Kindred Nursing & Rehabilitation - Mountain Valley - Kellogg Nursing Home
General Information
UPDATEFederal Provider Number
135065
Provider Name
KINDRED NURSING & REHABILITATION - MOUNTAIN VALLEY
Provider Address
601 WEST CAMERON AVENUE
KELLOGG, ID 83837
KELLOGG, ID 83837
Provider Phone Number
2087841283
Provider SSA County
390
Provider County Name
Shoshone
Ownership Type
For profit - Limited Liability
Number of Certified Beds
68
Number of Residents in Certified Beds
60
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
KINDRED NURSING CENTERS WEST LLC
Date First Approved to Provide Medicare and Medicaid services
1979-09-01
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
5
Overall Rating Footnote
Health Inspection Rating
5
Health Inspection Rating Footnote
QM Rating
5
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
3.37917
Reported LPN Staffing Hours per Resident per Day
0.58333
Reported RN Staffing Hours per Resident per Day
1.34750
Reported Licensed Staffing Hours per Resident per Day
1.93083
Reported Total Nurse Staffing Hours per Resident per Day
5.31000
Reported Physical Therapist Staffing Hours per Resident Per Day
0.19083
Expected CNA Staffing Hours per Resident per Day
2.17348
Expected LPN Staffing Hours per Resident per Day
0.63147
Expected RN Staffing Hours per Resident per Day
1.07011
Expected Total Nurse Staffing Hours per Resident per Day
3.87506
Adjusted CNA Staffing Hours per Resident per Day
3.81483
Adjusted LPN Staffing Hours per Resident per Day
0.76672
Adjusted RN Staffing Hours per Resident per Day
0.94089
Adjusted Total Nurse Staffing Hours per Resident per Day
5.52355
Cycle 1 Total Number of Health Deficiencies
5
Cycle 1 Number of Standard Health Deficiencies
5
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
24
Cycle 1 Standard Survey Health Date
2015-02-13
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
24
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
24
Cycle 2 Standard Health Survey Date
2013-11-07
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
4
Cycle 3 Number of Standard Health Deficiencies
4
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
16
Cycle 3 Standard Health Survey Date
2012-08-10
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
16
Total Weighted Health Survey Score
22.66700
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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