Edgerton Care Center, Inc - Edgerton Nursing Home
General Information
UPDATEFederal Provider Number
525241
Provider Name
EDGERTON CARE CENTER, INC
Provider Address
313 STOUGHTON RD
EDGERTON, WI 53534
EDGERTON, WI 53534
Provider Phone Number
(608) 884-1330
Provider SSA County
520
Provider County Name
Rock
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
61
Number of Residents in Certified Beds
52
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
WISCONSIN ILLINOIS SENIOR HOUSING INC
Date First Approved to Provide Medicare and Medicaid services
1971-05-11
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
3
QM Rating Footnote
Staffing Rating
4
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
3.95385
Reported LPN Staffing Hours per Resident per Day
1.32788
Reported RN Staffing Hours per Resident per Day
0.55096
Reported Licensed Staffing Hours per Resident per Day
1.87885
Reported Total Nurse Staffing Hours per Resident per Day
5.83269
Reported Physical Therapist Staffing Hours per Resident Per Day
0.10962
Expected CNA Staffing Hours per Resident per Day
2.59888
Expected LPN Staffing Hours per Resident per Day
0.63679
Expected RN Staffing Hours per Resident per Day
1.07649
Expected Total Nurse Staffing Hours per Resident per Day
4.31215
Adjusted CNA Staffing Hours per Resident per Day
3.73298
Adjusted LPN Staffing Hours per Resident per Day
1.73079
Adjusted RN Staffing Hours per Resident per Day
0.38243
Adjusted Total Nurse Staffing Hours per Resident per Day
5.45226
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
2015-04-15
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
9
Cycle 2 Number of Standard Health Deficiencies
5
Cycle 2 Number of Complaint Health Deficiencies
4
Cycle 2 Health Deficiency Score
56
Cycle 2 Standard Health Survey Date
2014-03-11
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
56
Cycle 3 Total Number of Health Deficiencies
7
Cycle 3 Number of Standard Health Deficiencies
7
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
32
Cycle 3 Standard Health Survey Date
2013-01-09
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
32
Total Weighted Health Survey Score
34.00000
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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