Avera Prince Of Peace - Sioux Falls Nursing Home
General Information
Update InformationReport Incorrect Information
Federal Provider Number
435066
Provider Name
AVERA PRINCE OF PEACE
Provider Address
4500 PRINCE OF PEACE PLACE
SIOUX FALLS, SD 57103
SIOUX FALLS, SD 57103
Provider Phone Number
(605) 322-5613
Provider SSA County
490
Provider County Name
Minnehaha
Provider Website
Provider Description
Ownership Type
Non profit - Church related
Number of Certified Beds
90
Number of Residents in Certified Beds
84
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
Y
Legal Business Name
AVERA MCKENNAN
Date First Approved to Provide Medicare and Medicaid services
1992-10-01
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
2
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
1
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
3.23571
Reported LPN Staffing Hours per Resident per Day
0.12440
Reported RN Staffing Hours per Resident per Day
1.11250
Reported Licensed Staffing Hours per Resident per Day
1.23690
Reported Total Nurse Staffing Hours per Resident per Day
4.47261
Reported Physical Therapist Staffing Hours per Resident Per Day
0.20833
Expected CNA Staffing Hours per Resident per Day
2.34617
Expected LPN Staffing Hours per Resident per Day
0.59621
Expected RN Staffing Hours per Resident per Day
0.95049
Expected Total Nurse Staffing Hours per Resident per Day
3.89287
Adjusted CNA Staffing Hours per Resident per Day
3.38401
Adjusted LPN Staffing Hours per Resident per Day
0.17318
Adjusted RN Staffing Hours per Resident per Day
0.87456
Adjusted Total Nurse Staffing Hours per Resident per Day
4.63120
Cycle 1 Total Number of Health Deficiencies
4
Cycle 1 Number of Standard Health Deficiencies
4
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
12
Cycle 1 Standard Survey Health Date
2014-09-18
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
12
Cycle 2 Total Number of Health Deficiencies
12
Cycle 2 Number of Standard Health Deficiencies
12
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
80
Cycle 2 Standard Health Survey Date
2013-11-07
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
80
Cycle 3 Total Number of Health Deficiencies
6
Cycle 3 Number of Standard Health Deficiencies
6
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
32
Cycle 3 Standard Health Survey Date
2012-12-12
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
32
Total Weighted Health Survey Score
38.00000
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
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