Edgewater Haven Nursing Home - Port Edwards Nursing Home
General Information
UPDATEFederal Provider Number
525088
Provider Name
EDGEWATER HAVEN NURSING HOME
Provider Address
1351 WISCONSIN RIVER DR
PORT EDWARDS, WI 54469
PORT EDWARDS, WI 54469
Provider Phone Number
(715) 885-8300
Provider SSA County
700
Provider County Name
Wood
Provider Website
Provider Description
Ownership Type
Government - County
Number of Certified Beds
90
Number of Residents in Certified Beds
68
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
COUNTY OF WOOD
Date First Approved to Provide Medicare and Medicaid services
1967-01-01
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
3
Health Inspection Rating Footnote
QM Rating
3
QM Rating Footnote
Staffing Rating
5
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
3.34632
Reported LPN Staffing Hours per Resident per Day
0.63309
Reported RN Staffing Hours per Resident per Day
1.12059
Reported Licensed Staffing Hours per Resident per Day
1.75368
Reported Total Nurse Staffing Hours per Resident per Day
5.10000
Reported Physical Therapist Staffing Hours per Resident Per Day
0.07426
Expected CNA Staffing Hours per Resident per Day
2.42026
Expected LPN Staffing Hours per Resident per Day
0.61995
Expected RN Staffing Hours per Resident per Day
0.98231
Expected Total Nurse Staffing Hours per Resident per Day
4.02252
Adjusted CNA Staffing Hours per Resident per Day
3.39255
Adjusted LPN Staffing Hours per Resident per Day
0.84759
Adjusted RN Staffing Hours per Resident per Day
0.85239
Adjusted Total Nurse Staffing Hours per Resident per Day
5.11063
Cycle 1 Total Number of Health Deficiencies
7
Cycle 1 Number of Standard Health Deficiencies
7
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
52
Cycle 1 Standard Survey Health Date
2014-09-25
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
52
Cycle 2 Total Number of Health Deficiencies
4
Cycle 2 Number of Standard Health Deficiencies
0
Cycle 2 Number of Complaint Health Deficiencies
4
Cycle 2 Health Deficiency Score
16
Cycle 2 Standard Health Survey Date
2013-08-22
Cycle 2 Number of Health Revisits
0
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
16
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
56
Cycle 3 Standard Health Survey Date
2012-07-12
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
56
Total Weighted Health Survey Score
40.66700
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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