Golden Livingcenter - Excelsior - Excelsior Nursing Home
General Information
UPDATEFederal Provider Number
245332
Provider Name
GOLDEN LIVINGCENTER - EXCELSIOR
Provider Address
515 DIVISION STREET
EXCELSIOR, MN 55331
EXCELSIOR, MN 55331
Provider Phone Number
(952) 474-5488
Provider SSA County
260
Provider County Name
Hennepin
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
56
Number of Residents in Certified Beds
50
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
GGNSC EXCELSIOR LLC
Date First Approved to Provide Medicare and Medicaid services
1986-07-01
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
2
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
4
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
1.77800
Reported LPN Staffing Hours per Resident per Day
0.95000
Reported RN Staffing Hours per Resident per Day
0.47100
Reported Licensed Staffing Hours per Resident per Day
1.42100
Reported Total Nurse Staffing Hours per Resident per Day
3.19900
Reported Physical Therapist Staffing Hours per Resident Per Day
0.10000
Expected CNA Staffing Hours per Resident per Day
2.40641
Expected LPN Staffing Hours per Resident per Day
0.55935
Expected RN Staffing Hours per Resident per Day
0.85254
Expected Total Nurse Staffing Hours per Resident per Day
3.81829
Adjusted CNA Staffing Hours per Resident per Day
1.81294
Adjusted LPN Staffing Hours per Resident per Day
1.40968
Adjusted RN Staffing Hours per Resident per Day
0.41281
Adjusted Total Nurse Staffing Hours per Resident per Day
3.37713
Cycle 1 Total Number of Health Deficiencies
15
Cycle 1 Number of Standard Health Deficiencies
14
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
64
Cycle 1 Standard Survey Health Date
2015-01-30
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
2
Cycle 2 Number of Standard Health Deficiencies
2
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
12
Cycle 2 Standard Health Survey Date
2014-02-06
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
12
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
20
Cycle 3 Standard Health Survey Date
2012-12-20
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
20
Total Weighted Health Survey Score
39.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
1
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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