Bethel Lutheran Nursing & Rehabilitation Center - 4-Star Rehab Facility in Williston, ND | PlacetClinical Quality Indicators
Long-stay residents , lower is better
Antipsychotic medication use 16.12%Falls causing major injury 6.85%Pressure ulcers (high-risk) 12.52%Admissions Contacts
No admissions contacts on file yet.
CMS Star Ratings
⚠️ Last inspected: Feb 2025 (485 days ago)🔍 Health Inspection
4/5
★★★★☆
📊 Quality Measures
3/5
★★★☆☆
Medicare
Source: CMS MDS Quality Measures. Updated quarterly.
State avg: 55 min · US avg: 41 min
Total Nurse / Resident / Day
4h 9m
State avg: 4h 25m · US avg: 3h 53m
0 min
State avg: 2 min · US avg: 4 min
59 per 100
State avg: 49 per 100 · US avg: 46 per 100
Weekend Staffing (PBJ Q3 2024)
Weekend vs. Weekday RN
71%above avg
US avg: 64%
Total Nurse Weekend
4h 59m
Federal Penalties
No federal penalties in the past 3 years.
✅ No penalty records on file
Inspection Citations
Survey: February 5, 2025(6 citations)
🟡 Potential for HarmResident Rights DeficienciesComplaint
🟡 Potential for HarmResident Assessment and Care Planning DeficienciesComplaint
🟡 Potential for HarmResident Rights DeficienciesComplaint
🟡 Potential for HarmResident Assessment and Care Planning DeficienciesComplaint
🟡 Potential for HarmResident Rights DeficienciesComplaint
🟡 Potential for HarmResident Assessment and Care Planning DeficienciesComplaint
Survey: February 7, 2024(3 citations)
🟠 Actual HarmQuality of Life and Care DeficienciesComplaint
🟠 Actual HarmQuality of Life and Care DeficienciesComplaint
🟠 Actual HarmQuality of Life and Care DeficienciesComplaint
Survey: December 7, 2023(24 citations)
🟡 Potential for HarmResident Rights Deficiencies
🟡 Potential for HarmResident Assessment and Care Planning Deficiencies
🟡 Potential for HarmResident Assessment and Care Planning Deficiencies
🟡 Potential for HarmQuality of Life and Care Deficiencies
🟡 Potential for HarmPharmacy Service Deficiencies
🟡 Potential for HarmPharmacy Service Deficiencies
🟡 Potential for HarmAdministration Deficiencies
Survey: November 17, 2022(30 citations)
🟡 Potential for HarmResident Rights Deficiencies
🟡 Potential for HarmQuality of Life and Care Deficiencies
🟡 Potential for HarmQuality of Life and Care Deficiencies
🟡 Potential for HarmQuality of Life and Care Deficiencies
🟡 Potential for HarmNursing and Physician Services Deficiencies
🟡 Potential for HarmPharmacy Service Deficiencies
🟡 Potential for HarmPharmacy Service Deficiencies
17.1 per 100
State avg: 20.9 · US avg: 23.9
9.6 per 100
State avg: 10.6 · US avg: 12.0
6.9 per 100
State avg: 5.1 · US avg: 3.3
12.5 per 100
State avg: 5.3 · US avg: 5.1
0.0 per 100
State avg: 2.0 · US avg: 1.6
82.8 per 100
State avg: 88.6 · US avg: 79.7
Rates shown per 100 patients · Green = better than average · Amber = average · Red = below average
VBP Performance Score
38/100
Incentive Payment
-0.88% penalty
Healthcare-Assoc. Infections
7.5 per 100
Higher performance scores lead to payment bonuses. Lower scores indicate risk of readmission penalties.
Avg Length of Stay
40.2 days
Avg Payment / Stay
$15,048.08
Patient Complexity
2.09 × avg
Avg LOS 15-30 days is typical for short-term rehab · Patient complexity = HCC risk score (1.0 = national average; higher = sicker patient mix)
🟡 Potential for HarmInfection Control Deficiencies
🟡 Potential for HarmResident Rights Deficiencies
🟡 Potential for HarmResident Assessment and Care Planning Deficiencies
🟡 Potential for HarmResident Assessment and Care Planning Deficiencies
🟡 Potential for HarmQuality of Life and Care Deficiencies
🟡 Potential for HarmPharmacy Service Deficiencies
🟡 Potential for HarmPharmacy Service Deficiencies
🟡 Potential for HarmAdministration Deficiencies
🟡 Potential for HarmInfection Control Deficiencies
🟡 Potential for HarmResident Rights Deficiencies
🟡 Potential for HarmResident Assessment and Care Planning Deficiencies
🟡 Potential for HarmResident Assessment and Care Planning Deficiencies
🟡 Potential for HarmQuality of Life and Care Deficiencies
🟡 Potential for HarmPharmacy Service Deficiencies
🟡 Potential for HarmPharmacy Service Deficiencies
🟡 Potential for HarmAdministration Deficiencies
🟡 Potential for HarmInfection Control Deficiencies
🟡 Potential for HarmPharmacy Service Deficiencies
🔴 Immediate JeopardyNutrition and Dietary Deficiencies
🟡 Potential for HarmInfection Control Deficiencies
🟡 Potential for HarmResident Rights Deficiencies
🟡 Potential for HarmQuality of Life and Care Deficiencies
🟡 Potential for HarmQuality of Life and Care Deficiencies
🟡 Potential for HarmQuality of Life and Care Deficiencies
🟡 Potential for HarmNursing and Physician Services Deficiencies
🟡 Potential for HarmPharmacy Service Deficiencies
🟡 Potential for HarmPharmacy Service Deficiencies
🟡 Potential for HarmPharmacy Service Deficiencies
🔴 Immediate JeopardyNutrition and Dietary Deficiencies
🟡 Potential for HarmInfection Control Deficiencies
🟡 Potential for HarmResident Rights Deficiencies
🟡 Potential for HarmQuality of Life and Care Deficiencies
🟡 Potential for HarmQuality of Life and Care Deficiencies
🟡 Potential for HarmQuality of Life and Care Deficiencies
🟡 Potential for HarmNursing and Physician Services Deficiencies
🟡 Potential for HarmPharmacy Service Deficiencies
🟡 Potential for HarmPharmacy Service Deficiencies
🟡 Potential for HarmPharmacy Service Deficiencies
🔴 Immediate JeopardyNutrition and Dietary Deficiencies
🟡 Potential for HarmInfection Control Deficiencies
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