Hillcrest Manor - Blackwell Nursing Home
General Information
UPDATEFederal Provider Number
375402
Provider Name
HILLCREST MANOR
Provider Address
1210 SOUTH 6TH STREET
BLACKWELL, OK 74631
BLACKWELL, OK 74631
Provider Phone Number
5803633244
Provider SSA County
350
Provider County Name
Kay
Ownership Type
For profit - Corporation
Number of Certified Beds
137
Number of Residents in Certified Beds
55
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
BEDLAM PROPERTIES, LLC
Date First Approved to Provide Medicare and Medicaid services
2001-08-29
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
2
Health Inspection Rating Footnote
QM Rating
3
QM Rating Footnote
Staffing Rating
2
Staffing Rating Footnote
RN Staffing Rating
1
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.28182
Reported LPN Staffing Hours per Resident per Day
0.91818
Reported RN Staffing Hours per Resident per Day
0.16364
Reported Licensed Staffing Hours per Resident per Day
1.08182
Reported Total Nurse Staffing Hours per Resident per Day
3.36364
Reported Physical Therapist Staffing Hours per Resident Per Day
0.13273
Expected CNA Staffing Hours per Resident per Day
2.11403
Expected LPN Staffing Hours per Resident per Day
0.56955
Expected RN Staffing Hours per Resident per Day
0.80499
Expected Total Nurse Staffing Hours per Resident per Day
3.48857
Adjusted CNA Staffing Hours per Resident per Day
2.64845
Adjusted LPN Staffing Hours per Resident per Day
1.33806
Adjusted RN Staffing Hours per Resident per Day
0.15189
Adjusted Total Nurse Staffing Hours per Resident per Day
3.88655
Cycle 1 Total Number of Health Deficiencies
10
Cycle 1 Number of Standard Health Deficiencies
5
Cycle 1 Number of Complaint Health Deficiencies
5
Cycle 1 Health Deficiency Score
60
Cycle 1 Standard Survey Health Date
2015-04-22
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
60
Cycle 2 Total Number of Health Deficiencies
20
Cycle 2 Number of Standard Health Deficiencies
13
Cycle 2 Number of Complaint Health Deficiencies
7
Cycle 2 Health Deficiency Score
148
Cycle 2 Standard Health Survey Date
2014-07-02
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
19
Cycle 3 Number of Standard Health Deficiencies
13
Cycle 3 Number of Complaint Health Deficiencies
6
Cycle 3 Health Deficiency Score
231
Cycle 3 Standard Health Survey Date
2013-05-15
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
231
Total Weighted Health Survey Score
117.83300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
14
Number of Fines
1
Total Amount of Fines in Dollars
7540
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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Shawn Manor Nursing Home
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