Crook Co Medical Service District Long Term Care - Sundance Nursing Home
General Information
UPDATEFederal Provider Number
535029
Provider Name
CROOK CO MEDICAL SERVICE DISTRICT LONG TERM CARE
Provider Address
713 OAK STREET
SUNDANCE, WY 82729
SUNDANCE, WY 82729
Provider Phone Number
(307) 283-2725
Provider SSA County
50
Provider County Name
Crook
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
32
Number of Residents in Certified Beds
29
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
CROOK COUNTY MEDICAL SERVICES DISTRICT
Date First Approved to Provide Medicare and Medicaid services
1986-12-31
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
2
Health Inspection Rating Footnote
QM Rating
2
QM Rating Footnote
Staffing Rating
3
Staffing Rating Footnote
RN Staffing Rating
4
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.21724
Reported LPN Staffing Hours per Resident per Day
0.41379
Reported RN Staffing Hours per Resident per Day
0.68966
Reported Licensed Staffing Hours per Resident per Day
1.10345
Reported Total Nurse Staffing Hours per Resident per Day
3.32069
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00517
Expected CNA Staffing Hours per Resident per Day
2.44169
Expected LPN Staffing Hours per Resident per Day
0.57665
Expected RN Staffing Hours per Resident per Day
0.83576
Expected Total Nurse Staffing Hours per Resident per Day
3.85409
Adjusted CNA Staffing Hours per Resident per Day
2.22815
Adjusted LPN Staffing Hours per Resident per Day
0.59559
Adjusted RN Staffing Hours per Resident per Day
0.61658
Adjusted Total Nurse Staffing Hours per Resident per Day
3.47303
Cycle 1 Total Number of Health Deficiencies
14
Cycle 1 Number of Standard Health Deficiencies
7
Cycle 1 Number of Complaint Health Deficiencies
7
Cycle 1 Health Deficiency Score
96
Cycle 1 Standard Survey Health Date
2015-02-26
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
96
Cycle 2 Total Number of Health Deficiencies
12
Cycle 2 Number of Standard Health Deficiencies
10
Cycle 2 Number of Complaint Health Deficiencies
2
Cycle 2 Health Deficiency Score
56
Cycle 2 Standard Health Survey Date
2014-02-13
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
56
Cycle 3 Total Number of Health Deficiencies
21
Cycle 3 Number of Standard Health Deficiencies
10
Cycle 3 Number of Complaint Health Deficiencies
11
Cycle 3 Health Deficiency Score
116
Cycle 3 Standard Health Survey Date
2013-08-22
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
116
Total Weighted Health Survey Score
86.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
13
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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