Berthoud Care and Rehabilitation: Data Analysis and Ratings
CMS Five Star Rating(3 out of 5):
855 FRANKLIN AVE BERTHOUD, CO 80513
970-532-2683
Data date: April 01, 2023
Get Monthly Updates for this Facility
CMS has identified this facility as either having actual cases of abuse or has decided that abuse is possible.
The Most Important Data about Berthoud Care and Rehabilitation
We've looked at a lot of nursing homes, this is what we think you need to see first and if you don't want to spend a lot of time. (It's the tl;dr section.)
CMS has identified this facility as either having actual cases of abuse or has decided that abuse is possible.
CMS 5-Star Overall Rating:
(3 out of 5):
(The national average overall star rating is 3 stars.)
Current Trend: Improving
Total Nursing Hours Spent Per Resident Per Day: 3.06
(The national average is 3.74 )
According to our analysis, Berthoud Care and Rehabilitation is ranked #16 out of 35 skilled nursing homes within a 25 mile radius. See detailed information from recent inspection reports, nursing hours analysis, surverys, and information on owners and operators. Click here to view the ranked list of nursing homes near Berthoud Care and Rehabilitation.
What is this page all about?
Below is everything shred of information that we can find about Berthoud Care and Rehabilitation, along with our best effort to make sense of the data. Our purpose here is to help you to make good decisions when picking a nursing home and to keep you informed once you have chosen a home. We know from personal experience that choosing a nursing home is not something you do once and then you forget about it. In fact, it gets worse. Once you select a nursing home and get through the initial steps of figuring out how to pay for it, then the real worries start. Are they taking good care of me or my loved one? This is the question that will keep you up at night: Can I really trust these people? We wish we could answer this question, we can't. What he can do is churn through the tons of data and try and help you to make sense of it. We hope it helps.
General Data Card
These are the basic data points for the facility.
Data date: April 01, 2023
Address: 855 FRANKLIN AVE
BERTHOUD, CO 80513
Phone: 970-532-2683
Ranking: Berthoud Care and Rehabilitation is ranked #3 out of 9 facilities within a 10 mile radius and #16 out of 35 facilities within a 25 mile radius.
Medicare Provider Number: 065265
Participating in Medicare Since: October 01, 1989
No. of Certified Beds: 74
No. of Residents: 66
Occupancy: 89.19 % (as of 05/21/2023 )
Amount fined in recent period: $21,136.70
Complaints filed: 6
Ratings History for Berthoud Care and Rehabilitation
Review of Berthoud Care and Rehabilitation Ratings and Inspection Scores
CMS regularly inspects every skilled nursing facility. (The timing is supposed to be annually, but since the beginning of the Covid pandemic, these inspections have not occured as frequently.) The results of the multi-day inspection is reduced to a series of scores which are then translated into the star ratings. The health inspection scores are an absolute value, so you can compare one facility's score directly to another. The Overall Star rating is based on the facility's performance as compared to other facilities in the same state, so you cannot easily compare one facility's Overall star rating to a facility in another state.
Ratings
| Overall Rating | 3: |
| Health Inspection Rating | 2: |
| Quality Rating | 5: |
| Staffing Rating | 2: |
Inspection Scores
| Cycle 1 Score (as of November 09, 2021) | 44 |
| Cycle 2 Score (as of January 30, 2020) | 60 |
| Cycle 3 Score (as of February 21, 2019) | 40 |
| Weighted All Cycles Score | 49 |
It has been 16 months since the most recent inspection.
What Goes Into the Nursing Home's 5-Star Rating
CMS has put a lot of effort into creating its very elaborate 5-Star Quality Rating System specifically to provide a quick way for residents and family members to easily understand how well a nursing home is performing and to make comparing nursing homes easier. The rating system allows people to easily compare facilities across numerous dimensions with the express purpose of identifying the best and best performing nursing homes. The rating system was initially developed in 2008 and the methodologies are regularly reviewed and updated.
The rating system has five separate ratings including:
- Overall rating
- Health Inspection rating
- Staff rating
- RN Staffing rating
- Quality Measures rating
Nursing homes are rated from 1-star to 5-stars with 1-star being the best rating and 5-star being the best rating. For the Health Inspection Rating the nursing homes in each state are ranked based on their weighted three year inspection score. The top 10 percent of nursing homes (those with the lowest scores) are awarded a 5-star rating; the bottom 20 percent (those with the highest scores) are awarded a 1-star rating. In between 1-star and 5-star, the remaining homes are divided equally into three tranches which correspond with the stars 2 to 4. The staff ratings and quality measure ratings follow a similar process but the divisions are based on a national ranking. The division between star ratings is called the “cut-rate”. Cut-rates are redefined periodically and are published by CMS. See the latest cut rates on this table.
Calculating the Overall Star Rating is done differently. According to CMS, the reason for adopting a different system is to give the Health Inspection Rating higher weight in the Overall Rating. So, since there are FIVE ratings and FIVE stars for each rating, there must also be a FIVE step process to calculate the Overall Rating (so symetrical!) :
- Begin with the Health Inspection Rating
- Add one star to the Health Inspection Rating if the Staffing Rating is at least four-stars and is higher than the Health Inspection Rating. (We will call this the "Adjusted Rating".)
- Subtract one star from the Health Inspection Rating if the Staffing Rating is one-star.
- Add a star to the Adjusted Rating if the Quality Measure Rating is 5-stars.
- Subtract one star from the Adjusted Rating if the Quality Measure Rating is 1-star.
Throughout the calculation of the Overall Rating, the rating cannot exceed 5-stars. The Overall Rating is capped at 2-stars if the Health Inspection rating is 1-star. No Overall Rating is awarded if the nursing home does not have a Health Inspection Rating (This effectively means that a nursing home is not rated until the home has been operating for more than two years.)
Changes in a nursing homes star rating can be due to the results of a new health inspection report, the processing of new complaints, the aging of older complaints, a new inspection control survey, a revisit, or the resolution of disputes that change the scope and or severity of deficiencies.
Most Recent Nursing Home Inspections
CMS is required to inspect each senior nursing facility at least annually. These inspections take several days. Additional follow-up inspections as conducted as needed or for certain purposes. Inspections stopped for more than seven months in 2020 due to the Covid pandemic. That stoppage has caused all inspections to be delayed as the inspectors continue to deal with a backlog. The table below shows the latest inspections for Berthoud Care and Rehabilitation including health, fire, and inspection control inspections:
| Inspection Type | Inspection Date |
|---|---|
| Fire Safety Standard | November 23, 2021 |
| Fire Safety Standard | February 26, 2020 |
| Fire Safety Standard | March 21, 2019 |
| Health Complaint | November 09, 2021 |
| Health Standard | November 09, 2021 |
| Health Standard | January 30, 2020 |
| Health Standard | February 21, 2019 |
| Infection Control | February 03, 2021 |
| Infection Control | December 16, 2020 |
| Infection Control | April 02, 2020 |
Owner and Operator Information for Berthoud Care and Rehabilitation
Our database of owners and operators shows all direct owners of the nursing nurse, any managers and directors, and the most adjacent indirect owners of the facility (that is, if the direct owner is company, then the owners of that company.) Lists of nursing home owners are available and you can search for nursing home owners and operators on our site.
Business Entity Name:
FRANKLIN AVENUE HEALTHCARE INC.
Owners:
- ENDURA HEALTHCARE LLC (DIRECT- 100%)
- THE ENSIGN GROUP INC (INDIRECT)
Managers and Directors:
- EDDY BOYLES (OFFICER)
- SOON BURNAM (OFFICER)
- CRAIG FITCH (OFFICER)
- JOSEPH GRAHAM (OPERATIONAL/MANAGERIAL CONTROL)
- JOSEPH GRAHAM (MANAGING EMPLOYEE)
- DAVID JORGENSEN (DIRECTOR)
Analysis of Nursing Hours Spent Per Patient
CMS provides detailed information about how long nursing staff spends with residents. This data includes nursing subcategories of Registered Nurse, Licensed Practical Nurse, and non-nursing Certified Nursing Assistants. More hours spend per patient should can indicate a better facility or it could indicate more complicated situations.
The nursing staff of Berthoud Care and Rehabilitation spends LESS time on average with its residents than the state average and LESS time than the national average for total nursing homes spent per resident.
| Type | Facility | State / National Avg |
|---|---|---|
| Registered Nurse (RN) | ||
| Hours | 0.82 | 0.83 / 0.65 |
| Case Mix | 0.34 | 0.36 / 0.39 |
| Adjusted | 0.94 | NA / NA |
| Licensed Practical Nurse (LPN) | ||
| Hours | 0.49 | 0.69 / 0.88 |
| Case Mix | 0.71 | NA / NA |
| Adjusted | 0.51 | NA / NA |
| Certified Nursing Assistants (CNA) | ||
| Hours | 1.76 | 2.15 / 2.21 |
| Case Mix | 1.97 | NA / NA |
| Adjusted | 1.82 | NA / NA |
| Total Licensed Staff | ||
| Hours | 1.30 | 1.53 / 1.53 |
| Physical Therapist (PT) | ||
| Hours | 0.09 | 0.08 / 0.07 |
| Total Nursing Homes Spent per Resident on Average | ||
| Hours | 3.06 | 3.68 / 3.74 |
| Case Mix | 3.01 | 3.03 / 3.16 |
| Adjusted | 3.21 | NA / NA |
Quality Measures
Quality measures are based both on patient survey information and on the results of actual claims that are filed with CMS. It is not clear what period is covered in the measures.
| Desc. | Perc. | State Avg. / Comparison |
|---|---|---|
| Percentage of short-stay residents who were rehospitalized after a nursing home admission (qm521) | 20.0% |
19.4% Worse |
| Percentage of short-stay residents who had an outpatient emergency department visit (qm522) | 8.2% |
12.6% Better |
| Number of hospitalizations per 1000 long-stay resident days (qm551) | 2.4% |
1.3% Worse |
| Number of outpatient emergency department visits per 1000 long-stay resident days (qm552) | 0.9% |
1.0% Better |
| Percentage of long-stay residents whose need for help with daily activities has increased (qm401) | 12.0% |
15.3% Better |
| Percentage of long-stay residents who lose too much weight (qm404) | 3.3% |
6.2% Better |
| Percentage of low risk long-stay residents who lose control of their bowels or bladder (qm405) | 57.8% |
47.6% Worse |
| Percentage of long-stay residents with a catheter inserted and left in their bladder (qm406) | 0.0% |
2.0% Better |
| Percentage of long-stay residents with a urinary tract infection (qm407) | 0.0% |
2.0% Better |
| Percentage of long-stay residents who have depressive symptoms (qm408) | 20.5% |
3.8% Worse |
| Percentage of long-stay residents who were physically restrained (qm409) | 0.0% |
0.1% Better |
| Percentage of long-stay residents experiencing one or more falls with major injury (qm410) | 2.8% |
3.7% Better |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine (qm415) | 89.3% |
86.9% Better |
| Percentage of long-stay residents who received an antipsychotic medication (qm419) | 21.2% |
17.7% Worse |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine (qm430) | 83.9% |
70.7% Better |
| Percentage of short-stay residents who newly received an antipsychotic medication (qm434) | 0.6% |
1.8% Better |
| Percentage of long-stay residents whose ability to move independently worsened (qm451) | 10.8% |
15.8% Better |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication (qm452) | 14.0% |
12.3% Worse |
| Percentage of high risk long-stay residents with pressure ulcers (qm453) | 3.6% |
5.8% Better |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine (qm454) | 83.3% |
93.6% Worse |
| Percentage of short-stay residents who made improvements in function (qm471) | 91.7% |
75.7% Better |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine (qm472) | 55.0% |
68.8% Worse |
Berthoud Care and Rehabilitation Violations, Complaints and Fines
These are complaints and fines that are reported by CMS. Some of the data is not very recent, but we have decided to include it here so that you have as much information as possible.
Amount fined in recent period: $21,136.70, Complaints filed: 6
| Deficiency | Deficiency Date / Date Corrected |
|---|---|
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. (Health) | 02-21-2019 / 03-23-2019 |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. (Health) | 02-21-2019 / 03-23-2019 |
| Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. (Health) | 02-21-2019 / 03-23-2019 |
| Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. (Health) | 02-21-2019 / 03-23-2019 |
| Provide and implement an infection prevention and control program. (Health) | 02-21-2019 / 03-23-2019 |
| Provide exit doors that are held open by devices that will automatically close on the activation of a fire alarm or smoke detector. (Fire Safety) | 03-21-2019 / 04-30-2019 |
| Meet other general requirements that are deficient. (Fire Safety) | 03-21-2019 / 04-30-2019 |
| Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system. (Fire Safety) | 03-21-2019 / 04-30-2019 |
| Inspect, test, and maintain automatic sprinkler systems. (Fire Safety) | 03-21-2019 / 04-30-2019 |
| Properly select, install, inspect, or maintain portable fire extinguishes. (Fire Safety) | 03-21-2019 / 04-30-2019 |
| Install corridor and hallway doors that block smoke. (Fire Safety) | 03-21-2019 / 04-30-2019 |
| Have elevators that firefighters can control in the event of a fire. (Fire Safety) | 03-21-2019 / 04-30-2019 |
| Have generator or other power source capable of supplying service within 10 seconds. (Fire Safety) | 03-21-2019 / 04-30-2019 |
| Ensure proper usage of power strips and extension cords. (Fire Safety) | 03-21-2019 / 04-30-2019 |
| Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. (Health) | 01-30-2020 / 03-04-2020 |
| Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. (Health) | 01-30-2020 / 03-04-2020 |
| Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment. (Health) | 01-30-2020 / 03-04-2020 |
| Provide care and assistance to perform activities of daily living for any resident who is unable. (Health) | 01-30-2020 / 03-04-2020 |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. (Health) | 01-30-2020 / 03-04-2020 |
| Observe each nurse aide's job performance and give regular training. (Health) | 01-30-2020 / 03-04-2020 |
| Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. (Health) | 01-30-2020 / 03-04-2020 |
| Provide and implement an infection prevention and control program. (Health) | 01-30-2020 / 03-04-2020 |
| Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. (Health) | 01-30-2020 / 03-04-2020 |
| Conduct testing and exercise requirements. (Fire Safety) | 01-30-2020 / 03-04-2020 |
| Have exits that are accessible at all times. (Fire Safety) | 02-26-2020 / 05-01-2020 |
| Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system. (Fire Safety) | 02-26-2020 / 04-15-2020 |
| Provide properly protected cooking facilities. (Fire Safety) | 02-26-2020 / 04-15-2020 |
| Have approved installation, maintenance and testing program for fire alarm systems. (Fire Safety) | 02-26-2020 / 04-15-2020 |
| Inspect, test, and maintain automatic sprinkler systems. (Fire Safety) | 02-26-2020 / 05-26-2020 |
| Properly select, install, inspect, or maintain portable fire extinguishes. (Fire Safety) | 02-26-2020 / 04-15-2020 |
| Install corridor and hallway doors that block smoke. (Fire Safety) | 02-26-2020 / 04-15-2020 |
| Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions. (Fire Safety) | 02-26-2020 / 04-06-2020 |
| Have simulated fire drills held at unexpected times. (Fire Safety) | 02-26-2020 / 06-16-2020 |
| Have restrictions on the use of highly flammable decorations. (Fire Safety) | 02-26-2020 / 04-15-2020 |
| Meet requirements for the installation and maintenance of electrical systems. (Fire Safety) | 02-26-2020 / 04-15-2020 |
| Provide and implement an infection prevention and control program. (Health) | 12-16-2020 / 01-14-2021 |
| Ensure services provided by the nursing facility meet professional standards of quality. (Health) | 02-03-2021 / 03-05-2021 |
| Protect each resident from separation (from other residents, his/her room, or confinement to his/her room). (Health) | 11-09-2021 / 11-09-2021 |
| Provide and implement an infection prevention and control program. (Health) | 11-09-2021 / 12-08-2021 |
| Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. (Health) | 11-09-2021 / 12-08-2021 |
| Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. (Health) | 11-09-2021 / 12-08-2021 |
| Provide care and assistance to perform activities of daily living for any resident who is unable. (Health) | 11-09-2021 / 12-08-2021 |
| Provide appropriate treatment and care according to orders, resident?s preferences and goals. (Health) | 11-09-2021 / 12-08-2021 |
| Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. (Health) | 11-09-2021 / 12-08-2021 |
| Provide properly protected cooking facilities. (Fire Safety) | 11-23-2021 / 12-26-2021 |
| Inspect, test, and maintain automatic sprinkler systems. (Fire Safety) | 11-23-2021 / 12-26-2021 |
| Install corridor and hallway doors that block smoke. (Fire Safety) | 11-23-2021 / 12-26-2021 |
| Ensure smoke barriers are constructed to a 1 hour fire resistance rating. (Fire Safety) | 11-23-2021 / 12-26-2021 |
| Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions. (Fire Safety) | 11-23-2021 / 12-13-2021 |
| Have simulated fire drills held at unexpected times. (Fire Safety) | 11-23-2021 / 12-26-2021 |
Hospitals Near Berthoud Care and Rehabilitation
Quite often skilled nursing facilities and hospitals work closely together to help patients recover or manage a terminal illness. Hospitals deals with acute care while nursing homes treat patients for a longer period of time. New residents at skilled nursing homes typically come from a hospital and nursing home residents may be readmitted to a hospital if their recovery does not proceed well. (Hospital readmission rates are closely monitored by CMS.) Consequently it is important that you consider which hospitals are near a nursing home which choosing one. Below is a list of hospitals near Berthoud Care and Rehabilitation.
This information is based on the most recent Hospital data. Historical data is not available.
| Hospital | 5-Star Overall Rating |
|---|---|
|
NORTH COLORADO MEDICAL CENTER 1801 16TH ST GREELEY, CO 80631 |
2 |
|
CENTURA LONGMONT UNITED HOSPITAL 1950 MOUNTAIN VIEW AVE LONGMONT, CO 80501 |
3 |
|
CENTURA HEALTH-AVISTA ADVENTIST HOSPITAL 100 HEALTH PARK DR LOUISVILLE, CO 80027 |
3 |
|
PLATTE VALLEY MEDICAL CENTER 1600 PRAIRIE CENTER PKWY BRIGHTON, CO 80601 |
4 |
|
MCKEE MEDICAL CENTER 2000 BOISE AVE LOVELAND, CO 80538 |
4 |
|
GOOD SAMARITAN MEDICAL CENTER LLC 200 EXEMPLA CIR LAFAYETTE, CO 80026 |
4 |
|
POUDRE VALLEY HOSPITAL 1024 S LEMAY AVE FORT COLLINS, CO 80524 |
5 |
|
BOULDER COMMUNITY HEALTH 4747 ARAPAHOE AVE BOULDER, CO 80303 |
5 |
|
CENTURA HEALTH-ST ANTHONY NORTH HEALTH CAMPUS 14300 ORCHARD PKWY WESTMINSTER, CO 80023 |
5 |
|
MEDICAL CENTER OF THE ROCKIES 2500 ROCKY MOUNTAIN AVE LOVELAND, CO 80538 |
5 |
|
LONGS PEAK HOSPITAL 1750 E KEN PRATT BLVD LONGMONT, CO 80504 |
5 |
|
BANNER FORT COLLINS MEDICAL CENTER 4700 LADY MOON DR FORT COLLINS, CO 80528 |
Not Available |
|
UCHEALTH GREELEY HOSPITAL 6767 W 29TH ST GREELEY, CO 80634 |
Not Available |
|
ESTES PARK MEDICAL CENTER 555 PROSPECT AVE ESTES PARK, CO 80517 |
Not Available |
|
CENTENNIAL PEAKS HOSPITAL 2255 S 88TH ST LOUISVILLE, CO 80027 |
Not Available |
|
JOHNSTOWN HEIGHTS BEHAVIORAL HEALTH LLC 4770 LARIMER PKWY JOHNSTOWN, CO 80534 |
Not Available |
Medical Professionals Associated with Berthoud Care and Rehabilitation
These are the doctors who are affiliated with Berthoud Care and Rehabilitation. The data is from the most recent period. Historical data is not available.
Detailed Analysis Pages:
Depending on the nursing home, this page can get really long. So, we have also broken up the data onto separate pages to allow you to find what you want more easily. We will keep adding to these pages as we continue to analyze the nursing home database.
CMS Five Star Ratings and Quality Measures for Berthoud Care and Rehabilitation
Five different rating results plus detailed inspection numbers and quality measures for Berthoud Care and Rehabilitation.
Covid Infections at Berthoud Care and Rehabilitation
This report is updated weekly and shows new and historical infection levels.
Nursing Hours Analysis for Berthoud Care and Rehabilitation
How long a nurse spends with a resident can be an important factor in their recovery. This page shows the average nursing hours spent per resident for RNs, LPNs, CNAs, PTs and all licensed staff.
Ownership Details for Berthoud Care and Rehabilitation
A list of all of the registered owners for Berthoud Care and Rehabilitation. This includes direct and indirect owners and managers.
Noted Deficiencies for Berthoud Care and Rehabilitation
A list of all of the deficiencies for the facility. This includes a description, type of deficiency, incident date and when the facility reports that the incident was corrected.
Comparison Ranking of Nearby Skilled Nursing Facilities
How does Berthoud Care and Rehabilitation compare to other skilled nursing facilities? This list shows the competitive set within a 25 mile radius.
Best Nursing Homes in BERTHOUD, CO
Homes that you should consider. A list ranking the best skilled nursing facilities in BERTHOUD based on their weighted inspection score as of April 01, 2023.
Worst Nursing Homes in BERTHOUD, CO
Homes that you avoid if possible. A list ranking the worst skilled nursing facilities in BERTHOUD based on their weighted inspection score as of April 01, 2023.
Other Data Periods:
Data on Berthoud Care and Rehabilitation is available for the following periods:
