Augustana Hcc of Apple Valley
14650 Garrett Avenue, Apple Valley, MN 55124


Augustana Hcc of Apple Valley is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 245264. The address is 14650 Garrett Avenue, Apple Valley, MN 55124. The zip code is 55124. The phone number is 9522362000.


Augustana Hcc of Apple Valley · 14650 Garrett Avenue, Apple Valley, MN 55124

Federal Provider Number 245264
Provider Name AUGUSTANA HCC OF APPLE VALLEY
Address 14650 GARRETT AVENUE
APPLE VALLEY, MN 55124
Phone Number 9522362000
SSA County Code 180
County Name Dakota
Ownership Type Non profit - Corporation
Certified Beds 178
Certified Beds Residents 155
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name AUGUSTANA HEALTH CARE CENTER OF APPLE VALLEY
Date First Approved to Provide Medicare Medicaid Services 07/01/1983
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 Resident
Automatic Sprinkler Systems in All Required Areas Yes
Overall Rating 3
Health Inspection Rating 2
Quality Measure Rating 4
Staffing Rating 4
RN Staffing Rating 5
Reported CNA Staffing Hours per Resident per Day 2.67839
Reported LPN Staffing Hours per Resident per Day 0.71677
Reported RN Staffing Hours per Resident per Day 1.10032
Reported Licensed Staffing Hours per Resident per Day 1.8171
Reported Total Nurse Staffing Hours per Resident per Day 4.49548
Reported Physical Therapist Staffing Hours per Resident Per Day 0.21419
Expected CNA Staffing Hours per Resident per Day 2.4377
Expected LPN Staffing Hours per Resident per Day 0.64855
Expected RN Staffing Hours per Resident per Day 1.12549
Expected Total Nurse Staffing Hours per Resident per Day 4.21174
Adjusted CNA Staffing Hours per Resident per Day 2.69597
Adjusted LPN Staffing Hours per Resident per Day 0.91731
Adjusted RN Staffing Hours per Resident per Day 0.73049
Adjusted Total Nurse Staffing Hours per Resident per Day 4.30246
Cycle 1 Total Number of Health Deficiencies 4
Cycle 1 Number of Standard Health Deficiencies 1
Cycle 1 Number of Complaint Health Deficiencies 3
Cycle 1 Health Deficiency Score 36
Cycle 1 Standard Survey Health Date 10/21/2016
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 36
Cycle 2 Total Number of Health Deficiencies 12
Cycle 2 Number of Standard Health Deficiencies 10
Cycle 2 Number of Complaint Health Deficiencies 2
Cycle 2 Health Deficiency Score 72
Cycle 2 Standard Health Survey Date 12/03/2015
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 72
Cycle 3 Total Number of Health Deficiencies 5
Cycle 3 Number of Standard Health Deficiencies 4
Cycle 3 Number of Complaint Health Deficiencies 1
Cycle 3 Health Deficiency Score 24
Cycle 3 Standard Health Survey Date 10/02/2014
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 24
Total Weighted Health Survey Score 46
Number of Facility Reported Incidents 4
Number of Substantiated Complaints 3
Number of Fines 2
Total Amount of Fines in Dollars $17356.00
Total Number of Penalties 2
Processing Date 08/01/2017

Owner or Manager · Augustana Hcc of Apple Valley

Owner Name Role Association Date
AUGUSTANA HEALTH CARE CENTER OF APPLE VALLEY (Organization) OPERATIONAL/MANAGERIAL CONTROL since 01/25/2006
ELLINGSON, ERIK (Individual) DIRECTOR since 01/01/2017
KITTELSON, CRAIG (Individual) DIRECTOR since 01/31/2006
KITTELSON, CRAIG (Individual) MANAGING EMPLOYEE since 01/25/2006
MACKAY, MARSHALL (Individual) DIRECTOR since 01/01/2017
PARKS, CHARLES (Individual) DIRECTOR since 01/01/2017
RAMSDALE, SCOTT (Individual) DIRECTOR since 01/01/2017
STADTHERR, SEELOCHANI (Individual) MANAGING EMPLOYEE since 03/17/2003
TUCKER, TIMOTHY (Individual) DIRECTOR since 01/31/2006
TUCKER, TIMOTHY (Individual) MANAGING EMPLOYEE since 01/25/2006
WILKERSON, GARY (Individual) DIRECTOR since 01/31/2006

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