Chippewa Manor Nursing Home - Chippewa Falls Nursing Home
General Information
UPDATEFederal Provider Number
525419
Provider Name
CHIPPEWA MANOR NURSING HOME
Provider Address
222 CHAPMAN RD
CHIPPEWA FALLS, WI 54729
CHIPPEWA FALLS, WI 54729
Provider Phone Number
(715) 723-4437
Provider SSA County
80
Provider County Name
Chippewa
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
90
Number of Residents in Certified Beds
53
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
CHIPPEWA MANOR NURSING HOME CORPORATION
Date First Approved to Provide Medicare and Medicaid services
1989-02-09
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
3
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
2.21887
Reported LPN Staffing Hours per Resident per Day
0.27264
Reported RN Staffing Hours per Resident per Day
1.42736
Reported Licensed Staffing Hours per Resident per Day
1.70000
Reported Total Nurse Staffing Hours per Resident per Day
3.91887
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00000
Expected CNA Staffing Hours per Resident per Day
2.56298
Expected LPN Staffing Hours per Resident per Day
0.64317
Expected RN Staffing Hours per Resident per Day
1.11415
Expected Total Nurse Staffing Hours per Resident per Day
4.32030
Adjusted CNA Staffing Hours per Resident per Day
2.12426
Adjusted LPN Staffing Hours per Resident per Day
0.35184
Adjusted RN Staffing Hours per Resident per Day
0.95725
Adjusted Total Nurse Staffing Hours per Resident per Day
3.65636
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
20
Cycle 1 Standard Survey Health Date
2014-09-24
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
20
Cycle 2 Total Number of Health Deficiencies
5
Cycle 2 Number of Standard Health Deficiencies
5
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
32
Cycle 2 Standard Health Survey Date
2013-11-14
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
2
Cycle 3 Number of Standard Health Deficiencies
2
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
4
Cycle 3 Standard Health Survey Date
2012-10-24
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
4
Total Weighted Health Survey Score
21.33300
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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