Stacyville Community Nursing Home - Stacyville Nursing Home
General Information
UPDATEFederal Provider Number
165438
Provider Name
STACYVILLE COMMUNITY NURSING HOME
Provider Address
413 SOUTH BROAD STREET
STACYVILLE, IA 50476
STACYVILLE, IA 50476
Provider Phone Number
6417102215
Provider SSA County
650
Provider County Name
Mitchell
Ownership Type
Non profit - Corporation
Number of Certified Beds
34
Number of Residents in Certified Beds
11
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
STACYVILLE COMMUNITY NURSING HOME
Date First Approved to Provide Medicare and Medicaid services
2001-04-01
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
5
Overall Rating Footnote
Health Inspection Rating
4
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
3.90455
Reported LPN Staffing Hours per Resident per Day
1.85000
Reported RN Staffing Hours per Resident per Day
1.56818
Reported Licensed Staffing Hours per Resident per Day
3.41818
Reported Total Nurse Staffing Hours per Resident per Day
7.32273
Reported Physical Therapist Staffing Hours per Resident Per Day
0.08636
Expected CNA Staffing Hours per Resident per Day
2.48570
Expected LPN Staffing Hours per Resident per Day
0.55120
Expected RN Staffing Hours per Resident per Day
0.78120
Expected Total Nurse Staffing Hours per Resident per Day
3.81810
Adjusted CNA Staffing Hours per Resident per Day
3.85429
Adjusted LPN Staffing Hours per Resident per Day
2.78575
Adjusted RN Staffing Hours per Resident per Day
1.49992
Adjusted Total Nurse Staffing Hours per Resident per Day
7.73086
Cycle 1 Total Number of Health Deficiencies
4
Cycle 1 Number of Standard Health Deficiencies
4
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
20
Cycle 1 Standard Survey Health Date
2014-07-09
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
20
Cycle 2 Total Number of Health Deficiencies
5
Cycle 2 Number of Standard Health Deficiencies
5
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
24
Cycle 2 Standard Health Survey Date
2013-04-04
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
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
2012-03-02
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
8
Total Weighted Health Survey Score
19.33300
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
Nursiong Homes Nearby
Good Samaritan Society - Saint Ansgar
701 East Fourth Street |
SAINT ANSGAR IA 50472 | 7.5 miles away
Faith Lutheran Home
914 Davidson Drive |
OSAGE IA 50461 | 10.9 miles away
Osage Rehab And Health Care Center
830 South Fifth Street |
OSAGE IA 50461 | 10.9 miles away
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