Wi Veterans Home-boland Hall - Union Grove Nursing Home
General Information
UPDATEFederal Provider Number
525688
Provider Name
WI VETERANS HOME-BOLAND HALL
Provider Address
21425 E SPRING ST
UNION GROVE, WI 53182
UNION GROVE, WI 53182
Provider Phone Number
(262) 878-6702
Provider SSA County
500
Provider County Name
Racine
Provider Website
Provider Description
Ownership Type
Government - State
Number of Certified Beds
158
Number of Residents in Certified Beds
151
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
STATE OF WISCONSIN
Date First Approved to Provide Medicare and Medicaid services
2006-12-01
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
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
3.05728
Reported LPN Staffing Hours per Resident per Day
0.70960
Reported RN Staffing Hours per Resident per Day
1.18079
Reported Licensed Staffing Hours per Resident per Day
1.89040
Reported Total Nurse Staffing Hours per Resident per Day
4.94767
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00960
Expected CNA Staffing Hours per Resident per Day
2.45680
Expected LPN Staffing Hours per Resident per Day
0.61538
Expected RN Staffing Hours per Resident per Day
0.99939
Expected Total Nurse Staffing Hours per Resident per Day
4.07157
Adjusted CNA Staffing Hours per Resident per Day
3.05342
Adjusted LPN Staffing Hours per Resident per Day
0.95708
Adjusted RN Staffing Hours per Resident per Day
0.88282
Adjusted Total Nurse Staffing Hours per Resident per Day
4.89825
Cycle 1 Total Number of Health Deficiencies
5
Cycle 1 Number of Standard Health Deficiencies
2
Cycle 1 Number of Complaint Health Deficiencies
4
Cycle 1 Health Deficiency Score
20
Cycle 1 Standard Survey Health Date
2014-04-17
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
20
Cycle 2 Total Number of Health Deficiencies
5
Cycle 2 Number of Standard Health Deficiencies
5
Cycle 2 Number of Complaint Health Deficiencies
3
Cycle 2 Health Deficiency Score
40
Cycle 2 Standard Health Survey Date
2013-03-04
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
40
Cycle 3 Total Number of Health Deficiencies
2
Cycle 3 Number of Standard Health Deficiencies
1
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
8
Cycle 3 Standard Health Survey Date
2012-03-20
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
8
Total Weighted Health Survey Score
24.66700
Number of Facility Reported Incidents
8
Number of Substantiated Complaints
5
Number of Fines
1
Total Amount of Fines in Dollars
8320
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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