Beechwood Rest Home - Kewaskum Nursing Home
General Information
UPDATEFederal Provider Number
52A417
Provider Name
BEECHWOOD REST HOME
Provider Address
N1495 W CTH A
KEWASKUM, WI 53040
KEWASKUM, WI 53040
Provider Phone Number
(920) 994-4717
Provider SSA County
580
Provider County Name
Sheboygan
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
26
Number of Residents in Certified Beds
15
Provider Type
Medicaid
Provider Resides in Hospital
N
Legal Business Name
Legal Business Name Not Available
Date First Approved to Provide Medicare and Medicaid services
1990-04-18
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
2
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
4
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
2.13333
Reported LPN Staffing Hours per Resident per Day
1.18667
Reported RN Staffing Hours per Resident per Day
0.56000
Reported Licensed Staffing Hours per Resident per Day
1.74667
Reported Total Nurse Staffing Hours per Resident per Day
3.88000
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00000
Expected CNA Staffing Hours per Resident per Day
2.23397
Expected LPN Staffing Hours per Resident per Day
0.52269
Expected RN Staffing Hours per Resident per Day
0.67603
Expected Total Nurse Staffing Hours per Resident per Day
3.43269
Adjusted CNA Staffing Hours per Resident per Day
2.34316
Adjusted LPN Staffing Hours per Resident per Day
1.88435
Adjusted RN Staffing Hours per Resident per Day
0.61896
Adjusted Total Nurse Staffing Hours per Resident per Day
4.55616
Cycle 1 Total Number of Health Deficiencies
5
Cycle 1 Number of Standard Health Deficiencies
5
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
24
Cycle 1 Standard Survey Health Date
2015-03-11
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
24
Cycle 2 Total Number of Health Deficiencies
11
Cycle 2 Number of Standard Health Deficiencies
11
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
116
Cycle 2 Standard Health Survey Date
2014-01-30
Cycle 2 Number of Health Revisits
2
Cycle 2 Health Revisit Score
58
Cycle 2 Total Health Score
174
Cycle 3 Total Number of Health Deficiencies
13
Cycle 3 Number of Standard Health Deficiencies
13
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
92
Cycle 3 Standard Health Survey Date
2012-12-06
Cycle 3 Number of Health Revisits
2
Cycle 3 Health Revisit Score
46
Cycle 3 Total Health Score
138
Total Weighted Health Survey Score
93.00000
Number of Facility Reported Incidents
1
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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