Sheboygan Senior Community Inc - Sheboygan Nursing Home
General Information
UPDATEFederal Provider Number
525598
Provider Name
SHEBOYGAN SENIOR COMMUNITY INC
Provider Address
930 N 6TH ST
SHEBOYGAN, WI 53081
SHEBOYGAN, WI 53081
Provider Phone Number
(920) 458-2137
Provider SSA County
580
Provider County Name
Sheboygan
Provider Website
Provider Description
Ownership Type
Non profit - Church related
Number of Certified Beds
60
Number of Residents in Certified Beds
44
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
SHEBOYGAN SENIOR COMMUNITY, INC.
Date First Approved to Provide Medicare and Medicaid services
1996-10-01
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
5
Overall Rating Footnote
Health Inspection Rating
3
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
2.66932
Reported LPN Staffing Hours per Resident per Day
0.58068
Reported RN Staffing Hours per Resident per Day
1.49091
Reported Licensed Staffing Hours per Resident per Day
2.07159
Reported Total Nurse Staffing Hours per Resident per Day
4.74091
Reported Physical Therapist Staffing Hours per Resident Per Day
0.05341
Expected CNA Staffing Hours per Resident per Day
2.46367
Expected LPN Staffing Hours per Resident per Day
0.57615
Expected RN Staffing Hours per Resident per Day
0.99629
Expected Total Nurse Staffing Hours per Resident per Day
4.03611
Adjusted CNA Staffing Hours per Resident per Day
2.65851
Adjusted LPN Staffing Hours per Resident per Day
0.83653
Adjusted RN Staffing Hours per Resident per Day
1.11816
Adjusted Total Nurse Staffing Hours per Resident per Day
4.73479
Cycle 1 Total Number of Health Deficiencies
3
Cycle 1 Number of Standard Health Deficiencies
3
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
24
Cycle 1 Standard Survey Health Date
2014-10-07
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
24
Cycle 2 Total Number of Health Deficiencies
7
Cycle 2 Number of Standard Health Deficiencies
5
Cycle 2 Number of Complaint Health Deficiencies
2
Cycle 2 Health Deficiency Score
44
Cycle 2 Standard Health Survey Date
2013-08-01
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
7
Cycle 3 Number of Standard Health Deficiencies
6
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
36
Cycle 3 Standard Health Survey Date
2012-06-28
Cycle 3 Number of Health Revisits
2
Cycle 3 Health Revisit Score
18
Cycle 3 Total Health Score
54
Total Weighted Health Survey Score
35.66700
Number of Facility Reported Incidents
1
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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