Cycle 1
Health 2025-03-19 · Fire 2025-03-19
6 health deficiencies
Top issue: Freedom from Abuse and Neglect and Exploitation (2 deficiencies)
0 fire-safety deficiencies
No concentrated fire-safety issue counts in this cycle.
Ludlow, VT
Gill Odd Fellows Home of Vermont
5-star overall rating with 4-star inspections with 6 recent health deficiencies
8 Gill Terrace, Ludlow, VT
(802) 228-4571
Overall
5 / 5
CMS overall stars
Health inspections
4 / 5
Survey and complaint cycles
Staffing
5 / 5
RN + nurse staffing
Quality measures
4 / 5
Resident outcomes and process measures
Quick facts
Facility snapshot
Beds
46
Certified beds
Average residents
42
Average occupied residents
Ownership
Non-Profit
Publicly displayed owner type
Chain
No chain reported
Operator or chain grouping
Approved since
1995-05-11
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
0.96
Registered nurse staffing · state 0.81 · national 0.68
LPN hours / resident day
0.33
Licensed practical nurse staffing · state 0.90 · national 0.87
Aide hours / resident day
2.81
Nurse aide staffing · state 2.60 · national 2.35
Total nurse hours
4.09
All reported nurse hours · state 4.31 · national 3.89
Licensed hours
1.28
RN + LPN hours · state 1.71 · national 1.54
Weekend hours
3.29
Weekend nurse staffing · state 3.69 · national 3.43
Weekend RN hours
0.75
Weekend registered nurse coverage · state 0.52 · national 0.47
Physical therapist
0.03
Reported PT staffing · state 0.10 · national 0.07
Adjusted RN hours
0.99
CMS adjusted RN staffing hours
Adjusted total hours
4.24
CMS adjusted total nurse staffing hours
Case-mix index
1.32
Higher values indicate more complex resident acuity
RN turnover
10%
Annual RN turnover · state 47% · national 45%
Total nurse turnover
26%
Annual nurse turnover · state 60% · national 46%
SNF VBP
Value-based purchasing
Program rank
4,027
Lower is better among SNFs in the FY 2026 VBP program.
Performance score
41.65
Composite VBP score used to determine payment impact.
Payment multiplier
0.9946
Above 1.000 increases Medicare payment; below 1.000 reduces it.
Program components
How the VBP score is built
Readmission
4.92
Performance 19.15% · Measure score 4.92 · Achievement 4.92 · This facility did not have sufficient data to calculate a baseline period measure result.
Healthcare-associated infections
3.91
Baseline 6.41% · Performance 6.67% · Measure score 3.91 · Achievement 3.91 · Improvement 0
Total nurse turnover
4.84
Baseline 57.78% · Performance 43.90% · Measure score 4.84 · Achievement 4.84 · Improvement 3.71
Adjusted total nurse staffing
2.99
Baseline 3.63 hours · Performance 3.93 hours · Measure score 2.99 · Achievement 2.99 · Improvement 0.87
SNF QRP
Medicare quality reporting measures
| Measure | Facility | National | Note |
|---|---|---|---|
| Potentially preventable 30-day readmission | 10.64% |
10.72%
0.1 pts better
|
No Different than the National Rate · Eligible stays 57 · Observed rate 10.53% · Lower 95% interval 6.38% |
| Discharge to community | 56.29% |
50.57%
5.7 pts better
|
No Different than the National Rate · Eligible stays 54 · Observed rate 51.85% · Lower 95% interval 44.55% |
| Medicare spending per beneficiary | 0.67 |
1.02
0.3 pts better
|
|
| Drug regimen review with follow-up | 100% |
95.27%
4.7 pts better
|
Numerator 30 · Denominator 30 |
| Falls with major injury | 0% |
0.77%
0.8 pts better
|
Numerator 0 · Denominator 30 |
| Discharge self-care score | 53.85% |
53.69%
0.2 pts better
|
Numerator 14 · Denominator 26 |
| Discharge mobility score | 53.85% |
50.94%
2.9 pts better
|
Numerator 14 · Denominator 26 |
| Pressure ulcers or injuries, new or worsened | 0% |
2.29%
2.3 pts better
|
Numerator 0 · Denominator 30 · Adjusted rate 0% |
| Healthcare-associated infections requiring hospitalization | 6.67% |
7.12%
0.5 pts better
|
No Different than the National Rate · Eligible stays 39 · Observed rate 5.13% · Lower 95% interval 3.66% |
| Staff COVID-19 vaccination coverage | 50% |
8.2%
41.8 pts better
|
Numerator 43 · Denominator 86 |
| Staff flu vaccination coverage | 61.46% |
42%
19.5 pts better
|
Numerator 59 · Denominator 96 |
| Discharge function score | 53.85% |
56.45%
2.6 pts worse
|
Numerator 14 · Denominator 26 |
| Transfer of health information to provider | 100% |
95.95%
4 pts better
|
Numerator 20 · Denominator 20 |
| Transfer of health information to patient | Not Available |
96.28%
|
Numerator Not Available · Denominator 2 · Too few residents or stays to report publicly. |
| Resident COVID-19 vaccinations up to date | Not Available |
25.2%
|
Numerator Not Available · Denominator 12 · Too few residents or stays to report publicly. |
Quality measures
Resident outcomes and process scores
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| Number of hospitalizations per 1000 long-stay resident days | 0.9 |
1.4
0.5 pts better
|
1.9
1 pts better
|
Long Stay · 20240701-20250630 · Adjusted 0.9 · Observed 0.7 · Expected 1.4 · Used in QM five-star |
| Number of outpatient emergency department visits per 1000 long-stay resident days | 1.8 |
2.5
0.7 pts better
|
1.8
About the same
|
Long Stay · 20240701-20250630 · Adjusted 1.8 · Observed 1.6 · Expected 1.6 · Used in QM five-star |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 87.0% |
95.4%
8.4 pts worse
|
93.4%
6.4 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 94.4% · Q2 84.2% · Q3 85.0% · Q4 85.0% · 4Q avg 87.0% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine | 100.0% |
97.6%
2.4 pts better
|
95.5%
4.5 pts better
|
Long Stay · 2024Q3-2025Q2 · 4Q avg 100.0% |
| Percentage of long-stay residents experiencing one or more falls with major injury | 0.6% |
5.9%
5.3 pts better
|
3.3%
2.7 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 2.5% · Q4 0.0% · 4Q avg 0.6% · Used in QM five-star |
| Percentage of long-stay residents who have depressive symptoms | 2.1% |
10.0%
7.9 pts better
|
11.4%
9.3 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 3.0% · Q2 0.0% · Q3 2.7% · Q4 2.6% · 4Q avg 2.1% |
| Percentage of long-stay residents who lose too much weight | 5.0% |
6.0%
1 pts better
|
5.4%
0.4 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 6.7% · Q3 9.4% · Q4 3.4% · 4Q avg 5.0% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 3.2% |
16.4%
13.2 pts better
|
19.6%
16.4 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 6.9% · Q2 3.1% · Q3 3.0% · Q4 0.0% · 4Q avg 3.2% |
| Percentage of long-stay residents who received an antipsychotic medication | 45.1% |
20.9%
24.2 pts worse
|
16.7%
28.4 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 42.9% · Q2 40.0% · Q3 51.7% · Q4 46.2% · 4Q avg 45.1% · 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 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0% |
| Percentage of long-stay residents whose ability to walk independently worsened | 25.4% |
19.3%
6.1 pts worse
|
16.3%
9.1 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 19.0% · Q2 55.5% · Q3 15.3% · Q4 11.7% · 4Q avg 25.4% · Used in QM five-star |
| Percentage of long-stay residents whose need for help with daily activities has increased | 30.5% |
20.3%
10.2 pts worse
|
14.9%
15.6 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 25.0% · Q2 56.7% · Q3 16.1% · Q4 24.1% · 4Q avg 30.5% · Used in QM five-star |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | 3.0% |
1.2%
1.8 pts worse
|
1.0%
2 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 3.2% · Q2 3.2% · Q3 5.6% · Q4 0.0% · 4Q avg 3.0% · Used in QM five-star |
| Percentage of long-stay residents with a urinary tract infection | 1.4% |
2.4%
1 pts better
|
1.7%
0.3 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 2.8% · Q3 2.6% · Q4 0.0% · 4Q avg 1.4% · Used in QM five-star |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | 22.8% |
27.4%
4.6 pts better
|
19.8%
3 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 10.5% · Q2 31.8% · Q3 18.2% · Q4 30.7% · 4Q avg 22.8% |
| Percentage of long-stay residents with pressure ulcers | 0.6% |
6.1%
5.5 pts better
|
5.1%
4.5 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 2.2% · Q4 0.0% · 4Q avg 0.6% · Used in QM five-star |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 74.7% |
84.4%
9.7 pts worse
|
81.7%
7 pts worse
|
Short Stay · 2024Q4-2025Q3 · Q1 80.8% · Q2 82.6% · 4Q avg 74.7% |
| Percentage of short-stay residents who newly received an antipsychotic medication | 0.0% |
1.9%
1.9 pts better
|
1.6%
1.6 pts better
|
Short Stay · 2024Q4-2025Q3 · 4Q avg 0.0% · Used in QM five-star |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 69.6% |
78.9%
9.3 pts worse
|
79.7%
10.1 pts worse
|
Short Stay · 2024Q3-2025Q2 · 4Q avg 69.6% |
Survey summary
Recent inspection cycles
Cycle 2
Health 2024-01-24 · Fire 2024-01-24
12 health deficiencies
Top issue: Resident Assessment and Care Planning (4 deficiencies)
0 fire-safety deficiencies
No concentrated fire-safety issue counts in this cycle.
Cycle 3
Health 2023-01-11 · Fire 2023-01-11
4 health deficiencies
Top issue: Environmental (1 deficiency)
3 fire-safety deficiencies
Top issue: Egress (2 deficiencies)
Fire safety
Fire-safety citations
D · Potential for more than minimal harm
2023-01-11
K363 · Smoke Deficiencies
Fire Safety
Install corridor and hallway doors that block smoke.
Corrected 2023-01-09
C · Minimal harm
2023-01-11
K291 · Egress Deficiencies
Fire Safety
Install emergency lighting that can last at least 1 1/2 hours.
Corrected 2023-01-11
B · Minimal harm
2023-01-11
K293 · Egress Deficiencies
Fire Safety
Have properly located and lighted "Exit" signs.
Corrected 2023-01-11
Inspection history
Recent health citations
D · Potential for more than minimal harm
2025-08-06
F609 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Health
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Corrected 2025-08-31
D · Potential for more than minimal harm
2025-08-06
F610 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Health
Respond appropriately to all alleged violations.
Corrected 2025-08-31
E · Potential for more than minimal harm
2025-03-19
F758 · Pharmacy Service Deficiencies
Health
Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.
Corrected 2025-04-09
E · Potential for more than minimal harm
2025-03-19
F880 · Infection Control Deficiencies
Health
Provide and implement an infection prevention and control program.
Corrected 2025-04-09
D · Potential for more than minimal harm
2025-03-19
F580 · Resident Rights Deficiencies
Health
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
Corrected 2025-04-25
D · Potential for more than minimal harm
2025-03-19
F699 · Quality of Life and Care Deficiencies
Health
Provide care or services that was trauma informed and/or culturally competent.
Corrected 2025-04-25
D · Potential for more than minimal harm
2024-11-12
F658 · Resident Assessment and Care Planning Deficiencies
Health
Ensure services provided by the nursing facility meet professional standards of quality.
Corrected 2025-01-03
D · Potential for more than minimal harm
2024-11-12
F726 · Nursing and Physician Services Deficiencies
Health
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.
Corrected 2025-01-03
F · Potential for more than minimal harm
2024-01-24
F726 · Nursing and Physician Services Deficiencies
Health
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.
Corrected 2024-03-01
E · Potential for more than minimal harm
2024-01-24
F658 · Resident Assessment and Care Planning Deficiencies
Health
Ensure services provided by the nursing facility meet professional standards of quality.
Corrected 2024-02-22
D · Potential for more than minimal harm
2024-01-24
F558 · Resident Rights Deficiencies
Health
Reasonably accommodate the needs and preferences of each resident.
Corrected 2024-02-22
D · Potential for more than minimal harm
2024-01-24
F626 · Resident Rights Deficiencies
Health
Permit a resident to return to the nursing home after hospitalization or therapeutic leave that exceeds bed-hold policy.
Corrected 2024-02-22
D · Potential for more than minimal harm
2024-01-24
F636 · Resident Assessment and Care Planning Deficiencies
Health
Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months.
Corrected 2024-02-22
D · Potential for more than minimal harm
2024-01-24
F655 · Resident Assessment and Care Planning Deficiencies
Health
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
Corrected 2024-02-22
D · Potential for more than minimal harm
2024-01-24
F689 · Quality of Life and Care Deficiencies
Health
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected 2024-02-22
D · Potential for more than minimal harm
2024-01-24
F695 · Quality of Life and Care Deficiencies
Health
Provide safe and appropriate respiratory care for a resident when needed.
Corrected 2024-02-22
D · Potential for more than minimal harm
2024-01-24
F710 · Nursing and Physician Services Deficiencies
Health
Obtain a doctor's order to admit a resident and ensure the resident is under a doctor's care.
Corrected 2024-02-22
D · Potential for more than minimal harm
2024-01-24
F880 · Infection Control Deficiencies
Health
Provide and implement an infection prevention and control program.
Corrected 2024-02-22
F · Potential for more than minimal harm
2023-01-11
F880 · Infection Control Deficiencies
Health
Provide and implement an infection prevention and control program.
Corrected 2023-02-06
E · Potential for more than minimal harm
2023-01-11
F908 · Environmental Deficiencies
Health
Keep all essential equipment working safely.
Corrected 2023-02-06
D · Potential for more than minimal harm
2023-01-11
F657 · Resident Assessment and Care Planning Deficiencies
Health
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Corrected 2023-02-06
D · Potential for more than minimal harm
2023-01-11
F689 · Quality of Life and Care Deficiencies
Health
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected 2023-02-06
Penalties and ownership
What sits behind the stars
Ownership
Benoit, Martha
Corporate Director · Individual
Devereux, Dennis
Corporate Director · Individual
George, Sandy
Corporate Director · Individual
Kettles, Charles
Corporate Director · Individual
Mcelwain, Maegan
W-2 Managing Employee · Individual
Reichert, January
Operational/Managerial Control · Individual
Nearby options
Other facilities in reach
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Springfield Health & Rehab
Springfield, VT
1-star overall rating with 1-star inspections with Special Focus status with abuse icon flag with $637,467 in total fines with 41 recent health deficiencies
#2
Cedar Hill Health Care Center
Windsor, VT
5-star overall rating with 4-star inspections with 5 recent health deficiencies with 1 fire-safety deficiencies in the latest cycle
#3
Elm Wood Center At Claremont
Claremont, NH
2-star overall rating with 2-star inspections with 7 recent health deficiencies with 6 fire-safety deficiencies in the latest cycle
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