Minnesota Nursing Homes >> Evansville Nursing Homes >> Evansville Care Center

Evansville Care Center - Evansville Nursing Home

General Information

UPDATE
Federal Provider Number
245510
Provider Name
EVANSVILLE CARE CENTER
Provider Address
649 STATE STREET NORTHWEST
EVANSVILLE, MN 56326
Provider Phone Number
2189482219
Provider SSA County
200
Provider County Name
Douglas
Ownership Type
For profit - Corporation
Number of Certified Beds
40
Number of Residents in Certified Beds
39
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
EVANSVILLE CARE CAMPUS LLC
Date First Approved to Provide Medicare and Medicaid services
1988-01-01
Continuing Care Retirement Community
Y
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Both
Automatic Sprinkler Systems in All Required Areas
Yes

Rating Detail Information

Overall Rating
4
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
2
QM Rating Footnote
Staffing Rating
3
Staffing Rating Footnote
RN Staffing Rating
3
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.09487
Reported LPN Staffing Hours per Resident per Day
0.93846
Reported RN Staffing Hours per Resident per Day
0.48333
Reported Licensed Staffing Hours per Resident per Day
1.42179
Reported Total Nurse Staffing Hours per Resident per Day
3.51666
Reported Physical Therapist Staffing Hours per Resident Per Day
0.02949
Expected CNA Staffing Hours per Resident per Day
2.32881
Expected LPN Staffing Hours per Resident per Day
0.59757
Expected RN Staffing Hours per Resident per Day
0.86341
Expected Total Nurse Staffing Hours per Resident per Day
3.78979
Adjusted CNA Staffing Hours per Resident per Day
2.20722
Adjusted LPN Staffing Hours per Resident per Day
1.30348
Adjusted RN Staffing Hours per Resident per Day
0.41828
Adjusted Total Nurse Staffing Hours per Resident per Day
3.74039
Cycle 1 Total Number of Health Deficiencies
1
Cycle 1 Number of Standard Health Deficiencies
1
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
4
Cycle 1 Standard Survey Health Date
2014-12-19
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
4
Cycle 2 Total Number of Health Deficiencies
3
Cycle 2 Number of Standard Health Deficiencies
3
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
12
Cycle 2 Standard Health Survey Date
2013-11-14
Cycle 2 Number of Health Revisits
2
Cycle 2 Health Revisit Score
6
Cycle 2 Total Health Score
6
Cycle 3 Total Number of Health Deficiencies
9
Cycle 3 Number of Standard Health Deficiencies
9
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
76
Cycle 3 Standard Health Survey Date
2012-12-13
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
76
Total Weighted Health Survey Score
20.66700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
0
Number of Fines
1
Total Amount of Fines in Dollars
5363
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01

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