Peabody Manor - Appleton Nursing Home
General Information
UPDATEFederal Provider Number
525548
Provider Name
PEABODY MANOR
Provider Address
2600 S HERITAGE WOODS DR
APPLETON, WI 54915
APPLETON, WI 54915
Provider Phone Number
(920) 738-3000
Provider SSA County
690
Provider County Name
Winnebago
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
58
Number of Residents in Certified Beds
56
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
THEDACARE, INCORPORATED
Date First Approved to Provide Medicare and Medicaid services
1994-10-01
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
3.02411
Reported LPN Staffing Hours per Resident per Day
0.62589
Reported RN Staffing Hours per Resident per Day
1.36518
Reported Licensed Staffing Hours per Resident per Day
1.99107
Reported Total Nurse Staffing Hours per Resident per Day
5.01518
Reported Physical Therapist Staffing Hours per Resident Per Day
0.26071
Expected CNA Staffing Hours per Resident per Day
2.55337
Expected LPN Staffing Hours per Resident per Day
0.59009
Expected RN Staffing Hours per Resident per Day
1.01236
Expected Total Nurse Staffing Hours per Resident per Day
4.15582
Adjusted CNA Staffing Hours per Resident per Day
2.90606
Adjusted LPN Staffing Hours per Resident per Day
0.88036
Adjusted RN Staffing Hours per Resident per Day
1.00761
Adjusted Total Nurse Staffing Hours per Resident per Day
4.86443
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
20
Cycle 1 Standard Survey Health Date
2015-03-12
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
20
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
44
Cycle 2 Standard Health Survey Date
2014-03-13
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
44
Cycle 3 Total Number of Health Deficiencies
13
Cycle 3 Number of Standard Health Deficiencies
7
Cycle 3 Number of Complaint Health Deficiencies
6
Cycle 3 Health Deficiency Score
251
Cycle 3 Standard Health Survey Date
2013-02-06
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
251
Total Weighted Health Survey Score
66.50000
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
1
Number of Fines
1
Total Amount of Fines in Dollars
20963
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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