Masonic Center For Health & Rehab Inc - Dousman Nursing Home

General Information

UPDATE
Federal Provider Number
525572
Provider Name
MASONIC CENTER FOR HEALTH & REHAB INC
Provider Address
400 N MAIN ST
DOUSMAN, WI 53118
Provider Phone Number
2629657245
Provider SSA County
660
Provider County Name
Waukesha
Ownership Type
For profit - Individual
Number of Certified Beds
84
Number of Residents in Certified Beds
73
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
MASONIC CENTER FOR HEALTH AND REHAB, INC.
Date First Approved to Provide Medicare and Medicaid services
1995-07-01
Continuing Care Retirement Community
Y
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
5
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
2.80000
Reported LPN Staffing Hours per Resident per Day
0.60274
Reported RN Staffing Hours per Resident per Day
1.39589
Reported Licensed Staffing Hours per Resident per Day
1.99863
Reported Total Nurse Staffing Hours per Resident per Day
4.79863
Reported Physical Therapist Staffing Hours per Resident Per Day
0.06644
Expected CNA Staffing Hours per Resident per Day
2.72934
Expected LPN Staffing Hours per Resident per Day
0.67127
Expected RN Staffing Hours per Resident per Day
0.96867
Expected Total Nurse Staffing Hours per Resident per Day
4.36929
Adjusted CNA Staffing Hours per Resident per Day
2.51722
Adjusted LPN Staffing Hours per Resident per Day
0.74526
Adjusted RN Staffing Hours per Resident per Day
1.07674
Adjusted Total Nurse Staffing Hours per Resident per Day
4.42699
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
8
Cycle 1 Standard Survey Health Date
2015-01-28
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
0
Cycle 2 Number of Standard Health Deficiencies
0
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
0
Cycle 2 Standard Health Survey Date
2013-11-15
Cycle 2 Number of Health Revisits
0
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
3
Cycle 3 Number of Standard Health Deficiencies
0
Cycle 3 Number of Complaint Health Deficiencies
3
Cycle 3 Health Deficiency Score
165
Cycle 3 Standard Health Survey Date
2012-07-18
Cycle 3 Number of Health Revisits
0
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
165
Total Weighted Health Survey Score
31.50000
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
0
Number of Fines
1
Total Amount of Fines in Dollars
30583
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01

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