Meadow View Manor - Sheboygan Nursing Home
General Information
UPDATEFederal Provider Number
525605
Provider Name
MEADOW VIEW MANOR
Provider Address
3613 S 13TH ST
SHEBOYGAN, WI 53081
SHEBOYGAN, WI 53081
Provider Phone Number
(920) 458-4040
Provider SSA County
580
Provider County Name
Sheboygan
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
74
Number of Residents in Certified Beds
37
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
EXTENDICARE HOMES, INC
Date First Approved to Provide Medicare and Medicaid services
1996-12-01
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
3
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
2.09324
Reported LPN Staffing Hours per Resident per Day
0.34324
Reported RN Staffing Hours per Resident per Day
1.25676
Reported Licensed Staffing Hours per Resident per Day
1.60000
Reported Total Nurse Staffing Hours per Resident per Day
3.69324
Reported Physical Therapist Staffing Hours per Resident Per Day
0.05946
Expected CNA Staffing Hours per Resident per Day
2.72530
Expected LPN Staffing Hours per Resident per Day
0.70756
Expected RN Staffing Hours per Resident per Day
1.06028
Expected Total Nurse Staffing Hours per Resident per Day
4.49314
Adjusted CNA Staffing Hours per Resident per Day
1.88463
Adjusted LPN Staffing Hours per Resident per Day
0.40264
Adjusted RN Staffing Hours per Resident per Day
0.88566
Adjusted Total Nurse Staffing Hours per Resident per Day
3.31329
Cycle 1 Total Number of Health Deficiencies
4
Cycle 1 Number of Standard Health Deficiencies
4
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
16
Cycle 1 Standard Survey Health Date
2015-03-19
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
16
Cycle 2 Total Number of Health Deficiencies
7
Cycle 2 Number of Standard Health Deficiencies
7
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
36
Cycle 2 Standard Health Survey Date
2014-05-08
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
36
Cycle 3 Total Number of Health Deficiencies
4
Cycle 3 Number of Standard Health Deficiencies
4
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
12
Cycle 3 Standard Health Survey Date
2013-04-25
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
12
Total Weighted Health Survey Score
22.00000
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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