Golden Livingcenter-fort Atkinson - Fort Atkinson Nursing Home
General Information
UPDATEFederal Provider Number
525262
Provider Name
GOLDEN LIVINGCENTER-FORT ATKINSON
Provider Address
430 WILCOX ST
FORT ATKINSON, WI 53538
FORT ATKINSON, WI 53538
Provider Phone Number
(920) 563-5533
Provider SSA County
270
Provider County Name
Jefferson
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
87
Number of Residents in Certified Beds
61
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
GGNSC FORT ATKINSON LLC
Date First Approved to Provide Medicare and Medicaid services
1979-06-01
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
4
QM Rating Footnote
Staffing Rating
3
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
1.63934
Reported LPN Staffing Hours per Resident per Day
0.65328
Reported RN Staffing Hours per Resident per Day
1.00984
Reported Licensed Staffing Hours per Resident per Day
1.66311
Reported Total Nurse Staffing Hours per Resident per Day
3.30246
Reported Physical Therapist Staffing Hours per Resident Per Day
0.05410
Expected CNA Staffing Hours per Resident per Day
2.41509
Expected LPN Staffing Hours per Resident per Day
0.63723
Expected RN Staffing Hours per Resident per Day
1.00605
Expected Total Nurse Staffing Hours per Resident per Day
4.05837
Adjusted CNA Staffing Hours per Resident per Day
1.66555
Adjusted LPN Staffing Hours per Resident per Day
0.85091
Adjusted RN Staffing Hours per Resident per Day
0.75001
Adjusted Total Nurse Staffing Hours per Resident per Day
3.28011
Cycle 1 Total Number of Health Deficiencies
13
Cycle 1 Number of Standard Health Deficiencies
13
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
72
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
72
Cycle 2 Total Number of Health Deficiencies
8
Cycle 2 Number of Standard Health Deficiencies
7
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
32
Cycle 2 Standard Health Survey Date
2013-09-24
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
32
Cycle 3 Total Number of Health Deficiencies
2
Cycle 3 Number of Standard Health Deficiencies
0
Cycle 3 Number of Complaint Health Deficiencies
2
Cycle 3 Health Deficiency Score
24
Cycle 3 Standard Health Survey Date
2012-08-23
Cycle 3 Number of Health Revisits
0
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
24
Total Weighted Health Survey Score
50.66700
Number of Facility Reported Incidents
1
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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