Montello Care Center - Montello Nursing Home
General Information
UPDATEFederal Provider Number
525657
Provider Name
MONTELLO CARE CENTER
Provider Address
251 FOREST LANE
MONTELLO, WI 53949
MONTELLO, WI 53949
Provider Phone Number
6082972153
Provider SSA County
380
Provider County Name
Marquette
Ownership Type
Non profit - Corporation
Number of Certified Beds
50
Number of Residents in Certified Beds
41
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
WISCONSIN ILLINOIS SENIOR HOUSING INC
Date First Approved to Provide Medicare and Medicaid services
2000-07-31
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
3
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
3
QM Rating Footnote
Staffing Rating
4
Staffing Rating Footnote
RN Staffing Rating
4
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
3.12683
Reported LPN Staffing Hours per Resident per Day
0.61951
Reported RN Staffing Hours per Resident per Day
0.66585
Reported Licensed Staffing Hours per Resident per Day
1.28537
Reported Total Nurse Staffing Hours per Resident per Day
4.41219
Reported Physical Therapist Staffing Hours per Resident Per Day
0.03902
Expected CNA Staffing Hours per Resident per Day
2.44634
Expected LPN Staffing Hours per Resident per Day
0.50629
Expected RN Staffing Hours per Resident per Day
0.72575
Expected Total Nurse Staffing Hours per Resident per Day
3.67837
Adjusted CNA Staffing Hours per Resident per Day
3.13624
Adjusted LPN Staffing Hours per Resident per Day
1.01561
Adjusted RN Staffing Hours per Resident per Day
0.68553
Adjusted Total Nurse Staffing Hours per Resident per Day
4.83504
Cycle 1 Total Number of Health Deficiencies
7
Cycle 1 Number of Standard Health Deficiencies
7
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
36
Cycle 1 Standard Survey Health Date
2014-06-24
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
36
Cycle 2 Total Number of Health Deficiencies
4
Cycle 2 Number of Standard Health Deficiencies
3
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
103
Cycle 2 Standard Health Survey Date
2013-07-12
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
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
32
Cycle 3 Standard Health Survey Date
2012-06-13
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
32
Total Weighted Health Survey Score
57.66700
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
0
Number of Fines
1
Total Amount of Fines in Dollars
5525
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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