Golden Livingcenter-beaver Dam - Beaver Dam Nursing Home
General Information
UPDATEFederal Provider Number
525338
Provider Name
GOLDEN LIVINGCENTER-BEAVER DAM
Provider Address
410 ROEDL CT
BEAVER DAM, WI 53916
BEAVER DAM, WI 53916
Provider Phone Number
(920) 887-7191
Provider SSA County
130
Provider County Name
Dodge
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
90
Number of Residents in Certified Beds
64
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
GGNSC BEAVER DAM LLC
Date First Approved to Provide Medicare and Medicaid services
1983-09-01
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
2
Health Inspection Rating Footnote
QM Rating
3
QM Rating Footnote
Staffing Rating
3
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
2.27500
Reported LPN Staffing Hours per Resident per Day
0.65234
Reported RN Staffing Hours per Resident per Day
0.73047
Reported Licensed Staffing Hours per Resident per Day
1.38281
Reported Total Nurse Staffing Hours per Resident per Day
3.65781
Reported Physical Therapist Staffing Hours per Resident Per Day
0.06797
Expected CNA Staffing Hours per Resident per Day
2.44944
Expected LPN Staffing Hours per Resident per Day
0.68291
Expected RN Staffing Hours per Resident per Day
1.19148
Expected Total Nurse Staffing Hours per Resident per Day
4.32383
Adjusted CNA Staffing Hours per Resident per Day
2.27896
Adjusted LPN Staffing Hours per Resident per Day
0.79284
Adjusted RN Staffing Hours per Resident per Day
0.45809
Adjusted Total Nurse Staffing Hours per Resident per Day
3.41001
Cycle 1 Total Number of Health Deficiencies
6
Cycle 1 Number of Standard Health Deficiencies
6
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
36
Cycle 1 Standard Survey Health Date
2015-04-01
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
36
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
169
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
169
Cycle 3 Total Number of Health Deficiencies
3
Cycle 3 Number of Standard Health Deficiencies
3
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
16
Cycle 3 Standard Health Survey Date
2012-11-19
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
16
Total Weighted Health Survey Score
77.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
0
Number of Fines
1
Total Amount of Fines in Dollars
4745
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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