Clarksville Skilled Nursing & Rehab Center - Clarksville Nursing Home
General Information
Update InformationReport Incorrect Information
Federal Provider Number
165495
Provider Name
CLARKSVILLE SKILLED NURSING & REHAB CENTER
Provider Address
115 NORTH HILTON ST
CLARKSVILLE, IA 50619
CLARKSVILLE, IA 50619
Provider Phone Number
(319) 278-4900
Provider SSA County
110
Provider County Name
Butler
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
42
Number of Residents in Certified Beds
41
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
COMMUNITY NURSING HOME INC
Date First Approved to Provide Medicare and Medicaid services
2004-04-01
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
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
2.58659
Reported LPN Staffing Hours per Resident per Day
0.78537
Reported RN Staffing Hours per Resident per Day
0.54634
Reported Licensed Staffing Hours per Resident per Day
1.33171
Reported Total Nurse Staffing Hours per Resident per Day
3.91830
Reported Physical Therapist Staffing Hours per Resident Per Day
0.04390
Expected CNA Staffing Hours per Resident per Day
2.38342
Expected LPN Staffing Hours per Resident per Day
0.62672
Expected RN Staffing Hours per Resident per Day
0.80536
Expected Total Nurse Staffing Hours per Resident per Day
3.81549
Adjusted CNA Staffing Hours per Resident per Day
2.66286
Adjusted LPN Staffing Hours per Resident per Day
1.04012
Adjusted RN Staffing Hours per Resident per Day
0.50689
Adjusted Total Nurse Staffing Hours per Resident per Day
4.13951
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
32
Cycle 1 Standard Survey Health Date
2014-04-24
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
32
Cycle 2 Total Number of Health Deficiencies
1
Cycle 2 Number of Standard Health Deficiencies
1
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
4
Cycle 2 Standard Health Survey Date
2013-02-27
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
12
Cycle 3 Standard Health Survey Date
2012-01-26
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
12
Total Weighted Health Survey Score
19.33300
Number of Facility Reported Incidents
1
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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