Haven Homes Of Maple Plain - Maple Plain Nursing Home
General Information
UPDATEFederal Provider Number
245497
Provider Name
HAVEN HOMES OF MAPLE PLAIN
Provider Address
1520 WYMAN AVENUE
MAPLE PLAIN, MN 55359
MAPLE PLAIN, MN 55359
Provider Phone Number
7634791993
Provider SSA County
260
Provider County Name
Hennepin
Ownership Type
Non profit - Corporation
Number of Certified Beds
52
Number of Residents in Certified Beds
49
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
HAVEN HOMES INC
Date First Approved to Provide Medicare and Medicaid services
1987-10-01
Continuing Care Retirement Community
Y
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
1
Health Inspection Rating Footnote
QM Rating
2
QM Rating Footnote
Staffing Rating
4
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
2.36429
Reported LPN Staffing Hours per Resident per Day
0.83980
Reported RN Staffing Hours per Resident per Day
0.59388
Reported Licensed Staffing Hours per Resident per Day
1.43367
Reported Total Nurse Staffing Hours per Resident per Day
3.79797
Reported Physical Therapist Staffing Hours per Resident Per Day
0.02143
Expected CNA Staffing Hours per Resident per Day
2.66888
Expected LPN Staffing Hours per Resident per Day
0.56053
Expected RN Staffing Hours per Resident per Day
0.85099
Expected Total Nurse Staffing Hours per Resident per Day
4.08041
Adjusted CNA Staffing Hours per Resident per Day
2.17367
Adjusted LPN Staffing Hours per Resident per Day
1.24352
Adjusted RN Staffing Hours per Resident per Day
0.52145
Adjusted Total Nurse Staffing Hours per Resident per Day
3.75189
Cycle 1 Total Number of Health Deficiencies
15
Cycle 1 Number of Standard Health Deficiencies
15
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
156
Cycle 1 Standard Survey Health Date
2014-09-12
Cycle 1 Number of Health Revisits
2
Cycle 1 Health Revisit Score
78
Cycle 1 Total Health Score
234
Cycle 2 Total Number of Health Deficiencies
7
Cycle 2 Number of Standard Health Deficiencies
7
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
44
Cycle 2 Standard Health Survey Date
2013-08-08
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
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
12
Cycle 3 Standard Health Survey Date
2012-05-16
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
12
Total Weighted Health Survey Score
133.66700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
0
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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