Cherokee Villa Nursing & Rehab - Cherokee Nursing Home
General Information
Update InformationReport Incorrect Information
Federal Provider Number
165330
Provider Name
CHEROKEE VILLA NURSING & REHAB
Provider Address
1011 NORTH ROOSEVELT
CHEROKEE, IA 51012
CHEROKEE, IA 51012
Provider Phone Number
(712) 225-5189
Provider SSA County
170
Provider County Name
Cherokee
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
62
Number of Residents in Certified Beds
45
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
CARE INITIATIVES INC
Date First Approved to Provide Medicare and Medicaid services
1997-06-23
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
4
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
2
QM Rating Footnote
Staffing Rating
3
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
2.05444
Reported LPN Staffing Hours per Resident per Day
0.47000
Reported RN Staffing Hours per Resident per Day
0.58000
Reported Licensed Staffing Hours per Resident per Day
1.05000
Reported Total Nurse Staffing Hours per Resident per Day
3.10444
Reported Physical Therapist Staffing Hours per Resident Per Day
0.02333
Expected CNA Staffing Hours per Resident per Day
2.35984
Expected LPN Staffing Hours per Resident per Day
0.58723
Expected RN Staffing Hours per Resident per Day
0.81186
Expected Total Nurse Staffing Hours per Resident per Day
3.75893
Adjusted CNA Staffing Hours per Resident per Day
2.13615
Adjusted LPN Staffing Hours per Resident per Day
0.66431
Adjusted RN Staffing Hours per Resident per Day
0.53380
Adjusted Total Nurse Staffing Hours per Resident per Day
3.32905
Cycle 1 Total Number of Health Deficiencies
3
Cycle 1 Number of Standard Health Deficiencies
2
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
24
Cycle 1 Standard Survey Health Date
2015-01-08
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
24
Cycle 2 Total Number of Health Deficiencies
1
Cycle 2 Number of Standard Health Deficiencies
1
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
4
Cycle 2 Standard Health Survey Date
2013-10-30
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
4
Cycle 3 Total Number of Health Deficiencies
3
Cycle 3 Number of Standard Health Deficiencies
3
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
20
Cycle 3 Standard Health Survey Date
2012-09-28
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
20
Total Weighted Health Survey Score
16.66700
Number of Facility Reported Incidents
1
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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