Golden Livingcenter-sheboygan - Sheboygan Nursing Home
General Information
UPDATEFederal Provider Number
525456
Provider Name
GOLDEN LIVINGCENTER-SHEBOYGAN
Provider Address
3129 MICHIGAN AVE
SHEBOYGAN, WI 53082
SHEBOYGAN, WI 53082
Provider Phone Number
(920) 458-1155
Provider SSA County
580
Provider County Name
Sheboygan
Provider Website
Provider Description
Ownership Type
For profit - Partnership
Number of Certified Beds
64
Number of Residents in Certified Beds
41
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
BEVERLY ENTERPRISES - WISCONSIN INC
Date First Approved to Provide Medicare and Medicaid services
1989-11-01
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
3
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
4
QM Rating Footnote
Staffing Rating
3
Staffing Rating Footnote
RN Staffing Rating
4
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
1.82317
Reported LPN Staffing Hours per Resident per Day
0.62073
Reported RN Staffing Hours per Resident per Day
0.88902
Reported Licensed Staffing Hours per Resident per Day
1.50976
Reported Total Nurse Staffing Hours per Resident per Day
3.33292
Reported Physical Therapist Staffing Hours per Resident Per Day
0.04878
Expected CNA Staffing Hours per Resident per Day
2.42495
Expected LPN Staffing Hours per Resident per Day
0.62109
Expected RN Staffing Hours per Resident per Day
1.05184
Expected Total Nurse Staffing Hours per Resident per Day
4.09788
Adjusted CNA Staffing Hours per Resident per Day
1.84479
Adjusted LPN Staffing Hours per Resident per Day
0.82952
Adjusted RN Staffing Hours per Resident per Day
0.63153
Adjusted Total Nurse Staffing Hours per Resident per Day
3.27844
Cycle 1 Total Number of Health Deficiencies
10
Cycle 1 Number of Standard Health Deficiencies
10
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
48
Cycle 1 Standard Survey Health Date
2015-01-27
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
48
Cycle 2 Total Number of Health Deficiencies
6
Cycle 2 Number of Standard Health Deficiencies
6
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
40
Cycle 2 Standard Health Survey Date
2013-12-06
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
2
Cycle 3 Number of Standard Health Deficiencies
2
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
20
Cycle 3 Standard Health Survey Date
2012-08-08
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
20
Total Weighted Health Survey Score
40.66700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
1
Number of Fines
1
Total Amount of Fines in Dollars
8775
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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