Wisconsin Nursing Homes >> Green Bay Nursing Homes >> Odd Fellow Home

Odd Fellow Home - Green Bay Nursing Home

General Information

UPDATE
Federal Provider Number
525559
Provider Name
ODD FELLOW HOME
Provider Address
1229 S JACKSON ST
GREEN BAY, WI 54301
Provider Phone Number
(920) 437-6523
Provider SSA County
40
Provider County Name
Brown
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
74
Number of Residents in Certified Beds
68
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
ODD FELLOW REBEKAH HOME ASSOCIATION INC
Date First Approved to Provide Medicare and Medicaid services
1995-01-01
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
4
Overall Rating Footnote
Health Inspection Rating
2
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
3.21176
Reported LPN Staffing Hours per Resident per Day
0.47353
Reported RN Staffing Hours per Resident per Day
1.21103
Reported Licensed Staffing Hours per Resident per Day
1.68456
Reported Total Nurse Staffing Hours per Resident per Day
4.89632
Reported Physical Therapist Staffing Hours per Resident Per Day
0.03971
Expected CNA Staffing Hours per Resident per Day
2.60998
Expected LPN Staffing Hours per Resident per Day
0.65627
Expected RN Staffing Hours per Resident per Day
1.00251
Expected Total Nurse Staffing Hours per Resident per Day
4.26877
Adjusted CNA Staffing Hours per Resident per Day
3.01944
Adjusted LPN Staffing Hours per Resident per Day
0.59888
Adjusted RN Staffing Hours per Resident per Day
0.90261
Adjusted Total Nurse Staffing Hours per Resident per Day
4.62348
Cycle 1 Total Number of Health Deficiencies
6
Cycle 1 Number of Standard Health Deficiencies
6
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
48
Cycle 1 Standard Survey Health Date
2015-03-06
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
48
Cycle 2 Total Number of Health Deficiencies
8
Cycle 2 Number of Standard Health Deficiencies
8
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
48
Cycle 2 Standard Health Survey Date
2014-02-05
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
48
Cycle 3 Total Number of Health Deficiencies
16
Cycle 3 Number of Standard Health Deficiencies
12
Cycle 3 Number of Complaint Health Deficiencies
4
Cycle 3 Health Deficiency Score
108
Cycle 3 Standard Health Survey Date
2012-11-19
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
108
Total Weighted Health Survey Score
58.00000
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
1
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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