St Paul Elder Services, Inc - Kaukauna Nursing Home
General Information
UPDATEFederal Provider Number
525617
Provider Name
ST PAUL ELDER SERVICES, INC
Provider Address
316 EAST 14TH STREET
KAUKAUNA, WI 54130
KAUKAUNA, WI 54130
Provider Phone Number
(920) 766-6020
Provider SSA County
430
Provider County Name
Outagamie
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
117
Number of Residents in Certified Beds
110
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
ST PAUL ELDER SERVICES, INC
Date First Approved to Provide Medicare and Medicaid services
1997-07-01
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
5
Overall Rating Footnote
Health Inspection Rating
4
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
2.96091
Reported LPN Staffing Hours per Resident per Day
0.16364
Reported RN Staffing Hours per Resident per Day
1.28500
Reported Licensed Staffing Hours per Resident per Day
1.44864
Reported Total Nurse Staffing Hours per Resident per Day
4.40955
Reported Physical Therapist Staffing Hours per Resident Per Day
0.08636
Expected CNA Staffing Hours per Resident per Day
2.61471
Expected LPN Staffing Hours per Resident per Day
0.69727
Expected RN Staffing Hours per Resident per Day
1.11071
Expected Total Nurse Staffing Hours per Resident per Day
4.42269
Adjusted CNA Staffing Hours per Resident per Day
2.77858
Adjusted LPN Staffing Hours per Resident per Day
0.19479
Adjusted RN Staffing Hours per Resident per Day
0.86445
Adjusted Total Nurse Staffing Hours per Resident per Day
4.01892
Cycle 1 Total Number of Health Deficiencies
6
Cycle 1 Number of Standard Health Deficiencies
6
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
44
Cycle 1 Standard Survey Health Date
2014-11-06
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
44
Cycle 2 Total Number of Health Deficiencies
0
Cycle 2 Number of Standard Health Deficiencies
0
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
0
Cycle 2 Standard Health Survey Date
2013-09-26
Cycle 2 Number of Health Revisits
0
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
8
Cycle 3 Number of Standard Health Deficiencies
7
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
56
Cycle 3 Standard Health Survey Date
2012-07-12
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
56
Total Weighted Health Survey Score
31.33300
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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