Katy Manor - Pilot Grove Nursing Home
General Information
UPDATEFederal Provider Number
265801
Provider Name
KATY MANOR
Provider Address
205 PROSPECT, PO BOX 8
PILOT GROVE, MO 65276
PILOT GROVE, MO 65276
Provider Phone Number
(660) 834-3111
Provider SSA County
260
Provider County Name
Cooper
Provider Website
Provider Description
Ownership Type
Government - County
Number of Certified Beds
60
Number of Residents in Certified Beds
56
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
COOPER COUNTY NURSING HOME DISTRICT NO 1
Date First Approved to Provide Medicare and Medicaid services
2006-03-15
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
5
Health Inspection Rating Footnote
QM Rating
3
QM Rating Footnote
Staffing Rating
3
Staffing Rating Footnote
RN Staffing Rating
3
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
1.97500
Reported LPN Staffing Hours per Resident per Day
0.47768
Reported RN Staffing Hours per Resident per Day
0.54107
Reported Licensed Staffing Hours per Resident per Day
1.01875
Reported Total Nurse Staffing Hours per Resident per Day
2.99375
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00893
Expected CNA Staffing Hours per Resident per Day
2.09006
Expected LPN Staffing Hours per Resident per Day
0.57836
Expected RN Staffing Hours per Resident per Day
0.83727
Expected Total Nurse Staffing Hours per Resident per Day
3.50568
Adjusted CNA Staffing Hours per Resident per Day
2.31863
Adjusted LPN Staffing Hours per Resident per Day
0.68552
Adjusted RN Staffing Hours per Resident per Day
0.48287
Adjusted Total Nurse Staffing Hours per Resident per Day
3.44227
Cycle 1 Total Number of Health Deficiencies
0
Cycle 1 Number of Standard Health Deficiencies
0
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
0
Cycle 1 Standard Survey Health Date
2015-03-04
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
0
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
2014-03-13
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
4
Cycle 3 Number of Standard Health Deficiencies
4
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
44
Cycle 3 Standard Health Survey Date
2013-03-27
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
44
Total Weighted Health Survey Score
10.00000
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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