Hetzel Care Nursing & Rehabilitation Center Llc - Bloomer Nursing Home
General Information
UPDATEFederal Provider Number
525580
Provider Name
HETZEL CARE NURSING & REHABILITATION CENTER LLC
Provider Address
1840 PRIDDY ST
BLOOMER, WI 54724
BLOOMER, WI 54724
Provider Phone Number
(715) 568-2503
Provider SSA County
80
Provider County Name
Chippewa
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
31
Number of Residents in Certified Beds
24
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
PHCN, LLC
Date First Approved to Provide Medicare and Medicaid services
1995-10-01
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
Y
With a Resident and Family Council
Resident
Automatic Sprinkler Systems in All Required Areas
Yes
Rating Detail Information
Overall Rating
4
Overall Rating Footnote
Health Inspection Rating
2
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
2.29167
Reported LPN Staffing Hours per Resident per Day
0.66250
Reported RN Staffing Hours per Resident per Day
0.66667
Reported Licensed Staffing Hours per Resident per Day
1.32917
Reported Total Nurse Staffing Hours per Resident per Day
3.62084
Reported Physical Therapist Staffing Hours per Resident Per Day
0.01458
Expected CNA Staffing Hours per Resident per Day
2.33833
Expected LPN Staffing Hours per Resident per Day
0.53979
Expected RN Staffing Hours per Resident per Day
0.95145
Expected Total Nurse Staffing Hours per Resident per Day
3.82958
Adjusted CNA Staffing Hours per Resident per Day
2.40474
Adjusted LPN Staffing Hours per Resident per Day
1.01868
Adjusted RN Staffing Hours per Resident per Day
0.52355
Adjusted Total Nurse Staffing Hours per Resident per Day
3.81119
Cycle 1 Total Number of Health Deficiencies
8
Cycle 1 Number of Standard Health Deficiencies
2
Cycle 1 Number of Complaint Health Deficiencies
7
Cycle 1 Health Deficiency Score
130
Cycle 1 Standard Survey Health Date
2014-04-16
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
130
Cycle 2 Total Number of Health Deficiencies
0
Cycle 2 Number of Standard Health Deficiencies
0
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
0
Cycle 2 Standard Health Survey Date
2013-07-09
Cycle 2 Number of Health Revisits
0
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
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
52
Cycle 3 Standard Health Survey Date
2012-06-28
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
52
Total Weighted Health Survey Score
73.66700
Number of Facility Reported Incidents
2
Number of Substantiated Complaints
2
Number of Fines
2
Total Amount of Fines in Dollars
4875
Number of Payment Denials
0
Total Number of Penalties
2
Location
Processing Date
2015-06-01
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