Pine Manor Health And Rehabilitation - Clintonville Nursing Home
General Information
UPDATEFederal Provider Number
525497
Provider Name
PINE MANOR HEALTH AND REHABILITATION
Provider Address
1625 E MAIN ST
CLINTONVILLE, WI 54929
CLINTONVILLE, WI 54929
Provider Phone Number
7158233135
Provider SSA County
670
Provider County Name
Waupaca
Ownership Type
For profit - Corporation
Number of Certified Beds
95
Number of Residents in Certified Beds
48
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
CLOVERLEAF HEALTHCARE INC
Date First Approved to Provide Medicare and Medicaid services
1992-11-01
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Both
Automatic Sprinkler Systems in All Required Areas
Yes
Rating Detail Information
Overall Rating
3
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
4
QM Rating Footnote
Staffing Rating
3
Staffing Rating Footnote
RN Staffing Rating
3
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.38333
Reported LPN Staffing Hours per Resident per Day
1.01979
Reported RN Staffing Hours per Resident per Day
0.59063
Reported Licensed Staffing Hours per Resident per Day
1.61042
Reported Total Nurse Staffing Hours per Resident per Day
3.99375
Reported Physical Therapist Staffing Hours per Resident Per Day
0.07188
Expected CNA Staffing Hours per Resident per Day
2.48983
Expected LPN Staffing Hours per Resident per Day
0.56757
Expected RN Staffing Hours per Resident per Day
0.88388
Expected Total Nurse Staffing Hours per Resident per Day
3.94127
Adjusted CNA Staffing Hours per Resident per Day
2.34875
Adjusted LPN Staffing Hours per Resident per Day
1.49132
Adjusted RN Staffing Hours per Resident per Day
0.49930
Adjusted Total Nurse Staffing Hours per Resident per Day
4.08457
Cycle 1 Total Number of Health Deficiencies
9
Cycle 1 Number of Standard Health Deficiencies
7
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
32
Cycle 1 Standard Survey Health Date
2015-02-25
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
32
Cycle 2 Total Number of Health Deficiencies
9
Cycle 2 Number of Standard Health Deficiencies
7
Cycle 2 Number of Complaint Health Deficiencies
2
Cycle 2 Health Deficiency Score
40
Cycle 2 Standard Health Survey Date
2014-03-06
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
10
Cycle 3 Number of Standard Health Deficiencies
9
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
64
Cycle 3 Standard Health Survey Date
2013-01-09
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
64
Total Weighted Health Survey Score
40.00000
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
3
Number of Fines
1
Total Amount of Fines in Dollars
1625
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
Nursiong Homes Nearby
Greentree Health And Rehab Ctr
70 Greentree Rd |
CLINTONVILLE WI 54929 | 4.7 miles away
Manawa Com Nur Ctr
400 East 4th St |
MANAWA WI 54949 | 18.8 miles away
St Joseph Residence
107 E Beckert Rd |
NEW LONDON WI 54961 | 21 miles away
Iola Living Assistance, Inc
185 Chet Krause Dr Po Box 237 |
IOLA WI 54945 | 24.9 miles away
Lakeview Manor
912 Manor Drive |
WEYAUWEGA WI 54983 | 26.4 miles away
Crossroads Care Center Of Weyauwega
717 E Alfred St |
WEYAUWEGA WI 54983 | 27.3 miles away
Crossroads Care Center Of Crystal River
1401 Churchill St |
WAUPACA WI 54981 | 29.9 miles away
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