Monroe Manor Nur Rehab - Monroe Nursing Home
General Information
UPDATEFederal Provider Number
525292
Provider Name
MONROE MANOR NUR REHAB
Provider Address
516 26TH AVE
MONROE, WI 53566
MONROE, WI 53566
Provider Phone Number
(608) 325-9141
Provider SSA County
220
Provider County Name
Green
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
74
Number of Residents in Certified Beds
40
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
EXTENDICARE HEALTH FACILITIES INC.
Date First Approved to Provide Medicare and Medicaid services
1978-09-01
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
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
5
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.36375
Reported LPN Staffing Hours per Resident per Day
0.63125
Reported RN Staffing Hours per Resident per Day
1.34000
Reported Licensed Staffing Hours per Resident per Day
1.97125
Reported Total Nurse Staffing Hours per Resident per Day
4.33500
Reported Physical Therapist Staffing Hours per Resident Per Day
0.13625
Expected CNA Staffing Hours per Resident per Day
2.65806
Expected LPN Staffing Hours per Resident per Day
0.74553
Expected RN Staffing Hours per Resident per Day
1.29472
Expected Total Nurse Staffing Hours per Resident per Day
4.69832
Adjusted CNA Staffing Hours per Resident per Day
2.18201
Adjusted LPN Staffing Hours per Resident per Day
0.70277
Adjusted RN Staffing Hours per Resident per Day
0.77333
Adjusted Total Nurse Staffing Hours per Resident per Day
3.71919
Cycle 1 Total Number of Health Deficiencies
16
Cycle 1 Number of Standard Health Deficiencies
9
Cycle 1 Number of Complaint Health Deficiencies
7
Cycle 1 Health Deficiency Score
96
Cycle 1 Standard Survey Health Date
2014-07-17
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
96
Cycle 2 Total Number of Health Deficiencies
26
Cycle 2 Number of Standard Health Deficiencies
20
Cycle 2 Number of Complaint Health Deficiencies
16
Cycle 2 Health Deficiency Score
412
Cycle 2 Standard Health Survey Date
2013-05-13
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
412
Cycle 3 Total Number of Health Deficiencies
18
Cycle 3 Number of Standard Health Deficiencies
12
Cycle 3 Number of Complaint Health Deficiencies
6
Cycle 3 Health Deficiency Score
112
Cycle 3 Standard Health Survey Date
2012-02-23
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
112
Total Weighted Health Survey Score
204.00000
Number of Facility Reported Incidents
3
Number of Substantiated Complaints
5
Number of Fines
1
Total Amount of Fines in Dollars
26781
Number of Payment Denials
1
Total Number of Penalties
2
Location
Processing Date
2015-06-01
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