Indian Hills-a Stonebridge Community - Chillicothe Nursing Home
General Information
UPDATEFederal Provider Number
265785
Provider Name
INDIAN HILLS-A STONEBRIDGE COMMUNITY
Provider Address
2601 FAIR STREET
CHILLICOTHE, MO 64601
CHILLICOTHE, MO 64601
Provider Phone Number
(660) 646-1230
Provider SSA County
580
Provider County Name
Livingston
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
75
Number of Residents in Certified Beds
58
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
ELDERCARE OF MID-MISSOURI IX INC
Date First Approved to Provide Medicare and Medicaid services
2004-04-23
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
5
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
4
Staffing Rating Footnote
RN Staffing Rating
4
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
3.65862
Reported LPN Staffing Hours per Resident per Day
0.48103
Reported RN Staffing Hours per Resident per Day
0.66293
Reported Licensed Staffing Hours per Resident per Day
1.14397
Reported Total Nurse Staffing Hours per Resident per Day
4.80258
Reported Physical Therapist Staffing Hours per Resident Per Day
0.02500
Expected CNA Staffing Hours per Resident per Day
2.38208
Expected LPN Staffing Hours per Resident per Day
0.57317
Expected RN Staffing Hours per Resident per Day
0.88803
Expected Total Nurse Staffing Hours per Resident per Day
3.84329
Adjusted CNA Staffing Hours per Resident per Day
3.76861
Adjusted LPN Staffing Hours per Resident per Day
0.69657
Adjusted RN Staffing Hours per Resident per Day
0.55780
Adjusted Total Nurse Staffing Hours per Resident per Day
5.03702
Cycle 1 Total Number of Health Deficiencies
1
Cycle 1 Number of Standard Health Deficiencies
1
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
4
Cycle 1 Standard Survey Health Date
2015-01-29
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
4
Cycle 2 Total Number of Health Deficiencies
2
Cycle 2 Number of Standard Health Deficiencies
2
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
8
Cycle 2 Standard Health Survey Date
2014-01-09
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
8
Cycle 3 Total Number of Health Deficiencies
10
Cycle 3 Number of Standard Health Deficiencies
10
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
76
Cycle 3 Standard Health Survey Date
2012-12-06
Cycle 3 Number of Health Revisits
2
Cycle 3 Health Revisit Score
38
Cycle 3 Total Health Score
114
Total Weighted Health Survey Score
23.66700
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
1
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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