Centracare Health Paynesville Koronis Manor Cc - Paynesville Nursing Home
General Information
UPDATEFederal Provider Number
245253
Provider Name
CENTRACARE HEALTH PAYNESVILLE KORONIS MANOR CC
Provider Address
200 FIRST STREET WEST
PAYNESVILLE, MN 56362
PAYNESVILLE, MN 56362
Provider Phone Number
(320) 243-3767
Provider SSA County
720
Provider County Name
Stearns
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
52
Number of Residents in Certified Beds
51
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
Y
Legal Business Name
CENTRACARE HEALTH - PAYNESVILLE, LLC
Date First Approved to Provide Medicare and Medicaid services
1987-09-01
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
4
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
4
QM Rating Footnote
Staffing Rating
4
Staffing Rating Footnote
RN Staffing Rating
4
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.22745
Reported LPN Staffing Hours per Resident per Day
0.72353
Reported RN Staffing Hours per Resident per Day
0.70196
Reported Licensed Staffing Hours per Resident per Day
1.42549
Reported Total Nurse Staffing Hours per Resident per Day
3.65294
Reported Physical Therapist Staffing Hours per Resident Per Day
0.02549
Expected CNA Staffing Hours per Resident per Day
2.46447
Expected LPN Staffing Hours per Resident per Day
0.54691
Expected RN Staffing Hours per Resident per Day
0.78526
Expected Total Nurse Staffing Hours per Resident per Day
3.79664
Adjusted CNA Staffing Hours per Resident per Day
2.21771
Adjusted LPN Staffing Hours per Resident per Day
1.09804
Adjusted RN Staffing Hours per Resident per Day
0.66794
Adjusted Total Nurse Staffing Hours per Resident per Day
3.87833
Cycle 1 Total Number of Health Deficiencies
5
Cycle 1 Number of Standard Health Deficiencies
5
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
20
Cycle 1 Standard Survey Health Date
2015-03-05
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
20
Cycle 2 Total Number of Health Deficiencies
4
Cycle 2 Number of Standard Health Deficiencies
4
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
24
Cycle 2 Standard Health Survey Date
2014-01-23
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
24
Cycle 3 Total Number of Health Deficiencies
5
Cycle 3 Number of Standard Health Deficiencies
5
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
32
Cycle 3 Standard Health Survey Date
2012-11-01
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
32
Total Weighted Health Survey Score
23.33300
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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