Dallas Ret Village Health Center - Dallas Nursing Home
General Information
UPDATEFederal Provider Number
385207
Provider Name
DALLAS RET VILLAGE HEALTH CENTER
Provider Address
377 NW JASPER STREET
DALLAS, OR 97338
DALLAS, OR 97338
Provider Phone Number
(503) 623-5581
Provider SSA County
260
Provider County Name
Polk
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
121
Number of Residents in Certified Beds
100
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
DALLAS HEALTH CARE CENTER LLC
Date First Approved to Provide Medicare and Medicaid services
1989-09-12
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
1
QM Rating Footnote
Staffing Rating
4
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
2.44850
Reported LPN Staffing Hours per Resident per Day
1.11950
Reported RN Staffing Hours per Resident per Day
0.65700
Reported Licensed Staffing Hours per Resident per Day
1.77650
Reported Total Nurse Staffing Hours per Resident per Day
4.22500
Reported Physical Therapist Staffing Hours per Resident Per Day
0.11650
Expected CNA Staffing Hours per Resident per Day
2.48059
Expected LPN Staffing Hours per Resident per Day
0.59185
Expected RN Staffing Hours per Resident per Day
0.98844
Expected Total Nurse Staffing Hours per Resident per Day
4.06088
Adjusted CNA Staffing Hours per Resident per Day
2.42195
Adjusted LPN Staffing Hours per Resident per Day
1.56998
Adjusted RN Staffing Hours per Resident per Day
0.49665
Adjusted Total Nurse Staffing Hours per Resident per Day
4.19381
Cycle 1 Total Number of Health Deficiencies
7
Cycle 1 Number of Standard Health Deficiencies
6
Cycle 1 Number of Complaint Health Deficiencies
5
Cycle 1 Health Deficiency Score
44
Cycle 1 Standard Survey Health Date
2014-10-28
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
44
Cycle 2 Total Number of Health Deficiencies
4
Cycle 2 Number of Standard Health Deficiencies
2
Cycle 2 Number of Complaint Health Deficiencies
2
Cycle 2 Health Deficiency Score
60
Cycle 2 Standard Health Survey Date
2013-08-26
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
60
Cycle 3 Total Number of Health Deficiencies
21
Cycle 3 Number of Standard Health Deficiencies
18
Cycle 3 Number of Complaint Health Deficiencies
3
Cycle 3 Health Deficiency Score
140
Cycle 3 Standard Health Survey Date
2012-04-05
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
140
Total Weighted Health Survey Score
65.33300
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
4
Number of Fines
4
Total Amount of Fines in Dollars
23075
Number of Payment Denials
0
Total Number of Penalties
4
Location
Processing Date
2015-06-01
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