Independence Manor Care Center - Independence Nursing Home
General Information
UPDATEFederal Provider Number
265682
Provider Name
INDEPENDENCE MANOR CARE CENTER
Provider Address
1600 SOUTH KINGSHIGHWAY
INDEPENDENCE, MO 64055
INDEPENDENCE, MO 64055
Provider Phone Number
(816) 833-4777
Provider SSA County
470
Provider County Name
Jackson
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
99
Number of Residents in Certified Beds
83
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
INDEPENDENCE MANOR INC
Date First Approved to Provide Medicare and Medicaid services
1997-11-01
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
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
2.88072
Reported LPN Staffing Hours per Resident per Day
0.77952
Reported RN Staffing Hours per Resident per Day
0.22771
Reported Licensed Staffing Hours per Resident per Day
1.00723
Reported Total Nurse Staffing Hours per Resident per Day
3.88795
Reported Physical Therapist Staffing Hours per Resident Per Day
0.06867
Expected CNA Staffing Hours per Resident per Day
2.07538
Expected LPN Staffing Hours per Resident per Day
0.58863
Expected RN Staffing Hours per Resident per Day
0.90232
Expected Total Nurse Staffing Hours per Resident per Day
3.56632
Adjusted CNA Staffing Hours per Resident per Day
3.40585
Adjusted LPN Staffing Hours per Resident per Day
1.09917
Adjusted RN Staffing Hours per Resident per Day
0.18856
Adjusted Total Nurse Staffing Hours per Resident per Day
4.39442
Cycle 1 Total Number of Health Deficiencies
14
Cycle 1 Number of Standard Health Deficiencies
14
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
76
Cycle 1 Standard Survey Health Date
2014-08-15
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
76
Cycle 2 Total Number of Health Deficiencies
6
Cycle 2 Number of Standard Health Deficiencies
6
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
28
Cycle 2 Standard Health Survey Date
2013-11-26
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
28
Cycle 3 Total Number of Health Deficiencies
10
Cycle 3 Number of Standard Health Deficiencies
9
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
72
Cycle 3 Standard Health Survey Date
2012-08-31
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
72
Total Weighted Health Survey Score
59.33300
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
1
Number of Fines
0
Total Amount of Fines in Dollars
0
Number of Payment Denials
1
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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