Heritage Manor - Dubuque Nursing Home
General Information
Update InformationReport Incorrect Information
Federal Provider Number
165565
Provider Name
HERITAGE MANOR
Provider Address
4885 ASBURY ROAD
DUBUQUE, IA 52002
DUBUQUE, IA 52002
Provider Phone Number
(563) 583-6447
Provider SSA County
300
Provider County Name
Dubuque
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
80
Number of Residents in Certified Beds
69
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
HAWKEYE CARE CENTER OF DUBUQUE LLC
Date First Approved to Provide Medicare and Medicaid services
2005-10-01
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
None
Automatic Sprinkler Systems in All Required Areas
Yes
Rating Detail Information
Overall Rating
5
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
5
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
2.28986
Reported LPN Staffing Hours per Resident per Day
0.63043
Reported RN Staffing Hours per Resident per Day
0.71594
Reported Licensed Staffing Hours per Resident per Day
1.34638
Reported Total Nurse Staffing Hours per Resident per Day
3.63623
Reported Physical Therapist Staffing Hours per Resident Per Day
0.14928
Expected CNA Staffing Hours per Resident per Day
2.45294
Expected LPN Staffing Hours per Resident per Day
0.57092
Expected RN Staffing Hours per Resident per Day
0.90026
Expected Total Nurse Staffing Hours per Resident per Day
3.92411
Adjusted CNA Staffing Hours per Resident per Day
2.29057
Adjusted LPN Staffing Hours per Resident per Day
0.91652
Adjusted RN Staffing Hours per Resident per Day
0.59422
Adjusted Total Nurse Staffing Hours per Resident per Day
3.73519
Cycle 1 Total Number of Health Deficiencies
4
Cycle 1 Number of Standard Health Deficiencies
3
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
20
Cycle 1 Standard Survey Health Date
2015-01-22
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
20
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
24
Cycle 2 Standard Health Survey Date
2013-10-31
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
24
Cycle 3 Total Number of Health Deficiencies
3
Cycle 3 Number of Standard Health Deficiencies
2
Cycle 3 Number of Complaint Health Deficiencies
2
Cycle 3 Health Deficiency Score
28
Cycle 3 Standard Health Survey Date
2012-08-10
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
28
Total Weighted Health Survey Score
22.66700
Number of Facility Reported Incidents
3
Number of Substantiated Complaints
3
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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