Transitional Care Unit - Fond Du Lac Nursing Home
General Information
UPDATEFederal Provider Number
525640
Provider Name
TRANSITIONAL CARE UNIT
Provider Address
430 E DIVISION ST
FOND DU LAC, WI 54935
FOND DU LAC, WI 54935
Provider Phone Number
(920) 926-4700
Provider SSA County
190
Provider County Name
Fond Du Lac
Provider Website
Provider Description
Ownership Type
Non profit - Church related
Number of Certified Beds
17
Number of Residents in Certified Beds
6
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
Y
Legal Business Name
Legal Business Name Not Available
Date First Approved to Provide Medicare and Medicaid services
1997-10-30
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
2
QM Rating Footnote
Staffing Rating
5
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
2.38333
Reported LPN Staffing Hours per Resident per Day
2.85833
Reported RN Staffing Hours per Resident per Day
3.20000
Reported Licensed Staffing Hours per Resident per Day
6.05833
Reported Total Nurse Staffing Hours per Resident per Day
8.44166
Reported Physical Therapist Staffing Hours per Resident Per Day
0.47500
Expected CNA Staffing Hours per Resident per Day
2.09315
Expected LPN Staffing Hours per Resident per Day
0.92068
Expected RN Staffing Hours per Resident per Day
1.82250
Expected Total Nurse Staffing Hours per Resident per Day
4.83633
Adjusted CNA Staffing Hours per Resident per Day
2.79386
Adjusted LPN Staffing Hours per Resident per Day
2.57682
Adjusted RN Staffing Hours per Resident per Day
1.31196
Adjusted Total Nurse Staffing Hours per Resident per Day
7.03581
Cycle 1 Total Number of Health Deficiencies
3
Cycle 1 Number of Standard Health Deficiencies
3
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
24
Cycle 1 Standard Survey Health Date
2015-04-30
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
24
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
2014-06-18
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
2
Cycle 3 Number of Standard Health Deficiencies
2
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
20
Cycle 3 Standard Health Survey Date
2013-05-29
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
20
Total Weighted Health Survey Score
15.33300
Number of Facility Reported Incidents
0
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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