| General |
| City |
| Plymouth |
Sparta |
| State attribute explanation |
| Wi |
Wi |
| Street |
| N7135 Rocky Knoll Parkway |
14345 Cty Hwy B |
| Zip Code |
| 53,073 |
54,656 |
| Phone |
| 9,208,936,441 |
6,082,698,800 |
|
Overall Star Rating |
| 2 |
3 |
|
Health Inspections Star Rating |
| 2 |
2 |
|
Nurse Staffing Star Rating |
|
4 |
|
Quality Measures Star Rating |
| 4 |
4 |
|
RN Only Star Rating |
|
4 |
|
Number of Certified Beds |
| 165 |
90 |
|
Total Number of Residents |
| 148 |
80 |
|
Percent of Occupied Beds |
| 90 % |
89 % |
| Health Survey Date |
| 2/28/2012 |
7/29/2011 |
| Fire Survey Date |
| 2/28/2012 |
8/11/2011 |
| Sprinkler Status |
| Fully Sprinklered |
Partially Sprinklered |
| Program Participation |
| Medicare And Medicaid |
Medicare And Medicaid |
| Type of Ownership |
| Government - County |
Government - County |
| Located Within a Hospital? |
| No |
No |
| Multi Nursing Home Ownership? |
| No |
No |
| Resident and Family Councils |
| Resident |
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 |
| 75.2 |
75.2 |
| # of deficiencies |
| 17 |
5 |
|
| Staff Information |
| Number of Residents |
| 148 |
80 |
| Number of RN Hours Per Resident Per Day |
|
0.75 |
| Number of LPN/LVN Hours Per Resident Per Day |
|
0.7 |
| Total Number of Licensed Staff Hours Per Resident Per Day |
|
1.45 |
| Number of CNA Hours Per Resident Per Day |
|
0.01 |
| Number Therapy Hours Per Resident Per Day |
|
0.01 |
| Environmental Deficiencies |
| Deficiency #1 |
| 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: 02/28/2012date Of Correction: 04/05/2012 |
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: 10/06/2011date Of Correction: 10/14/2011 |
| Deficiency #2 |
| 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: 01/18/2012date Of Correction: 02/15/2012 |
|
| Deficiency #3 |
| Scope: Fewlevel Of Harm: 2deficiency: Have A Program That Investigates, Controls And Keeps Infection From Spreading.survey Date: 06/22/2010date Of Correction: 07/09/2010 |
|
| Mistreatment Deficiencies |
| Deficiency #1 |
| Scope: Somelevel Of Harm: 2deficiency: Develop Policies That Prevent Mistreatment, Neglect, Or Abuse Of Residents Or Theft Of Resident Property.survey Date: 01/18/2012date Of Correction: 02/15/2012 |
Scope: Somelevel Of Harm: 2deficiency: Develop Policies That Prevent Mistreatment, Neglect, Or Abuse Of Residents Or Theft Of Resident Property.survey Date: 07/29/2011date Of Correction: 10/06/2011 |
| 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: 01/18/2012date Of Correction: 02/15/2012 |
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: 07/29/2011date Of Correction: 10/06/2011 |
| Deficiency #3 |
| Scope: Somelevel Of Harm: 2deficiency: Develop Policies That Prevent Mistreatment, Neglect, Or Abuse Of Residents Or Theft Of Resident Property.survey Date: 01/25/2011date Of Correction: 02/25/2011 |
|
| Deficiency #4 |
| Scope: Somelevel 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: 01/25/2011date Of Correction: 02/25/2011 |
|
| Deficiency #5 |
| Scope: Somelevel Of Harm: 2deficiency: Develop Policies That Prevent Mistreatment, Neglect, Or Abuse Of Residents Or Theft Of Resident Property.survey Date: 11/30/2010date Of Correction: 12/17/2010 |
|
| Deficiency #6 |
| Scope: Somelevel 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: 11/30/2010date Of Correction: 12/17/2010 |
|
| Deficiency #7 |
| Scope: Fewlevel Of Harm: 2deficiency: Develop Policies That Prevent Mistreatment, Neglect, Or Abuse Of Residents Or Theft Of Resident Property.survey Date: 04/15/2010date Of Correction: 05/14/2010 |
|
| Deficiency #8 |
| 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: 04/15/2010date Of Correction: 05/14/2010 |
|
| Resident Rights Deficiencies |
| Deficiency #1 |
| 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: 01/18/2012date Of Correction: 02/15/2012 |
|
| Quality Care Deficiencies |
| Deficiency #1 |
| Scope: Fewlevel Of Harm: 2deficiency: Make Sure That Residents With Reduced Range Of Motion Get Proper Treatment And Services To Increase Range Of Motion.survey Date: 02/28/2012date Of Correction: 04/05/2012 |
Scope: Somelevel Of Harm: 2deficiency: Have Enough Nurses To Care For Every Resident In A Way That Maximizes The Resident's Well Being.survey Date: 01/21/2010date Of Correction: 02/21/2010 |
| Deficiency #2 |
| Scope: Somelevel Of Harm: 2deficiency: Provide Care By Qualified Persons According To Each Resident's Written Plan Of Care.survey Date: 02/28/2012date Of Correction: 04/05/2012 |
Scope: Somelevel Of Harm: 2deficiency: Have Enough Nurses To Care For Every Resident In A Way That Maximizes The Resident's Well Being.survey Date: 04/29/2009date Of Correction: 05/29/2009 |
| Deficiency #3 |
| Scope: Fewlevel Of Harm: 2deficiency: Provide Care By Qualified Persons According To Each Resident's Written Plan Of Care.survey Date: 01/18/2012date Of Correction: 02/15/2012 |
|
| Administration Deficiencies |
| Deficiency #1 |
| Scope: Fewlevel 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: 04/15/2010date Of Correction: 05/14/2010 |
|
| 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: 11/30/2010date Of Correction: 12/17/2010 |
|
| Quality Measures Q1 |
| Percent of long-stay residents who received an antipsychotic medication |
| 27.1 % |
21.9 % |
| Percent of long-stay residents whose need for help with daily activities has increased |
| 2.1 % |
3.6 % |
| Percent of long-stay residents who self-report moderate to severe pain |
| 9.1 % |
15.7 % |
| Percent of long-stay high-risk residents with pressure ulcers |
| 6.9 % |
4.3 % |
| Percent of long-stay residents who lose too much weight |
| 3.1 % |
13.2 % |
| Percent of long-stay low-risk residents who lose control of their bowels or bladder |
| 35.9 % |
38.7 % |
| Percent of long-stay residents who have had a catheter inserted and left in their bladder |
| 3.3 % |
8.7 % |
| Percent of long-stay residents with a urinary tract infection |
| 75.2 % |
2.6 / 3 |
| Percent of long-stay residents who have depressive symptoms |
| 3.2 % |
5.5 % |
| 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 |
| 29.3 % |
44.4 % |
| Percent of short-stay residents assessed and given, appropriately, the seasonal influenza vaccine |
| 65.1 % |
78 % |
| Percent of short-stay residents with Pressure ulcers that are new or worsened |
| 78 % |
90.7 % |
| Percent of short-stay residents who newly received an antipsychotic medication |
| 75.2 |
75.2 |
| Percent of long-stay residents experiencing one or more falls with major injury |
| 2.4 % |
75.2 % |
| Quality Measures Q3 |
| Percent of long-stay residents who received an antipsychotic medication |
| 26.3 (79.3) |
24.9 % |
| Percent of long-stay residents whose need for help with daily activities has increased |
| 1.7 % |
2 % |
| Percent of long-stay residents who self-report moderate to severe pain |
| 9.7 % |
18.7 % |
| Percent of long-stay high-risk residents with pressure ulcers |
| 5.1 % |
3.8 % |
| Percent of long-stay residents who lose too much weight |
| 7.8 % |
7.9:1 |
| Percent of long-stay low-risk residents who lose control of their bowels or bladder |
| 34.9 % |
38 % |
| Percent of long-stay residents who have had a catheter inserted and left in their bladder |
| 4.8 % |
5.4 % |
| Percent of long-stay residents with a urinary tract infection |
| 1.3 % |
1.9 % |
| Percent of long-stay residents who have depressive symptoms |
| 1.9 % |
5.3 % |
| Percent of long-stay residents who were physically restrained |
| 75.2 % |
75.2 % |
| Percent of long-stay residents experiencing one or more falls with major injury |
| 3.2 % |
0.5 - 2.0 |
| Percent of short-stay residents who self-report moderate to severe pain |
| 30.5 % |
35.8 % |
| Percent of short-stay residents assessed and given, appropriately, the seasonal influenza vaccine |
| 64.2 % |
83.8 % |
| Percent of short-stay residents with Pressure ulcers that are new or worsened |
| 80.3 % |
88.1 % |
| Percent of short-stay residents who newly received an antipsychotic medication |
| 2.8 % |
3.1 % |