Fairhaven Corporation - Whitewater Nursing Home
General Information
UPDATEFederal Provider Number
525587
Provider Name
FAIRHAVEN CORPORATION
Provider Address
435 W STARIN RD
WHITEWATER, WI 53190
WHITEWATER, WI 53190
Provider Phone Number
(262) 473-2140
Provider SSA County
630
Provider County Name
Walworth
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
84
Number of Residents in Certified Beds
80
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
FAIRHAVEN CORPORATION
Date First Approved to Provide Medicare and Medicaid services
1996-08-01
Continuing Care Retirement Community
Y
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
4
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
3.32625
Reported LPN Staffing Hours per Resident per Day
0.75063
Reported RN Staffing Hours per Resident per Day
0.61438
Reported Licensed Staffing Hours per Resident per Day
1.36500
Reported Total Nurse Staffing Hours per Resident per Day
4.69126
Reported Physical Therapist Staffing Hours per Resident Per Day
0.02500
Expected CNA Staffing Hours per Resident per Day
2.69320
Expected LPN Staffing Hours per Resident per Day
0.68413
Expected RN Staffing Hours per Resident per Day
1.05614
Expected Total Nurse Staffing Hours per Resident per Day
4.43347
Adjusted CNA Staffing Hours per Resident per Day
3.03045
Adjusted LPN Staffing Hours per Resident per Day
0.91068
Adjusted RN Staffing Hours per Resident per Day
0.43466
Adjusted Total Nurse Staffing Hours per Resident per Day
4.26528
Cycle 1 Total Number of Health Deficiencies
3
Cycle 1 Number of Standard Health Deficiencies
3
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
24
Cycle 1 Standard Survey Health Date
2014-12-16
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
8
Cycle 2 Number of Standard Health Deficiencies
8
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
76
Cycle 2 Standard Health Survey Date
2013-11-04
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
76
Cycle 3 Total Number of Health Deficiencies
0
Cycle 3 Number of Standard Health Deficiencies
0
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
0
Cycle 3 Standard Health Survey Date
2012-08-06
Cycle 3 Number of Health Revisits
0
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
0
Total Weighted Health Survey Score
37.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
0
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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