Cordova Community Med Ltc - Cordova Nursing Home
General Information
UPDATEFederal Provider Number
25028
Provider Name
CORDOVA COMMUNITY MED LTC
Provider Address
P.O. BOX 160
CORDOVA, AK 99574
CORDOVA, AK 99574
Provider Phone Number
9074248000
Provider SSA County
80
Provider County Name
Valdez Cordova
Ownership Type
Government - City
Number of Certified Beds
10
Number of Residents in Certified Beds
10
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
Y
Legal Business Name
Legal Business Name Not Available
Date First Approved to Provide Medicare and Medicaid services
1994-03-22
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
3
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
0
QM Rating Footnote
Data Not Available
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
2.04000
Reported LPN Staffing Hours per Resident per Day
1.12000
Reported RN Staffing Hours per Resident per Day
2.90500
Reported Licensed Staffing Hours per Resident per Day
4.02500
Reported Total Nurse Staffing Hours per Resident per Day
6.06500
Reported Physical Therapist Staffing Hours per Resident Per Day
0.11500
Expected CNA Staffing Hours per Resident per Day
2.30923
Expected LPN Staffing Hours per Resident per Day
0.63177
Expected RN Staffing Hours per Resident per Day
0.93087
Expected Total Nurse Staffing Hours per Resident per Day
3.87187
Adjusted CNA Staffing Hours per Resident per Day
2.16762
Adjusted LPN Staffing Hours per Resident per Day
1.47141
Adjusted RN Staffing Hours per Resident per Day
2.33183
Adjusted Total Nurse Staffing Hours per Resident per Day
6.31410
Cycle 1 Total Number of Health Deficiencies
16
Cycle 1 Number of Standard Health Deficiencies
16
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
128
Cycle 1 Standard Survey Health Date
2015-02-19
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
128
Cycle 2 Total Number of Health Deficiencies
24
Cycle 2 Number of Standard Health Deficiencies
24
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
275
Cycle 2 Standard Health Survey Date
2014-03-27
Cycle 2 Number of Health Revisits
2
Cycle 2 Health Revisit Score
138
Cycle 2 Total Health Score
138
Cycle 3 Total Number of Health Deficiencies
6
Cycle 3 Number of Standard Health Deficiencies
6
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
80
Cycle 3 Standard Health Survey Date
2013-04-04
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
80
Total Weighted Health Survey Score
215.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
0
Number of Fines
1
Total Amount of Fines in Dollars
21548
Number of Payment Denials
1
Total Number of Penalties
2
Location
Processing Date
2015-06-01
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