St Olaf Residence - Minneapolis Nursing Home
General Information
UPDATEFederal Provider Number
245387
Provider Name
ST OLAF RESIDENCE
Provider Address
2912 FREMONT AVENUE NORTH
MINNEAPOLIS, MN 55411
MINNEAPOLIS, MN 55411
Provider Phone Number
6122873565
Provider SSA County
260
Provider County Name
Hennepin
Ownership Type
Non profit - Church related
Number of Certified Beds
80
Number of Residents in Certified Beds
68
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
ST. OLAF RESIDENCE, INC.
Date First Approved to Provide Medicare and Medicaid services
1986-12-01
Continuing Care Retirement Community
N
Special Focus Facility
Y
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
1
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
4
QM Rating Footnote
Staffing Rating
2
Staffing Rating Footnote
RN Staffing Rating
1
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.57868
Reported LPN Staffing Hours per Resident per Day
0.83382
Reported RN Staffing Hours per Resident per Day
0.26838
Reported Licensed Staffing Hours per Resident per Day
1.10221
Reported Total Nurse Staffing Hours per Resident per Day
3.68088
Reported Physical Therapist Staffing Hours per Resident Per Day
0.03971
Expected CNA Staffing Hours per Resident per Day
2.15275
Expected LPN Staffing Hours per Resident per Day
0.61399
Expected RN Staffing Hours per Resident per Day
0.88480
Expected Total Nurse Staffing Hours per Resident per Day
3.65154
Adjusted CNA Staffing Hours per Resident per Day
2.93918
Adjusted LPN Staffing Hours per Resident per Day
1.12717
Adjusted RN Staffing Hours per Resident per Day
0.22664
Adjusted Total Nurse Staffing Hours per Resident per Day
4.06329
Cycle 1 Total Number of Health Deficiencies
18
Cycle 1 Number of Standard Health Deficiencies
18
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
84
Cycle 1 Standard Survey Health Date
2015-01-15
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
84
Cycle 2 Total Number of Health Deficiencies
18
Cycle 2 Number of Standard Health Deficiencies
18
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
92
Cycle 2 Standard Health Survey Date
2014-06-27
Cycle 2 Number of Health Revisits
2
Cycle 2 Health Revisit Score
46
Cycle 2 Total Health Score
46
Cycle 3 Total Number of Health Deficiencies
30
Cycle 3 Number of Standard Health Deficiencies
30
Cycle 3 Number of Complaint Health Deficiencies
3
Cycle 3 Health Deficiency Score
295
Cycle 3 Standard Health Survey Date
2013-08-19
Cycle 3 Number of Health Revisits
2
Cycle 3 Health Revisit Score
148
Cycle 3 Total Health Score
443
Total Weighted Health Survey Score
161.83300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
3
Number of Fines
2
Total Amount of Fines in Dollars
5751
Number of Payment Denials
1
Total Number of Penalties
3
Location
Processing Date
2015-06-01
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