Wisconsin Nursing Homes >> Hazel Green Nursing Homes >> St Dominic Villa

St Dominic Villa - Hazel Green Nursing Home

General Information

UPDATE
Federal Provider Number
525660
Provider Name
ST DOMINIC VILLA
Provider Address
2375 SINSINAWA RD
HAZEL GREEN, WI 53811
Provider Phone Number
6087489814
Provider SSA County
210
Provider County Name
Grant
Ownership Type
Non profit - Corporation
Number of Certified Beds
62
Number of Residents in Certified Beds
61
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
SINSINAWA NURSING INC
Date First Approved to Provide Medicare and Medicaid services
2000-12-08
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Both
Automatic Sprinkler Systems in All Required Areas
Yes

Rating Detail Information

Overall Rating
5
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
5
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
1.99426
Reported LPN Staffing Hours per Resident per Day
0.21148
Reported RN Staffing Hours per Resident per Day
0.86393
Reported Licensed Staffing Hours per Resident per Day
1.07541
Reported Total Nurse Staffing Hours per Resident per Day
3.06967
Reported Physical Therapist Staffing Hours per Resident Per Day
0.03607
Expected CNA Staffing Hours per Resident per Day
2.30042
Expected LPN Staffing Hours per Resident per Day
0.55210
Expected RN Staffing Hours per Resident per Day
0.83823
Expected Total Nurse Staffing Hours per Resident per Day
3.69075
Adjusted CNA Staffing Hours per Resident per Day
2.12714
Adjusted LPN Staffing Hours per Resident per Day
0.31793
Adjusted RN Staffing Hours per Resident per Day
0.77011
Adjusted Total Nurse Staffing Hours per Resident per Day
3.35258
Cycle 1 Total Number of Health Deficiencies
2
Cycle 1 Number of Standard Health Deficiencies
2
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
12
Cycle 1 Standard Survey Health Date
2014-05-14
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
12
Cycle 2 Total Number of Health Deficiencies
4
Cycle 2 Number of Standard Health Deficiencies
4
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
28
Cycle 2 Standard Health Survey Date
2013-03-11
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
6
Cycle 3 Number of Standard Health Deficiencies
6
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
28
Cycle 3 Standard Health Survey Date
2012-01-10
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
28
Total Weighted Health Survey Score
20.00000
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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