Wisconsin Nursing Homes >> Soldiers Grove Nursing Homes >> Sannes Skogdalen Heim

Sannes Skogdalen Heim - Soldiers Grove Nursing Home

General Information

UPDATE
Federal Provider Number
525622
Provider Name
SANNES SKOGDALEN HEIM
Provider Address
101 SUNSHINE BLVD PO BOX 177
SOLDIERS GROVE, WI 54655
Provider Phone Number
6086245244
Provider SSA County
110
Provider County Name
Crawford
Ownership Type
Non profit - Corporation
Number of Certified Beds
50
Number of Residents in Certified Beds
47
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
SANNES SKOGDALEN NURSING FACILITY LLC
Date First Approved to Provide Medicare and Medicaid services
1997-08-01
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
3
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
3
QM Rating Footnote
Staffing Rating
4
Staffing Rating Footnote
RN Staffing Rating
4
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
3.24681
Reported LPN Staffing Hours per Resident per Day
0.63191
Reported RN Staffing Hours per Resident per Day
0.86702
Reported Licensed Staffing Hours per Resident per Day
1.49894
Reported Total Nurse Staffing Hours per Resident per Day
4.74574
Reported Physical Therapist Staffing Hours per Resident Per Day
0.10213
Expected CNA Staffing Hours per Resident per Day
2.48265
Expected LPN Staffing Hours per Resident per Day
0.62949
Expected RN Staffing Hours per Resident per Day
0.97706
Expected Total Nurse Staffing Hours per Resident per Day
4.08920
Adjusted CNA Staffing Hours per Resident per Day
3.20895
Adjusted LPN Staffing Hours per Resident per Day
0.83319
Adjusted RN Staffing Hours per Resident per Day
0.66305
Adjusted Total Nurse Staffing Hours per Resident per Day
4.67808
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
2014-05-22
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
11
Cycle 2 Number of Standard Health Deficiencies
11
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
88
Cycle 2 Standard Health Survey Date
2013-03-14
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
8
Cycle 3 Number of Standard Health Deficiencies
5
Cycle 3 Number of Complaint Health Deficiencies
3
Cycle 3 Health Deficiency Score
48
Cycle 3 Standard Health Survey Date
2012-01-31
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
48
Total Weighted Health Survey Score
61.33300
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
0
Number of Fines
1
Total Amount of Fines in Dollars
1463
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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