Provider Name: SHADY LANE NURSING CARE CENTER
Address: 1235 S 24TH ST, MANITOWOC, WI 54220
Phone: (920) 682-8254
County: Manitowoc (350)
Ownership Type: Non profit - Corporation
Certified Beds: 50
Average Residents Per Day: 38.7 ()
Provider Type: Medicare and Medicaid, Resides in Hospital: No
Legal Business Name: Legal Business Name Not Available
First Approved Date: October 1, 1995
Affiliated Entity: ()
Retirement Community: N, Special Focus Status:
Ownership Change in Last 12 Months: N
Resident Family Council: Resident
Sprinkler System Status: Yes
Overall Rating: 5 ()
Health Inspection Rating: 4 ()
QM Rating: 4 ()
Long Stay QM Rating: 4 ()
Short Stay QM Rating: 4 ()
Staffing Rating: 5 ()
Staffing Report Note:
PT Staffing Note:
Nurse Aide Staff Hours Per Day, per resident: 2.52254, LPN Staff Hours Per Day: 0.6003, RN Staff Hours Per Day: 0.9736, Licensed Staff Hours Per Day: 1.5739
Total Nurse Staff Hours Per Day, per resident: 4.09646
Weekend Nurse Staff Hours: 3.63170, Weekend RN Staff Hours: 0.7399
PT Staff Hours Per Day, per resident: 0.0373
Nurse Staff Turnover: 41.5, Nurse Turnover Note:
RN Turnover: 9.1, RN Turnover Note:
Admin Left Number: 0, Admin Turnover Note:
Case Mix Nurse Aide Hours Per Day, per resident: 2.2955, Case Mix LPN Hours Per Day: 0.6285, Case Mix RN Hours Per Day: 0.2736
Adjusted Nurse Aide Hours Per Day, per resident: 2.23870, Adjusted LPN Hours Per Day: 0.7048, Adjusted RN Hours Per Day: 1.3408
Total Adjusted Nurse Hours Per Day, per resident: 4.03793
Adjusted Weekend Nurse Hours Per Day, per resident: 3.57981
Health Survey Dates and Scores: Cycle 1: 2023-02-08 (Score: 4), Cycle 2: 2021-12-15 (Score: 28), Cycle 3: 2020-02-13 (Score: 12)
Total Weighted Health Score: 13.333
Reported Incidents: 0, Substantiated Complaints: 1
Infection Control Citations:
Fines and Penalties: Number of Fines: 0, Total Fines in Dollars: 0.00, Payment Denials Number: 0, Total Penalties Number: 0
Location and GPS: 1235 S 24TH ST,MANITOWOC,WI,54220 (44.0847, -87.678)
Process Date: 2024-03-01
Each record details specific health deficiencies found during inspections, categorized by type, severity, and whether they were corrected. Below are the severity levels and their implications:
Type: Health, Deficiency: Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2023-12-28
Type: Health, Deficiency: Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
Severity: C - Level 1: No actual harm with potential for minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2022-01-12
Type: Health, Deficiency: Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Severity: G - Level 3: Actual harm that is not immediate jeopardy. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2022-01-12
Type: Health, Deficiency: Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Severity: E - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2022-01-12
Type: Health, Deficiency: Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2020-03-06
Type: Health, Deficiency: Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
Severity: E - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2020-03-06
Each record details specific fire safety deficiencies found during inspections, categorized by type, severity, and whether they were corrected. Below are the severity levels and their implications:
Type: Fire Safety, Tag: 0927, Version: New
Description: Have proper fire barriers, ventilation and signs for the transfilling of oxygen.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2023-02-20
Type: Fire Safety, Tag: 0712, Version: New
Description: Have simulated fire drills held at unexpected times.
Severity: F - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2020-03-06