Willowdale Nursing And Rehab Ctr - New Holstein Nursing Home
General Information
UPDATEFederal Provider Number
525411
Provider Name
WILLOWDALE NURSING AND REHAB CTR
Provider Address
1610 HOOVER ST
NEW HOLSTEIN, WI 53061
NEW HOLSTEIN, WI 53061
Provider Phone Number
(920) 898-5706
Provider SSA County
70
Provider County Name
Calumet
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
49
Number of Residents in Certified Beds
42
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
Legal Business Name Not Available
Date First Approved to Provide Medicare and Medicaid services
1987-12-11
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
5
QM Rating Footnote
Staffing Rating
3
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
2.27500
Reported LPN Staffing Hours per Resident per Day
0.37976
Reported RN Staffing Hours per Resident per Day
1.42500
Reported Licensed Staffing Hours per Resident per Day
1.80476
Reported Total Nurse Staffing Hours per Resident per Day
4.07976
Reported Physical Therapist Staffing Hours per Resident Per Day
0.11786
Expected CNA Staffing Hours per Resident per Day
2.78208
Expected LPN Staffing Hours per Resident per Day
0.72821
Expected RN Staffing Hours per Resident per Day
1.17312
Expected Total Nurse Staffing Hours per Resident per Day
4.68341
Adjusted CNA Staffing Hours per Resident per Day
2.00647
Adjusted LPN Staffing Hours per Resident per Day
0.43284
Adjusted RN Staffing Hours per Resident per Day
0.90763
Adjusted Total Nurse Staffing Hours per Resident per Day
3.51135
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
16
Cycle 1 Standard Survey Health Date
2015-03-12
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
16
Cycle 2 Total Number of Health Deficiencies
3
Cycle 2 Number of Standard Health Deficiencies
2
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
12
Cycle 2 Standard Health Survey Date
2014-03-20
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
12
Cycle 3 Total Number of Health Deficiencies
6
Cycle 3 Number of Standard Health Deficiencies
6
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
56
Cycle 3 Standard Health Survey Date
2013-01-29
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
56
Total Weighted Health Survey Score
21.33300
Number of Facility Reported Incidents
1
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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