Hillside Manor - Beaver Dam Nursing Home
General Information
UPDATEFederal Provider Number
525447
Provider Name
HILLSIDE MANOR
Provider Address
803 S UNIVERSITY AVE
BEAVER DAM, WI 53916
BEAVER DAM, WI 53916
Provider Phone Number
(920) 887-5902
Provider SSA County
130
Provider County Name
Dodge
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
115
Number of Residents in Certified Beds
97
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
Y
Legal Business Name
BEAVER DAM COMMUNITY HOSPITALS, INC
Date First Approved to Provide Medicare and Medicaid services
1989-11-15
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
2
Health Inspection Rating Footnote
QM Rating
5
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
2.18196
Reported LPN Staffing Hours per Resident per Day
0.57320
Reported RN Staffing Hours per Resident per Day
0.90000
Reported Licensed Staffing Hours per Resident per Day
1.47320
Reported Total Nurse Staffing Hours per Resident per Day
3.65516
Reported Physical Therapist Staffing Hours per Resident Per Day
0.10361
Expected CNA Staffing Hours per Resident per Day
2.55162
Expected LPN Staffing Hours per Resident per Day
0.61559
Expected RN Staffing Hours per Resident per Day
1.06099
Expected Total Nurse Staffing Hours per Resident per Day
4.22820
Adjusted CNA Staffing Hours per Resident per Day
2.09823
Adjusted LPN Staffing Hours per Resident per Day
0.77285
Adjusted RN Staffing Hours per Resident per Day
0.63382
Adjusted Total Nurse Staffing Hours per Resident per Day
3.48460
Cycle 1 Total Number of Health Deficiencies
7
Cycle 1 Number of Standard Health Deficiencies
7
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
44
Cycle 1 Standard Survey Health Date
2014-11-13
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
44
Cycle 2 Total Number of Health Deficiencies
6
Cycle 2 Number of Standard Health Deficiencies
5
Cycle 2 Number of Complaint Health Deficiencies
2
Cycle 2 Health Deficiency Score
24
Cycle 2 Standard Health Survey Date
2013-10-02
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
11
Cycle 3 Number of Standard Health Deficiencies
9
Cycle 3 Number of Complaint Health Deficiencies
2
Cycle 3 Health Deficiency Score
185
Cycle 3 Standard Health Survey Date
2012-08-08
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
185
Total Weighted Health Survey Score
60.83300
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
2
Number of Fines
1
Total Amount of Fines in Dollars
3218
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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