Lakeside Medical Center - Pine City Nursing Home
General Information
UPDATEFederal Provider Number
245374
Provider Name
LAKESIDE MEDICAL CENTER
Provider Address
129 EAST 6TH AVENUE
PINE CITY, MN 55063
PINE CITY, MN 55063
Provider Phone Number
(320) 629-2542
Provider SSA County
570
Provider County Name
Pine
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
46
Number of Residents in Certified Beds
31
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
LAKESIDE MEDICAL CENTER, INC.
Date First Approved to Provide Medicare and Medicaid services
1987-02-01
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
2
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
2
QM Rating Footnote
Staffing Rating
4
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
2.73871
Reported LPN Staffing Hours per Resident per Day
0.89194
Reported RN Staffing Hours per Resident per Day
0.56452
Reported Licensed Staffing Hours per Resident per Day
1.45645
Reported Total Nurse Staffing Hours per Resident per Day
4.19517
Reported Physical Therapist Staffing Hours per Resident Per Day
0.06452
Expected CNA Staffing Hours per Resident per Day
2.33387
Expected LPN Staffing Hours per Resident per Day
0.60747
Expected RN Staffing Hours per Resident per Day
0.87386
Expected Total Nurse Staffing Hours per Resident per Day
3.81520
Adjusted CNA Staffing Hours per Resident per Day
2.87933
Adjusted LPN Staffing Hours per Resident per Day
1.21868
Adjusted RN Staffing Hours per Resident per Day
0.48269
Adjusted Total Nurse Staffing Hours per Resident per Day
4.43235
Cycle 1 Total Number of Health Deficiencies
19
Cycle 1 Number of Standard Health Deficiencies
19
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
509
Cycle 1 Standard Survey Health Date
2015-04-08
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
509
Cycle 2 Total Number of Health Deficiencies
12
Cycle 2 Number of Standard Health Deficiencies
12
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
123
Cycle 2 Standard Health Survey Date
2014-07-15
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
123
Cycle 3 Total Number of Health Deficiencies
11
Cycle 3 Number of Standard Health Deficiencies
11
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
80
Cycle 3 Standard Health Survey Date
2013-06-06
Cycle 3 Number of Health Revisits
2
Cycle 3 Health Revisit Score
40
Cycle 3 Total Health Score
120
Total Weighted Health Survey Score
315.50000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
2
Number of Fines
1
Total Amount of Fines in Dollars
12025
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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