Christian Home And Rehab Ctr - Waupun Nursing Home
General Information
UPDATEFederal Provider Number
525531
Provider Name
CHRISTIAN HOME AND REHAB CTR
Provider Address
331 BLY ST
WAUPUN, WI 53963
WAUPUN, WI 53963
Provider Phone Number
(920) 324-9051
Provider SSA County
130
Provider County Name
Dodge
Provider Website
Provider Description
Ownership Type
Non profit - Church related
Number of Certified Beds
50
Number of Residents in Certified Beds
49
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
CHRISTIAN HOME & REHABILITATION CENTER INC
Date First Approved to Provide Medicare and Medicaid services
1994-05-01
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
3
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
3
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
2.27857
Reported LPN Staffing Hours per Resident per Day
0.53061
Reported RN Staffing Hours per Resident per Day
1.01327
Reported Licensed Staffing Hours per Resident per Day
1.54388
Reported Total Nurse Staffing Hours per Resident per Day
3.82245
Reported Physical Therapist Staffing Hours per Resident Per Day
0.03061
Expected CNA Staffing Hours per Resident per Day
2.33824
Expected LPN Staffing Hours per Resident per Day
0.56853
Expected RN Staffing Hours per Resident per Day
0.83255
Expected Total Nurse Staffing Hours per Resident per Day
3.73932
Adjusted CNA Staffing Hours per Resident per Day
2.39108
Adjusted LPN Staffing Hours per Resident per Day
0.77465
Adjusted RN Staffing Hours per Resident per Day
0.90939
Adjusted Total Nurse Staffing Hours per Resident per Day
4.12051
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
12
Cycle 1 Standard Survey Health Date
2014-06-13
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
12
Cycle 2 Total Number of Health Deficiencies
16
Cycle 2 Number of Standard Health Deficiencies
14
Cycle 2 Number of Complaint Health Deficiencies
2
Cycle 2 Health Deficiency Score
92
Cycle 2 Standard Health Survey Date
2013-04-11
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
92
Cycle 3 Total Number of Health Deficiencies
12
Cycle 3 Number of Standard Health Deficiencies
10
Cycle 3 Number of Complaint Health Deficiencies
2
Cycle 3 Health Deficiency Score
72
Cycle 3 Standard Health Survey Date
2012-01-31
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
72
Total Weighted Health Survey Score
48.66700
Number of Facility Reported Incidents
1
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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