Villa Loretto Nursing Home
N8114 County Ww, Mount Calvary, WI 53057


Villa Loretto Nursing Home is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 525621. The address is N8114 County Ww, Mount Calvary, WI 53057. The zip code is 53057. The phone number is 9207533211.


Villa Loretto Nursing Home · N8114 County Ww, Mount Calvary, WI 53057

Federal Provider Number 525621
Provider Name VILLA LORETTO NURSING HOME
Address N8114 COUNTY WW
MOUNT CALVARY, WI 53057
Phone Number 9207533211
SSA County Code 190
County Name Fond Du Lac
Ownership Type Non profit - Corporation
Certified Beds 50
Certified Beds Residents 47
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name SSCK INC
Date First Approved to Provide Medicare Medicaid Services 07/01/1997
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 5
Health Inspection Rating 4
Quality Measure Rating 5
Staffing Rating 3
RN Staffing Rating 4
Reported CNA Staffing Hours per Resident per Day 2.21596
Reported LPN Staffing Hours per Resident per Day 0.42128
Reported RN Staffing Hours per Resident per Day 0.85532
Reported Licensed Staffing Hours per Resident per Day 1.2766
Reported Total Nurse Staffing Hours per Resident per Day 3.49256
Reported Physical Therapist Staffing Hours per Resident Per Day 0.05319
Expected CNA Staffing Hours per Resident per Day 2.44516
Expected LPN Staffing Hours per Resident per Day 0.63574
Expected RN Staffing Hours per Resident per Day 0.93365
Expected Total Nurse Staffing Hours per Resident per Day 4.01455
Adjusted CNA Staffing Hours per Resident per Day 2.2237
Adjusted LPN Staffing Hours per Resident per Day 0.55
Adjusted RN Staffing Hours per Resident per Day 0.68451
Adjusted Total Nurse Staffing Hours per Resident per Day 3.50678
Cycle 1 Total Number of Health Deficiencies 6
Cycle 1 Number of Standard Health Deficiencies 6
Cycle 1 Health Deficiency Score 36
Cycle 1 Standard Survey Health Date 07/21/2016
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 36
Cycle 2 Total Number of Health Deficiencies 1
Cycle 2 Number of Standard Health Deficiencies 1
Cycle 2 Health Deficiency Score 4
Cycle 2 Standard Health Survey Date 05/13/2015
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 4
Cycle 3 Total Number of Health Deficiencies 7
Cycle 3 Number of Standard Health Deficiencies 7
Cycle 3 Health Deficiency Score 20
Cycle 3 Standard Health Survey Date 06/12/2014
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 20
Total Weighted Health Survey Score 22.667
Total Amount of Fines in Dollars $0.00
Processing Date 08/01/2017

Owner or Manager · Villa Loretto Nursing Home

Owner Name Role Association Date
AGNESIAN HEALTHCARE INC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
100%
since 10/01/2015
BLUESL, BONA (Individual) DIRECTOR since 10/01/2015
BROWN, MARY (Individual) DIRECTOR since 10/01/2015
FRANKE, STEPHEN (Individual) DIRECTOR since 07/01/1996
HYLAND, CAROL (Individual) DIRECTOR since 10/01/2015
KUSEK, DAVID (Individual) DIRECTOR since 12/01/2016
LAUBY, GERALD (Individual) DIRECTOR since 10/01/2015
LITTLE, STEVEN (Individual) DIRECTOR since 10/01/2015
MCKAY, LAURIE (Individual) MANAGING EMPLOYEE since 10/01/2015
RANDALL, SANDRA (Individual) MANAGING EMPLOYEE since 01/16/2012
RANDALL, SANDRA (Individual) OPERATIONAL/MANAGERIAL CONTROL since 08/17/2008
SCOTT, MARIE (Individual) DIRECTOR since 10/01/2015
SENN, BARBARA (Individual) DIRECTOR since 12/01/2016
TROST, DOUGLAS (Individual) MANAGING EMPLOYEE since 10/01/2015
ZIMMERMAN, CATHERINE (Individual) DIRECTOR since 10/01/2015

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