Sholom Home West - Saint Louis Park Nursing Home
General Information
UPDATEFederal Provider Number
245574
Provider Name
SHOLOM HOME WEST
Provider Address
3620 PHILLIPS PARKWAY SOUTH
SAINT LOUIS PARK, MN 55426
SAINT LOUIS PARK, MN 55426
Provider Phone Number
(952) 935-6311
Provider SSA County
260
Provider County Name
Hennepin
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
179
Number of Residents in Certified Beds
159
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
SHOLOM HOME WEST INC
Date First Approved to Provide Medicare and Medicaid services
1991-07-24
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
2
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
3
QM Rating Footnote
Staffing Rating
3
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
2.08428
Reported LPN Staffing Hours per Resident per Day
0.48868
Reported RN Staffing Hours per Resident per Day
1.01855
Reported Licensed Staffing Hours per Resident per Day
1.50723
Reported Total Nurse Staffing Hours per Resident per Day
3.59151
Reported Physical Therapist Staffing Hours per Resident Per Day
0.14151
Expected CNA Staffing Hours per Resident per Day
2.48167
Expected LPN Staffing Hours per Resident per Day
0.57337
Expected RN Staffing Hours per Resident per Day
0.93792
Expected Total Nurse Staffing Hours per Resident per Day
3.99296
Adjusted CNA Staffing Hours per Resident per Day
2.06079
Adjusted LPN Staffing Hours per Resident per Day
0.70740
Adjusted RN Staffing Hours per Resident per Day
0.81143
Adjusted Total Nurse Staffing Hours per Resident per Day
3.62564
Cycle 1 Total Number of Health Deficiencies
5
Cycle 1 Number of Standard Health Deficiencies
5
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
40
Cycle 1 Standard Survey Health Date
2014-08-07
Cycle 1 Number of Health Revisits
2
Cycle 1 Health Revisit Score
20
Cycle 1 Total Health Score
60
Cycle 2 Total Number of Health Deficiencies
6
Cycle 2 Number of Standard Health Deficiencies
6
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
28
Cycle 2 Standard Health Survey Date
2013-05-17
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
28
Cycle 3 Total Number of Health Deficiencies
1
Cycle 3 Number of Standard Health Deficiencies
1
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
4
Cycle 3 Standard Health Survey Date
2012-04-05
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
4
Total Weighted Health Survey Score
40.00000
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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