Dave's Place - Keokuk Nursing Home
General Information
UPDATEFederal Provider Number
16F002
Provider Name
DAVE'S PLACE
Provider Address
3140 PLANK ROAD
KEOKUK, IA 52632
KEOKUK, IA 52632
Provider Phone Number
(319) 524-1800
Provider SSA County
550
Provider County Name
Lee
Provider Website
Provider Description
Ownership Type
For profit - Individual
Number of Certified Beds
57
Number of Residents in Certified Beds
51
Provider Type
Medicaid
Provider Resides in Hospital
N
Legal Business Name
Legal Business Name Not Available
Date First Approved to Provide Medicare and Medicaid services
2011-05-07
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
3
Health Inspection Rating Footnote
QM Rating
1
QM Rating Footnote
Staffing Rating
3
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
1.20882
Reported LPN Staffing Hours per Resident per Day
0.63627
Reported RN Staffing Hours per Resident per Day
0.78922
Reported Licensed Staffing Hours per Resident per Day
1.42549
Reported Total Nurse Staffing Hours per Resident per Day
2.63431
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00000
Expected CNA Staffing Hours per Resident per Day
2.01300
Expected LPN Staffing Hours per Resident per Day
0.56311
Expected RN Staffing Hours per Resident per Day
0.74337
Expected Total Nurse Staffing Hours per Resident per Day
3.31949
Adjusted CNA Staffing Hours per Resident per Day
1.47346
Adjusted LPN Staffing Hours per Resident per Day
0.93783
Adjusted RN Staffing Hours per Resident per Day
0.79328
Adjusted Total Nurse Staffing Hours per Resident per Day
3.19888
Cycle 1 Total Number of Health Deficiencies
4
Cycle 1 Number of Standard Health Deficiencies
4
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
20
Cycle 1 Standard Survey Health Date
2014-10-16
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
9
Cycle 2 Number of Standard Health Deficiencies
6
Cycle 2 Number of Complaint Health Deficiencies
9
Cycle 2 Health Deficiency Score
40
Cycle 2 Standard Health Survey Date
2013-08-08
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
40
Cycle 3 Total Number of Health Deficiencies
5
Cycle 3 Number of Standard Health Deficiencies
2
Cycle 3 Number of Complaint Health Deficiencies
3
Cycle 3 Health Deficiency Score
32
Cycle 3 Standard Health Survey Date
2012-06-01
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
32
Total Weighted Health Survey Score
28.66700
Number of Facility Reported Incidents
3
Number of Substantiated Complaints
4
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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