Samaritan's Cedar Crossing Subacute Unit - West Bend Nursing Home
General Information
UPDATEFederal Provider Number
525618
Provider Name
SAMARITAN'S CEDAR CROSSING SUBACUTE UNIT
Provider Address
3200 W PLEASANT VALLEY RD
WEST BEND, WI 53095
WEST BEND, WI 53095
Provider Phone Number
(262) 677-6800
Provider SSA County
650
Provider County Name
Washington
Provider Website
Provider Description
Ownership Type
Government - County
Number of Certified Beds
18
Number of Residents in Certified Beds
15
Provider Type
Medicare
Provider Resides in Hospital
N
Legal Business Name
WASHINGTON COUNTY WISCONSIN
Date First Approved to Provide Medicare and Medicaid services
1997-02-25
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
4
Overall Rating Footnote
Health Inspection Rating
5
Health Inspection Rating Footnote
QM Rating
1
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
2.00667
Reported LPN Staffing Hours per Resident per Day
0.45667
Reported RN Staffing Hours per Resident per Day
3.18000
Reported Licensed Staffing Hours per Resident per Day
3.63667
Reported Total Nurse Staffing Hours per Resident per Day
5.64334
Reported Physical Therapist Staffing Hours per Resident Per Day
0.44667
Expected CNA Staffing Hours per Resident per Day
2.51065
Expected LPN Staffing Hours per Resident per Day
0.83476
Expected RN Staffing Hours per Resident per Day
1.92978
Expected Total Nurse Staffing Hours per Resident per Day
5.27519
Adjusted CNA Staffing Hours per Resident per Day
1.96115
Adjusted LPN Staffing Hours per Resident per Day
0.45407
Adjusted RN Staffing Hours per Resident per Day
1.23128
Adjusted Total Nurse Staffing Hours per Resident per Day
4.31221
Cycle 1 Total Number of Health Deficiencies
0
Cycle 1 Number of Standard Health Deficiencies
0
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
0
Cycle 1 Standard Survey Health Date
2014-11-26
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
0
Cycle 2 Total Number of Health Deficiencies
3
Cycle 2 Number of Standard Health Deficiencies
3
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
24
Cycle 2 Standard Health Survey Date
2013-11-04
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
24
Cycle 3 Total Number of Health Deficiencies
2
Cycle 3 Number of Standard Health Deficiencies
2
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
24
Cycle 3 Standard Health Survey Date
2012-11-08
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
24
Total Weighted Health Survey Score
12.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
0
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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