AMERICAN LUTHERAN HOME-MONDOVI - MONDOVI, WI
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AMERICAN LUTHERAN HOME-MONDOVI
200 MEMORIAL DR MONDOVI, WI 54755 RELIGIOUS NONMEDICAL HEALTH CARE INSTITUTIONS SNF/NF (DUALLY CERTIFIED) Services provided by AMERICAN LUTHERAN HOME-MONDOVI:
Beds - Total (Total number of beds in a facility, including those in non-Participating or non-licensed areas): 110 Beds - Total certified (Number of beds in Medicare and/or Medicaid certified areas within a facility): 110 Lpn/lvn - Full time (The number of full-time equivalent licensed practical/ vocational nurses employed by a facility on a full time basis): 4.47 Registered nurse - Full time (The number of full-time equivalent registered nurses employed by a facility on a full time basis): 4.57 Change of ownership counter (The number of times a change of ownership (chow) has taken place for a particular provider): 2 Compliance: life safety code (Indicates if a waiver of the life safety code has been recommended for a provider): WAIVER RECOMMENDED Program participation (Indicates if the provider participates in Medicare, Medicaid, or both programs): MEDICARE AND MEDICAID Regional override #1 (number beds) (This field is set to "y" when the regional office has to ok a pending record in the special fields screen. this field only applies to categories in the odie data entry system): Yes Regional override #2 (staffing) (This field is set to "y" when the regional office has to ok a pending record in the special fields screen. this field only applies to categories in the odie data entry system): Yes Activity professional - Full time (The number of full-time equivalent activities professionals employed full time by a facility): 1.14 Administrator - Full time (The number of full-time equivalent administrative staff employed on a full time basis by a facility): 4.23 Beds - Snf/nf (Number of beds certified for both Medicare and Medicaid skilled nursing care in a long term care facility): 110 Cert nurse aides - Full time (The number of full-time equivalent certified nurse aides employed by a facility on a full time basis): 17.14 Cert nurse aides - Part time (The number of full-time equivalent certified nurse aides employed by a facility on a part time basis): 19.37 Dietitians - Contract (The number of full-time equivalent under contract to a facility): 0.23 Food service - Full time (The number of full-time equivalent food service personnel employed by a facility on a full time basis): 7.11 Food service - Part time (The number of full-time equivalent food service personnel employed by a facility on a part time basis): 7.17 Housekeeping - Full time (The number of full-time equivalent housekeeping personnel employed by a facility on a full time basis): 9.07 Housekeeping - Part time (The number of full-time equivalent housekeeping personnel employed by a facility on a part time basis): 2.17 Lpn/lvn - Part time (The number of full-time equivalent licensed practical/ vocational nurses employed by a facility on a part time basis): 1.44 Medication aides/techs-Full time (The number of full-time equivalent medication aides/ technicians employed by a facility on a full time basis): 1.07 Medication aides/techs-Part time (The number of full-time equivalent medication aides/ technicians employed bya facility on a part time basis): 1.77 Nurses with admin duties-Full time (The number of full-time equivalent nurses with administrative duties employed by a facility on a full time basis): 2.29 Organized resident group (Indicates if the facility has an organized residents group): Yes Other - Part time (The number of full-time equivalent persons not included in any other categories employed by the facility on a part-time basis): 0.26 Other activities staff-Part time (Number of part time staff hours provided by other activ ities staff): 2.24 Othr social serv staff-Full time (Number of full-time staff hours provided by other socia l services staff): 1.14 Pharmacists - Contract (The number of full-time equivalent pharmacists under contract to a facility): 0.11 Registered nurse - Part time (The number of full-time equivalent registered nurses employed by a facility on a part time basis): 2.06 Rn director of nursing - Full time (The number of full-time equivalent rn director of nursing employed by a facility on a full time basis): 1.14 Social worker - Part time (The number of full-time equivalent social workers employed by a facility on a part time basis): 0.91 Compliance: plan of correction (Indicates if a provider is in compliance with program requirements based on an acceptable plan for correction of deficiencies): COMPLIANCE BASED ON ACCEPTABLE POC Compliance: status (Indicates if a provider or supplier is in compliance with program requirements): IN COMPLIANCE Current survey date (The date of the health or life safety code survey, whichever is later. the "official" survey date for the provider): Nov 2001 Eligibility code (Indicates if a facility is eligible to participate in the Medicare and/or Medicaid programs): ELIGIBLE TO PARTICIPATE Participation date (The date a facility is first approved to provide Medicare and/or Medicaid services): Apr 1985 |
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