Geneva Lake Manor - Lake Geneva Nursing Home
General Information
UPDATEFederal Provider Number
525565
Provider Name
GENEVA LAKE MANOR
Provider Address
211 S CURTIS ST
LAKE GENEVA, WI 53147
LAKE GENEVA, WI 53147
Provider Phone Number
(262) 248-3145
Provider SSA County
630
Provider County Name
Walworth
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
60
Number of Residents in Certified Beds
47
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
1995-05-01
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
2
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
2
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
3.30319
Reported LPN Staffing Hours per Resident per Day
0.52872
Reported RN Staffing Hours per Resident per Day
0.99681
Reported Licensed Staffing Hours per Resident per Day
1.52553
Reported Total Nurse Staffing Hours per Resident per Day
4.82872
Reported Physical Therapist Staffing Hours per Resident Per Day
0.10745
Expected CNA Staffing Hours per Resident per Day
2.43124
Expected LPN Staffing Hours per Resident per Day
0.60787
Expected RN Staffing Hours per Resident per Day
0.94540
Expected Total Nurse Staffing Hours per Resident per Day
3.98452
Adjusted CNA Staffing Hours per Resident per Day
3.33370
Adjusted LPN Staffing Hours per Resident per Day
0.72192
Adjusted RN Staffing Hours per Resident per Day
0.78783
Adjusted Total Nurse Staffing Hours per Resident per Day
4.88493
Cycle 1 Total Number of Health Deficiencies
5
Cycle 1 Number of Standard Health Deficiencies
5
Cycle 1 Number of Complaint Health Deficiencies
4
Cycle 1 Health Deficiency Score
153
Cycle 1 Standard Survey Health Date
2014-10-13
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
153
Cycle 2 Total Number of Health Deficiencies
7
Cycle 2 Number of Standard Health Deficiencies
7
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
40
Cycle 2 Standard Health Survey Date
2013-11-14
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
40
Cycle 3 Total Number of Health Deficiencies
5
Cycle 3 Number of Standard Health Deficiencies
5
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
24
Cycle 3 Standard Health Survey Date
2012-08-02
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
24
Total Weighted Health Survey Score
93.83300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
1
Number of Fines
2
Total Amount of Fines in Dollars
5395
Number of Payment Denials
0
Total Number of Penalties
2
Location
Processing Date
2015-06-01
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