Lake Minnetonka Care Center - Deephaven Nursing Home
General Information
UPDATEFederal Provider Number
245606
Provider Name
LAKE MINNETONKA CARE CENTER
Provider Address
20395 SUMMERVILLE ROAD
DEEPHAVEN, MN 55331
DEEPHAVEN, MN 55331
Provider Phone Number
9524744474
Provider SSA County
260
Provider County Name
Hennepin
Ownership Type
For profit - Corporation
Number of Certified Beds
21
Number of Residents in Certified Beds
20
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
Legal Business Name Not Available
Date First Approved to Provide Medicare and Medicaid services
1992-07-02
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
2
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
2
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
0.80000
Reported LPN Staffing Hours per Resident per Day
0.65750
Reported RN Staffing Hours per Resident per Day
0.45750
Reported Licensed Staffing Hours per Resident per Day
1.11500
Reported Total Nurse Staffing Hours per Resident per Day
1.91500
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00000
Expected CNA Staffing Hours per Resident per Day
1.70583
Expected LPN Staffing Hours per Resident per Day
0.48300
Expected RN Staffing Hours per Resident per Day
0.70208
Expected Total Nurse Staffing Hours per Resident per Day
2.89092
Adjusted CNA Staffing Hours per Resident per Day
1.15073
Adjusted LPN Staffing Hours per Resident per Day
1.12987
Adjusted RN Staffing Hours per Resident per Day
0.48690
Adjusted Total Nurse Staffing Hours per Resident per Day
2.67015
Cycle 1 Total Number of Health Deficiencies
1
Cycle 1 Number of Standard Health Deficiencies
1
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
4
Cycle 1 Standard Survey Health Date
2014-04-02
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
4
Cycle 2 Total Number of Health Deficiencies
15
Cycle 2 Number of Standard Health Deficiencies
15
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
116
Cycle 2 Standard Health Survey Date
2013-01-22
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
12
Cycle 3 Number of Standard Health Deficiencies
12
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
88
Cycle 3 Standard Health Survey Date
2012-04-12
Cycle 3 Number of Health Revisits
3
Cycle 3 Health Revisit Score
62
Cycle 3 Total Health Score
150
Total Weighted Health Survey Score
65.66700
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
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