Evans Memorial Home - Cresco Nursing Home

General Information

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Federal Provider Number
165491
Provider Name
EVANS MEMORIAL HOME
Provider Address
1010 NORTH ELM STREET
CRESCO, IA 52136
Provider Phone Number
(563) 547-2364
Provider SSA County
440
Provider County Name
Howard
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
52
Number of Residents in Certified Beds
52
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
EVANS MEMORIAL HOME FOR THE AGED, INC.
Date First Approved to Provide Medicare and Medicaid services
2003-07-01
Continuing Care Retirement Community
Y
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
None
Automatic Sprinkler Systems in All Required Areas
Yes

Rating Detail Information

Overall Rating
5
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
2
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
1.88846
Reported LPN Staffing Hours per Resident per Day
0.40385
Reported RN Staffing Hours per Resident per Day
0.44712
Reported Licensed Staffing Hours per Resident per Day
0.85096
Reported Total Nurse Staffing Hours per Resident per Day
2.73943
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00000
Expected CNA Staffing Hours per Resident per Day
2.43780
Expected LPN Staffing Hours per Resident per Day
0.54725
Expected RN Staffing Hours per Resident per Day
0.76469
Expected Total Nurse Staffing Hours per Resident per Day
3.74974
Adjusted CNA Staffing Hours per Resident per Day
1.90078
Adjusted LPN Staffing Hours per Resident per Day
0.61250
Adjusted RN Staffing Hours per Resident per Day
0.43690
Adjusted Total Nurse Staffing Hours per Resident per Day
2.94483
Cycle 1 Total Number of Health Deficiencies
2
Cycle 1 Number of Standard Health Deficiencies
0
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
24
Cycle 1 Standard Survey Health Date
2014-10-09
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
24
Cycle 2 Total Number of Health Deficiencies
0
Cycle 2 Number of Standard Health Deficiencies
0
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
0
Cycle 2 Standard Health Survey Date
2013-08-22
Cycle 2 Number of Health Revisits
0
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
2
Cycle 3 Number of Standard Health Deficiencies
2
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
16
Cycle 3 Standard Health Survey Date
2012-08-03
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
16
Total Weighted Health Survey Score
14.66700
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
2
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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