Brewster Village - Appleton Nursing Home
General Information
UPDATEFederal Provider Number
525574
Provider Name
BREWSTER VILLAGE
Provider Address
3300 W BREWSTER ST
APPLETON, WI 54914
APPLETON, WI 54914
Provider Phone Number
(920) 832-5400
Provider SSA County
430
Provider County Name
Outagamie
Provider Website
Provider Description
Ownership Type
Government - County
Number of Certified Beds
204
Number of Residents in Certified Beds
190
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
COUNTY OF OUTAGAMIE
Date First Approved to Provide Medicare and Medicaid services
1995-08-01
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
4
Overall Rating Footnote
Health Inspection Rating
4
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
3.02763
Reported LPN Staffing Hours per Resident per Day
0.04711
Reported RN Staffing Hours per Resident per Day
1.21921
Reported Licensed Staffing Hours per Resident per Day
1.26632
Reported Total Nurse Staffing Hours per Resident per Day
4.29395
Reported Physical Therapist Staffing Hours per Resident Per Day
0.04053
Expected CNA Staffing Hours per Resident per Day
2.42156
Expected LPN Staffing Hours per Resident per Day
0.60966
Expected RN Staffing Hours per Resident per Day
0.89272
Expected Total Nurse Staffing Hours per Resident per Day
3.92394
Adjusted CNA Staffing Hours per Resident per Day
3.06782
Adjusted LPN Staffing Hours per Resident per Day
0.06414
Adjusted RN Staffing Hours per Resident per Day
1.02047
Adjusted Total Nurse Staffing Hours per Resident per Day
4.41099
Cycle 1 Total Number of Health Deficiencies
0
Cycle 1 Number of Standard Health Deficiencies
0
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
0
Cycle 1 Standard Survey Health Date
2014-09-29
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
0
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
44
Cycle 2 Standard Health Survey Date
2013-09-24
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
44
Cycle 3 Total Number of Health Deficiencies
6
Cycle 3 Number of Standard Health Deficiencies
6
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
32
Cycle 3 Standard Health Survey Date
2012-08-10
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
32
Total Weighted Health Survey Score
20.00000
Number of Facility Reported Incidents
0
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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