St Marys Home For The Aged - Manitowoc Nursing Home
General Information
UPDATEFederal Provider Number
525609
Provider Name
ST MARYS HOME FOR THE AGED
Provider Address
1635 S 21ST STREET
MANITOWOC, WI 54220
MANITOWOC, WI 54220
Provider Phone Number
(920) 684-7171
Provider SSA County
350
Provider County Name
Manitowoc
Provider Website
Provider Description
Ownership Type
Non profit - Church related
Number of Certified Beds
84
Number of Residents in Certified Beds
82
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
ST. MARY'S HOME FOR THE AGED, INC
Date First Approved to Provide Medicare and Medicaid services
1996-12-01
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
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
3.12683
Reported LPN Staffing Hours per Resident per Day
0.45366
Reported RN Staffing Hours per Resident per Day
0.90610
Reported Licensed Staffing Hours per Resident per Day
1.35976
Reported Total Nurse Staffing Hours per Resident per Day
4.48659
Reported Physical Therapist Staffing Hours per Resident Per Day
0.08963
Expected CNA Staffing Hours per Resident per Day
2.63128
Expected LPN Staffing Hours per Resident per Day
0.58444
Expected RN Staffing Hours per Resident per Day
0.95303
Expected Total Nurse Staffing Hours per Resident per Day
4.16876
Adjusted CNA Staffing Hours per Resident per Day
2.91580
Adjusted LPN Staffing Hours per Resident per Day
0.64427
Adjusted RN Staffing Hours per Resident per Day
0.71041
Adjusted Total Nurse Staffing Hours per Resident per Day
4.33822
Cycle 1 Total Number of Health Deficiencies
8
Cycle 1 Number of Standard Health Deficiencies
8
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
40
Cycle 1 Standard Survey Health Date
2015-02-05
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
40
Cycle 2 Total Number of Health Deficiencies
3
Cycle 2 Number of Standard Health Deficiencies
3
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
24
Cycle 2 Standard Health Survey Date
2014-02-20
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
24
Cycle 3 Total Number of Health Deficiencies
8
Cycle 3 Number of Standard Health Deficiencies
4
Cycle 3 Number of Complaint Health Deficiencies
4
Cycle 3 Health Deficiency Score
40
Cycle 3 Standard Health Survey Date
2012-12-17
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
40
Total Weighted Health Survey Score
34.66700
Number of Facility Reported Incidents
2
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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