Pine Kirk Care Center - Kirkersville Nursing Home
General Information
UPDATEFederal Provider Number
366324
Provider Name
PINE KIRK CARE CENTER
Provider Address
205 EAST MAIN STREET
KIRKERSVILLE, OH 43033
KIRKERSVILLE, OH 43033
Provider Phone Number
7409273209
Provider SSA County
460
Provider County Name
Licking
Ownership Type
For profit - Individual
Number of Certified Beds
24
Number of Residents in Certified Beds
23
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
LIVING CARE ALTERNATIVES OF KIRKERSVILLE, INC.
Date First Approved to Provide Medicare and Medicaid services
2006-03-03
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
2
QM Rating Footnote
Staffing Rating
3
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
2.24130
Reported LPN Staffing Hours per Resident per Day
0.48478
Reported RN Staffing Hours per Resident per Day
1.08478
Reported Licensed Staffing Hours per Resident per Day
1.56957
Reported Total Nurse Staffing Hours per Resident per Day
3.81086
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00000
Expected CNA Staffing Hours per Resident per Day
2.31679
Expected LPN Staffing Hours per Resident per Day
0.82200
Expected RN Staffing Hours per Resident per Day
1.48081
Expected Total Nurse Staffing Hours per Resident per Day
4.61960
Adjusted CNA Staffing Hours per Resident per Day
2.37375
Adjusted LPN Staffing Hours per Resident per Day
0.48950
Adjusted RN Staffing Hours per Resident per Day
0.54737
Adjusted Total Nurse Staffing Hours per Resident per Day
3.32522
Cycle 1 Total Number of Health Deficiencies
1
Cycle 1 Number of Standard Health Deficiencies
1
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
16
Cycle 1 Standard Survey Health Date
2014-08-21
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
16
Cycle 2 Total Number of Health Deficiencies
0
Cycle 2 Number of Standard Health Deficiencies
0
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
0
Cycle 2 Standard Health Survey Date
2013-05-16
Cycle 2 Number of Health Revisits
0
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
2012-02-09
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
8
Total Weighted Health Survey Score
9.33300
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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Arlington Care Center
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Newark Hills Health And Rehabilitation Center
17 Forry Street |
NEWARK OH 43055 | 11.5 miles away
Price Road Health And Rehabilitation Center
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Utica Care Center
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