Adams Street -a Stonebridge Community - Jefferson City Nursing Home
General Information
UPDATEFederal Provider Number
265810
Provider Name
ADAMS STREET -A STONEBRIDGE COMMUNITY
Provider Address
1024 ADAMS STREET
JEFFERSON CITY, MO 65101
JEFFERSON CITY, MO 65101
Provider Phone Number
(573) 635-1320
Provider SSA County
250
Provider County Name
Cole
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
120
Number of Residents in Certified Beds
45
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
ELDERCARE OF MID-MISSOURI X INC
Date First Approved to Provide Medicare and Medicaid services
2007-03-10
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
3
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
3.21667
Reported LPN Staffing Hours per Resident per Day
0.80778
Reported RN Staffing Hours per Resident per Day
0.92667
Reported Licensed Staffing Hours per Resident per Day
1.73444
Reported Total Nurse Staffing Hours per Resident per Day
4.95112
Reported Physical Therapist Staffing Hours per Resident Per Day
0.28889
Expected CNA Staffing Hours per Resident per Day
2.44608
Expected LPN Staffing Hours per Resident per Day
0.56583
Expected RN Staffing Hours per Resident per Day
0.83742
Expected Total Nurse Staffing Hours per Resident per Day
3.84933
Adjusted CNA Staffing Hours per Resident per Day
3.22669
Adjusted LPN Staffing Hours per Resident per Day
1.18491
Adjusted RN Staffing Hours per Resident per Day
0.82683
Adjusted Total Nurse Staffing Hours per Resident per Day
5.18466
Cycle 1 Total Number of Health Deficiencies
6
Cycle 1 Number of Standard Health Deficiencies
5
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
36
Cycle 1 Standard Survey Health Date
2014-09-24
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
36
Cycle 2 Total Number of Health Deficiencies
4
Cycle 2 Number of Standard Health Deficiencies
4
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
20
Cycle 2 Standard Health Survey Date
2013-09-20
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
20
Cycle 3 Total Number of Health Deficiencies
8
Cycle 3 Number of Standard Health Deficiencies
8
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
32
Cycle 3 Standard Health Survey Date
2012-11-29
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
32
Total Weighted Health Survey Score
30.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
3
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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