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Wellspring Lutheran Services

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About Wellspring Lutheran Services

General Information

Legal Business NameLutheran Homes Of Michigan, Inc
Ownership TypeNon Profit - Church Related
Changed Ownership In The Last 12 MonthsNo
First Accepted MedicareMarch 1, 1976 (41 years)
Capacity112
Residents90
Percent Occupied80%
Program ParticipationMedicare And Medicaid
Resident And Family CouncilsResident
In HospitalNo
Continuing Care Retirement CommunityNo
Special Focus FacilityNo
Auto Sprinkler System In Required AreasYes

Ratings for Wellspring Lutheran Services

Wellspring Lutheran Services
was reviewed by Medicare to have a rating of 2 out of 5. About Medicare Ratings
Overall Rating
Health Inspections Rating
Quality Measures Rating
Staff Rating
RN Staff Rating

Overall Ratings of Michigan Nursing Homes

Fines, Complaints, and Inspection Problems in the Past 3 Years

Compare The Number of Problems

Types of Problems at Nursing Homes

Some issues within a nursing home are much more severe than others. Medicare evaluates each problem based on 2 scales: the number of residents affected by a problem and the severity of the potential or actual harm to residents based on the problem. We have color coded the matrix below to make it easier to pick out the more severe problems. In general, orange and red issues related to the treatment of a resident are considered substandard quality of care.

  Residents Affected
Severity of the Deficiency Few Some Many
Immediate jeopardy to resident health or safety J K L
Actual harm that is not immediate jeopardy G H I
No actual harm with potential for more than minimal harm that is not immediate jeopardy D E F
No actual harm with potential for minimal harm A B C

June 18, 2015 - 18 months ago

 Residents AffectedSeveritySource/TypeDescription
---Fine$5,200 fine
JFewImmediate JeopardyComplaintEnsure that a nursing home area is free from accident hazards and provide adequate supervision to prevent avoidable accidents.

May 21, 2015 - 2 years ago

 Residents AffectedSeveritySource/TypeDescription
ESomePotential for HarmComplaintHave enough nurses to care for every resident in a way that maximizes the resident's well being.
DFewPotential for HarmComplaintAssist those residents who need help with eating/drinking, grooming and personal and oral hygiene.
DFewPotential for HarmComplaint1) 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.

March 27, 2015 - 2 years ago

 Residents AffectedSeveritySource/TypeDescription
FManyPotential for HarmComplaint+InspectionStore, cook, and serve food in a safe and clean way.
ESomePotential for HarmComplaint+InspectionMaintain drug records and properly mark/label drugs and other similar products according to accepted professional standards.
DFewPotential for HarmComplaint+InspectionEnsure that residents with limited range of motion receive appropriate treatment and services to increase range of motion or prevent further decrease in range of motion.
DFewPotential for HarmComplaint+InspectionHave a program that investigates, controls and keeps infection from spreading.
DFewPotential for HarmComplaint+InspectionAssist those residents who need help with eating/drinking, grooming and personal and oral hygiene.
DFewPotential for HarmComplaint+InspectionHelp and prepare each resident for a safe and easy discharge or transfer from the nursing home.
DFewPotential for HarmFire Safety InspectionSmoke barrier doors that can resist smoke for at least 20 minutes.
DFewPotential for HarmFire Safety InspectionPortable fire extinguishers.
DFewPotential for HarmFire Safety InspectionProperly installed electrical wiring and equipment.
DFewPotential for HarmComplaint+InspectionKeep residents' personal and medical records private and confidential.
DFewPotential for HarmFire Safety InspectionExit doors that are held open by devices that will automatically close on the activation of a fire alarm or smoke detector.

September 8, 2014 - 2 years ago

 Residents AffectedSeveritySource/TypeDescription
ESomePotential for HarmComplaintProvide care for residents in a way that maintains or improves their dignity and respect in full recognition of their individuality.

February 27, 2014 - 3 years ago

 Residents AffectedSeveritySource/TypeDescription
FManyPotential for HarmFire Safety InspectionProper medical gas storage and administration areas.
FManyPotential for HarmFire Safety InspectionAutomatic sprinkler systems that have been maintained in working order.
FManyPotential for HarmHealth InspectionStore, cook, and serve food in a safe and clean way.
ESomePotential for HarmFire Safety InspectionProperly installed hallway dispensers for alcohol-based hand rub.
ESomePotential for HarmHealth Inspection1) Provide 3 meals at regular times; 2) serve breakfast within 14 hours of dinner; and 3) offer a snack at bedtime each day.
ESomePotential for HarmFire Safety InspectionCorridor and hallway doors that block smoke.
CManyPotential for Minimal HarmHealth InspectionSet up an ongoing quality assessment and assurance group to review quality deficiencies quarterly, and develop corrective plans of action.
CManyPotential for Minimal HarmHealth InspectionDevelop 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.
DFewPotential for HarmHealth InspectionEnsure residents have the right to have a choice over activities, their schedules, and health care according to their interests, assessments, and plans of care.
DFewPotential for HarmHealth InspectionReasonably accommodate the needs and preferences of each resident.
DFewPotential for HarmHealth InspectionHave a program that investigates, controls and keeps infection from spreading.
DFewPotential for HarmHealth InspectionGive residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores.

December 6, 2013 - 3 years ago

 Residents AffectedSeveritySource/TypeDescription
---Fine$5,493 fine

October 11, 2013 - 3 years ago

 Residents AffectedSeveritySource/TypeDescription
---Fine$7,150 fine

April 4, 2013 - 4 years ago

 Residents AffectedSeveritySource/TypeDescription
---Fine$6,435 fine

Staffing Levels Per Resident per Day

Medicare determines the expected staffing time per resident per day depending on level of care the residents of Wellspring Lutheran Services require. It is important to compare the reported time to expected time for a single facility instead of comparing the amount of time per resident of two facilities. Learn why.

3hr 5min
2hr 35min
ReportedExpected
CNA
35min
40min
ReportedExpected
LPN
50min
1hr 10min
ReportedExpected
RN
4hr 35min
4hr 30min
ReportedExpected
Total Nursing

This facility also provides approximately 30min per resident per WEEK of physical therapist time.

Quality Measures for Long Stay Residents

94.7%
95.1%
95.1%
92.8%
Q1 2015Q2 2015Q3 2015MI
Assessed and Appropriately Given the Seasonal Influenza Vaccine
93.4%
93.3%
95.7%
93.6%
Q1 2015Q2 2015Q3 2015MI
Assessed and Appropriately Given the Pneumococcal Vaccine
84.6%
88.2%
75.8%
48.9%
Q1 2015Q2 2015Q3 2015MI
Low Risk Residents Who Lose Control of Their Bowel or Bladder
4.1%
6.8%
8.8%
13.8%
Q1 2015Q2 2015Q3 2015MI
Received an Antipsychotic Medication
16.9%
14.7%
11.1%
14.1%
Q1 2015Q2 2015Q3 2015MI
Need for Help with ADLs has Increased
-
14.2%
-
8.2%
Q1 2015Q2 2015Q3 2015MI
* The data for this facility for some quarters is unavailable.
Self Report Moderate to Severe Pain
8.3%
5.5%
11.9%
7.9%
Q1 2015Q2 2015Q3 2015MI
Lose Too Much Weight
4.8%
4.8%
1.7%
5.9%
Q1 2015Q2 2015Q3 2015MI
High Risk Residents With Pressure Ulcers
2.8%
4.3%
4.6%
3.3%
Q1 2015Q2 2015Q3 2015MI
Have Depressive Symptoms
9.6%
9.5%
6.0%
4.9%
Q1 2015Q2 2015Q3 2015MI
With a Urinary Tract Infection
2.6%
2.7%
1.4%
3.0%
Q1 2015Q2 2015Q3 2015MI
Experiencing One or More Falls with Major Injury
3.9%
9.9%
4.5%
3.4%
Q1 2015Q2 2015Q3 2015MI
With a Catheter Inserted and Left in Their Bladder
10.5%
9.3%
14.3%
1.1%
Q1 2015Q2 2015Q3 2015MI
Were Physically Restrained

Quality Measures for Short Stay Residents

84.1%
86.6%
84.6%
81.6%
Q1 2015Q2 2015Q3 2015MI
Assessed and Appropriately Given the Pneumococcal Vaccine
84.1%
84.0%
84.0%
80.9%
Q1 2015Q2 2015Q3 2015MI
Were Assessed and Appropriately Given the Seasonal Influenza Vaccine
1.9%
10.3%
25.0%
18.0%
Q1 2015Q2 2015Q3 2015MI
Self Report Moderate to Severe Pain
1.0%
0.0%
2.2%
1.8%
Q1 2015Q2 2015Q3 2015MI
Newly Received an Antipsychotic Medication
2.7%
3.2%
0.0%
1.1%
Q1 2015Q2 2015Q3 2015MI
With Pressure Ulcers That Are New or Worsened