Mitchell Manor - West Allis Nursing Home

General Information

UPDATE
Federal Provider Number
525600
Provider Name
MITCHELL MANOR
Provider Address
5301 W LINCOLN AVE
WEST ALLIS, WI 53219
Provider Phone Number
4146157200
Provider SSA County
390
Provider County Name
Milwaukee
Ownership Type
For profit - Corporation
Number of Certified Beds
74
Number of Residents in Certified Beds
40
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
Legal Business Name Not Available
Date First Approved to Provide Medicare and Medicaid services
1996-07-01
Continuing Care Retirement Community
Y
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
None
Automatic Sprinkler Systems in All Required Areas
Yes

Rating Detail Information

Overall Rating
2
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
4
Staffing Rating Footnote
RN Staffing Rating
4
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.78875
Reported LPN Staffing Hours per Resident per Day
1.10375
Reported RN Staffing Hours per Resident per Day
0.82875
Reported Licensed Staffing Hours per Resident per Day
1.93250
Reported Total Nurse Staffing Hours per Resident per Day
4.72125
Reported Physical Therapist Staffing Hours per Resident Per Day
0.17625
Expected CNA Staffing Hours per Resident per Day
2.47870
Expected LPN Staffing Hours per Resident per Day
0.64295
Expected RN Staffing Hours per Resident per Day
1.14542
Expected Total Nurse Staffing Hours per Resident per Day
4.26708
Adjusted CNA Staffing Hours per Resident per Day
2.76062
Adjusted LPN Staffing Hours per Resident per Day
1.42485
Adjusted RN Staffing Hours per Resident per Day
0.54062
Adjusted Total Nurse Staffing Hours per Resident per Day
4.45993
Cycle 1 Total Number of Health Deficiencies
30
Cycle 1 Number of Standard Health Deficiencies
26
Cycle 1 Number of Complaint Health Deficiencies
9
Cycle 1 Health Deficiency Score
295
Cycle 1 Standard Survey Health Date
2014-08-21
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
295
Cycle 2 Total Number of Health Deficiencies
2
Cycle 2 Number of Standard Health Deficiencies
2
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
4
Cycle 2 Standard Health Survey Date
2013-09-19
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
1
Cycle 3 Number of Standard Health Deficiencies
1
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
0
Cycle 3 Standard Health Survey Date
2012-06-21
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
0
Total Weighted Health Survey Score
148.83300
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
4
Number of Fines
1
Total Amount of Fines in Dollars
5200
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01

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