Holton Manor - Elkhorn Nursing Home
General Information
UPDATEFederal Provider Number
525541
Provider Name
HOLTON MANOR
Provider Address
645 N CHURCH ST
ELKHORN, WI 53121
ELKHORN, WI 53121
Provider Phone Number
2627234963
Provider SSA County
630
Provider County Name
Walworth
Ownership Type
Non profit - Corporation
Number of Certified Beds
50
Number of Residents in Certified Beds
50
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
WISCONSIN ILLINOIS SENIOR HOUSING INC
Date First Approved to Provide Medicare and Medicaid services
1994-03-16
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
5
Overall Rating Footnote
Health Inspection Rating
5
Health Inspection Rating Footnote
QM Rating
3
QM Rating Footnote
Staffing Rating
4
Staffing Rating Footnote
RN Staffing Rating
3
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.99400
Reported LPN Staffing Hours per Resident per Day
0.80000
Reported RN Staffing Hours per Resident per Day
0.71900
Reported Licensed Staffing Hours per Resident per Day
1.51900
Reported Total Nurse Staffing Hours per Resident per Day
4.51300
Reported Physical Therapist Staffing Hours per Resident Per Day
0.11300
Expected CNA Staffing Hours per Resident per Day
2.42649
Expected LPN Staffing Hours per Resident per Day
0.64951
Expected RN Staffing Hours per Resident per Day
1.07806
Expected Total Nurse Staffing Hours per Resident per Day
4.15406
Adjusted CNA Staffing Hours per Resident per Day
3.02757
Adjusted LPN Staffing Hours per Resident per Day
1.02232
Adjusted RN Staffing Hours per Resident per Day
0.49833
Adjusted Total Nurse Staffing Hours per Resident per Day
4.37920
Cycle 1 Total Number of Health Deficiencies
0
Cycle 1 Number of Standard Health Deficiencies
0
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
0
Cycle 1 Standard Survey Health Date
2014-07-03
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
0
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
2013-09-26
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
1
Cycle 3 Number of Standard Health Deficiencies
0
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
4
Cycle 3 Standard Health Survey Date
2012-06-28
Cycle 3 Number of Health Revisits
0
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
4
Total Weighted Health Survey Score
0.66700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
1
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
Nursiong Homes Nearby
Lakeland Health Care Ctr
1922 Cty Rd Nn |
ELKHORN WI 53121 | 2.8 miles away
Willowfield Nursing And Rehab
905 E Geneva St |
DELAVAN WI 53115 | 5.8 miles away
Atrium Post Acute Care Of Williams Bay
146 Clover St |
WILLIAMS BAY WI 53191 | 7.2 miles away
Geneva Lake Manor
211 S Curtis St |
LAKE GENEVA WI 53147 | 9.1 miles away
East Troy Manor
3271 North St |
EAST TROY WI 53120 | 9.7 miles away
Golden Years Health Center
270 Ridge Road |
WALWORTH WI 53184 | 10.9 miles away
Fairhaven Corporation
435 W Starin Rd |
WHITEWATER WI 53190 | 14.4 miles away
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