Countryside Home - Madison Nursing Home
General Information
UPDATEFederal Provider Number
285207
Provider Name
COUNTRYSIDE HOME
Provider Address
703 NORTH MAIN STREET
MADISON, NE 68748
MADISON, NE 68748
Provider Phone Number
4024543373
Provider SSA County
590
Provider County Name
Madison
Ownership Type
Government - City/county
Number of Certified Beds
70
Number of Residents in Certified Beds
54
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
COUNTRYSIDE HOME
Date First Approved to Provide Medicare and Medicaid services
1997-04-01
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
4
Health Inspection Rating Footnote
QM Rating
1
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
4.04815
Reported LPN Staffing Hours per Resident per Day
0.72593
Reported RN Staffing Hours per Resident per Day
1.10648
Reported Licensed Staffing Hours per Resident per Day
1.83241
Reported Total Nurse Staffing Hours per Resident per Day
5.88056
Reported Physical Therapist Staffing Hours per Resident Per Day
0.18889
Expected CNA Staffing Hours per Resident per Day
2.40405
Expected LPN Staffing Hours per Resident per Day
0.62516
Expected RN Staffing Hours per Resident per Day
0.96136
Expected Total Nurse Staffing Hours per Resident per Day
3.99057
Adjusted CNA Staffing Hours per Resident per Day
4.13176
Adjusted LPN Staffing Hours per Resident per Day
0.96379
Adjusted RN Staffing Hours per Resident per Day
0.85999
Adjusted Total Nurse Staffing Hours per Resident per Day
5.94000
Cycle 1 Total Number of Health Deficiencies
5
Cycle 1 Number of Standard Health Deficiencies
5
Cycle 1 Number of Complaint Health Deficiencies
5
Cycle 1 Health Deficiency Score
28
Cycle 1 Standard Survey Health Date
2014-04-08
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
1
Cycle 2 Number of Standard Health Deficiencies
1
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
8
Cycle 2 Standard Health Survey Date
2013-03-04
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
3
Cycle 3 Number of Standard Health Deficiencies
3
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
20
Cycle 3 Standard Health Survey Date
2011-11-17
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
20
Total Weighted Health Survey Score
20.00000
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
3
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
Nursiong Homes Nearby
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NORFOLK NE 68701 | 12.9 miles away
Community Pride Care Center
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BATTLE CREEK NE 68715 | 13 miles away
St. Joseph's Rehabilitation & Care Center
401 North 18th Street |
NORFOLK NE 68701 | 13.8 miles away
Heritage Of Bel Air
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NORFOLK NE 68702 | 14.4 miles away
Mid-nebraska Lutheran Home
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