Fond Du Lac Lutheran Home - Fond Du Lac Nursing Home
General Information
UPDATEFederal Provider Number
525655
Provider Name
FOND DU LAC LUTHERAN HOME
Provider Address
244 N MACY ST
FOND DU LAC, WI 54935
FOND DU LAC, WI 54935
Provider Phone Number
(920) 921-9520
Provider SSA County
190
Provider County Name
Fond Du Lac
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
94
Number of Residents in Certified Beds
83
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
FOND DU LAC LUTHERAN HOME, INC.
Date First Approved to Provide Medicare and Medicaid services
2000-01-01
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
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
2.84940
Reported LPN Staffing Hours per Resident per Day
0.60723
Reported RN Staffing Hours per Resident per Day
1.08855
Reported Licensed Staffing Hours per Resident per Day
1.69578
Reported Total Nurse Staffing Hours per Resident per Day
4.54518
Reported Physical Therapist Staffing Hours per Resident Per Day
0.02771
Expected CNA Staffing Hours per Resident per Day
2.68233
Expected LPN Staffing Hours per Resident per Day
0.62115
Expected RN Staffing Hours per Resident per Day
0.94528
Expected Total Nurse Staffing Hours per Resident per Day
4.24877
Adjusted CNA Staffing Hours per Resident per Day
2.60653
Adjusted LPN Staffing Hours per Resident per Day
0.81139
Adjusted RN Staffing Hours per Resident per Day
0.86045
Adjusted Total Nurse Staffing Hours per Resident per Day
4.31211
Cycle 1 Total Number of Health Deficiencies
8
Cycle 1 Number of Standard Health Deficiencies
8
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
40
Cycle 1 Standard Survey Health Date
2015-02-16
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
40
Cycle 2 Total Number of Health Deficiencies
1
Cycle 2 Number of Standard Health Deficiencies
1
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
4
Cycle 2 Standard Health Survey Date
2014-02-25
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
4
Cycle 3 Total Number of Health Deficiencies
20
Cycle 3 Number of Standard Health Deficiencies
10
Cycle 3 Number of Complaint Health Deficiencies
10
Cycle 3 Health Deficiency Score
191
Cycle 3 Standard Health Survey Date
2012-11-14
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
191
Total Weighted Health Survey Score
53.16700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
3
Number of Fines
1
Total Amount of Fines in Dollars
46704
Number of Payment Denials
1
Total Number of Penalties
2
Location
Processing Date
2015-06-01
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