St Joseph Residence - New London Nursing Home
General Information
UPDATEFederal Provider Number
525599
Provider Name
ST JOSEPH RESIDENCE
Provider Address
107 E BECKERT RD
NEW LONDON, WI 54961
NEW LONDON, WI 54961
Provider Phone Number
9209825354
Provider SSA County
670
Provider County Name
Waupaca
Ownership Type
Non profit - Church related
Number of Certified Beds
97
Number of Residents in Certified Beds
81
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
ST JOSEPH RESIDENCE INC
Date First Approved to Provide Medicare and Medicaid services
1996-09-01
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
5
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.74012
Reported LPN Staffing Hours per Resident per Day
0.56111
Reported RN Staffing Hours per Resident per Day
1.01543
Reported Licensed Staffing Hours per Resident per Day
1.57654
Reported Total Nurse Staffing Hours per Resident per Day
4.31666
Reported Physical Therapist Staffing Hours per Resident Per Day
0.07037
Expected CNA Staffing Hours per Resident per Day
2.48468
Expected LPN Staffing Hours per Resident per Day
0.61222
Expected RN Staffing Hours per Resident per Day
0.93992
Expected Total Nurse Staffing Hours per Resident per Day
4.03682
Adjusted CNA Staffing Hours per Resident per Day
2.70596
Adjusted LPN Staffing Hours per Resident per Day
0.76070
Adjusted RN Staffing Hours per Resident per Day
0.80723
Adjusted Total Nurse Staffing Hours per Resident per Day
4.31033
Cycle 1 Total Number of Health Deficiencies
2
Cycle 1 Number of Standard Health Deficiencies
0
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
125
Cycle 1 Standard Survey Health Date
2015-05-05
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
125
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
12
Cycle 2 Standard Health Survey Date
2014-06-16
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
7
Cycle 3 Number of Standard Health Deficiencies
7
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
28
Cycle 3 Standard Health Survey Date
2013-04-18
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
28
Total Weighted Health Survey Score
71.16700
Number of Facility Reported Incidents
0
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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