Gold Crest Retirement Center - Adams Nursing Home

General Information

UPDATE
Federal Provider Number
285065
Provider Name
GOLD CREST RETIREMENT CENTER
Provider Address
200 LEVI LANE
ADAMS, NE 68301
Provider Phone Number
4029887115
Provider SSA County
330
Provider County Name
Gage
Ownership Type
Non profit - Corporation
Number of Certified Beds
52
Number of Residents in Certified Beds
44
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
COFFMAN LEVI CHARITABLE TRUST
Date First Approved to Provide Medicare and Medicaid services
1984-06-07
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
4
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
3
Staffing Rating Footnote
RN Staffing Rating
2
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.42841
Reported LPN Staffing Hours per Resident per Day
0.75909
Reported RN Staffing Hours per Resident per Day
0.42500
Reported Licensed Staffing Hours per Resident per Day
1.18409
Reported Total Nurse Staffing Hours per Resident per Day
3.61250
Reported Physical Therapist Staffing Hours per Resident Per Day
0.04091
Expected CNA Staffing Hours per Resident per Day
2.34840
Expected LPN Staffing Hours per Resident per Day
0.60374
Expected RN Staffing Hours per Resident per Day
0.92864
Expected Total Nurse Staffing Hours per Resident per Day
3.88078
Adjusted CNA Staffing Hours per Resident per Day
2.53730
Adjusted LPN Staffing Hours per Resident per Day
1.04357
Adjusted RN Staffing Hours per Resident per Day
0.34196
Adjusted Total Nurse Staffing Hours per Resident per Day
3.75225
Cycle 1 Total Number of Health Deficiencies
8
Cycle 1 Number of Standard Health Deficiencies
8
Cycle 1 Number of Complaint Health Deficiencies
8
Cycle 1 Health Deficiency Score
44
Cycle 1 Standard Survey Health Date
2014-11-10
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
44
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
16
Cycle 2 Standard Health Survey Date
2014-01-15
Cycle 2 Number of Health Revisits
1
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
1
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
12
Cycle 3 Standard Health Survey Date
2012-09-27
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
12
Total Weighted Health Survey Score
29.33300
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
0
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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