Syverson Lutheran Home - Eau Claire Nursing Home
General Information
UPDATEFederal Provider Number
525505
Provider Name
SYVERSON LUTHERAN HOME
Provider Address
816 PORTER AVE
EAU CLAIRE, WI 54701
EAU CLAIRE, WI 54701
Provider Phone Number
(715) 832-1644
Provider SSA County
170
Provider County Name
Eau Claire
Provider Website
Provider Description
Ownership Type
Non profit - Church related
Number of Certified Beds
102
Number of Residents in Certified Beds
93
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
GRACE LUTHERAN FOUNDATION, INC.
Date First Approved to Provide Medicare and Medicaid services
1993-03-01
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
4
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
2.77473
Reported LPN Staffing Hours per Resident per Day
0.39946
Reported RN Staffing Hours per Resident per Day
1.02097
Reported Licensed Staffing Hours per Resident per Day
1.42043
Reported Total Nurse Staffing Hours per Resident per Day
4.19516
Reported Physical Therapist Staffing Hours per Resident Per Day
0.05699
Expected CNA Staffing Hours per Resident per Day
2.54162
Expected LPN Staffing Hours per Resident per Day
0.59961
Expected RN Staffing Hours per Resident per Day
0.88250
Expected Total Nurse Staffing Hours per Resident per Day
4.02372
Adjusted CNA Staffing Hours per Resident per Day
2.67875
Adjusted LPN Staffing Hours per Resident per Day
0.55295
Adjusted RN Staffing Hours per Resident per Day
0.86444
Adjusted Total Nurse Staffing Hours per Resident per Day
4.20264
Cycle 1 Total Number of Health Deficiencies
5
Cycle 1 Number of Standard Health Deficiencies
4
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
36
Cycle 1 Standard Survey Health Date
2015-01-13
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
36
Cycle 2 Total Number of Health Deficiencies
13
Cycle 2 Number of Standard Health Deficiencies
13
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
76
Cycle 2 Standard Health Survey Date
2014-01-30
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
76
Cycle 3 Total Number of Health Deficiencies
11
Cycle 3 Number of Standard Health Deficiencies
11
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
72
Cycle 3 Standard Health Survey Date
2012-12-06
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
72
Total Weighted Health Survey Score
55.33300
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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