Crest View Lutheran Home
4444 Reservoir Boulevard Northeast, Columbia Heights, MN 55421


Crest View Lutheran Home is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 245018. The address is 4444 Reservoir Boulevard Northeast, Columbia Heights, MN 55421. The zip code is 55421. The phone number is 7637821611.


Crest View Lutheran Home · 4444 Reservoir Boulevard Northeast, Columbia Heights, MN 55421

Federal Provider Number 245018
Provider Name CREST VIEW LUTHERAN HOME
Address 4444 RESERVOIR BOULEVARD NORTHEAST
COLUMBIA HEIGHTS, MN 55421
Phone Number 7637821611
SSA County Code 10
County Name Anoka
Ownership Type Non profit - Corporation
Certified Beds 122
Certified Beds Residents 113
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name CREST VIEW CORPORATION
Date First Approved to Provide Medicare Medicaid Services 01/01/1967
Continuing Care Retirement Community false
Special Focus Facility false
Most Recent Health Inspection More Than 2 Years Ago false
Changed Ownership Last 12 Months false
With Resident Family Council Both
Automatic Sprinkler Systems in All Required Areas Yes
Overall Rating 2
Health Inspection Rating 1
Quality Measure Rating 4
Staffing Rating 4
RN Staffing Rating 3
Reported CNA Staffing Hours per Resident per Day 2.7469
Reported LPN Staffing Hours per Resident per Day 0.82168
Reported RN Staffing Hours per Resident per Day 0.55619
Reported Licensed Staffing Hours per Resident per Day 1.37788
Reported Total Nurse Staffing Hours per Resident per Day 4.12477
Reported Physical Therapist Staffing Hours per Resident Per Day 0.05044
Expected CNA Staffing Hours per Resident per Day 2.4729
Expected LPN Staffing Hours per Resident per Day 0.60092
Expected RN Staffing Hours per Resident per Day 0.89788
Expected Total Nurse Staffing Hours per Resident per Day 3.97169
Adjusted CNA Staffing Hours per Resident per Day 2.72558
Adjusted LPN Staffing Hours per Resident per Day 1.13492
Adjusted RN Staffing Hours per Resident per Day 0.46285
Adjusted Total Nurse Staffing Hours per Resident per Day 4.18626
Cycle 1 Total Number of Health Deficiencies 10
Cycle 1 Number of Standard Health Deficiencies 10
Cycle 1 Health Deficiency Score 56
Cycle 1 Standard Survey Health Date 05/11/2017
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 56
Cycle 2 Total Number of Health Deficiencies 12
Cycle 2 Number of Standard Health Deficiencies 12
Cycle 2 Number of Complaint Health Deficiencies 1
Cycle 2 Health Deficiency Score 68
Cycle 2 Standard Health Survey Date 07/14/2016
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 68
Cycle 3 Total Number of Health Deficiencies 9
Cycle 3 Number of Standard Health Deficiencies 9
Cycle 3 Health Deficiency Score 44
Cycle 3 Standard Health Survey Date 09/03/2015
Cycle 3 Number of Health Revisits 2
Cycle 3 Health Revisit Score 22
Cycle 3 Total Health Score 66
Total Weighted Health Survey Score 61.667
Number of Substantiated Complaints 1
Total Amount of Fines in Dollars $0.00
Processing Date 08/01/2017

Owner or Manager · Crest View Lutheran Home

Owner Name Role Association Date
BARNES, SHIRLEY (Individual) OFFICER since 08/21/1995
CARLSTROM, DAVID (Individual) DIRECTOR since 04/01/1990
CREST VIEW CORPORATION (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 04/09/2007
DOMMER, PHILIP (Individual) DIRECTOR since 04/01/2009
FREDERICKSON, BRUCE (Individual) DIRECTOR since 04/01/2005
HULL, RANDOLPH (Individual) DIRECTOR since 04/01/2010
MCFARLAND, PATRICK (Individual) DIRECTOR since 04/01/2010
PALMER, DOUGLAS (Individual) DIRECTOR since 04/01/1984
PIETRZAK, LARRY (Individual) DIRECTOR since 04/01/2005
RICE, JOHN (Individual) DIRECTOR since 04/01/1980
SOMA, JEROME (Individual) DIRECTOR since 04/01/2006
STOEBIG, THOMAS (Individual) DIRECTOR since 04/01/2011
SVOR, KEN (Individual) OFFICER since 04/30/2004
TOBALSKY, MATTHEW (Individual) MANAGING EMPLOYEE since 05/22/2013
VITZTHUM, GERALD (Individual) DIRECTOR since 04/01/2003

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