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Chetopa Manor - Chetopa Nursing Home

General Information

UPDATE
Federal Provider Number
175396
Provider Name
CHETOPA MANOR
Provider Address
814 WALNUT PO BOX 167
CHETOPA, KS 67336
Provider Phone Number
6202367248
Provider SSA County
490
Provider County Name
Labette
Ownership Type
For profit - Corporation
Number of Certified Beds
38
Number of Residents in Certified Beds
23
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
WOODWORTH ENTERPRISES, INC.
Date First Approved to Provide Medicare and Medicaid services
1997-01-01
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Resident
Automatic Sprinkler Systems in All Required Areas
Yes

Rating Detail Information

Overall Rating
4
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
2
QM Rating Footnote
Staffing Rating
5
Staffing Rating Footnote
RN Staffing Rating
5
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.97174
Reported LPN Staffing Hours per Resident per Day
0.39130
Reported RN Staffing Hours per Resident per Day
1.22174
Reported Licensed Staffing Hours per Resident per Day
1.61304
Reported Total Nurse Staffing Hours per Resident per Day
4.58478
Reported Physical Therapist Staffing Hours per Resident Per Day
0.12391
Expected CNA Staffing Hours per Resident per Day
2.60103
Expected LPN Staffing Hours per Resident per Day
0.58013
Expected RN Staffing Hours per Resident per Day
0.82279
Expected Total Nurse Staffing Hours per Resident per Day
4.00395
Adjusted CNA Staffing Hours per Resident per Day
2.80341
Adjusted LPN Staffing Hours per Resident per Day
0.55984
Adjusted RN Staffing Hours per Resident per Day
1.10950
Adjusted Total Nurse Staffing Hours per Resident per Day
4.61564
Cycle 1 Total Number of Health Deficiencies
5
Cycle 1 Number of Standard Health Deficiencies
5
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
28
Cycle 1 Standard Survey Health Date
2015-01-05
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
28
Cycle 2 Total Number of Health Deficiencies
4
Cycle 2 Number of Standard Health Deficiencies
4
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
48
Cycle 2 Standard Health Survey Date
2013-09-16
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
12
Cycle 3 Number of Standard Health Deficiencies
12
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
213
Cycle 3 Standard Health Survey Date
2012-06-07
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
213
Total Weighted Health Survey Score
65.50000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
0
Number of Fines
1
Total Amount of Fines in Dollars
1950
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01

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