Bethany Home - Waupaca Nursing Home
General Information
UPDATEFederal Provider Number
525538
Provider Name
BETHANY HOME
Provider Address
1226 BERLIN ST
WAUPACA, WI 54981
WAUPACA, WI 54981
Provider Phone Number
7152585521
Provider SSA County
670
Provider County Name
Waupaca
Ownership Type
Non profit - Church related
Number of Certified Beds
104
Number of Residents in Certified Beds
99
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
BETHANY HOME INC
Date First Approved to Provide Medicare and Medicaid services
1994-07-01
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Resident
Automatic Sprinkler Systems in All Required Areas
Yes
Rating Detail Information
Overall Rating
5
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
5
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
2.71717
Reported LPN Staffing Hours per Resident per Day
0.34848
Reported RN Staffing Hours per Resident per Day
0.93939
Reported Licensed Staffing Hours per Resident per Day
1.28788
Reported Total Nurse Staffing Hours per Resident per Day
4.00504
Reported Physical Therapist Staffing Hours per Resident Per Day
0.04495
Expected CNA Staffing Hours per Resident per Day
2.55485
Expected LPN Staffing Hours per Resident per Day
0.64275
Expected RN Staffing Hours per Resident per Day
1.03243
Expected Total Nurse Staffing Hours per Resident per Day
4.23004
Adjusted CNA Staffing Hours per Resident per Day
2.60959
Adjusted LPN Staffing Hours per Resident per Day
0.45000
Adjusted RN Staffing Hours per Resident per Day
0.67986
Adjusted Total Nurse Staffing Hours per Resident per Day
3.81650
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
32
Cycle 1 Standard Survey Health Date
2015-01-08
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
32
Cycle 2 Total Number of Health Deficiencies
6
Cycle 2 Number of Standard Health Deficiencies
6
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
28
Cycle 2 Standard Health Survey Date
2014-01-08
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
8
Cycle 3 Number of Standard Health Deficiencies
7
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
32
Cycle 3 Standard Health Survey Date
2012-10-23
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
32
Total Weighted Health Survey Score
30.66700
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
Nursiong Homes Nearby
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Iola Living Assistance, Inc
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