Cloverlodge Care Center - St Edward Nursing Home
General Information
UPDATEFederal Provider Number
285201
Provider Name
CLOVERLODGE CARE CENTER
Provider Address
301 NORTH 13TH STREET
ST EDWARD, NE 68660
ST EDWARD, NE 68660
Provider Phone Number
4026782294
Provider SSA County
50
Provider County Name
Boone
Ownership Type
For profit - Corporation
Number of Certified Beds
55
Number of Residents in Certified Beds
42
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
HERITAGE OF FAIRBURY ST EDWARD INC
Date First Approved to Provide Medicare and Medicaid services
1996-10-01
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
3
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
2
Staffing Rating Footnote
RN Staffing Rating
2
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.73929
Reported LPN Staffing Hours per Resident per Day
0.57381
Reported RN Staffing Hours per Resident per Day
0.39762
Reported Licensed Staffing Hours per Resident per Day
0.97143
Reported Total Nurse Staffing Hours per Resident per Day
3.71072
Reported Physical Therapist Staffing Hours per Resident Per Day
0.06310
Expected CNA Staffing Hours per Resident per Day
2.57716
Expected LPN Staffing Hours per Resident per Day
0.59542
Expected RN Staffing Hours per Resident per Day
0.91825
Expected Total Nurse Staffing Hours per Resident per Day
4.09083
Adjusted CNA Staffing Hours per Resident per Day
2.60807
Adjusted LPN Staffing Hours per Resident per Day
0.79988
Adjusted RN Staffing Hours per Resident per Day
0.32355
Adjusted Total Nurse Staffing Hours per Resident per Day
3.65636
Cycle 1 Total Number of Health Deficiencies
9
Cycle 1 Number of Standard Health Deficiencies
9
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
92
Cycle 1 Standard Survey Health Date
2014-08-27
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
92
Cycle 2 Total Number of Health Deficiencies
3
Cycle 2 Number of Standard Health Deficiencies
3
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
20
Cycle 2 Standard Health Survey Date
2013-05-10
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
2
Cycle 3 Number of Standard Health Deficiencies
2
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
8
Cycle 3 Standard Health Survey Date
2012-01-31
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
8
Total Weighted Health Survey Score
54.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
0
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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