Overall Rating
Address
1250 Evergreen St
Shawano, WI 54166
Contact
7155263107
Certification Date
1983-12-01
CMS Certification Number
525343
Ownership Type
For profit - Limited Liability company
Number of Certified Beds
50
Average Number of Residents per Day
41.4
Provider Type
Medicare and Medicaid
Legal Business Name
NSH SHAWANO-EVERGREEN LLC
Affiliated Entity Name
NORTH SHORE HEALTHCARE
Affiliated Entity ID
377
Health Inspection Rating
4
Quality Measure Rating
5
Staffing Rating
3
Reported Nurse Aide Staffing Hours per Resident per Day
1.85314
Reported LPN Staffing Hours per Resident per Day
0.74109
Reported RN Staffing Hours per Resident per Day
0.63559
Reported Total Nurse Staffing Hours per Resident per Day
3.22982
Total Number of Nurse Staff Hours per Resident per Day on the Weekend
2.85847
Registered Nurse Hours per Resident per Day on the Weekend
0.31939
Reported Physical Therapist Staffing Hours per Resident Per Day
0.03889
Long-Stay Quality Measure Rating
5
Short-Stay Quality Measure Rating
4
Total Weighted Health Survey Score
14.000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
1
Number of Citations from Infection Control Inspections
Standard Health Survey Date
2023-05-10
Total Number of Health Deficiencies
4
Number of Standard Health Deficiencies
2
Number of Complaint Health Deficiencies
2
Health Deficiency Score
28
Number of Health Revisits
1
Health Revisit Score
0
Total Health Score
28
Standard Health Survey Date
2022-05-12
Total Number of Health Deficiencies
0
Number of Standard Health Deficiencies
0
Number of Complaint Health Deficiencies
0
Health Deficiency Score
0
Number of Health Revisits
0
Health Revisit Score
0
Total Health Score
0
Standard Health Survey Date
2021-05-05
Total Number of Health Deficiencies
0
Number of Standard Health Deficiencies
0
Number of Complaint Health Deficiencies
0
Health Deficiency Score
0
Number of Health Revisits
0
Health Revisit Score
0
Total Health Score
0
Number of Fines
0
Total Amount of Fines in Dollars
0.00
Number of Payment Denials
0
Total Number of Penalties
0