Colonial Manor Ii - Hollis Nursing Home

General Information

UPDATE
Federal Provider Number
370000000000000000000000000000
Provider Name
COLONIAL MANOR II
Provider Address
120 WEST VERSA
HOLLIS, OK 73550
Provider Phone Number
5806882828
Provider SSA County
280
Provider County Name
Harmon
Ownership Type
Government - County
Number of Certified Beds
92
Number of Residents in Certified Beds
42
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
1978-07-01
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
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
2
QM Rating Footnote
Staffing Rating
2
Staffing Rating Footnote
RN Staffing Rating
1
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
3.03690
Reported LPN Staffing Hours per Resident per Day
0.69762
Reported RN Staffing Hours per Resident per Day
0.20714
Reported Licensed Staffing Hours per Resident per Day
0.90476
Reported Total Nurse Staffing Hours per Resident per Day
3.94166
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00476
Expected CNA Staffing Hours per Resident per Day
2.18239
Expected LPN Staffing Hours per Resident per Day
0.62063
Expected RN Staffing Hours per Resident per Day
0.83280
Expected Total Nurse Staffing Hours per Resident per Day
3.63581
Adjusted CNA Staffing Hours per Resident per Day
3.41445
Adjusted LPN Staffing Hours per Resident per Day
0.93297
Adjusted RN Staffing Hours per Resident per Day
0.18585
Adjusted Total Nurse Staffing Hours per Resident per Day
4.36999
Cycle 1 Total Number of Health Deficiencies
2
Cycle 1 Number of Standard Health Deficiencies
2
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
16
Cycle 1 Standard Survey Health Date
2014-09-04
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
16
Cycle 2 Total Number of Health Deficiencies
2
Cycle 2 Number of Standard Health Deficiencies
2
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
16
Cycle 2 Standard Health Survey Date
2013-10-17
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
11
Cycle 3 Number of Standard Health Deficiencies
11
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
72
Cycle 3 Standard Health Survey Date
2012-09-13
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
72
Total Weighted Health Survey Score
25.33300
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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