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Amie Holt Care Center - Buffalo Nursing Home

General Information

UPDATE
Federal Provider Number
53A002
Provider Name
AMIE HOLT CARE CENTER
Provider Address
497 W LOTT
BUFFALO, WY 82834
Provider Phone Number
3076845521
Provider SSA County
90
Provider County Name
Johnson
Ownership Type
Government - Hospital district
Number of Certified Beds
50
Number of Residents in Certified Beds
42
Provider Type
Medicaid
Provider Resides in Hospital
Y
Legal Business Name
Legal Business Name Not Available
Date First Approved to Provide Medicare and Medicaid services
1974-03-31
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Both
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
4
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
3.07857
Reported LPN Staffing Hours per Resident per Day
0.24881
Reported RN Staffing Hours per Resident per Day
1.27381
Reported Licensed Staffing Hours per Resident per Day
1.52262
Reported Total Nurse Staffing Hours per Resident per Day
4.60119
Reported Physical Therapist Staffing Hours per Resident Per Day
0.40595
Expected CNA Staffing Hours per Resident per Day
2.24053
Expected LPN Staffing Hours per Resident per Day
0.54307
Expected RN Staffing Hours per Resident per Day
0.78583
Expected Total Nurse Staffing Hours per Resident per Day
3.56943
Adjusted CNA Staffing Hours per Resident per Day
3.37147
Adjusted LPN Staffing Hours per Resident per Day
0.38027
Adjusted RN Staffing Hours per Resident per Day
1.21119
Adjusted Total Nurse Staffing Hours per Resident per Day
5.19605
Cycle 1 Total Number of Health Deficiencies
10
Cycle 1 Number of Standard Health Deficiencies
10
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
56
Cycle 1 Standard Survey Health Date
2014-11-07
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
56
Cycle 2 Total Number of Health Deficiencies
1
Cycle 2 Number of Standard Health Deficiencies
1
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
4
Cycle 2 Standard Health Survey Date
2013-10-17
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
4
Cycle 3 Number of Standard Health Deficiencies
4
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
24
Cycle 3 Standard Health Survey Date
2012-12-20
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
24
Total Weighted Health Survey Score
33.33300
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
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