Woodside Lutheran Home - Green Bay Nursing Home
General Information
UPDATEFederal Provider Number
525557
Provider Name
WOODSIDE LUTHERAN HOME
Provider Address
1040 PILGRIM WAY
GREEN BAY, WI 54304
GREEN BAY, WI 54304
Provider Phone Number
9204991481
Provider SSA County
40
Provider County Name
Brown
Ownership Type
Non profit - Church related
Number of Certified Beds
130
Number of Residents in Certified Beds
112
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
BAY AREA LUTHERAN HOMES INC
Date First Approved to Provide Medicare and Medicaid services
1995-01-01
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
5
QM Rating Footnote
Staffing Rating
4
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
2.65982
Reported LPN Staffing Hours per Resident per Day
0.48705
Reported RN Staffing Hours per Resident per Day
1.04464
Reported Licensed Staffing Hours per Resident per Day
1.53170
Reported Total Nurse Staffing Hours per Resident per Day
4.19151
Reported Physical Therapist Staffing Hours per Resident Per Day
0.07009
Expected CNA Staffing Hours per Resident per Day
2.56777
Expected LPN Staffing Hours per Resident per Day
0.65027
Expected RN Staffing Hours per Resident per Day
1.03781
Expected Total Nurse Staffing Hours per Resident per Day
4.25586
Adjusted CNA Staffing Hours per Resident per Day
2.54166
Adjusted LPN Staffing Hours per Resident per Day
0.62166
Adjusted RN Staffing Hours per Resident per Day
0.75212
Adjusted Total Nurse Staffing Hours per Resident per Day
3.96996
Cycle 1 Total Number of Health Deficiencies
0
Cycle 1 Number of Standard Health Deficiencies
0
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
0
Cycle 1 Standard Survey Health Date
2014-09-18
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
0
Cycle 2 Total Number of Health Deficiencies
3
Cycle 2 Number of Standard Health Deficiencies
3
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
16
Cycle 2 Standard Health Survey Date
2013-08-16
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
8
Cycle 3 Number of Standard Health Deficiencies
7
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
56
Cycle 3 Standard Health Survey Date
2012-08-02
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
56
Total Weighted Health Survey Score
14.66700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
2
Number of Fines
1
Total Amount of Fines in Dollars
6630
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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