Mayo Clinic Hlth System Chippewa Valley-maplewood - Bloomer Nursing Home
General Information
UPDATEFederal Provider Number
525479
Provider Name
MAYO CLINIC HLTH SYSTEM CHIPPEWA VALLEY-MAPLEWOOD
Provider Address
1501 THOMPSON ST
BLOOMER, WI 54724
BLOOMER, WI 54724
Provider Phone Number
(715) 568-6157
Provider SSA County
80
Provider County Name
Chippewa
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
35
Number of Residents in Certified Beds
28
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
Y
Legal Business Name
MAYO CLINIC HEALTH SYSTEM - CHIPPEWA VALLEY, INC
Date First Approved to Provide Medicare and Medicaid services
1992-01-01
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
3
Health Inspection Rating Footnote
QM Rating
4
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
2.78571
Reported LPN Staffing Hours per Resident per Day
0.12321
Reported RN Staffing Hours per Resident per Day
1.32679
Reported Licensed Staffing Hours per Resident per Day
1.45000
Reported Total Nurse Staffing Hours per Resident per Day
4.23571
Reported Physical Therapist Staffing Hours per Resident Per Day
0.28036
Expected CNA Staffing Hours per Resident per Day
2.57577
Expected LPN Staffing Hours per Resident per Day
0.60857
Expected RN Staffing Hours per Resident per Day
0.90607
Expected Total Nurse Staffing Hours per Resident per Day
4.09041
Adjusted CNA Staffing Hours per Resident per Day
2.65369
Adjusted LPN Staffing Hours per Resident per Day
0.16804
Adjusted RN Staffing Hours per Resident per Day
1.09415
Adjusted Total Nurse Staffing Hours per Resident per Day
4.17408
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
32
Cycle 1 Standard Survey Health Date
2015-01-22
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
32
Cycle 2 Total Number of Health Deficiencies
3
Cycle 2 Number of Standard Health Deficiencies
3
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
28
Cycle 2 Standard Health Survey Date
2014-02-25
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
28
Cycle 3 Total Number of Health Deficiencies
9
Cycle 3 Number of Standard Health Deficiencies
7
Cycle 3 Number of Complaint Health Deficiencies
2
Cycle 3 Health Deficiency Score
48
Cycle 3 Standard Health Survey Date
2013-01-09
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
48
Total Weighted Health Survey Score
33.33300
Number of Facility Reported Incidents
1
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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