Countryside Nursing And Rehabilitation Center - Sioux City Nursing Home
General Information
UPDATEFederal Provider Number
165540
Provider Name
COUNTRYSIDE NURSING AND REHABILITATION CENTER
Provider Address
6120 MORNINGSIDE AVENUE
SIOUX CITY, IA 51106
SIOUX CITY, IA 51106
Provider Phone Number
7122763000
Provider SSA County
960
Provider County Name
Woodbury
Ownership Type
For profit - Corporation
Number of Certified Beds
36
Number of Residents in Certified Beds
24
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
PCNR, LLC
Date First Approved to Provide Medicare and Medicaid services
2004-04-01
Continuing Care Retirement Community
Y
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
3
Health Inspection Rating Footnote
QM Rating
4
QM Rating Footnote
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
2.73542
Reported LPN Staffing Hours per Resident per Day
0.50833
Reported RN Staffing Hours per Resident per Day
1.51042
Reported Licensed Staffing Hours per Resident per Day
2.01875
Reported Total Nurse Staffing Hours per Resident per Day
4.75417
Reported Physical Therapist Staffing Hours per Resident Per Day
0.06250
Expected CNA Staffing Hours per Resident per Day
2.33332
Expected LPN Staffing Hours per Resident per Day
0.62150
Expected RN Staffing Hours per Resident per Day
1.04570
Expected Total Nurse Staffing Hours per Resident per Day
4.00052
Adjusted CNA Staffing Hours per Resident per Day
2.87654
Adjusted LPN Staffing Hours per Resident per Day
0.67887
Adjusted RN Staffing Hours per Resident per Day
1.07926
Adjusted Total Nurse Staffing Hours per Resident per Day
4.79027
Cycle 1 Total Number of Health Deficiencies
5
Cycle 1 Number of Standard Health Deficiencies
5
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
20
Cycle 1 Standard Survey Health Date
2014-10-30
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
20
Cycle 2 Total Number of Health Deficiencies
3
Cycle 2 Number of Standard Health Deficiencies
3
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
16
Cycle 2 Standard Health Survey Date
2013-08-22
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
10
Cycle 3 Number of Standard Health Deficiencies
4
Cycle 3 Number of Complaint Health Deficiencies
7
Cycle 3 Health Deficiency Score
60
Cycle 3 Standard Health Survey Date
2012-08-02
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
60
Total Weighted Health Survey Score
25.33300
Number of Facility Reported Incidents
2
Number of Substantiated Complaints
7
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
Nursiong Homes Nearby
Sunrise Retirement Community
5501 Gordon Drive East |
SIOUX CITY IA 51106 | 1.2 miles away
Embassy Healthcare Community
206 Port Neal Road |
SERGEANT BLUFF IA 51054 | 4.4 miles away
Hallmark Care Center
3800 Indian Hills Drive |
SIOUX CITY IA 51104 | 5.8 miles away
Touchstone Living Center
1800 Indian Hills Drive |
SIOUX CITY IA 51104 | 5.9 miles away
Casa De Paz Health Care Center
2121 West 19th Street |
SIOUX CITY IA 51103 | 6.5 miles away
Holy Spirit Retirement Home
1701 West 25th Street |
SIOUX CITY IA 51103 | 6.7 miles away
Westwood Nursing & Rehab Cente
4201 Fieldcrest Drive |
SIOUX CITY IA 51104 | 7.3 miles away
Correctionville Nursing & Reha
1116 East Highway 20 |
CORRECTIONVILLE IA 51016 | 28.1 miles away
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