Fort Dodge Health And Rehabilitation - Fort Dodge Nursing Home

General Information

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Federal Provider Number
165156
Provider Name
FORT DODGE HEALTH AND REHABILITATION
Provider Address
728 14TH AVENUE NORTH
FORT DODGE, IA 50501
Provider Phone Number
(515) 576-7226
Provider SSA County
930
Provider County Name
Webster
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
65
Number of Residents in Certified Beds
40
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
GYPSUM CREEK HEALTHCARE, INC.
Date First Approved to Provide Medicare and Medicaid services
1990-07-17
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Both
Automatic Sprinkler Systems in All Required Areas
Yes

Rating Detail Information

Overall Rating
2
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
3
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
2.17750
Reported LPN Staffing Hours per Resident per Day
0.66625
Reported RN Staffing Hours per Resident per Day
0.79500
Reported Licensed Staffing Hours per Resident per Day
1.46125
Reported Total Nurse Staffing Hours per Resident per Day
3.63875
Reported Physical Therapist Staffing Hours per Resident Per Day
0.06625
Expected CNA Staffing Hours per Resident per Day
2.21195
Expected LPN Staffing Hours per Resident per Day
0.58459
Expected RN Staffing Hours per Resident per Day
0.76778
Expected Total Nurse Staffing Hours per Resident per Day
3.56432
Adjusted CNA Staffing Hours per Resident per Day
2.41548
Adjusted LPN Staffing Hours per Resident per Day
0.94594
Adjusted RN Staffing Hours per Resident per Day
0.77369
Adjusted Total Nurse Staffing Hours per Resident per Day
4.11507
Cycle 1 Total Number of Health Deficiencies
9
Cycle 1 Number of Standard Health Deficiencies
7
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
36
Cycle 1 Standard Survey Health Date
2015-01-29
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
36
Cycle 2 Total Number of Health Deficiencies
15
Cycle 2 Number of Standard Health Deficiencies
12
Cycle 2 Number of Complaint Health Deficiencies
4
Cycle 2 Health Deficiency Score
80
Cycle 2 Standard Health Survey Date
2013-11-07
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
80
Cycle 3 Total Number of Health Deficiencies
14
Cycle 3 Number of Standard Health Deficiencies
9
Cycle 3 Number of Complaint Health Deficiencies
5
Cycle 3 Health Deficiency Score
88
Cycle 3 Standard Health Survey Date
2012-09-21
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
88
Total Weighted Health Survey Score
59.33300
Number of Facility Reported Incidents
2
Number of Substantiated Complaints
12
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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