Wooster, OH

Wooster Community Hospital SNF

5-star overall rating with 5-star inspections with 2 recent health deficiencies with 1 fire-safety deficiencies in the latest cycle

1761 Beall Avenue, Wooster, OH

(330) 263-8100

Compare this facility

Overall

5 / 5

CMS overall stars

Health inspections

5 / 5

Survey and complaint cycles

Staffing

5 / 5

RN + nurse staffing

Quality measures

5 / 5

Resident outcomes and process measures

Quick facts

Facility snapshot

Beds

22

Certified beds

Average residents

20

Average occupied residents

Ownership

Government

Publicly displayed owner type

Chain

No chain reported

Operator or chain grouping

Approved since

2013-03-29

CMS approved date

Coverage

Medicare

Participation flags

Changed ownership

No

Within the last 12 months

Family council

No

Resident and family council reported

Sprinklers

Yes

Automatic sprinklers in all required areas

Hospital-based

Yes

CMS reports the provider resides in a hospital

Staffing

Hours and turnover

RN hours / resident day

3.04

Registered nurse staffing · state 0.63 · national 0.68

LPN hours / resident day

1.41

Licensed practical nurse staffing · state 0.96 · national 0.87

Aide hours / resident day

2.36

Nurse aide staffing · state 2.14 · national 2.35

Total nurse hours

6.81

All reported nurse hours · state 3.72 · national 3.89

Licensed hours

4.45

RN + LPN hours · state 1.59 · national 1.54

Weekend hours

5.98

Weekend nurse staffing · state 3.29 · national 3.43

Weekend RN hours

2.27

Weekend registered nurse coverage · state 0.41 · national 0.47

Physical therapist

0.07

Reported PT staffing · state 0.05 · national 0.07

Adjusted RN hours

2.74

CMS adjusted RN staffing hours

Adjusted total hours

6.13

CMS adjusted total nurse staffing hours

Case-mix index

1.52

Higher values indicate more complex resident acuity

RN turnover

17%

Annual RN turnover · state 47% · national 45%

Total nurse turnover

31%

Annual nurse turnover · state 50% · national 46%

SNF VBP

Value-based purchasing

Program rank

188

Lower is better among SNFs in the FY 2026 VBP program.

Performance score

79.04

Composite VBP score used to determine payment impact.

Payment multiplier

1.0256

Above 1.000 increases Medicare payment; below 1.000 reduces it.

Program components

How the VBP score is built

Readmission

5.64

Baseline 17.68% · Performance 18.82% · Measure score 5.64 · Achievement 5.64 · Improvement 0

Healthcare-associated infections

8.07

Baseline 4.23% · Performance 5.42% · Measure score 8.07 · Achievement 8.07 · Improvement 0

Total nurse turnover

10

Baseline 58.62% · Performance 21.21% · Measure score 10 · Achievement 10 · Improvement 9

Adjusted total nurse staffing

Not reported

This facility did not meet this measure's case minimum policy requirement and therefore no measure data is publicly reported.

SNF QRP

Medicare quality reporting measures

Measure	Facility	National	Note
Potentially preventable 30-day readmission	8.79%	10.72% 1.9 pts better	No Different than the National Rate · Eligible stays 246 · Observed rate 6.5% · Lower 95% interval 5.99%
Discharge to community	71.91%	50.57% 21.3 pts better	Better than the National Rate · Eligible stays 212 · Observed rate 74.06% · Lower 95% interval 66.13%
Medicare spending per beneficiary	0.86	1.02 0.2 pts better
Drug regimen review with follow-up	100%	95.27% 4.7 pts better	Numerator 145 · Denominator 145
Falls with major injury	0.69%	0.77% 0.1 pts better	Numerator 1 · Denominator 145
Discharge self-care score	34.82%	53.69% 18.9 pts worse	Numerator 39 · Denominator 112
Discharge mobility score	38.39%	50.94% 12.5 pts worse	Numerator 43 · Denominator 112
Pressure ulcers or injuries, new or worsened	0%	2.29% 2.3 pts better	Numerator 0 · Denominator 145 · Adjusted rate 0%
Healthcare-associated infections requiring hospitalization	5.42%	7.12% 1.7 pts better	No Different than the National Rate · Eligible stays 128 · Observed rate 2.34% · Lower 95% interval 2.83%
Staff COVID-19 vaccination coverage	0%	8.2% 8.2 pts worse	Numerator 0 · Denominator 56
Staff flu vaccination coverage	82.41%	42% 40.4 pts better	Numerator 178 · Denominator 216
Discharge function score	43.75%	56.45% 12.7 pts worse	Numerator 49 · Denominator 112
Transfer of health information to provider	100%	95.95% 4 pts better	Numerator 115 · Denominator 115
Transfer of health information to patient	100%	96.28% 3.7 pts better	Numerator 28 · Denominator 28
Resident COVID-19 vaccinations up to date	34.94%	25.2% 9.7 pts better	Numerator 29 · Denominator 83

Quality measures

Resident outcomes and process scores

Measure	Facility	State	National	Note
Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine	89.3%	78.1% 11.2 pts better	81.7% 7.6 pts better	Short Stay · 2024Q4-2025Q3 · Q1 88.6% · Q2 92.0% · Q3 90.4% · Q4 86.1% · 4Q avg 89.3%
Percentage of short-stay residents who had an outpatient emergency department visit	10.7%	12.5% 1.8 pts better	12.0% 1.3 pts better	Short Stay · 20240701-20250630 · Adjusted 10.7% · Observed 11.5% · Expected 12.0% · Used in QM five-star
Percentage of short-stay residents who newly received an antipsychotic medication	0.0%	1.2% 1.2 pts better	1.6% 1.6 pts better	Short Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0% · Used in QM five-star
Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine	99.5%	75.6% 23.9 pts better	79.7% 19.8 pts better	Short Stay · 2024Q3-2025Q2 · 4Q avg 99.5%
Percentage of short-stay residents who were rehospitalized after a nursing home admission	19.3%	25.1% 5.8 pts better	23.9% 4.6 pts better	Short Stay · 20240701-20250630 · Adjusted 19.3% · Observed 20.0% · Expected 24.6% · Used in QM five-star

Survey summary

Recent inspection cycles

Cycle 1 Health 2024-01-04 · Fire 2024-01-04

2 health deficiencies

Top issue: Pharmacy Service (1 deficiency)

1 fire-safety deficiencies

Top issue: Egress (1 deficiency)

Cycle 2 Health 2021-11-23 · Fire 2021-11-23

0 health deficiencies

No concentrated health issue counts in this cycle.

4 fire-safety deficiencies

Top issue: Construction (1 deficiency)

Cycle 3 Health 2020-02-13 · Fire 2020-02-13

1 health deficiencies

Top issue: Infection Control (1 deficiency)

2 fire-safety deficiencies

Top issue: Egress (1 deficiency)

Fire safety

Fire-safety citations

E · Potential for more than minimal harm 2024-01-04

K225 · Egress Deficiencies

Fire Safety

Have stairways and smokeproof enclosures used as exits that meet safety requirements.

Corrected 2024-02-23

F · Potential for more than minimal harm 2021-11-23

K161 · Construction Deficiencies

Fire Safety

Use approved construction type or materials.

Corrected 2021-12-10

F · Potential for more than minimal harm 2021-11-23

K222 · Egress Deficiencies

Fire Safety

Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.

Corrected 2021-12-10

F · Potential for more than minimal harm 2021-11-23

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 2021-12-10

F · Potential for more than minimal harm 2021-11-23

K919 · Gas, Vacuum, and Electrical Systems Deficiencies

Fire Safety

Meet requirements for the use of electrical equipment.

Corrected 2021-12-10

F · Potential for more than minimal harm 2020-02-13

K291 · Egress Deficiencies

Fire Safety

Install emergency lighting that can last at least 1 1/2 hours.

Corrected 2020-03-20

F · Potential for more than minimal harm 2020-02-13

K923 · Gas, Vacuum, and Electrical Systems Deficiencies

Fire Safety

Have proper medical gas storage and administration areas.

Corrected 2020-03-20

Inspection history

Recent health citations

D · Potential for more than minimal harm 2024-01-04

F695 · Quality of Life and Care Deficiencies

Health

Provide safe and appropriate respiratory care for a resident when needed.

Corrected 2024-02-21

D · Potential for more than minimal harm 2024-01-04

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 2024-02-21

F · Potential for more than minimal harm 2020-02-13

F880 · Infection Control Deficiencies

Health

Provide and implement an infection prevention and control program.

Corrected 2020-03-20

Penalties and ownership

What sits behind the stars

Ownership

City Of Wooster

5% Or Greater Direct Ownership Interest · Organization

100% 1 facilities 2011-11-16

Adams, Kyle