Providence Place - Minneapolis Nursing Home
General Information
UPDATEFederal Provider Number
245271
Provider Name
PROVIDENCE PLACE
Provider Address
3720 23RD AVENUE SOUTH
MINNEAPOLIS, MN 55407
MINNEAPOLIS, MN 55407
Provider Phone Number
6127245495
Provider SSA County
260
Provider County Name
Hennepin
Ownership Type
Non profit - Corporation
Number of Certified Beds
190
Number of Residents in Certified Beds
175
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
SENIOR CARE PROVIDENCE, LLC
Date First Approved to Provide Medicare and Medicaid services
1984-05-29
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
2
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
2.34686
Reported LPN Staffing Hours per Resident per Day
0.70571
Reported RN Staffing Hours per Resident per Day
1.17571
Reported Licensed Staffing Hours per Resident per Day
1.88143
Reported Total Nurse Staffing Hours per Resident per Day
4.22828
Reported Physical Therapist Staffing Hours per Resident Per Day
0.04486
Expected CNA Staffing Hours per Resident per Day
2.50457
Expected LPN Staffing Hours per Resident per Day
0.63613
Expected RN Staffing Hours per Resident per Day
0.97683
Expected Total Nurse Staffing Hours per Resident per Day
4.11752
Adjusted CNA Staffing Hours per Resident per Day
2.29919
Adjusted LPN Staffing Hours per Resident per Day
0.92079
Adjusted RN Staffing Hours per Resident per Day
0.89933
Adjusted Total Nurse Staffing Hours per Resident per Day
4.13933
Cycle 1 Total Number of Health Deficiencies
6
Cycle 1 Number of Standard Health Deficiencies
4
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
28
Cycle 1 Standard Survey Health Date
2015-04-02
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
28
Cycle 2 Total Number of Health Deficiencies
13
Cycle 2 Number of Standard Health Deficiencies
13
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
72
Cycle 2 Standard Health Survey Date
2014-03-31
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
6
Cycle 3 Number of Standard Health Deficiencies
6
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
36
Cycle 3 Standard Health Survey Date
2013-05-16
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
36
Total Weighted Health Survey Score
44.00000
Number of Facility Reported Incidents
0
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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