Contract Nursing Home Exclusion Review

Part of the initial review for contracting and part of the annual review.

Name of Nursing Home CROSSROADS CARE CENTER OF MAYVILLE
Address 305 S CLARK ST
MAYVILLE WI, 53050
Telephone
Six Digit Provider Number 525616

A. Deficiencies

Rating (G-L) Program Requirements Corrected Date Current Survey Date
G Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. 02/26/2018 01/25/2018
G Provide appropriate pressure ulcer care and prevent new ulcers from developing. 02/26/2018 01/25/2018
G Ensure each resident??s drug regimen must be free from unnecessary drugs. 02/26/2018 01/25/2018
K Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. 02/26/2018 01/25/2018
K Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. 02/26/2018 01/25/2018
L Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. 02/26/2018 01/25/2018
L Develop and implement policies and procedures to prevent abuse, neglect, and theft. 02/26/2018 01/25/2018
Deficiency Count: 7
Section Rating: FAIL

*Facility fails if there are three level "G" or worse deficiencies in the current survey.

B. Health Requirement Deficiencies

Current Number at Facility State Average
Total Health Requirement Deficiencies: 19 5.3
Section Rating: FAIL

Health Requirement Deficiencies: (The total number of health requirements deficiencies cannot be more than twice the State average in the current survey.)

C. RN Hours

RN Hours Current Average at Facility State Average
RN Hours per Resident Day: 0.58 0.99
Section Rating: FAIL

* Program requirement: Fail if less than state average

D. Total Nursing Staff

Total Nursing Staff Current Average at Facility State Average
Total Nursing Staff Hours per resident Day: 2.6 3.98
Section Rating: FAIL

* Program requirement: Fail if less than state average

E. Quality Measures

NOTE:

Although the Centers for Medicare and Medicaid Services (CMS) has released 24 Quality Measures, current VHA guidelines indicate that the following 18 Quality Measures be used to determine Pass/Fail for Section G of the review.

Quality Measures Facility Percent State Average Flagged
Percentage of high risk long-stay residents with pressure ulcers 0% 4%
Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine 0% 91%
Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine 0% 91.4%
Percentage of long-stay residents experiencing one or more falls with major injury 0% 3.2%
Percentage of long-stay residents who have depressive symptoms 0% 4.5%
Percentage of long-stay residents who lose too much weight 0% 6.4%
Percentage of long-stay residents who received an antipsychotic medication 0% 11.6%
Percentage of long-stay residents who self-report moderate to severe pain 0% 5.8%
Percentage of long-stay residents who were physically restrained 0% 0.2%
Percentage of long-stay residents whose need for help with daily activities has increased 0% 12%
Percentage of long-stay residents with a catheter inserted and left in their bladder 0% 2.2%
Percentage of long-stay residents with a urinary tract infection 0% 2.9%

* A facility fails when six or more of the CMS Quality Measures listed below in Nursing Home Compare fall above the state average.
N.A.= contact home, data not submitted N.S. = contact home, numbers too small