Golden Age Manor - Amery Nursing Home
General Information
UPDATEFederal Provider Number
525507
Provider Name
GOLDEN AGE MANOR
Provider Address
220 SCHOLL CT
AMERY, WI 54001
AMERY, WI 54001
Provider Phone Number
(715) 268-7107
Provider SSA County
470
Provider County Name
Polk
Provider Website
Provider Description
Ownership Type
Government - County
Number of Certified Beds
114
Number of Residents in Certified Beds
112
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
POLK COUNTY-DEPT OF ADMINISTRATION
Date First Approved to Provide Medicare and Medicaid services
1993-05-01
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Both
Automatic Sprinkler Systems in All Required Areas
Yes
Rating Detail Information
Overall Rating
1
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
1
QM Rating Footnote
Staffing Rating
2
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
2.22634
Reported LPN Staffing Hours per Resident per Day
0.39107
Reported RN Staffing Hours per Resident per Day
0.57188
Reported Licensed Staffing Hours per Resident per Day
0.96295
Reported Total Nurse Staffing Hours per Resident per Day
3.18929
Reported Physical Therapist Staffing Hours per Resident Per Day
0.05536
Expected CNA Staffing Hours per Resident per Day
2.49519
Expected LPN Staffing Hours per Resident per Day
0.58447
Expected RN Staffing Hours per Resident per Day
0.86617
Expected Total Nurse Staffing Hours per Resident per Day
3.94583
Adjusted CNA Staffing Hours per Resident per Day
2.18932
Adjusted LPN Staffing Hours per Resident per Day
0.55535
Adjusted RN Staffing Hours per Resident per Day
0.49333
Adjusted Total Nurse Staffing Hours per Resident per Day
3.25805
Cycle 1 Total Number of Health Deficiencies
12
Cycle 1 Number of Standard Health Deficiencies
12
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
64
Cycle 1 Standard Survey Health Date
2014-10-28
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
64
Cycle 2 Total Number of Health Deficiencies
20
Cycle 2 Number of Standard Health Deficiencies
20
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
72
Cycle 2 Standard Health Survey Date
2013-10-24
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
72
Cycle 3 Total Number of Health Deficiencies
16
Cycle 3 Number of Standard Health Deficiencies
13
Cycle 3 Number of Complaint Health Deficiencies
3
Cycle 3 Health Deficiency Score
84
Cycle 3 Standard Health Survey Date
2012-10-04
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
84
Total Weighted Health Survey Score
70.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
4
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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