Wisconsin Nursing Homes >> Mount Horeb Nursing Homes >> Ingleside Manor

Ingleside Manor - Mount Horeb Nursing Home

General Information

UPDATE
Federal Provider Number
525331
Provider Name
INGLESIDE MANOR
Provider Address
407 N EIGHTH ST
MOUNT HOREB, WI 53572
Provider Phone Number
6084375511
Provider SSA County
120
Provider County Name
Dane
Ownership Type
Non profit - Corporation
Number of Certified Beds
100
Number of Residents in Certified Beds
73
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
1983-04-07
Continuing Care Retirement Community
Y
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
5
Overall Rating Footnote
Health Inspection Rating
3
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
2.86164
Reported LPN Staffing Hours per Resident per Day
0.60000
Reported RN Staffing Hours per Resident per Day
0.71507
Reported Licensed Staffing Hours per Resident per Day
1.31507
Reported Total Nurse Staffing Hours per Resident per Day
4.17671
Reported Physical Therapist Staffing Hours per Resident Per Day
0.09315
Expected CNA Staffing Hours per Resident per Day
2.54344
Expected LPN Staffing Hours per Resident per Day
0.57800
Expected RN Staffing Hours per Resident per Day
0.86351
Expected Total Nurse Staffing Hours per Resident per Day
3.98495
Adjusted CNA Staffing Hours per Resident per Day
2.76067
Adjusted LPN Staffing Hours per Resident per Day
0.86160
Adjusted RN Staffing Hours per Resident per Day
0.61875
Adjusted Total Nurse Staffing Hours per Resident per Day
4.22487
Cycle 1 Total Number of Health Deficiencies
6
Cycle 1 Number of Standard Health Deficiencies
6
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
48
Cycle 1 Standard Survey Health Date
2014-08-12
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
48
Cycle 2 Total Number of Health Deficiencies
4
Cycle 2 Number of Standard Health Deficiencies
4
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
20
Cycle 2 Standard Health Survey Date
2013-07-11
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
4
Cycle 3 Number of Standard Health Deficiencies
4
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
32
Cycle 3 Standard Health Survey Date
2012-06-01
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
32
Total Weighted Health Survey Score
36.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
0
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

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