Manorcare Health Services - Fond Du Lac Nursing Home
General Information
UPDATEFederal Provider Number
525274
Provider Name
MANORCARE HEALTH SERVICES
Provider Address
265 S NATIONAL AVE
FOND DU LAC, WI 54935
FOND DU LAC, WI 54935
Provider Phone Number
(920) 922-7342
Provider SSA County
190
Provider County Name
Fond Du Lac
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
108
Number of Residents in Certified Beds
57
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
MANOR CARE OF FOND DU LAC WI LLC
Date First Approved to Provide Medicare and Medicaid services
1976-12-01
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
5
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
5
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
2.35351
Reported LPN Staffing Hours per Resident per Day
0.06140
Reported RN Staffing Hours per Resident per Day
1.50439
Reported Licensed Staffing Hours per Resident per Day
1.56579
Reported Total Nurse Staffing Hours per Resident per Day
3.91930
Reported Physical Therapist Staffing Hours per Resident Per Day
0.07632
Expected CNA Staffing Hours per Resident per Day
2.48063
Expected LPN Staffing Hours per Resident per Day
0.61073
Expected RN Staffing Hours per Resident per Day
0.99006
Expected Total Nurse Staffing Hours per Resident per Day
4.08141
Adjusted CNA Staffing Hours per Resident per Day
2.32796
Adjusted LPN Staffing Hours per Resident per Day
0.08345
Adjusted RN Staffing Hours per Resident per Day
1.13537
Adjusted Total Nurse Staffing Hours per Resident per Day
3.87079
Cycle 1 Total Number of Health Deficiencies
5
Cycle 1 Number of Standard Health Deficiencies
5
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
20
Cycle 1 Standard Survey Health Date
2014-05-21
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
20
Cycle 2 Total Number of Health Deficiencies
11
Cycle 2 Number of Standard Health Deficiencies
10
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
48
Cycle 2 Standard Health Survey Date
2013-03-06
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
48
Cycle 3 Total Number of Health Deficiencies
8
Cycle 3 Number of Standard Health Deficiencies
7
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
36
Cycle 3 Standard Health Survey Date
2012-03-28
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
36
Total Weighted Health Survey Score
32.00000
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
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