Calvin Community - Des Moines Nursing Home

General Information

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Federal Provider Number
165479
Provider Name
CALVIN COMMUNITY
Provider Address
4210 HICKMAN ROAD
DES MOINES, IA 50310
Provider Phone Number
(515) 277-6141
Provider SSA County
760
Provider County Name
Polk
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
59
Number of Residents in Certified Beds
57
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
CALVIN COMMUNITY
Date First Approved to Provide Medicare and Medicaid services
2003-04-01
Continuing Care Retirement Community
Y
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
3
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
3.66053
Reported LPN Staffing Hours per Resident per Day
0.87456
Reported RN Staffing Hours per Resident per Day
0.92018
Reported Licensed Staffing Hours per Resident per Day
1.79474
Reported Total Nurse Staffing Hours per Resident per Day
5.45527
Reported Physical Therapist Staffing Hours per Resident Per Day
0.03158
Expected CNA Staffing Hours per Resident per Day
2.53612
Expected LPN Staffing Hours per Resident per Day
0.54409
Expected RN Staffing Hours per Resident per Day
0.78772
Expected Total Nurse Staffing Hours per Resident per Day
3.86793
Adjusted CNA Staffing Hours per Resident per Day
3.54157
Adjusted LPN Staffing Hours per Resident per Day
1.33412
Adjusted RN Staffing Hours per Resident per Day
0.87285
Adjusted Total Nurse Staffing Hours per Resident per Day
5.68512
Cycle 1 Total Number of Health Deficiencies
9
Cycle 1 Number of Standard Health Deficiencies
9
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
56
Cycle 1 Standard Survey Health Date
2014-02-27
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
2
Cycle 2 Number of Standard Health Deficiencies
2
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
12
Cycle 2 Standard Health Survey Date
2013-01-03
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
12
Cycle 3 Total Number of Health Deficiencies
6
Cycle 3 Number of Standard Health Deficiencies
5
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
20
Cycle 3 Standard Health Survey Date
2011-12-27
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
20
Total Weighted Health Survey Score
35.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
1
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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