Terraceview Living Ctr, Inc - Shell Lake Nursing Home
General Information
UPDATEFederal Provider Number
525553
Provider Name
TERRACEVIEW LIVING CTR, INC
Provider Address
802 E CTY HWY B PO BOX 609
SHELL LAKE, WI 54871
SHELL LAKE, WI 54871
Provider Phone Number
(715) 468-7292
Provider SSA County
640
Provider County Name
Washburn
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
50
Number of Residents in Certified Beds
49
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
TERRACEVIEW LIVING CENTER, INC.
Date First Approved to Provide Medicare and Medicaid services
1994-11-01
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
3
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
4
Staffing Rating Footnote
RN Staffing Rating
4
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.38571
Reported LPN Staffing Hours per Resident per Day
0.65204
Reported RN Staffing Hours per Resident per Day
0.70714
Reported Licensed Staffing Hours per Resident per Day
1.35918
Reported Total Nurse Staffing Hours per Resident per Day
3.74489
Reported Physical Therapist Staffing Hours per Resident Per Day
0.01122
Expected CNA Staffing Hours per Resident per Day
2.44616
Expected LPN Staffing Hours per Resident per Day
0.57037
Expected RN Staffing Hours per Resident per Day
0.87169
Expected Total Nurse Staffing Hours per Resident per Day
3.88823
Adjusted CNA Staffing Hours per Resident per Day
2.39306
Adjusted LPN Staffing Hours per Resident per Day
0.94884
Adjusted RN Staffing Hours per Resident per Day
0.60615
Adjusted Total Nurse Staffing Hours per Resident per Day
3.88230
Cycle 1 Total Number of Health Deficiencies
7
Cycle 1 Number of Standard Health Deficiencies
6
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
44
Cycle 1 Standard Survey Health Date
2015-04-09
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
44
Cycle 2 Total Number of Health Deficiencies
11
Cycle 2 Number of Standard Health Deficiencies
9
Cycle 2 Number of Complaint Health Deficiencies
2
Cycle 2 Health Deficiency Score
48
Cycle 2 Standard Health Survey Date
2014-04-24
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
48
Cycle 3 Total Number of Health Deficiencies
5
Cycle 3 Number of Standard Health Deficiencies
5
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
28
Cycle 3 Standard Health Survey Date
2013-03-27
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
28
Total Weighted Health Survey Score
42.66700
Number of Facility Reported Incidents
2
Number of Substantiated Complaints
0
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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