Augustana Mercy Care Center - Moose Lake Nursing Home
General Information
UPDATEFederal Provider Number
245491
Provider Name
AUGUSTANA MERCY CARE CENTER
Provider Address
710 SOUTH KENWOOD AVENUE
MOOSE LAKE, MN 55767
MOOSE LAKE, MN 55767
Provider Phone Number
(218) 485-4481
Provider SSA County
80
Provider County Name
Carlton
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
72
Number of Residents in Certified Beds
65
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
AUGUSTANA MERCY CARE CENTER LLC
Date First Approved to Provide Medicare and Medicaid services
1987-07-01
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
4
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
5
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
2.57077
Reported LPN Staffing Hours per Resident per Day
0.95308
Reported RN Staffing Hours per Resident per Day
0.56462
Reported Licensed Staffing Hours per Resident per Day
1.51769
Reported Total Nurse Staffing Hours per Resident per Day
4.08847
Reported Physical Therapist Staffing Hours per Resident Per Day
0.07231
Expected CNA Staffing Hours per Resident per Day
2.54872
Expected LPN Staffing Hours per Resident per Day
0.59079
Expected RN Staffing Hours per Resident per Day
0.87617
Expected Total Nurse Staffing Hours per Resident per Day
4.01569
Adjusted CNA Staffing Hours per Resident per Day
2.47493
Adjusted LPN Staffing Hours per Resident per Day
1.33897
Adjusted RN Staffing Hours per Resident per Day
0.48151
Adjusted Total Nurse Staffing Hours per Resident per Day
4.10396
Cycle 1 Total Number of Health Deficiencies
2
Cycle 1 Number of Standard Health Deficiencies
1
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
28
Cycle 1 Standard Survey Health Date
2014-09-18
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
28
Cycle 2 Total Number of Health Deficiencies
7
Cycle 2 Number of Standard Health Deficiencies
7
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
32
Cycle 2 Standard Health Survey Date
2013-07-25
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
32
Cycle 3 Total Number of Health Deficiencies
5
Cycle 3 Number of Standard Health Deficiencies
5
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
20
Cycle 3 Standard Health Survey Date
2012-08-23
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
20
Total Weighted Health Survey Score
28.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
1
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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