American Lutheran Home-mondovi - Mondovi Nursing Home
General Information
UPDATEFederal Provider Number
525383
Provider Name
AMERICAN LUTHERAN HOME-MONDOVI
Provider Address
200 MEMORIAL DR
MONDOVI, WI 54755
MONDOVI, WI 54755
Provider Phone Number
(715) 926-4962
Provider SSA County
50
Provider County Name
Buffalo
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
50
Number of Residents in Certified Beds
43
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
AMERICAN LUTHERAN HOMES, INC.
Date First Approved to Provide Medicare and Medicaid services
1985-04-01
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Resident
Automatic Sprinkler Systems in All Required Areas
Yes
Rating Detail Information
Overall Rating
3
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
4
QM Rating Footnote
Staffing Rating
4
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
2.75930
Reported LPN Staffing Hours per Resident per Day
0.38256
Reported RN Staffing Hours per Resident per Day
1.05233
Reported Licensed Staffing Hours per Resident per Day
1.43488
Reported Total Nurse Staffing Hours per Resident per Day
4.19419
Reported Physical Therapist Staffing Hours per Resident Per Day
0.11628
Expected CNA Staffing Hours per Resident per Day
2.63889
Expected LPN Staffing Hours per Resident per Day
0.62413
Expected RN Staffing Hours per Resident per Day
1.07590
Expected Total Nurse Staffing Hours per Resident per Day
4.33892
Adjusted CNA Staffing Hours per Resident per Day
2.56566
Adjusted LPN Staffing Hours per Resident per Day
0.50875
Adjusted RN Staffing Hours per Resident per Day
0.73083
Adjusted Total Nurse Staffing Hours per Resident per Day
3.89644
Cycle 1 Total Number of Health Deficiencies
7
Cycle 1 Number of Standard Health Deficiencies
6
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
32
Cycle 1 Standard Survey Health Date
2014-11-13
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
32
Cycle 2 Total Number of Health Deficiencies
13
Cycle 2 Number of Standard Health Deficiencies
13
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
80
Cycle 2 Standard Health Survey Date
2014-01-16
Cycle 2 Number of Health Revisits
2
Cycle 2 Health Revisit Score
40
Cycle 2 Total Health Score
120
Cycle 3 Total Number of Health Deficiencies
9
Cycle 3 Number of Standard Health Deficiencies
8
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
36
Cycle 3 Standard Health Survey Date
2012-12-05
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
36
Total Weighted Health Survey Score
62.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
2
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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