legal History Of Abusing, Neglecting Or Mistreating Residents; Or 2) Report And Investigate Any Acts Or Reports Of Abuse, Neglect Or Mistreatment Of Residents.survey Date: 02/01/2010date Of Correction: 03/01/2010 |
|
| Resident Rights Deficiencies |
| Deficiency #1 |
| Scope: Fewlevel Of Harm: 2deficiency: Try To Resolve Each Resident's Complaints Quickly.survey Date: 06/01/2011date Of Correction: 07/20/2011 |
|
| Deficiency #2 |
| Scope: Fewlevel Of Harm: 2deficiency: Immediately Tell The Resident, The Resident's Doctor And A Family Member Of The Resident Of Situations (injury/decline/room, Etc.) That Affect The Resident.survey Date: 06/01/2011date Of Correction: 07/20/2011 |
|
| Quality Care Deficiencies |
| Deficiency #1 |
| Scope: Fewlevel Of Harm: 4deficiency: Provide Necessary Care And Services To Maintain The Highest Well Being Of Each Resident .survey Date: 06/01/2011date Of Correction: 07/20/2011 |
Scope: Fewlevel Of Harm: 2deficiency: Provide Care By Qualified Persons According To Each Resident's Written Plan Of Care.survey Date: 04/29/2012date Of Correction: 05/28/2012 |
| Deficiency #2 |
| Scope: Fewlevel Of Harm: 4deficiency: Make Sure Services Provided By The Nursing Facility Meet Professional Standards Of Quality.survey Date: 06/01/2011date Of Correction: 07/20/2011 |
|
| Deficiency #3 |
| Scope: Fewlevel Of Harm: 2deficiency: Provide Care By Qualified Persons According To Each Resident's Written Plan Of Care.survey Date: 02/01/2010date Of Correction: 03/01/2010 |
|
| Resident Assessment Deficiencies |
| Deficiency #1 |
| Scope: Fewlevel Of Harm: 2deficiency: Develop A Complete Care Plan That Meets All Of A Resident's Needs, With Timetables And Actions That Can Be Measured.survey Date: 10/18/2011date Of Correction: 11/18/2011 |
|
| Deficiency #2 |
| Scope: Fewlevel Of Harm: 2deficiency: Develop A Complete Care Plan That Meets All Of A Resident's Needs, With Timetables And Actions That Can Be Measured.survey Date: 02/01/2010date Of Correction: 03/01/2010 |
|
| Administration Deficiencies |
| Deficiency #1 |
| Scope: Somelevel Of Harm: 2deficiency: Keep Accurate, Complete And Organized Clinical Records On Each Resident That Meet Professional Standards.survey Date: 10/18/2011date Of Correction: 11/18/2011 |
|
| Deficiency #2 |
| Scope: Fewlevel Of Harm: 2deficiency: Keep Accurate, Complete And Organized Clinical Records On Each Resident That Meet Professional Standards.survey Date: 06/01/2011date Of Correction: 07/20/2011 |
|
| Deficiency #3 |
| Scope: Somelevel Of Harm: 2deficiency: 1) Review The Work Of Each Nurse Aide Every Year; And 2) Give Regular In-service Training Based Upon These Reviews.survey Date: 06/01/2011date Of Correction: 07/20/2011 |
|
| Deficiency #4 |
| Scope: Fewlevel Of Harm: 2deficiency: Keep Accurate, Complete And Organized Clinical Records On Each Resident That Meet Professional Standards.survey Date: 02/01/2010date Of Correction: 03/01/2010 |
|
| Pharmacy Service Deficiencies |
| Deficiency #1 |
| Scope: Fewlevel Of Harm: 2deficiency: Safely Provide Drugs And Other Similar Products Available, Which Are Needed Every Day And In Emergencies, By A Licensed Pharmacist.survey Date: 02/06/2012date Of Correction: 03/06/2012 |
|
| Deficiency #2 |
| Scope: Fewlevel Of Harm: 2deficiency: 1) Make Sure That Each Resident's Drug Regimen Is Free From Unnecessary Drugs; 2) Each Resident's Entire Drug/medication Is Managed And Monitored To Achieve Highest Well Being.survey Date: 02/06/2012date Of Correction: 03/06/2012 |
|
| Quality Measures Q1 |
| Percent of long-stay residents who received an antipsychotic medication |
| 17.5 % |
24 % |
| Percent of long-stay residents whose need for help with daily activities has increased |
| 1 % |
1.7 % |
| Percent of long-stay residents who self-report moderate to severe pain |
| 25.6 (78.1) |
6.5 % |
| Percent of long-stay high-risk residents with pressure ulcers |
| 3.4 % |
3.2 % |
| Percent of long-stay residents who lose too much weight |
| 2.5 % |
4.1 % |
| Percent of long-stay low-risk residents who lose control of their bowels or bladder |
| 73 % |
48.9 % |
| Percent of long-stay residents who have had a catheter inserted and left in their bladder |
| 6.1 % |
5.8 % |
| Percent of long-stay residents with a urinary tract infection |
| 2.5 % |
9.5 % |
| Percent of long-stay residents who have depressive symptoms |
| 10.1:1 |
75.2 % |
| Percent of long-stay residents who were physically restrained |
| 75.2 % |
75.2 % |
| Percent of short-stay residents who self-report moderate to severe pain |
| 36.2 % |
20.2 (68.4) |
| Percent of short-stay residents assessed and given, appropriately, the seasonal influenza vaccine |
| 81.3 % |
93.4 % |
| Percent of short-stay residents with Pressure ulcers that are new or worsened |
| 72.3 % |
94.4 % |
| Percent of short-stay residents who newly received an antipsychotic medication |
| 1.50 % |
2.1 % |
| Percent of long-stay residents experiencing one or more falls with major injury |
| 75.2 % |
1.3 % |
| Quality Measures Q3 |
| Percent of long-stay residents who received an antipsychotic medication |
| 20.7 (69.3) |
25.7 % |
| Percent of long-stay residents whose need for help with daily activities has increased |
| 0.8 % |
0.9 % |
| Percent of long-stay residents who self-report moderate to severe pain |
| 23.5 % |
7.4 % |
| Percent of long-stay high-risk residents with pressure ulcers |
| 1.1 % |
3.2 % |
| Percent of long-stay residents who lose too much weight |
| 4.4 % |
4.5 % |
| Percent of long-stay low-risk residents who lose control of their bowels or bladder |
| 66.4 % |
42.6 % |
| Percent of long-stay residents who have had a catheter inserted and left in their bladder |
| 7.3 % |
6.5 % |
| Percent of long-stay residents with a urinary tract infection |
| 2.8 % |
9.8 % |
| Percent of long-stay residents who have depressive symptoms |
| 11.7 % |
1.8 % |
| Percent of long-stay residents who were physically restrained |
| 75.2 % |
1.3 % |
| Percent of long-stay residents experiencing one or more falls with major injury |
| 2 % |
0.9 % |
| Percent of short-stay residents who self-report moderate to severe pain |
| 37.5 % |
29.4 % |
| Percent of short-stay residents assessed and given, appropriately, the seasonal influenza vaccine |
| 82.8 % |
94.8 % |
| Percent of short-stay residents with Pressure ulcers that are new or worsened |
| 77.8 % |
94.3 % |
| Percent of short-stay residents who newly received an antipsychotic medication |
| 12.4-2413.6-24 |
14.3 % |