Kadoka Nursing Home - Kadoka Nursing Home
General Information
UPDATEFederal Provider Number
43A103
Provider Name
KADOKA NURSING HOME
Provider Address
605 MAPLE ST W POST OFFICE BOX 310
KADOKA, SD 57543
KADOKA, SD 57543
Provider Phone Number
6058372247
Provider SSA County
350
Provider County Name
Jackson
Ownership Type
Non profit - Corporation
Number of Certified Beds
30
Number of Residents in Certified Beds
29
Provider Type
Medicaid
Provider Resides in Hospital
N
Legal Business Name
Legal Business Name Not Available
Date First Approved to Provide Medicare and Medicaid services
1991-05-01
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
4
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
4
QM Rating Footnote
Staffing Rating
4
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
1.88621
Reported LPN Staffing Hours per Resident per Day
0.23621
Reported RN Staffing Hours per Resident per Day
0.98448
Reported Licensed Staffing Hours per Resident per Day
1.22069
Reported Total Nurse Staffing Hours per Resident per Day
3.10690
Reported Physical Therapist Staffing Hours per Resident Per Day
0.05000
Expected CNA Staffing Hours per Resident per Day
1.92726
Expected LPN Staffing Hours per Resident per Day
0.54173
Expected RN Staffing Hours per Resident per Day
0.67571
Expected Total Nurse Staffing Hours per Resident per Day
3.14470
Adjusted CNA Staffing Hours per Resident per Day
2.40143
Adjusted LPN Staffing Hours per Resident per Day
0.36191
Adjusted RN Staffing Hours per Resident per Day
1.08863
Adjusted Total Nurse Staffing Hours per Resident per Day
3.98244
Cycle 1 Total Number of Health Deficiencies
6
Cycle 1 Number of Standard Health Deficiencies
6
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
32
Cycle 1 Standard Survey Health Date
2014-10-01
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
32
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
24
Cycle 2 Standard Health Survey Date
2013-09-11
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
3
Cycle 3 Number of Standard Health Deficiencies
3
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
12
Cycle 3 Standard Health Survey Date
2012-07-11
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
12
Total Weighted Health Survey Score
26.00000
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
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