Clark County Nursing Home - Kahoka Nursing Home
General Information
UPDATEFederal Provider Number
265485
Provider Name
CLARK COUNTY NURSING HOME
Provider Address
1260 NORTH JOHNSON STREET
KAHOKA, MO 63445
KAHOKA, MO 63445
Provider Phone Number
6607273303
Provider SSA County
220
Provider County Name
Clark
Ownership Type
Government - County
Number of Certified Beds
99
Number of Residents in Certified Beds
51
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
CLARK COUNTY NURSING HOME
Date First Approved to Provide Medicare and Medicaid services
1992-01-30
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Both
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
4
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
4.31078
Reported LPN Staffing Hours per Resident per Day
0.33333
Reported RN Staffing Hours per Resident per Day
1.00392
Reported Licensed Staffing Hours per Resident per Day
1.33725
Reported Total Nurse Staffing Hours per Resident per Day
5.64803
Reported Physical Therapist Staffing Hours per Resident Per Day
0.01275
Expected CNA Staffing Hours per Resident per Day
2.39251
Expected LPN Staffing Hours per Resident per Day
0.62646
Expected RN Staffing Hours per Resident per Day
0.89886
Expected Total Nurse Staffing Hours per Resident per Day
3.91784
Adjusted CNA Staffing Hours per Resident per Day
4.42103
Adjusted LPN Staffing Hours per Resident per Day
0.44163
Adjusted RN Staffing Hours per Resident per Day
0.83453
Adjusted Total Nurse Staffing Hours per Resident per Day
5.81102
Cycle 1 Total Number of Health Deficiencies
6
Cycle 1 Number of Standard Health Deficiencies
5
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
36
Cycle 1 Standard Survey Health Date
2014-08-13
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
36
Cycle 2 Total Number of Health Deficiencies
6
Cycle 2 Number of Standard Health Deficiencies
6
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
24
Cycle 2 Standard Health Survey Date
2013-09-13
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
6
Cycle 3 Number of Standard Health Deficiencies
6
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
32
Cycle 3 Standard Health Survey Date
2012-12-12
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
32
Total Weighted Health Survey Score
31.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
1
Number of Fines
0
Total Amount of Fines in Dollars
0
Number of Payment Denials
0
Total Number of Penalties
0
Location
Processing Date
2015-06-01
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