Village Shalom Inc - Overland Park Nursing Home
General Information
UPDATEFederal Provider Number
175441
Provider Name
VILLAGE SHALOM INC
Provider Address
5500 WEST 123RD ST
OVERLAND PARK, KS 66209
OVERLAND PARK, KS 66209
Provider Phone Number
9133172600
Provider SSA County
450
Provider County Name
Johnson
Ownership Type
Non profit - Corporation
Number of Certified Beds
76
Number of Residents in Certified Beds
72
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
VILLAGE SHALOM, INC
Date First Approved to Provide Medicare and Medicaid services
2000-10-31
Continuing Care Retirement Community
Y
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
3
QM Rating Footnote
Staffing Rating
4
Staffing Rating Footnote
RN Staffing Rating
3
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
3.50833
Reported LPN Staffing Hours per Resident per Day
1.19375
Reported RN Staffing Hours per Resident per Day
0.62986
Reported Licensed Staffing Hours per Resident per Day
1.82361
Reported Total Nurse Staffing Hours per Resident per Day
5.33194
Reported Physical Therapist Staffing Hours per Resident Per Day
0.19722
Expected CNA Staffing Hours per Resident per Day
2.52114
Expected LPN Staffing Hours per Resident per Day
0.63846
Expected RN Staffing Hours per Resident per Day
1.11945
Expected Total Nurse Staffing Hours per Resident per Day
4.27905
Adjusted CNA Staffing Hours per Resident per Day
3.41449
Adjusted LPN Staffing Hours per Resident per Day
1.55188
Adjusted RN Staffing Hours per Resident per Day
0.42041
Adjusted Total Nurse Staffing Hours per Resident per Day
5.02273
Cycle 1 Total Number of Health Deficiencies
3
Cycle 1 Number of Standard Health Deficiencies
3
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
28
Cycle 1 Standard Survey Health Date
2015-01-14
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
7
Cycle 2 Number of Standard Health Deficiencies
7
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
52
Cycle 2 Standard Health Survey Date
2013-09-25
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
16
Cycle 3 Standard Health Survey Date
2012-06-12
Cycle 3 Number of Health Revisits
0
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
16
Total Weighted Health Survey Score
34.00000
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
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OVERLAND PARK KS 66212 | 2.3 miles away
Manorcare Health Services - Overland Park
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OVERLAND PARK KS 66207 | 2.4 miles away
The Forum At Overland Park
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OVERLAND PARK KS 66206 | 3.6 miles away
Delmar Gardens Of Overland Park
12100 W 109th St |
OVERLAND PARK KS 66210 | 4.4 miles away
Delmar Gardens Of Lenexa
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The Plaza Health Services At Santa Marta
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