SANCTUARY AT ST MARY'S - GRAND RAPIDS, MI

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Address

1050 FOUR MILE NW
GRAND RAPIDS, MI, 49504

Phone (make sure to verify first before calling): (616) 784-0646

Number of Certified Beds: 187
Total Number of Residents: 169
Percent of Occupied Beds: 90%
Sprinkler Status: Fully Sprinklered
Program Participation: Medicare and Medicaid
Type of Ownership: Non profit - Corporation
Located Within a Hospital?: No
Multi Nursing Home Ownership?: Yes
Resident and Family Councils: Resident
Continuing Care Retirement Community?: No
Quality Indicator Survey?: No
Special Focus Facility?: No
Type: Skilled Nursing Facilities

Overall Star Rating: 4 Stars
Health Inspections Star Rating: 4 Stars
Nurse Staffing Star Rating: 3 Stars
Quality Measures Star Rating: 4 Stars
RN Only Star Rating: 3 Stars

Employment Full-Time Equivalent

Administrative Staff - Full Time: 6.69
Certified Nurse Aides - Full Time: 60.13
Certified Nurse Aides - Part Time: 17.57
Food Service Personnel - Full Time: 14.29
Food Service Personnel - Part Time: 2.79
Housekeeping Personnel - Full Time: 8.64
Licensed Practical/ Vocational Nurses - Full Time: 22.01
Licensed Practical/ Vocational Nurses - Part Time: 4.94
Mental Health Services Personnel - Under Contract: 0.06
Persons Not Included In Any Other Categories - Full Time: 7.54
Physical Therapists - Under Contract: 2.44
Registered Nurses - Full Time: 4.07
Rn Director Of Nursing - Full Time: 1.14
Social Workers - Full Time: 3.31
Activities Professionals - Full Time: 1.14
Occupational Therapists - Under Contract: 2.36
Pharmacists - Under Contract: 0.09
Podiatrists - Under Contract: 0.11
Speech Pathologists - Under Contract: 1.64
Other Physicians - Under Contract: 0.91
Physician Extenders - Under Contract: 0.11
Dietitians - Full Time: 2.29
Persons Not Included In Any Other Categories - Part Time: 2.10
Registered Nurses - Part Time: 2.20
Occupational Therapy Assistants - Under Contract: 2.54
Housekeeping Personnel - Part Time: 3.60
Physical Therapy Aide - Under Contract: 2.20

Provided Services

Activities Services Are Provided Onsite To Residents
Clinical Laboratory Services Are Provided Offsite To Residents
Clinical Laboratory Services Are Provided Onsite To Residents
Dental Services Are Provided Offsite To Residents
Dental Services Are Provided Onsite To Residents
Diagnostic Xray Services Are Provided Offsite To Residents
Diagnostic Xray Services Are Provided Onsite To Residents
Dietary Services Are Provided Onsite To Residents
Housekeeping Services Are Provided Onsite To Residents
Mental Health Services Are Provided Offsite To Residents
Mental Health Services Are Provided Onsite To Residents
Nursing Services Are Provided Onsite To Residents
Occupational Therapy Services Are Provided Onsite To Residents
Pharmacy Services Are Provided Onsite To Residents
Physical Therapy Services Are Provided Onsite To Residents
Physician Extender Services Are Provided Onsite To Residents
Physician Services Are Provided Offsite To Residents
Physician Services Are Provided Onsite To Residents
Podiatry Services Are Provided Offsite To Residents
Podiatry Services Are Provided Onsite To Residents
Social Work Services Are Provided Onsite To Residents
Speech/Language Pathology Services Are Provided Onsite To Residents
Therapeutic Recreation Specialist Services Are Provided Onsite To Residents
Vocational Services Are Provided Onsite To Residents

Quality Measures

Percent of long-stay residents whose need for help with daily activities has increased

Here:	14.3%
Michigan:	14.8%

Percent of long-stay residents who self-report moderate to severe pain

This Nursing Home:	18.6%
State:	10.4%

Percent of long-stay high-risk residents with pressure ulcers

Here:	2.6%
Michigan:	6.3%

Percent of long-stay residents who lose too much weight

Here:	6.0%
Michigan:	7.4%

Percent of long-stay low-risk residents who lose control of their bowels or bladder

Here:	51.7%
Michigan:	48.3%

Percent of long-stay residents who have had a catheter inserted and left in their bladder

Here:	4.6%
Michigan:	4.0%

Percent of long-stay residents with a urinary tract infection

This Nursing Home:	7.4%
State:	6.2%

Percent of long-stay residents who have depressive symptoms

Here:	3.3%
Michigan:	4.8%

Percent of long-stay residents experiencing one or more falls with major injury

This Nursing Home:	3.2%
Michigan:	2.8%

Percent of long-stay residents assessed and given, appropriately, the seasonal influenza vaccine

Here:	96.2%
State:	92.5%

Percent of long-stay residents assessed and given, appropriately, the pneumococcal vaccine

Here:	96.2%
Michigan:	94.6%

Percent of short-stay residents who self-report moderate to severe pain

This Nursing Home:	30.9%
Michigan:	21.5%

Percent of short-stay residents assessed and given, appropriately, the seasonal influenza vaccine

This Nursing Home:	70.5%
Michigan:	84.1%

Percent of short-stay residents assessed and given, appropriately, the pneumococcal vaccine

This Nursing Home:	77.6%
Michigan:	82.9%

Percent of short-stay residents who newly received an antipsychotic medication

Here:	0.8%
State:	1.9%

Percent of long-stay residents who received an antipsychotic medication

Here:	10.6%
Michigan:	16.0%

Staff Information

Number of Registered Nurses Hours Per Resident Per Day

Here:	0.660
State:	0.749

Number of Licensed Practical and Licensed Vocational Nurses Hours Per Resident Per Day

This Nursing Home:	0.610
Michigan:	0.782

Total Number of Licensed Staff Hours Per Resident Per Day

This Nursing Home:	1.270
State:	1.525

Number of ,Certified Nurse Assistant Hours Per Resident Per Day

This Nursing Home:	0.080
State:	0.109

Number Therapy Hours Per Resident Per Day

Here:	0.080
Michigan:	0.112

Complaint Deficiency

At least once a month, have a licensed pharmacist review each resident's medication(s) and report any irregularities to the attending doctor: Few (Minimal harm or potential for actual harm)

Proper medical gas storage and administration areas: Few (Minimal harm or potential for actual harm)

Let the resident refuse treatment or refuse to take part in an experiment and formulate advance directives: Few (Minimal harm or potential for actual harm)

Determine if it is safe for the resident to self-administer drugs: Few (Minimal harm or potential for actual harm)

Provide housekeeping and maintenance services: Few (Minimal harm or potential for actual harm)

Conduct initial and periodic assessments of each resident's functional capacity: Some (Minimal harm or potential for actual harm)

Check and assess each resident's assessment at least every 3 months: Some (Potential for minimal harm)

Make sure services provided by the nursing facility meet professional standards of quality: Few (Minimal harm or potential for actual harm)

Develop a post-discharge plan with the resident and family for the resident's care after leaving the nursing home: Some (Potential for minimal harm)

Make sure that the nursing home area is free from accident hazards and risks and provides supervision to prevent avoidable accidents: Some (Minimal harm or potential for actual harm)

Properly care for residents needing special services, including: injections, colostomy, ureostomy, ileostomy, tracheostomy care, tracheal suctioning, respiratory care, foot care, and prostheses: Some (Minimal harm or potential for actual harm)

1) Make sure that each resident's drug regimen is free from unnecessary drugs; 2) Each resident's entire drug/medication is managed and monitored to achieve highest well being: Some (Minimal harm or potential for actual harm)

Keep the rate of medication errors (wrong drug, wrong dose, wrong time) to less than 5%: Some (Minimal harm or potential for actual harm)

Store, cook, and serve food in a safe and clean way: Some (Minimal harm or potential for actual harm)

Have a program that investigates, controls and keeps infection from spreading: Few (Minimal harm or potential for actual harm)

Give or get quality lab services/tests in a timely manner to meet the needs of residents: Some (Minimal harm or potential for actual harm)

Keep accurate, complete and organized clinical records on each resident that meet professional standards: Some (Minimal harm or potential for actual harm)

Weekly inspections and monthly testing of generators: Many (Minimal harm or potential for actual harm)

Properly installed electrical wiring and equipment: Few (Minimal harm or potential for actual harm)

Develop a complete care plan that meets all of a resident's needs, with timetables and actions that can be measured: Some (Minimal harm or potential for actual harm)

Provide necessary care and services to maintain the highest well being of each resident : Few (Minimal harm or potential for actual harm)

1) Make sure that each resident's drug regimen is free from unnecessary drugs; 2) Each resident's entire drug/medication is managed and monitored to achieve highest well being: Few (Minimal harm or potential for actual harm)

Record of quarterly fire drills for each shift under varying conditions: Many (Minimal harm or potential for actual harm)

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: Few (Minimal harm or potential for actual harm)

Make sure that each resident gets a nutritional and well balanced diet, unless it is not possible to do so: Some (Potential for minimal harm)

1) Make sure that each resident's drug regimen is free from unnecessary drugs; 2) Each resident's entire drug/medication is managed and monitored to achieve highest well being: Few (Minimal harm or potential for actual harm)

Store, cook, and serve food in a safe and clean way: Many (Minimal harm or potential for actual harm)

Have a program that investigates, controls and keeps infection from spreading: Many (Minimal harm or potential for actual harm)

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