Shorehaven Hlth & Rehab Ctr - Oconomowoc Nursing Home

General Information

UPDATE

Federal Provider Number

525560

Provider Name

SHOREHAVEN HLTH & REHAB CTR

Provider Address

1305 W WISCONSIN AVE
OCONOMOWOC, WI 53066

Provider Phone Number

(262) 567-8341

Provider SSA County

660

Provider County Name

Waukesha

Provider Website

Provider Description

Ownership Type

Non profit - Corporation

Number of Certified Beds

120

Number of Residents in Certified Beds

103

Provider Type

Medicare and Medicaid

Provider Resides in Hospital

Legal Business Name

LUTHERAN HOMES OF OCONOMOWOC INC.

Date First Approved to Provide Medicare and Medicaid services

1995-02-01

Continuing Care Retirement Community

Special Focus Facility

Provider Changed Ownership in Last 12 Months

With a Resident and Family Council

Resident

Automatic Sprinkler Systems in All Required Areas

Yes

Rating Detail Information

Overall Rating

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Health Inspection Rating

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QM Rating

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Staffing Rating

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RN Staffing Rating

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Reported Staffing Footnote

Physical Therapist Staffing Footnote

Reported CNA Staffing Hours per Resident per Day

2.86553

Reported LPN Staffing Hours per Resident per Day

0.47039

Reported RN Staffing Hours per Resident per Day

1.09612

Reported Licensed Staffing Hours per Resident per Day

1.56650

Reported Total Nurse Staffing Hours per Resident per Day

4.43204

Reported Physical Therapist Staffing Hours per Resident Per Day

0.07621

Expected CNA Staffing Hours per Resident per Day

2.67663

Expected LPN Staffing Hours per Resident per Day

0.57497

Expected RN Staffing Hours per Resident per Day

0.88906

Expected Total Nurse Staffing Hours per Resident per Day

4.14067

Adjusted CNA Staffing Hours per Resident per Day

2.62687

Adjusted LPN Staffing Hours per Resident per Day

0.67903

Adjusted RN Staffing Hours per Resident per Day

0.92122

Adjusted Total Nurse Staffing Hours per Resident per Day

4.31455

Cycle 1 Total Number of Health Deficiencies

Cycle 1 Number of Standard Health Deficiencies

Cycle 1 Number of Complaint Health Deficiencies

Cycle 1 Health Deficiency Score

Cycle 1 Standard Survey Health Date

2014-10-22

Cycle 1 Number of Health Revisits

Cycle 1 Health Revisit Score

Cycle 1 Total Health Score

Cycle 2 Total Number of Health Deficiencies

Cycle 2 Number of Standard Health Deficiencies

Cycle 2 Number of Complaint Health Deficiencies

Cycle 2 Health Deficiency Score

Cycle 2 Standard Health Survey Date

2013-11-26

Cycle 2 Number of Health Revisits

Cycle 2 Health Revisit Score

Cycle 2 Total Health Score

Cycle 3 Total Number of Health Deficiencies

Cycle 3 Number of Standard Health Deficiencies

Cycle 3 Number of Complaint Health Deficiencies

Cycle 3 Health Deficiency Score

Cycle 3 Standard Health Survey Date

2012-08-20

Cycle 3 Number of Health Revisits

Cycle 3 Health Revisit Score

Cycle 3 Total Health Score

Total Weighted Health Survey Score

2.66700

Number of Facility Reported Incidents

Number of Substantiated Complaints

Number of Fines

Total Amount of Fines in Dollars

Number of Payment Denials

Total Number of Penalties

Location

Processing Date

2015-06-01

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