Humboldt County Memorial Hospi - Humboldt Nursing Home
General Information
UPDATEFederal Provider Number
16E718
Provider Name
HUMBOLDT COUNTY MEMORIAL HOSPI
Provider Address
1000 NORTH 15TH STREET
HUMBOLDT, IA 50548
HUMBOLDT, IA 50548
Provider Phone Number
5153324200
Provider SSA County
450
Provider County Name
Humboldt
Ownership Type
Government - County
Number of Certified Beds
28
Number of Residents in Certified Beds
27
Provider Type
Medicaid
Provider Resides in Hospital
Y
Legal Business Name
Legal Business Name Not Available
Date First Approved to Provide Medicare and Medicaid services
2001-11-08
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
2
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
5
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
2.80741
Reported LPN Staffing Hours per Resident per Day
0.39074
Reported RN Staffing Hours per Resident per Day
1.32037
Reported Licensed Staffing Hours per Resident per Day
1.71111
Reported Total Nurse Staffing Hours per Resident per Day
4.51852
Reported Physical Therapist Staffing Hours per Resident Per Day
0.02593
Expected CNA Staffing Hours per Resident per Day
2.31965
Expected LPN Staffing Hours per Resident per Day
0.59488
Expected RN Staffing Hours per Resident per Day
0.78446
Expected Total Nurse Staffing Hours per Resident per Day
3.69898
Adjusted CNA Staffing Hours per Resident per Day
2.96965
Adjusted LPN Staffing Hours per Resident per Day
0.54518
Adjusted RN Staffing Hours per Resident per Day
1.25766
Adjusted Total Nurse Staffing Hours per Resident per Day
4.92398
Cycle 1 Total Number of Health Deficiencies
5
Cycle 1 Number of Standard Health Deficiencies
5
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
36
Cycle 1 Standard Survey Health Date
2015-04-09
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
8
Cycle 2 Number of Standard Health Deficiencies
8
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
40
Cycle 2 Standard Health Survey Date
2014-02-21
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
2
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
8
Cycle 3 Standard Health Survey Date
2013-01-17
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
8
Total Weighted Health Survey Score
32.66700
Number of Facility Reported Incidents
0
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
Nursiong Homes Nearby
Qhc Humboldt North, Llc
1111 11th Ave North |
HUMBOLDT IA 50548 | 0.3 mile away
Qhc Humboldt South, Llc
800 13th Street South |
HUMBOLDT IA 50548 | 1.4 miles away
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