Lake Minnetonka Shores - Spring Park Nursing Home
General Information
UPDATEFederal Provider Number
245210
Provider Name
LAKE MINNETONKA SHORES
Provider Address
4527 SHORELINE DRIVE
SPRING PARK, MN 55384
SPRING PARK, MN 55384
Provider Phone Number
9524714000
Provider SSA County
260
Provider County Name
Hennepin
Ownership Type
Non profit - Corporation
Number of Certified Beds
145
Number of Residents in Certified Beds
134
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
PHS LAKE MINNETONKA LLC
Date First Approved to Provide Medicare and Medicaid services
1977-01-01
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
4
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
4
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
3.05149
Reported LPN Staffing Hours per Resident per Day
0.66455
Reported RN Staffing Hours per Resident per Day
0.90784
Reported Licensed Staffing Hours per Resident per Day
1.57239
Reported Total Nurse Staffing Hours per Resident per Day
4.62388
Reported Physical Therapist Staffing Hours per Resident Per Day
0.17537
Expected CNA Staffing Hours per Resident per Day
2.49088
Expected LPN Staffing Hours per Resident per Day
0.60460
Expected RN Staffing Hours per Resident per Day
0.96026
Expected Total Nurse Staffing Hours per Resident per Day
4.05574
Adjusted CNA Staffing Hours per Resident per Day
3.00594
Adjusted LPN Staffing Hours per Resident per Day
0.91230
Adjusted RN Staffing Hours per Resident per Day
0.70641
Adjusted Total Nurse Staffing Hours per Resident per Day
4.59556
Cycle 1 Total Number of Health Deficiencies
2
Cycle 1 Number of Standard Health Deficiencies
2
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
8
Cycle 1 Standard Survey Health Date
2014-06-12
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
8
Cycle 2 Total Number of Health Deficiencies
6
Cycle 2 Number of Standard Health Deficiencies
6
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
28
Cycle 2 Standard Health Survey Date
2013-07-25
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
0
Cycle 3 Number of Standard Health Deficiencies
0
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
0
Cycle 3 Standard Health Survey Date
2012-04-26
Cycle 3 Number of Health Revisits
0
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
0
Total Weighted Health Survey Score
13.33300
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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