Juliette Manor - Berlin Nursing Home
General Information
UPDATEFederal Provider Number
525286
Provider Name
JULIETTE MANOR
Provider Address
169 E HURON ST
BERLIN, WI 54923
BERLIN, WI 54923
Provider Phone Number
(920) 361-3092
Provider SSA County
230
Provider County Name
Green Lake
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
37
Number of Residents in Certified Beds
27
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
COMMUNITY HEALTH NETWORK INC
Date First Approved to Provide Medicare and Medicaid services
1977-12-01
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
4
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
4
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
2.77778
Reported LPN Staffing Hours per Resident per Day
0.55926
Reported RN Staffing Hours per Resident per Day
1.38148
Reported Licensed Staffing Hours per Resident per Day
1.94074
Reported Total Nurse Staffing Hours per Resident per Day
4.71852
Reported Physical Therapist Staffing Hours per Resident Per Day
0.15556
Expected CNA Staffing Hours per Resident per Day
2.46581
Expected LPN Staffing Hours per Resident per Day
0.70864
Expected RN Staffing Hours per Resident per Day
1.32639
Expected Total Nurse Staffing Hours per Resident per Day
4.50084
Adjusted CNA Staffing Hours per Resident per Day
2.76414
Adjusted LPN Staffing Hours per Resident per Day
0.65504
Adjusted RN Staffing Hours per Resident per Day
0.77823
Adjusted Total Nurse Staffing Hours per Resident per Day
4.22585
Cycle 1 Total Number of Health Deficiencies
8
Cycle 1 Number of Standard Health Deficiencies
8
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
40
Cycle 1 Standard Survey Health Date
2014-10-06
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
40
Cycle 2 Total Number of Health Deficiencies
7
Cycle 2 Number of Standard Health Deficiencies
6
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
44
Cycle 2 Standard Health Survey Date
2013-10-30
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
44
Cycle 3 Total Number of Health Deficiencies
10
Cycle 3 Number of Standard Health Deficiencies
10
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
72
Cycle 3 Standard Health Survey Date
2012-09-13
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
72
Total Weighted Health Survey Score
46.66700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
2
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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