Childserve Habilitation Center - Johnston Nursing Home
General Information
UPDATEFederal Provider Number
16A001
Provider Name
CHILDSERVE HABILITATION CENTER
Provider Address
5900 PIONEER PARKWAY
JOHNSTON, IA 50131
JOHNSTON, IA 50131
Provider Phone Number
5152702205
Provider SSA County
760
Provider County Name
Polk
Ownership Type
Non profit - Corporation
Number of Certified Beds
58
Number of Residents in Certified Beds
49
Provider Type
Medicaid
Provider Resides in Hospital
N
Legal Business Name
Legal Business Name Not Available
Date First Approved to Provide Medicare and Medicaid services
1976-07-01
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Family
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
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
3.80714
Reported LPN Staffing Hours per Resident per Day
1.30612
Reported RN Staffing Hours per Resident per Day
4.04898
Reported Licensed Staffing Hours per Resident per Day
5.35510
Reported Total Nurse Staffing Hours per Resident per Day
9.16224
Reported Physical Therapist Staffing Hours per Resident Per Day
0.43776
Expected CNA Staffing Hours per Resident per Day
2.79895
Expected LPN Staffing Hours per Resident per Day
1.21093
Expected RN Staffing Hours per Resident per Day
1.66502
Expected Total Nurse Staffing Hours per Resident per Day
5.67490
Adjusted CNA Staffing Hours per Resident per Day
3.33753
Adjusted LPN Staffing Hours per Resident per Day
0.89524
Adjusted RN Staffing Hours per Resident per Day
1.81704
Adjusted Total Nurse Staffing Hours per Resident per Day
6.50796
Cycle 1 Total Number of Health Deficiencies
1
Cycle 1 Number of Standard Health Deficiencies
1
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
4
Cycle 1 Standard Survey Health Date
2014-08-13
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
4
Cycle 2 Total Number of Health Deficiencies
0
Cycle 2 Number of Standard Health Deficiencies
0
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
0
Cycle 2 Standard Health Survey Date
2013-11-14
Cycle 2 Number of Health Revisits
0
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
7
Cycle 3 Number of Standard Health Deficiencies
7
Cycle 3 Number of Complaint Health Deficiencies
5
Cycle 3 Health Deficiency Score
48
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
48
Total Weighted Health Survey Score
10.00000
Number of Facility Reported Incidents
3
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
Nursiong Homes Nearby
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Scottish Rite Park Inc
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