Blair House - Burlington Nursing Home
General Information
Update InformationReport Incorrect Information
Federal Provider Number
165439
Provider Name
BLAIR HOUSE
Provider Address
1212 INDIAN HILLS DRIVE
BURLINGTON, IA 52601
BURLINGTON, IA 52601
Provider Phone Number
(319) 752-4100
Provider SSA County
280
Provider County Name
Des Moines
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
60
Number of Residents in Certified Beds
49
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
BENTON HEALTHCARE, L.L.C.
Date First Approved to Provide Medicare and Medicaid services
2001-07-20
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
4
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
3
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
2.08878
Reported LPN Staffing Hours per Resident per Day
0.44388
Reported RN Staffing Hours per Resident per Day
1.01837
Reported Licensed Staffing Hours per Resident per Day
1.46224
Reported Total Nurse Staffing Hours per Resident per Day
3.55103
Reported Physical Therapist Staffing Hours per Resident Per Day
0.08163
Expected CNA Staffing Hours per Resident per Day
2.36700
Expected LPN Staffing Hours per Resident per Day
0.61984
Expected RN Staffing Hours per Resident per Day
1.01453
Expected Total Nurse Staffing Hours per Resident per Day
4.00137
Adjusted CNA Staffing Hours per Resident per Day
2.16529
Adjusted LPN Staffing Hours per Resident per Day
0.59438
Adjusted RN Staffing Hours per Resident per Day
0.75003
Adjusted Total Nurse Staffing Hours per Resident per Day
3.57724
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
16
Cycle 1 Standard Survey Health Date
2014-05-29
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
16
Cycle 2 Total Number of Health Deficiencies
3
Cycle 2 Number of Standard Health Deficiencies
3
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
16
Cycle 2 Standard Health Survey Date
2013-04-11
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
16
Cycle 3 Total Number of Health Deficiencies
2
Cycle 3 Number of Standard Health Deficiencies
1
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
8
Cycle 3 Standard Health Survey Date
2012-03-01
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
8
Total Weighted Health Survey Score
14.66700
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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