Belmont Nursing And Rehab Ctr - Madison Nursing Home
General Information
UPDATEFederal Provider Number
525074
Provider Name
BELMONT NURSING AND REHAB CTR
Provider Address
110 BELMONT RD
MADISON, WI 53714
MADISON, WI 53714
Provider Phone Number
(608) 249-7391
Provider SSA County
120
Provider County Name
Dane
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
90
Number of Residents in Certified Beds
81
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
LSS OF MADISON LLC
Date First Approved to Provide Medicare and Medicaid services
1974-11-01
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
1.90679
Reported LPN Staffing Hours per Resident per Day
0.70926
Reported RN Staffing Hours per Resident per Day
0.59321
Reported Licensed Staffing Hours per Resident per Day
1.30247
Reported Total Nurse Staffing Hours per Resident per Day
3.20926
Reported Physical Therapist Staffing Hours per Resident Per Day
0.05741
Expected CNA Staffing Hours per Resident per Day
2.28506
Expected LPN Staffing Hours per Resident per Day
0.61112
Expected RN Staffing Hours per Resident per Day
1.05737
Expected Total Nurse Staffing Hours per Resident per Day
3.95355
Adjusted CNA Staffing Hours per Resident per Day
2.04751
Adjusted LPN Staffing Hours per Resident per Day
0.96329
Adjusted RN Staffing Hours per Resident per Day
0.41920
Adjusted Total Nurse Staffing Hours per Resident per Day
3.27205
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
16
Cycle 1 Standard Survey Health Date
2015-03-05
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
16
Cycle 2 Total Number of Health Deficiencies
8
Cycle 2 Number of Standard Health Deficiencies
7
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
48
Cycle 2 Standard Health Survey Date
2014-02-13
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
48
Cycle 3 Total Number of Health Deficiencies
13
Cycle 3 Number of Standard Health Deficiencies
8
Cycle 3 Number of Complaint Health Deficiencies
5
Cycle 3 Health Deficiency Score
80
Cycle 3 Standard Health Survey Date
2013-04-16
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
80
Total Weighted Health Survey Score
37.33300
Number of Facility Reported Incidents
3
Number of Substantiated Complaints
3
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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