Hospitality Nur Rehab Ctr - Kenosha Nursing Home
General Information
UPDATEFederal Provider Number
525282
Provider Name
HOSPITALITY NUR REHAB CTR
Provider Address
8633 32ND AVE
KENOSHA, WI 53142
KENOSHA, WI 53142
Provider Phone Number
(262) 694-8300
Provider SSA County
290
Provider County Name
Kenosha
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
133
Number of Residents in Certified Beds
74
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
EXTENDICARE HOMES, INC
Date First Approved to Provide Medicare and Medicaid services
1977-03-28
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
3
QM Rating Footnote
Staffing Rating
4
Staffing Rating Footnote
RN Staffing Rating
5
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.31959
Reported LPN Staffing Hours per Resident per Day
0.83243
Reported RN Staffing Hours per Resident per Day
1.06284
Reported Licensed Staffing Hours per Resident per Day
1.89527
Reported Total Nurse Staffing Hours per Resident per Day
4.21486
Reported Physical Therapist Staffing Hours per Resident Per Day
0.07905
Expected CNA Staffing Hours per Resident per Day
2.43584
Expected LPN Staffing Hours per Resident per Day
0.67985
Expected RN Staffing Hours per Resident per Day
1.11751
Expected Total Nurse Staffing Hours per Resident per Day
4.23320
Adjusted CNA Staffing Hours per Resident per Day
2.33660
Adjusted LPN Staffing Hours per Resident per Day
1.01628
Adjusted RN Staffing Hours per Resident per Day
0.71065
Adjusted Total Nurse Staffing Hours per Resident per Day
4.01344
Cycle 1 Total Number of Health Deficiencies
2
Cycle 1 Number of Standard Health Deficiencies
1
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
20
Cycle 1 Standard Survey Health Date
2015-02-23
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
7
Cycle 2 Number of Standard Health Deficiencies
6
Cycle 2 Number of Complaint Health Deficiencies
6
Cycle 2 Health Deficiency Score
28
Cycle 2 Standard Health Survey Date
2013-12-18
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
28
Cycle 3 Total Number of Health Deficiencies
13
Cycle 3 Number of Standard Health Deficiencies
3
Cycle 3 Number of Complaint Health Deficiencies
13
Cycle 3 Health Deficiency Score
193
Cycle 3 Standard Health Survey Date
2012-09-26
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
193
Total Weighted Health Survey Score
51.50000
Number of Facility Reported Incidents
6
Number of Substantiated Complaints
19
Number of Fines
1
Total Amount of Fines in Dollars
84400
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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