Kimball County Manor - Kimball Nursing Home
General Information
UPDATEFederal Provider Number
285256
Provider Name
KIMBALL COUNTY MANOR
Provider Address
810 EAST 7TH STREET
KIMBALL, NE 69145
KIMBALL, NE 69145
Provider Phone Number
3082354693
Provider SSA County
520
Provider County Name
Kimball
Ownership Type
Government - County
Number of Certified Beds
49
Number of Residents in Certified Beds
41
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
KIMBALL COUNTY MANOR
Date First Approved to Provide Medicare and Medicaid services
2004-07-01
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
2
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
2
QM Rating Footnote
Staffing Rating
4
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
2.48415
Reported LPN Staffing Hours per Resident per Day
0.29390
Reported RN Staffing Hours per Resident per Day
0.80488
Reported Licensed Staffing Hours per Resident per Day
1.09878
Reported Total Nurse Staffing Hours per Resident per Day
3.58293
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00000
Expected CNA Staffing Hours per Resident per Day
2.24960
Expected LPN Staffing Hours per Resident per Day
0.49925
Expected RN Staffing Hours per Resident per Day
0.69581
Expected Total Nurse Staffing Hours per Resident per Day
3.44466
Adjusted CNA Staffing Hours per Resident per Day
2.70953
Adjusted LPN Staffing Hours per Resident per Day
0.48860
Adjusted RN Staffing Hours per Resident per Day
0.86432
Adjusted Total Nurse Staffing Hours per Resident per Day
4.19270
Cycle 1 Total Number of Health Deficiencies
14
Cycle 1 Number of Standard Health Deficiencies
13
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
124
Cycle 1 Standard Survey Health Date
2014-01-27
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
124
Cycle 2 Total Number of Health Deficiencies
12
Cycle 2 Number of Standard Health Deficiencies
9
Cycle 2 Number of Complaint Health Deficiencies
3
Cycle 2 Health Deficiency Score
76
Cycle 2 Standard Health Survey Date
2012-11-28
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
28
Cycle 3 Standard Health Survey Date
2011-10-06
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
28
Total Weighted Health Survey Score
92.00000
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
2
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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