Fellowship Village - Inwood Nursing Home
General Information
Update InformationReport Incorrect Information
Federal Provider Number
165283
Provider Name
FELLOWSHIP VILLAGE
Provider Address
300 EAST JEFFERSON
INWOOD, IA 51240
INWOOD, IA 51240
Provider Phone Number
(712) 753-4663
Provider SSA County
590
Provider County Name
Lyon
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
40
Number of Residents in Certified Beds
34
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
FELLOWSHIP VILLAGE, INC.
Date First Approved to Provide Medicare and Medicaid services
1996-09-01
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
5
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
4
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
2.48235
Reported LPN Staffing Hours per Resident per Day
0.31912
Reported RN Staffing Hours per Resident per Day
0.85000
Reported Licensed Staffing Hours per Resident per Day
1.16912
Reported Total Nurse Staffing Hours per Resident per Day
3.65147
Reported Physical Therapist Staffing Hours per Resident Per Day
0.02059
Expected CNA Staffing Hours per Resident per Day
2.37798
Expected LPN Staffing Hours per Resident per Day
0.55124
Expected RN Staffing Hours per Resident per Day
0.70507
Expected Total Nurse Staffing Hours per Resident per Day
3.63430
Adjusted CNA Staffing Hours per Resident per Day
2.56139
Adjusted LPN Staffing Hours per Resident per Day
0.48049
Adjusted RN Staffing Hours per Resident per Day
0.90078
Adjusted Total Nurse Staffing Hours per Resident per Day
4.04994
Cycle 1 Total Number of Health Deficiencies
0
Cycle 1 Number of Standard Health Deficiencies
0
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
0
Cycle 1 Standard Survey Health Date
2015-02-05
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
0
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
12
Cycle 2 Standard Health Survey Date
2013-11-27
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
12
Cycle 3 Total Number of Health Deficiencies
5
Cycle 3 Number of Standard Health Deficiencies
5
Cycle 3 Number of Complaint Health Deficiencies
5
Cycle 3 Health Deficiency Score
32
Cycle 3 Standard Health Survey Date
2012-10-26
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
32
Total Weighted Health Survey Score
9.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
1
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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