Citizens Memorial Healthcare Facility - Bolivar Nursing Home
General Information
UPDATEFederal Provider Number
265545
Provider Name
CITIZENS MEMORIAL HEALTHCARE FACILITY
Provider Address
1218 WEST LOCUST, PO BOX 590
BOLIVAR, MO 65613
BOLIVAR, MO 65613
Provider Phone Number
(417) 326-7648
Provider SSA County
821
Provider County Name
Polk
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
111
Number of Residents in Certified Beds
108
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
CITIZENS MEMORIAL HEALTH CARE FOUNDATION
Date First Approved to Provide Medicare and Medicaid services
1993-09-27
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
5
Health Inspection Rating Footnote
QM Rating
4
QM Rating Footnote
Staffing Rating
3
Staffing Rating Footnote
RN Staffing Rating
3
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.41620
Reported LPN Staffing Hours per Resident per Day
0.30046
Reported RN Staffing Hours per Resident per Day
0.51481
Reported Licensed Staffing Hours per Resident per Day
0.81528
Reported Total Nurse Staffing Hours per Resident per Day
3.23147
Reported Physical Therapist Staffing Hours per Resident Per Day
0.05417
Expected CNA Staffing Hours per Resident per Day
2.26160
Expected LPN Staffing Hours per Resident per Day
0.60703
Expected RN Staffing Hours per Resident per Day
0.87093
Expected Total Nurse Staffing Hours per Resident per Day
3.73956
Adjusted CNA Staffing Hours per Resident per Day
2.62144
Adjusted LPN Staffing Hours per Resident per Day
0.41082
Adjusted RN Staffing Hours per Resident per Day
0.44167
Adjusted Total Nurse Staffing Hours per Resident per Day
3.48323
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
2015-01-23
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
2014-04-04
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
0
Cycle 3 Number of Standard Health Deficiencies
0
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
0
Cycle 3 Standard Health Survey Date
2013-04-26
Cycle 3 Number of Health Revisits
0
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
0
Total Weighted Health Survey Score
2.00000
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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