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Independence Health And Rehabilitation Center - Independence Nursing Home

General Information

UPDATE
Federal Provider Number
385188
Provider Name
INDEPENDENCE HEALTH AND REHABILITATION CENTER
Provider Address
1525 MONMOUTH STREET
INDEPENDENCE, OR 97351
Provider Phone Number
5038380001
Provider SSA County
260
Provider County Name
Polk
Ownership Type
For profit - Corporation
Number of Certified Beds
80
Number of Residents in Certified Beds
47
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
EVERGREEN OREGON HEALTHCARE INDEPENDENCE, L.L.C.
Date First Approved to Provide Medicare and Medicaid services
1989-03-13
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
5
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
4
Staffing Rating Footnote
RN Staffing Rating
4
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.72979
Reported LPN Staffing Hours per Resident per Day
0.86489
Reported RN Staffing Hours per Resident per Day
0.92340
Reported Licensed Staffing Hours per Resident per Day
1.78830
Reported Total Nurse Staffing Hours per Resident per Day
4.51808
Reported Physical Therapist Staffing Hours per Resident Per Day
0.12340
Expected CNA Staffing Hours per Resident per Day
2.57151
Expected LPN Staffing Hours per Resident per Day
0.71662
Expected RN Staffing Hours per Resident per Day
1.14272
Expected Total Nurse Staffing Hours per Resident per Day
4.43086
Adjusted CNA Staffing Hours per Resident per Day
2.60473
Adjusted LPN Staffing Hours per Resident per Day
1.00172
Adjusted RN Staffing Hours per Resident per Day
0.60379
Adjusted Total Nurse Staffing Hours per Resident per Day
4.11025
Cycle 1 Total Number of Health Deficiencies
12
Cycle 1 Number of Standard Health Deficiencies
10
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
40
Cycle 1 Standard Survey Health Date
2015-01-13
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
40
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
20
Cycle 2 Standard Health Survey Date
2013-09-19
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
1
Cycle 3 Number of Standard Health Deficiencies
0
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
4
Cycle 3 Standard Health Survey Date
2012-06-28
Cycle 3 Number of Health Revisits
0
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
4
Total Weighted Health Survey Score
27.33300
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
5
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

Dallas Ret Village Health Center

377 Nw Jasper Street | DALLAS OR 97338 | 7.7 miles away

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