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Evansville Manor - Evansville Nursing Home

General Information

UPDATE
Federal Provider Number
525418
Provider Name
EVANSVILLE MANOR
Provider Address
470 GARFIELD AVE
EVANSVILLE, WI 53536
Provider Phone Number
(608) 882-5700
Provider SSA County
520
Provider County Name
Rock
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
71
Number of Residents in Certified Beds
60
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
EVANSVILLE MANOR, INC.
Date First Approved to Provide Medicare and Medicaid services
1988-09-06
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
4
Health Inspection Rating Footnote
QM Rating
1
QM Rating Footnote
Staffing Rating
3
Staffing Rating Footnote
RN Staffing Rating
4
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.60750
Reported LPN Staffing Hours per Resident per Day
0.25000
Reported RN Staffing Hours per Resident per Day
0.70417
Reported Licensed Staffing Hours per Resident per Day
0.95417
Reported Total Nurse Staffing Hours per Resident per Day
3.56167
Reported Physical Therapist Staffing Hours per Resident Per Day
0.05917
Expected CNA Staffing Hours per Resident per Day
2.52168
Expected LPN Staffing Hours per Resident per Day
0.66140
Expected RN Staffing Hours per Resident per Day
0.99370
Expected Total Nurse Staffing Hours per Resident per Day
4.17678
Adjusted CNA Staffing Hours per Resident per Day
2.53720
Adjusted LPN Staffing Hours per Resident per Day
0.31373
Adjusted RN Staffing Hours per Resident per Day
0.52949
Adjusted Total Nurse Staffing Hours per Resident per Day
3.43727
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
24
Cycle 1 Standard Survey Health Date
2014-07-31
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
24
Cycle 2 Total Number of Health Deficiencies
7
Cycle 2 Number of Standard Health Deficiencies
5
Cycle 2 Number of Complaint Health Deficiencies
2
Cycle 2 Health Deficiency Score
28
Cycle 2 Standard Health Survey Date
2013-10-23
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
28
Cycle 3 Total Number of Health Deficiencies
8
Cycle 3 Number of Standard Health Deficiencies
7
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
40
Cycle 3 Standard Health Survey Date
2012-08-14
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
40
Total Weighted Health Survey Score
28.00000
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
3
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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