Heritage Manor - Elroy Nursing Home
General Information
UPDATEFederal Provider Number
525452
Provider Name
HERITAGE MANOR
Provider Address
307 ROYALL AVE PO BOX 167
ELROY, WI 53929
ELROY, WI 53929
Provider Phone Number
(608) 462-8491
Provider SSA County
280
Provider County Name
Juneau
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
76
Number of Residents in Certified Beds
69
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
EDGEWOOD CARE CENTER, INC.
Date First Approved to Provide Medicare and Medicaid services
1990-01-01
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
2
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
2.23551
Reported LPN Staffing Hours per Resident per Day
0.29058
Reported RN Staffing Hours per Resident per Day
0.76522
Reported Licensed Staffing Hours per Resident per Day
1.05580
Reported Total Nurse Staffing Hours per Resident per Day
3.29131
Reported Physical Therapist Staffing Hours per Resident Per Day
0.04348
Expected CNA Staffing Hours per Resident per Day
2.42224
Expected LPN Staffing Hours per Resident per Day
0.58458
Expected RN Staffing Hours per Resident per Day
0.91046
Expected Total Nurse Staffing Hours per Resident per Day
3.91728
Adjusted CNA Staffing Hours per Resident per Day
2.26454
Adjusted LPN Staffing Hours per Resident per Day
0.41257
Adjusted RN Staffing Hours per Resident per Day
0.62800
Adjusted Total Nurse Staffing Hours per Resident per Day
3.38677
Cycle 1 Total Number of Health Deficiencies
8
Cycle 1 Number of Standard Health Deficiencies
8
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
64
Cycle 1 Standard Survey Health Date
2014-12-17
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
9
Cycle 2 Number of Standard Health Deficiencies
9
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
48
Cycle 2 Standard Health Survey Date
2014-03-27
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
48
Cycle 3 Total Number of Health Deficiencies
11
Cycle 3 Number of Standard Health Deficiencies
11
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
84
Cycle 3 Standard Health Survey Date
2013-02-08
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
84
Total Weighted Health Survey Score
62.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
0
Number of Fines
1
Total Amount of Fines in Dollars
1625
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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