Country View - Waterloo Nursing Home
General Information
Update InformationReport Incorrect Information
Federal Provider Number
165307
Provider Name
COUNTRY VIEW
Provider Address
1410 WEST DUNKERTON ROAD
WATERLOO, IA 50703
WATERLOO, IA 50703
Provider Phone Number
(319) 291-2509
Provider SSA County
60
Provider County Name
Black Hawk
Provider Website
Provider Description
Ownership Type
Government - County
Number of Certified Beds
134
Number of Residents in Certified Beds
126
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
COUNTY OF BLACKHAWK
Date First Approved to Provide Medicare and Medicaid services
1997-03-13
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
2
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
5
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
2.10635
Reported LPN Staffing Hours per Resident per Day
0.64246
Reported RN Staffing Hours per Resident per Day
0.36627
Reported Licensed Staffing Hours per Resident per Day
1.00873
Reported Total Nurse Staffing Hours per Resident per Day
3.11508
Reported Physical Therapist Staffing Hours per Resident Per Day
0.01349
Expected CNA Staffing Hours per Resident per Day
1.91002
Expected LPN Staffing Hours per Resident per Day
0.53378
Expected RN Staffing Hours per Resident per Day
0.70033
Expected Total Nurse Staffing Hours per Resident per Day
3.14414
Adjusted CNA Staffing Hours per Resident per Day
2.70591
Adjusted LPN Staffing Hours per Resident per Day
0.99898
Adjusted RN Staffing Hours per Resident per Day
0.39078
Adjusted Total Nurse Staffing Hours per Resident per Day
3.99364
Cycle 1 Total Number of Health Deficiencies
12
Cycle 1 Number of Standard Health Deficiencies
7
Cycle 1 Number of Complaint Health Deficiencies
6
Cycle 1 Health Deficiency Score
108
Cycle 1 Standard Survey Health Date
2014-06-05
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
108
Cycle 2 Total Number of Health Deficiencies
6
Cycle 2 Number of Standard Health Deficiencies
4
Cycle 2 Number of Complaint Health Deficiencies
3
Cycle 2 Health Deficiency Score
24
Cycle 2 Standard Health Survey Date
2013-03-26
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
24
Cycle 3 Total Number of Health Deficiencies
5
Cycle 3 Number of Standard Health Deficiencies
4
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
32
Cycle 3 Standard Health Survey Date
2012-02-24
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
32
Total Weighted Health Survey Score
67.33300
Number of Facility Reported Incidents
6
Number of Substantiated Complaints
3
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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