Willowfield Nursing And Rehab - Delavan Nursing Home
General Information
UPDATEFederal Provider Number
525324
Provider Name
WILLOWFIELD NURSING AND REHAB
Provider Address
905 E GENEVA ST
DELAVAN, WI 53115
DELAVAN, WI 53115
Provider Phone Number
(262) 728-6319
Provider SSA County
630
Provider County Name
Walworth
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
61
Number of Residents in Certified Beds
48
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
EXTENDICARE HOMES, INC
Date First Approved to Provide Medicare and Medicaid services
1982-11-01
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
4
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
3
QM Rating Footnote
Staffing Rating
2
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
2.01458
Reported LPN Staffing Hours per Resident per Day
0.58958
Reported RN Staffing Hours per Resident per Day
1.19896
Reported Licensed Staffing Hours per Resident per Day
1.78854
Reported Total Nurse Staffing Hours per Resident per Day
3.80312
Reported Physical Therapist Staffing Hours per Resident Per Day
0.07292
Expected CNA Staffing Hours per Resident per Day
2.63676
Expected LPN Staffing Hours per Resident per Day
0.75739
Expected RN Staffing Hours per Resident per Day
1.31998
Expected Total Nurse Staffing Hours per Resident per Day
4.71413
Adjusted CNA Staffing Hours per Resident per Day
1.87471
Adjusted LPN Staffing Hours per Resident per Day
0.64610
Adjusted RN Staffing Hours per Resident per Day
0.67870
Adjusted Total Nurse Staffing Hours per Resident per Day
3.25193
Cycle 1 Total Number of Health Deficiencies
9
Cycle 1 Number of Standard Health Deficiencies
2
Cycle 1 Number of Complaint Health Deficiencies
8
Cycle 1 Health Deficiency Score
40
Cycle 1 Standard Survey Health Date
2014-07-16
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
40
Cycle 2 Total Number of Health Deficiencies
2
Cycle 2 Number of Standard Health Deficiencies
2
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
20
Cycle 2 Standard Health Survey Date
2013-09-24
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
20
Cycle 3 Total Number of Health Deficiencies
5
Cycle 3 Number of Standard Health Deficiencies
3
Cycle 3 Number of Complaint Health Deficiencies
2
Cycle 3 Health Deficiency Score
24
Cycle 3 Standard Health Survey Date
2012-07-31
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
24
Total Weighted Health Survey Score
30.66700
Number of Facility Reported Incidents
3
Number of Substantiated Complaints
4
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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