General Information: AMERICAN LUTHERAN HOME-MENOMONIE
Nursing home name AMERICAN LUTHERAN HOME-MENOMONIE
Address915 ELM AVE
MENOMONIE, WI 54751
Phone number (715) 235-9041
Located within a hospital No
Type of ownership Non profit - Church related
Owner operates multiple homesYes
Accept Medicare or Medicaid Medicare and Medicaid
Continue Care Retirement CommunityNo
Resident and family councils Resident
Certified number of beds 44
Total number of residents 41
Perc of occupied beds 93
Sprinkler status Yes
Number of Facility Reported Incidents1
Number of Substantiated Complaints0
Number of Fines2
Total Amount of Fines$26813
Total Number of Penalties0
Total Number of Penalties2
Ratings Summary: AMERICAN LUTHERAN HOME-MENOMONIE
Overall rating 2
2
Nursing Home Staffing 4
4
Registered Nurses only 5
5
Health Inspections 1
1
Quality Measures 5
5
Nursing Home Staffing Info: AMERICAN LUTHERAN HOME-MENOMONIE
National AverageWisconsin AverageAMERICAN LUTHERAN HOME-MENOMONIE
Overall staff rating NA NA 4
4
Registered Nurses only rating NANA 5
5
Total Number of Residents NA NA 41
Total Number of Nurse Staff Hours per Resident per Day 4.11 hours 4.16 hours 4.09 hours
Total Number of Licensed Nurse Staff Hours per Resident per Day 1.64 hours 1.55 hours 1.44 hours
Registered Nurses Hours per Residents per Day 0.81 hours 1.0 hours 1.14 hours
Licensed Practical or Vacation Nurses Hours per Resident per Day 0.83 hours 0.55 hours 0.3 hours
Certified Nursing Assistants Hours per Residents per Day 2.47 hours 2.61 hours 2.66 hours
Physical Therapy Staffing Hours per Resident Per Day 0.1 hours 0.09 hours 0.04 hours
Health Survey: AMERICAN LUTHERAN HOME-MENOMONIE
Heath Survey Summary on 2013-08-12
Total Number of Health Deficiencies 18
Scope and Severity of most Severe Health Deficiency Widespread /Immediate jeopardy to resident health or safety
Heath Survey Summary on 2012-08-22
Total Number of Health Deficiencies 6
Scope and Severity of most Severe Health Deficiency Widespread /Minimal harm or potential for actual harm
Heath Survey Summary on 2011-07-13
Total Number of Health Deficiencies 0
Scope and Severity of most Severe Health Deficiency
Health Survey Details: AMERICAN LUTHERAN HOME-MENOMONIE
Inspection Results: 08/12/2013
Corrected Deficiency Scope and Severity
09/06/2013 Give residents a notice of rights, rules, services and charges. Widespread/Potential for minimal harm
09/06/2013 Protect each resident from all abuse, physical punishment, and involuntary separation from others. Isolated /Immediate jeopardy to resident health or safety
09/06/2013 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. Widespread /Immediate jeopardy to resident health or safety
09/06/2013 Develop and implement policies for 1) screening and training employees; and the 2) prevention, identification, investigation, and reporting of any abuse, neglect, mistreatment and misappropriation of property. Widespread /Immediate jeopardy to resident health or safety
09/06/2013 Allow residents the right to participate in the planning or revision of care and treatment. Isolated/Minimal harm or potential for actual harm
09/06/2013 Provide care by qualified persons according to each resident's written plan of care. Isolated/Minimal harm or potential for actual harm
09/06/2013 Set up an ongoing quality assessment and assurance group to review quality deficiencies quarterly, and develop corrective plans of action. Isolated/Minimal harm or potential for actual harm
09/06/2013 Keep accurate, complete and organized clinical records on each resident that meet professional standards. Pattern/Minimal harm or potential for actual harm
09/06/2013 Make sure that the facility is administered in an acceptable way that maintains the well-being of each resident . Widespread /Minimal harm or potential for actual harm
09/06/2013 Have a program that investigates, controls and keeps infection from spreading. Widespread /Immediate jeopardy to resident health or safety
09/06/2013 Provide routine and emergency drugs through a licensed pharmacist and only under the general supervision of a licensed nurse. Isolated/Minimal harm or potential for actual harm
09/06/2013 Assist those residents who need help with eating/drinking, grooming and personal and oral hygiene. Isolated/Minimal harm or potential for actual harm
09/06/2013 Store, cook, and serve food in a safe and clean way. Isolated/Minimal harm or potential for actual harm
09/06/2013 Ensure that residents are safe from serious medication errors. Isolated/Minimal harm or potential for actual harm
09/06/2013 Ensure that each resident's 1) entire drug/medication regimen is free from unnecessary drugs; and 2) is managed and monitored to achieve highest level of well-being. Pattern/Minimal harm or potential for actual harm
09/06/2013 Ensure that a nursing home area is free from accident hazards and provide adequate supervision to prevent avoidable accidents. Isolated/Minimal harm or potential for actual harm
09/06/2013 Give residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores. Isolated/Actual harm
09/06/2013 Make sure that doctors visit residents regularly, as required. Pattern/Minimal harm or potential for actual harm
Inspection Results: 08/22/2012
Corrected Deficiency Scope and Severity
09/22/2012 Allow residents to self-administer drugs if determined safe. Isolated/Minimal harm or potential for actual harm
09/22/2012 Develop a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Isolated/Minimal harm or potential for actual harm
09/22/2012 Post nurse staffing information/data on a daily basis. Pattern/Potential for minimal harm
09/22/2012 1) Provide 3 meals at regular times; 2) serve breakfast within 14 hours of dinner; and 3) offer a snack at bedtime each day. Pattern/Minimal harm or potential for actual harm
09/22/2012 Store, cook, and serve food in a safe and clean way. Widespread /Minimal harm or potential for actual harm
09/22/2012 Have a program that investigates, controls and keeps infection from spreading. Pattern/Minimal harm or potential for actual harm

Fire Safety Survey: AMERICAN LUTHERAN HOME-MENOMONIE
Fire Safety Survey Summary on 2013-08-12
Total Number of Fire SafetyDeficiencies 0
Scope and Severity of most Severe Health Deficiency
Fire Safety Survey Summary on 2012-08-27
Total Number of Fire SafetyDeficiencies 3
Scope and Severity of most Severe Health Deficiency Pattern/Minimal harm or potential for actual harm
Fire Safety Survey Summary on 2011-07-13
Total Number of Fire SafetyDeficiencies 0
Scope and Severity of most Severe Health Deficiency
Fire Safety Survey: AMERICAN LUTHERAN HOME-MENOMONIE
Fire Safety Survey Results: 08/27/2012
Corrected Deficiency Severity
10/05/2012 Proper fire barriers, ventilation and signs for the transfilling of oxygen. Isolated/Minimal harm or potential for actual harm
10/05/2012 Special areas constructed so that walls can resist fire for one hour or an approved fire extinguishing system. Isolated/Minimal harm or potential for actual harm
10/05/2012 Corridor and hallway doors that block smoke. Pattern/Minimal harm or potential for actual harm

Resident Complaints: AMERICAN LUTHERAN HOME-MENOMONIE
Date Complaint Substantiated: 09/20/2012
CorrectedCategoryDeficiencySeverity
10/19/2012Ensure that a nursing home area is free from accident hazards and provide adequate supervision to prevent avoidable accidents. E

Quality Measures: AMERICAN LUTHERAN HOME-MENOMONIE
Quality Measures National Average Wisconsin Average AMERICAN LUTHERAN HOME-MENOMONIE
Overall quality rating NA NA 5
5
Long-Stay Residents
Percent of Long Stay Residents Whose Need for Help with ADLs has Increased 15.4% 14.4% 14.0%
Percent of Long Stay Residents Who Self Report Moderate to Severe Pain 8.3% 9.0% 3.9%
Percent of High Risk Long Stay Residents With Pressure Ulcers 6.1% 4.3% 9.8%
Percent of Long Stay Residents Who Lose Too Much Weight 7.2% 7.0% 6.2%
Percent of Low Risk Long Stay Residents Who Lose Control of Their Bowel or Bladder 43.9% 43.7% 39.2%
Percent of Long Stay Residents with a Catheter Inserted and Left in Their Bladder 3.2% 3.8% 3.1%
Percent of Long Stay Residents With a Urinary Tract Infection 6.2% 5.5% 3.1%
Percent of Long Stay Residents Who Have Depressive Symptoms 6.3% 5.8% 0.0%
Percent of Long Stay Residents Who Were Physically Restrained 1.4% 0.7% 0.0%
Percent of Long Stay Residents Experiencing One or More Falls with Major Injury 3.2% 3.4% 5.9%
Percent of Long Stay Residents Assessed and Appropriately Given the Seasonal Influenza Vaccine 92.7% 94.4% 97.0%
Percent of Long Stay Residents Assessed and Appropriately Given the Pneumococcal Vaccine 94.3% 98.2% 95.0%
Percent of Long Stay Residents Who Received an Antipsychotic Medication 20.7% 16.5% 7.4%
Short-Stay Residents
Percent of Short Stay Residents Who Self Report Moderate to Severe Pain 19.2% 21.1% 10.9%
Percent of Short Stay Residents With Pressure Ulcers That Are New or Worsened 1.2% 1.1% 0.7%
Percent of Short Stay Residents Who Were Assessed and Appropriately Given the Seasonal Influenza Vaccine 83.4% 88.6% 88.2%
Percent of Short Stay Residents Assessed and Appropriately Given the Pneumococcal Vaccine 82.4% 91.2% 89.1%
Percent of Short Stay Residents Who Newly Received an Antipsychotic Medication 2.6% 1.5% 0.0%

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