Tomah Nursing And Rehab - Tomah Nursing Home
General Information
UPDATEFederal Provider Number
525442
Provider Name
TOMAH NURSING AND REHAB
Provider Address
1505 BUTTS AVE
TOMAH, WI 54660
TOMAH, WI 54660
Provider Phone Number
(608) 372-3241
Provider SSA County
400
Provider County Name
Monroe
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
74
Number of Residents in Certified Beds
57
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
ORION TOMAH LLC
Date First Approved to Provide Medicare and Medicaid services
1989-10-01
Continuing Care Retirement Community
N
Special Focus Facility
N
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
2
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
3
QM Rating Footnote
Staffing Rating
2
Staffing Rating Footnote
RN Staffing Rating
3
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.05789
Reported LPN Staffing Hours per Resident per Day
0.48509
Reported RN Staffing Hours per Resident per Day
0.66842
Reported Licensed Staffing Hours per Resident per Day
1.15351
Reported Total Nurse Staffing Hours per Resident per Day
3.21140
Reported Physical Therapist Staffing Hours per Resident Per Day
0.07544
Expected CNA Staffing Hours per Resident per Day
2.58086
Expected LPN Staffing Hours per Resident per Day
0.67351
Expected RN Staffing Hours per Resident per Day
1.06831
Expected Total Nurse Staffing Hours per Resident per Day
4.32267
Adjusted CNA Staffing Hours per Resident per Day
1.95650
Adjusted LPN Staffing Hours per Resident per Day
0.59780
Adjusted RN Staffing Hours per Resident per Day
0.46751
Adjusted Total Nurse Staffing Hours per Resident per Day
2.99464
Cycle 1 Total Number of Health Deficiencies
9
Cycle 1 Number of Standard Health Deficiencies
9
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
52
Cycle 1 Standard Survey Health Date
2014-11-13
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
52
Cycle 2 Total Number of Health Deficiencies
14
Cycle 2 Number of Standard Health Deficiencies
10
Cycle 2 Number of Complaint Health Deficiencies
4
Cycle 2 Health Deficiency Score
68
Cycle 2 Standard Health Survey Date
2014-02-10
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
68
Cycle 3 Total Number of Health Deficiencies
9
Cycle 3 Number of Standard Health Deficiencies
9
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
68
Cycle 3 Standard Health Survey Date
2013-01-08
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
68
Total Weighted Health Survey Score
60.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
7
Number of Fines
1
Total Amount of Fines in Dollars
5233
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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