Ambassador Manor Nursing Center - Tulsa Nursing Home
General Information
UPDATEFederal Provider Number
375168
Provider Name
AMBASSADOR MANOR NURSING CENTER
Provider Address
1340 EAST 61ST STREET
TULSA, OK 74136
TULSA, OK 74136
Provider Phone Number
(918) 743-8978
Provider SSA County
710
Provider County Name
Tulsa
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
171
Number of Residents in Certified Beds
133
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
AMBASSADOR MANOR NURSING CENTER L.L.C.
Date First Approved to Provide Medicare and Medicaid services
1994-05-01
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
3
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
2
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
2.60075
Reported LPN Staffing Hours per Resident per Day
0.72406
Reported RN Staffing Hours per Resident per Day
0.49398
Reported Licensed Staffing Hours per Resident per Day
1.21805
Reported Total Nurse Staffing Hours per Resident per Day
3.81879
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00902
Expected CNA Staffing Hours per Resident per Day
2.12408
Expected LPN Staffing Hours per Resident per Day
0.54539
Expected RN Staffing Hours per Resident per Day
0.80569
Expected Total Nurse Staffing Hours per Resident per Day
3.47516
Adjusted CNA Staffing Hours per Resident per Day
3.00433
Adjusted LPN Staffing Hours per Resident per Day
1.10192
Adjusted RN Staffing Hours per Resident per Day
0.45812
Adjusted Total Nurse Staffing Hours per Resident per Day
4.42948
Cycle 1 Total Number of Health Deficiencies
14
Cycle 1 Number of Standard Health Deficiencies
13
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
80
Cycle 1 Standard Survey Health Date
2014-12-04
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
80
Cycle 2 Total Number of Health Deficiencies
24
Cycle 2 Number of Standard Health Deficiencies
13
Cycle 2 Number of Complaint Health Deficiencies
12
Cycle 2 Health Deficiency Score
239
Cycle 2 Standard Health Survey Date
2013-09-13
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
239
Cycle 3 Total Number of Health Deficiencies
11
Cycle 3 Number of Standard Health Deficiencies
11
Cycle 3 Number of Complaint Health Deficiencies
11
Cycle 3 Health Deficiency Score
80
Cycle 3 Standard Health Survey Date
2012-11-09
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
80
Total Weighted Health Survey Score
133.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
6
Number of Fines
2
Total Amount of Fines in Dollars
22718
Number of Payment Denials
0
Total Number of Penalties
2
Location
Processing Date
2015-06-01
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