Friendship Village Retirement - Waterloo Nursing Home
General Information
Update InformationReport Incorrect Information
Federal Provider Number
165081
Provider Name
FRIENDSHIP VILLAGE RETIREMENT
Provider Address
600 PARK LANE
WATERLOO, IA 50702
WATERLOO, IA 50702
Provider Phone Number
(319) 291-8100
Provider SSA County
60
Provider County Name
Black Hawk
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
72
Number of Residents in Certified Beds
63
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
FRIENDSHIP VILLAGE INC.
Date First Approved to Provide Medicare and Medicaid services
1968-08-15
Continuing Care Retirement Community
Y
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
4
QM Rating Footnote
Staffing Rating
3
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
2.31111
Reported LPN Staffing Hours per Resident per Day
1.21190
Reported RN Staffing Hours per Resident per Day
0.61905
Reported Licensed Staffing Hours per Resident per Day
1.83095
Reported Total Nurse Staffing Hours per Resident per Day
4.14206
Reported Physical Therapist Staffing Hours per Resident Per Day
0.04762
Expected CNA Staffing Hours per Resident per Day
2.61592
Expected LPN Staffing Hours per Resident per Day
0.62473
Expected RN Staffing Hours per Resident per Day
0.96379
Expected Total Nurse Staffing Hours per Resident per Day
4.20444
Adjusted CNA Staffing Hours per Resident per Day
2.16779
Adjusted LPN Staffing Hours per Resident per Day
1.61011
Adjusted RN Staffing Hours per Resident per Day
0.47993
Adjusted Total Nurse Staffing Hours per Resident per Day
3.97110
Cycle 1 Total Number of Health Deficiencies
4
Cycle 1 Number of Standard Health Deficiencies
3
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
8
Cycle 1 Standard Survey Health Date
2014-06-12
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
8
Cycle 2 Total Number of Health Deficiencies
5
Cycle 2 Number of Standard Health Deficiencies
4
Cycle 2 Number of Complaint Health Deficiencies
2
Cycle 2 Health Deficiency Score
72
Cycle 2 Standard Health Survey Date
2013-03-07
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
72
Cycle 3 Total Number of Health Deficiencies
4
Cycle 3 Number of Standard Health Deficiencies
3
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
52
Cycle 3 Standard Health Survey Date
2012-02-10
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
52
Total Weighted Health Survey Score
36.66700
Number of Facility Reported Incidents
3
Number of Substantiated Complaints
0
Number of Fines
1
Total Amount of Fines in Dollars
3088
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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