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Willowbrook Nursing Center

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About Willowbrook Nursing Center

General Information

Legal Business NameNacogdoches Csnhc Enterprises, LLC
Ownership TypeFor Profit - Individual
Changed Ownership In The Last 12 MonthsNo
First Accepted MedicareApril 28, 1987 (30 years)
Capacity166
Residents88
Percent Occupied53%
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 Willowbrook Nursing Center

Willowbrook Nursing Center
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 Texas 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

November 17, 2016 - 7 months ago

 Residents AffectedSeveritySource/TypeDescription
FManyPotential for HarmComplaint+InspectionMake sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
FManyPotential for HarmHealth InspectionKeep all essential equipment working safely.
FManyPotential for HarmHealth InspectionStore, cook, and serve food in a safe and clean way.

November 10, 2016 - 8 months ago

 Residents AffectedSeveritySource/TypeDescription
ESomePotential for HarmComplaintProvide care by qualified persons according to each resident's written plan of care.

December 2, 2015 - 2 years ago

 Residents AffectedSeveritySource/TypeDescription
---Fine$1,551 fine
---Payment DenialPayment denial for 3 days
FManyPotential for HarmComplaint+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.
FManyPotential for HarmHealth InspectionDevelop a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
FManyPotential for HarmHealth InspectionLet residents refuse treatment, refuse to take part in an experiment, or formulate advance directives.
FManyPotential for HarmHealth Inspection1) 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.
GFewActual HarmComplaint+InspectionEnsure that a nursing home area is free from accident hazards and provide adequate supervision to prevent avoidable accidents.
ESomePotential for HarmHealth InspectionProvide routine and emergency drugs through a licensed pharmacist and only under the general supervision of a licensed nurse.
ESomePotential for HarmHealth InspectionMake sure that special or therapeutic diets are ordered by the attending doctor.
ESomePotential for HarmHealth InspectionMake sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
ESomePotential for HarmHealth InspectionMaintain comfortable and safe temperature levels.
ESomePotential for HarmHealth InspectionProvide care for residents in a way that maintains or improves their dignity and respect in full recognition of their individuality.
ESomePotential for HarmHealth InspectionReasonably accommodate the needs and preferences of each resident.
ESomePotential for HarmHealth InspectionProvide adequate and comfortable lighting levels in all areas.
ESomePotential for HarmHealth InspectionProvide food in a way that meets a resident's needs.

June 11, 2015 - 2 years ago

 Residents AffectedSeveritySource/TypeDescription
ESomePotential for HarmComplaintAssist those residents who need help with eating/drinking, grooming and personal and oral hygiene.
ESomePotential for HarmComplaintGive proper treatment to residents with feeding tubes to prevent problems (such as aspiration pneumonia, diarrhea, vomiting, dehydration, metabolic abnormalities, nasal-pharyngeal ulcers) and help restore eating skills, if possible.
ESomePotential for HarmComplaintEnsure that a nursing home area is free from accident hazards and provide adequate supervision to prevent avoidable accidents.
ESomePotential for HarmComplaintProvide care by qualified persons according to each resident's written plan of care.
ESomePotential for HarmComplaintDevelop a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
ESomePotential for HarmComplaintProvide care for residents in a way that maintains or improves their dignity and respect in full recognition of their individuality.
ESomePotential for HarmComplaintEnsure residents have the right to have a choice over activities, their schedules, and health care according to their interests, assessments, and plans of care.
ESomePotential for HarmComplaintImmediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.

October 30, 2014 - 3 years ago

 Residents AffectedSeveritySource/TypeDescription
FManyPotential for HarmHealth InspectionKeep all essential equipment working safely.
FManyPotential for HarmHealth InspectionStore, cook, and serve food in a safe and clean way.
FManyPotential for HarmHealth InspectionPrepare food that is nutritional, appetizing, tasty, attractive, well-cooked, and at the right temperature.
FManyPotential for HarmHealth InspectionDevelop a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
ESomePotential for HarmHealth InspectionMake sure that nurse aides show they have the skills and techniques to be able to care for residents' needs.
ESomePotential for HarmHealth InspectionHave a program that investigates, controls and keeps infection from spreading.
ESomePotential for HarmHealth InspectionProvide routine and emergency drugs through a licensed pharmacist and only under the general supervision of a licensed nurse.
ESomePotential for HarmHealth InspectionProvide activities to meet the interests and needs of each resident.
ESomePotential for HarmHealth InspectionProvide care by qualified persons according to each resident's written plan of care.
ESomePotential for HarmHealth InspectionEnsure that each resident who enters the nursing home without a catheter is not given a catheter, unless medically necessary, and that incontinent patients receive proper services to prevent urinary tract infections and restore normal bladder functions.

October 14, 2014 - 3 years ago

 Residents AffectedSeveritySource/TypeDescription
ESomePotential for HarmComplaintAssist those residents who need help with eating/drinking, grooming and personal and oral hygiene.

Staffing Levels Per Resident per Day

Medicare determines the expected staffing time per resident per day depending on level of care the residents of Willowbrook Nursing Center 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.

2hr 25min
2hr 30min
ReportedExpected
CNA
40min
45min
ReportedExpected
LPN
30min
1hr 15min
ReportedExpected
RN
3hr 40min
4hr 30min
ReportedExpected
Total Nursing

This facility also provides approximately 5min per resident per WEEK of physical therapist time.

Quality Measures for Long Stay Residents

86.1%
97.6%
97.6%
97.6%
91.6%
Q4 2015Q1 2016Q2 2016Q3 2016TX
Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine
97.1%
98.7%
100.0%
100.0%
89.8%
Q4 2015Q1 2016Q2 2016Q3 2016TX
Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine
50.0%
48.7%
52.6%
65.6%
48.3%
Q4 2015Q1 2016Q2 2016Q3 2016TX
Percentage of low risk long-stay residents who lose control of their bowels or bladder
23.1%
16.2%
15.9%
19.4%
27.1%
Q4 2015Q1 2016Q2 2016Q3 2016TX
Percentage of long-stay residents who received an antianxiety or hypnotic medication
6.4%
5.9%
7.7%
11.6%
20.7%
Q4 2015Q1 2016Q2 2016Q3 2016TX
Percentage of long-stay residents whose ability to move independently worsened
26.9%
29.6%
28.4%
31.9%
19.1%
Q4 2015Q1 2016Q2 2016Q3 2016TX
Percentage of long-stay residents who received an antipsychotic medication
23.3%
20.0%
16.2%
14.1%
19.1%
Q4 2015Q1 2016Q2 2016Q3 2016TX
Percentage of long-stay residents whose need for help with daily activities has increased
11.5%
10.0%
5.3%
0.0%
7.0%
Q4 2015Q1 2016Q2 2016Q3 2016TX
Percentage of long-stay residents who self-report moderate to severe pain
4.5%
0.0%
3.8%
4.0%
6.0%
Q4 2015Q1 2016Q2 2016Q3 2016TX
Percentage of long-stay residents who lose too much weight
11.1%
13.7%
11.3%
13.2%
6.3%
Q4 2015Q1 2016Q2 2016Q3 2016TX
Percentage of high risk long-stay residents with pressure ulcers
13.3%
9.0%
9.3%
10.1%
4.9%
Q4 2015Q1 2016Q2 2016Q3 2016TX
Percentage of long-stay residents who have depressive symptoms
3.0%
1.3%
1.2%
4.0%
4.4%
Q4 2015Q1 2016Q2 2016Q3 2016TX
Percentage of long-stay residents with a urinary tract infection
1.4%
1.3%
1.2%
2.7%
3.6%
Q4 2015Q1 2016Q2 2016Q3 2016TX
Percentage of long-stay residents experiencing one or more falls with major injury
9.3%
6.8%
3.2%
2.5%
2.7%
Q4 2015Q1 2016Q2 2016Q3 2016TX
Percentage of long-stay residents with a catheter inserted and left in their bladder
0.0%
0.0%
0.0%
0.0%
0.4%
Q4 2015Q1 2016Q2 2016Q3 2016TX
Percentage of long-stay residents who were physically restrained

Quality Measures for Short Stay Residents

87.7%
90.4%
73.0%
79.8%
74.0%
Q4 2015Q1 2016Q2 2016Q3 2016TX
Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine
17.5%
78.8%
78.8%
78.8%
71.0%
Q4 2015Q1 2016Q2 2016Q3 2016TX
Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine
34.5%
28.7%
36.6%
33.6%
55.7%
Q4 2015Q1 2016Q2 2016Q3 2016TX
Percentage of short-stay residents who made improvements in function
25.8%
20.0%
24.1%
12.6%
14.2%
Q4 2015Q1 2016Q2 2016Q3 2016TX
Percentage of short-stay residents who self-report moderate to severe pain
2.4%
1.4%
1.2%
1.2%
3.1%
Q4 2015Q1 2016Q2 2016Q3 2016TX
Percentage of short-stay residents who newly received an antipsychotic medication
0.0%
0.0%
1.5%
1.4%
1.0%
Q4 2015Q1 2016Q2 2016Q3 2016TX
Percentage of short-stay residents with pressure ulcers that are new or worsened