Saint Therese At Oxbow Lake - Brooklyn Park Nursing Home
General Information
UPDATEFederal Provider Number
245619
Provider Name
SAINT THERESE AT OXBOW LAKE
Provider Address
5200 OAK GROVE PARKWAY
BROOKLYN PARK, MN 55443
BROOKLYN PARK, MN 55443
Provider Phone Number
7634937000
Provider SSA County
260
Provider County Name
Hennepin
Ownership Type
Non profit - Corporation
Number of Certified Beds
64
Number of Residents in Certified Beds
62
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
OXBOW LAKE CARE CENTER LLC
Date First Approved to Provide Medicare and Medicaid services
2013-07-16
Continuing Care Retirement Community
N
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
5
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
5
Staffing Rating Footnote
RN Staffing Rating
5
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
3.00403
Reported LPN Staffing Hours per Resident per Day
0.65968
Reported RN Staffing Hours per Resident per Day
1.18548
Reported Licensed Staffing Hours per Resident per Day
1.84516
Reported Total Nurse Staffing Hours per Resident per Day
4.84919
Reported Physical Therapist Staffing Hours per Resident Per Day
0.37823
Expected CNA Staffing Hours per Resident per Day
2.51926
Expected LPN Staffing Hours per Resident per Day
0.57033
Expected RN Staffing Hours per Resident per Day
0.93997
Expected Total Nurse Staffing Hours per Resident per Day
4.02955
Adjusted CNA Staffing Hours per Resident per Day
2.92586
Adjusted LPN Staffing Hours per Resident per Day
0.96004
Adjusted RN Staffing Hours per Resident per Day
0.94236
Adjusted Total Nurse Staffing Hours per Resident per Day
4.85081
Cycle 1 Total Number of Health Deficiencies
4
Cycle 1 Number of Standard Health Deficiencies
4
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
12
Cycle 1 Standard Survey Health Date
2014-10-23
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
12
Cycle 2 Total Number of Health Deficiencies
12
Cycle 2 Number of Standard Health Deficiencies
12
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
44
Cycle 2 Standard Health Survey Date
2014-01-10
Cycle 2 Number of Health Revisits
2
Cycle 2 Health Revisit Score
22
Cycle 2 Total Health Score
22
Cycle 3 Total Number of Health Deficiencies
2
Cycle 3 Number of Standard Health Deficiencies
2
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
8
Cycle 3 Standard Health Survey Date
2013-05-30
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
8
Total Weighted Health Survey Score
29.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
0
Number of Fines
0
Total Amount of Fines in Dollars
0
Number of Payment Denials
0
Total Number of Penalties
0
Location
Processing Date
2015-06-01
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