Woodland Terrace - Waverly Nursing Home

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Federal Provider Number
165442
Provider Name
WOODLAND TERRACE
Provider Address
1922 FIFTH AVENUE NW
WAVERLY, IA 50677
Provider Phone Number
(319) 352-4540
Provider SSA County
80
Provider County Name
Bremer
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
126
Number of Residents in Certified Beds
121
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
BARTELS LUTHERAN HOME
Date First Approved to Provide Medicare and Medicaid services
2002-04-01
Continuing Care Retirement Community
Y
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
3
Health Inspection Rating Footnote
QM Rating
4
QM Rating Footnote
Staffing Rating
4
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
2.16033
Reported LPN Staffing Hours per Resident per Day
0.71612
Reported RN Staffing Hours per Resident per Day
0.60331
Reported Licensed Staffing Hours per Resident per Day
1.31942
Reported Total Nurse Staffing Hours per Resident per Day
3.47976
Reported Physical Therapist Staffing Hours per Resident Per Day
0.02231
Expected CNA Staffing Hours per Resident per Day
2.29515
Expected LPN Staffing Hours per Resident per Day
0.56477
Expected RN Staffing Hours per Resident per Day
0.79814
Expected Total Nurse Staffing Hours per Resident per Day
3.65806
Adjusted CNA Staffing Hours per Resident per Day
2.30957
Adjusted LPN Staffing Hours per Resident per Day
1.05243
Adjusted RN Staffing Hours per Resident per Day
0.56480
Adjusted Total Nurse Staffing Hours per Resident per Day
3.83443
Cycle 1 Total Number of Health Deficiencies
3
Cycle 1 Number of Standard Health Deficiencies
2
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
16
Cycle 1 Standard Survey Health Date
2014-10-02
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
6
Cycle 2 Number of Standard Health Deficiencies
2
Cycle 2 Number of Complaint Health Deficiencies
4
Cycle 2 Health Deficiency Score
28
Cycle 2 Standard Health Survey Date
2013-06-13
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
28
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
44
Cycle 3 Standard Health Survey Date
2012-04-06
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
44
Total Weighted Health Survey Score
24.66700
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
6
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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