Heritage Manor - Rice Lake Nursing Home
General Information
UPDATEFederal Provider Number
525374
Provider Name
HERITAGE MANOR
Provider Address
19 W NEWTON ST PO BOX 311
RICE LAKE, WI 54868
RICE LAKE, WI 54868
Provider Phone Number
(715) 234-2161
Provider SSA County
20
Provider County Name
Barron
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
92
Number of Residents in Certified Beds
75
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
FIRST AMERICAN ENTERPRISES INC
Date First Approved to Provide Medicare and Medicaid services
1984-11-01
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
2.23800
Reported LPN Staffing Hours per Resident per Day
0.49933
Reported RN Staffing Hours per Resident per Day
0.82000
Reported Licensed Staffing Hours per Resident per Day
1.31933
Reported Total Nurse Staffing Hours per Resident per Day
3.55733
Reported Physical Therapist Staffing Hours per Resident Per Day
0.12000
Expected CNA Staffing Hours per Resident per Day
2.39451
Expected LPN Staffing Hours per Resident per Day
0.60472
Expected RN Staffing Hours per Resident per Day
0.94832
Expected Total Nurse Staffing Hours per Resident per Day
3.94755
Adjusted CNA Staffing Hours per Resident per Day
2.29332
Adjusted LPN Staffing Hours per Resident per Day
0.68535
Adjusted RN Staffing Hours per Resident per Day
0.64609
Adjusted Total Nurse Staffing Hours per Resident per Day
3.63244
Cycle 1 Total Number of Health Deficiencies
4
Cycle 1 Number of Standard Health Deficiencies
4
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
20
Cycle 1 Standard Survey Health Date
2014-10-07
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
11
Cycle 2 Number of Standard Health Deficiencies
11
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
80
Cycle 2 Standard Health Survey Date
2013-12-05
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
80
Cycle 3 Total Number of Health Deficiencies
6
Cycle 3 Number of Standard Health Deficiencies
6
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
60
Cycle 3 Standard Health Survey Date
2012-10-24
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
60
Total Weighted Health Survey Score
46.66700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
0
Number of Fines
2
Total Amount of Fines in Dollars
10791
Number of Payment Denials
0
Total Number of Penalties
2
Location
Processing Date
2015-06-01
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