Potosi Manor, Inc - Potosi Nursing Home
General Information
UPDATEFederal Provider Number
265681
Provider Name
POTOSI MANOR, INC
Provider Address
307 SOUTH HIGHWAY 21
POTOSI, MO 63664
POTOSI, MO 63664
Provider Phone Number
5734383225
Provider SSA County
992
Provider County Name
Washington
Ownership Type
For profit - Corporation
Number of Certified Beds
90
Number of Residents in Certified Beds
73
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
POTOSI MANOR, INC.
Date First Approved to Provide Medicare and Medicaid services
1997-08-11
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
1
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
1
QM Rating Footnote
Staffing Rating
1
Staffing Rating Footnote
RN Staffing Rating
2
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
1.93630
Reported LPN Staffing Hours per Resident per Day
0.53356
Reported RN Staffing Hours per Resident per Day
0.45068
Reported Licensed Staffing Hours per Resident per Day
0.98425
Reported Total Nurse Staffing Hours per Resident per Day
2.92054
Reported Physical Therapist Staffing Hours per Resident Per Day
0.08425
Expected CNA Staffing Hours per Resident per Day
2.28375
Expected LPN Staffing Hours per Resident per Day
0.62275
Expected RN Staffing Hours per Resident per Day
1.01317
Expected Total Nurse Staffing Hours per Resident per Day
3.91966
Adjusted CNA Staffing Hours per Resident per Day
2.08040
Adjusted LPN Staffing Hours per Resident per Day
0.71113
Adjusted RN Staffing Hours per Resident per Day
0.33237
Adjusted Total Nurse Staffing Hours per Resident per Day
3.00342
Cycle 1 Total Number of Health Deficiencies
5
Cycle 1 Number of Standard Health Deficiencies
5
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
28
Cycle 1 Standard Survey Health Date
2014-06-06
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
18
Cycle 2 Number of Standard Health Deficiencies
18
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
104
Cycle 2 Standard Health Survey Date
2013-05-28
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
6
Cycle 3 Number of Standard Health Deficiencies
6
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
44
Cycle 3 Standard Health Survey Date
2012-05-04
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
44
Total Weighted Health Survey Score
56.00000
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
Nursiong Homes Nearby
Georgian Gardens
1 Georgian Gardens Drive |
POTOSI MO 63664 | 0.8 mile away
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