Cycle 1
Health 2025-06-04 · Fire 2025-06-04
2 health deficiencies
Top issue: Quality of Life and Care (1 deficiency)
1 fire-safety deficiencies
Top issue: Miscellaneous (1 deficiency)
Medford, WI
Aspirus Care & Rehab-Medford
5-star overall rating with 5-star inspections with 2 recent health deficiencies with 1 fire-safety deficiencies in the latest cycle
135 S Gibson St, Medford, WI
(715) 748-8100
Overall
5 / 5
CMS overall stars
Health inspections
5 / 5
Survey and complaint cycles
Staffing
5 / 5
RN + nurse staffing
Quality measures
2 / 5
Resident outcomes and process measures
Quick facts
Facility snapshot
Beds
50
Certified beds
Average residents
25
Average occupied residents
Ownership
Non-Profit
Publicly displayed owner type
Chain
No chain reported
Operator or chain grouping
Approved since
1998-03-01
CMS approved date
Coverage
Medicare + Medicaid
Participation flags
Changed ownership
No
Within the last 12 months
Family council
Yes
Resident and family council reported
Sprinklers
Yes
Automatic sprinklers in all required areas
Staffing
Hours and turnover
RN hours / resident day
1.99
Registered nurse staffing · state 0.97 · national 0.68
LPN hours / resident day
0.00
Licensed practical nurse staffing
Aide hours / resident day
2.06
Nurse aide staffing · state 2.59 · national 2.35
Total nurse hours
4.05
All reported nurse hours · state 4.20 · national 3.89
Licensed hours
1.99
RN + LPN hours · state 1.60 · national 1.54
Weekend hours
3.37
Weekend nurse staffing · state 3.72 · national 3.43
Weekend RN hours
1.30
Weekend registered nurse coverage · state 0.66 · national 0.47
Physical therapist
0.00
Reported PT staffing
Adjusted RN hours
2.05
CMS adjusted RN staffing hours
Adjusted total hours
4.17
CMS adjusted total nurse staffing hours
Case-mix index
1.33
Higher values indicate more complex resident acuity
RN turnover
0%
Annual RN turnover
Total nurse turnover
20%
Annual nurse turnover · state 48% · national 46%
SNF QRP
Medicare quality reporting measures
| Measure | Facility | National | Note |
|---|---|---|---|
| Potentially preventable 30-day readmission | 11.76% |
10.72%
1 pts worse
|
No Different than the National Rate · Eligible stays 31 · Observed rate 16.13% · Lower 95% interval 6.89% |
| Discharge to community | 55.28% |
50.57%
4.7 pts better
|
No Different than the National Rate · Eligible stays 31 · Observed rate 61.29% · Lower 95% interval 41.03% |
| Medicare spending per beneficiary | 0.71 |
1.02
0.3 pts better
|
|
| Drug regimen review with follow-up | 100% |
95.27%
4.7 pts better
|
Numerator 25 · Denominator 25 |
| Falls with major injury | 0% |
0.77%
0.8 pts better
|
Numerator 0 · Denominator 25 |
| Discharge self-care score | 50% |
53.69%
3.7 pts worse
|
Numerator 11 · Denominator 22 |
| Discharge mobility score | 59.09% |
50.94%
8.2 pts better
|
Numerator 13 · Denominator 22 |
| Pressure ulcers or injuries, new or worsened | 8% |
2.29%
5.7 pts worse
|
Numerator 2 · Denominator 25 · Adjusted rate 8.62% |
| Healthcare-associated infections requiring hospitalization | Not Available |
7.12%
|
Not Available · Eligible stays 16 · Observed rate Not Available · Lower 95% interval Not Available · Too few residents or stays to report publicly. |
| Staff COVID-19 vaccination coverage | 2.88% |
8.2%
5.3 pts worse
|
Numerator 4 · Denominator 139 |
| Staff flu vaccination coverage | 76.36% |
42%
34.4 pts better
|
Numerator 42 · Denominator 55 |
| Discharge function score | 59.09% |
56.45%
2.6 pts better
|
Numerator 13 · Denominator 22 |
| Transfer of health information to provider | Not Available |
95.95%
|
Numerator Not Available · Denominator 18 · Too few residents or stays to report publicly. |
| Transfer of health information to patient | Not Available |
96.28%
|
Numerator Not Available · Denominator 3 · Too few residents or stays to report publicly. |
| Resident COVID-19 vaccinations up to date | Not Available |
25.2%
|
Numerator Not Available · Denominator 16 · Too few residents or stays to report publicly. |
Quality measures
Resident outcomes and process scores
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 98.4% |
95.7%
2.7 pts better
|
93.4%
5 pts better
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 98.4% |
| Percentage of long-stay residents experiencing one or more falls with major injury | 1.6% |
3.2%
1.6 pts better
|
3.3%
1.7 pts better
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 1.6% · Used in QM five-star |
| Percentage of long-stay residents who have depressive symptoms | 3.3% |
5.0%
1.7 pts better
|
11.4%
8.1 pts better
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 3.3% |
| Percentage of long-stay residents who lose too much weight | 4.0% |
4.9%
0.9 pts better
|
5.4%
1.4 pts better
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 4.0% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 14.0% |
16.6%
2.6 pts better
|
19.6%
5.6 pts better
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 14.0% |
| Percentage of long-stay residents who received an antipsychotic medication | 10.6% |
16.7%
6.1 pts better
|
16.7%
6.1 pts better
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 10.6% · Used in QM five-star |
| Percentage of long-stay residents who were physically restrained | 0.0% |
0.1%
0.1 pts better
|
0.1%
0.1 pts better
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 0.0% |
| Percentage of long-stay residents whose need for help with daily activities has increased | 24.5% |
17.3%
7.2 pts worse
|
14.9%
9.6 pts worse
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 24.5% · Used in QM five-star |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | 3.7% |
2.3%
1.4 pts worse
|
1.0%
2.7 pts worse
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 3.7% · Used in QM five-star |
| Percentage of long-stay residents with a urinary tract infection | 6.2% |
3.0%
3.2 pts worse
|
1.7%
4.5 pts worse
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 6.2% · Used in QM five-star |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | 37.0% |
25.5%
11.5 pts worse
|
19.8%
17.2 pts worse
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 37.0% |
| Percentage of long-stay residents with pressure ulcers | 5.4% |
5.5%
0.1 pts better
|
5.1%
0.3 pts worse
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 5.4% · Used in QM five-star |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 98.5% |
86.8%
11.7 pts better
|
81.7%
16.8 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 95.7% · Q2 98.3% · Q3 100.0% · Q4 100.0% · 4Q avg 98.5% |
| Percentage of short-stay residents who had an outpatient emergency department visit | 24.8% |
15.0%
9.8 pts worse
|
12.0%
12.8 pts worse
|
Short Stay · 20240701-20250630 · Adjusted 24.8% · Observed 22.7% · Expected 10.2% · Used in QM five-star |
| Percentage of short-stay residents who newly received an antipsychotic medication | 3.2% |
1.3%
1.9 pts worse
|
1.6%
1.6 pts worse
|
Short Stay · 2024Q4-2025Q3 · Q1 3.3% · Q2 2.9% · Q3 3.0% · Q4 3.8% · 4Q avg 3.2% · Used in QM five-star |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 98.3% |
82.2%
16.1 pts better
|
79.7%
18.6 pts better
|
Short Stay · 2024Q3-2025Q2 · 4Q avg 98.3% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission | 15.3% |
22.7%
7.4 pts better
|
23.9%
8.6 pts better
|
Short Stay · 20240701-20250630 · Adjusted 15.3% · Observed 13.6% · Expected 21.2% · Used in QM five-star |
Survey summary
Recent inspection cycles
Cycle 2
Health 2024-05-01 · Fire 2024-05-01
3 health deficiencies
Top issue: Freedom from Abuse and Neglect and Exploitation (1 deficiency)
0 fire-safety deficiencies
No concentrated fire-safety issue counts in this cycle.
Cycle 3
Health 2023-04-26 · Fire 2023-04-26
1 health deficiencies
Top issue: Pharmacy Service (1 deficiency)
1 fire-safety deficiencies
Top issue: Smoke (1 deficiency)
Fire safety
Fire-safety citations
F · Potential for more than minimal harm
2025-06-04
K712 · Miscellaneous Deficiencies
Fire Safety
Have simulated fire drills held at unexpected times.
Corrected 2025-06-10
D · Potential for more than minimal harm
2023-04-26
K321 · Smoke Deficiencies
Fire Safety
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
Corrected 2023-04-25
Inspection history
Recent health citations
D · Potential for more than minimal harm
2025-06-04
F656 · Resident Assessment and Care Planning Deficiencies
Health
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Corrected 2025-07-11
D · Potential for more than minimal harm
2025-06-04
F684 · Quality of Life and Care Deficiencies
Health
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected 2025-07-11
F · Potential for more than minimal harm
2024-05-01
F812 · Nutrition and Dietary Deficiencies
Health
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected 2024-06-07
D · Potential for more than minimal harm
2024-05-01
F610 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Health
Respond appropriately to all alleged violations.
Corrected 2024-06-07
D · Potential for more than minimal harm
2024-05-01
F880 · Infection Control Deficiencies
Health
Provide and implement an infection prevention and control program.
Corrected 2024-06-07
D · Potential for more than minimal harm
2023-04-26
F756 · Pharmacy Service Deficiencies
Health
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
Corrected 2023-05-11
Penalties and ownership
What sits behind the stars
Ownership
Aspirus, Inc
5% Or Greater Direct Ownership Interest · Organization
Anderson, Diane
Corporate Director · Individual
Arndt, Brent
Corporate Director · Individual
Bradley, Connie
Corporate Director · Individual
Dixon, Rachel
Corporate Officer · Individual
Hack, Tyler
Corporate Director · Individual
Hamman, Leonard
Corporate Director · Individual
Heywood, Matthew
Corporate Officer · Individual
Juedes, Randy
Corporate Director · Individual
Koenig, Jeffrey
Corporate Director · Individual
Lange, John
Corporate Director · Individual
Matheson, James
Corporate Director · Individual
Peck, Lori
Corporate Director · Individual
Schneider, Susan
Corporate Director · Individual
Scully, Hilary
Operational/Managerial Control · Individual
Shaw, Greg
Operational/Managerial Control · Individual
Steliga, Jason
Corporate Director · Individual
Strama, Mallori
Operational/Managerial Control · Individual
Yang, Jerry
Corporate Director · Individual
Yang, Jerry
Corporate Officer · Individual
Nearby options
Other facilities in reach
#1
Abbotsford Health Care Center
Abbotsford, WI
2-star overall rating with 2-star inspections with $15,939 in total fines with 14 recent health deficiencies with 4 fire-safety deficiencies in the latest cycle
#2
Rib Lake Health Services
Rib Lake, WI
3-star overall rating with 3-star inspections with 7 recent health deficiencies with 3 fire-safety deficiencies in the latest cycle
#3
Colonial Health Services
Colby, WI
2-star overall rating with 2-star inspections with $34,140 in total fines with 6 recent health deficiencies with 4 fire-safety deficiencies in the latest cycle
Jump out