Kennybrook Village - Grimes Nursing Home

General Information

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Federal Provider Number
165605
Provider Name
KENNYBROOK VILLAGE
Provider Address
200 SW BROOKSIDE DRIVE
GRIMES, IA 50111
Provider Phone Number
(515) 986-9925
Provider SSA County
760
Provider County Name
Polk
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
34
Number of Residents in Certified Beds
33
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
CCRC OF GRIMES, LLC
Date First Approved to Provide Medicare and Medicaid services
2012-03-23
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
3
Health Inspection Rating Footnote
QM Rating
5
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
2.42424
Reported LPN Staffing Hours per Resident per Day
0.59697
Reported RN Staffing Hours per Resident per Day
0.99848
Reported Licensed Staffing Hours per Resident per Day
1.59545
Reported Total Nurse Staffing Hours per Resident per Day
4.01969
Reported Physical Therapist Staffing Hours per Resident Per Day
0.04091
Expected CNA Staffing Hours per Resident per Day
2.47912
Expected LPN Staffing Hours per Resident per Day
0.61790
Expected RN Staffing Hours per Resident per Day
0.96285
Expected Total Nurse Staffing Hours per Resident per Day
4.05987
Adjusted CNA Staffing Hours per Resident per Day
2.39938
Adjusted LPN Staffing Hours per Resident per Day
0.80189
Adjusted RN Staffing Hours per Resident per Day
0.77485
Adjusted Total Nurse Staffing Hours per Resident per Day
3.99101
Cycle 1 Total Number of Health Deficiencies
4
Cycle 1 Number of Standard Health Deficiencies
4
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
12
Cycle 1 Standard Survey Health Date
2014-03-13
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
12
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
40
Cycle 2 Standard Health Survey Date
2013-01-24
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
40
Cycle 3 Total Number of Health Deficiencies
6
Cycle 3 Number of Standard Health Deficiencies
6
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
36
Cycle 3 Standard Health Survey Date
2012-02-15
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
36
Total Weighted Health Survey Score
25.33300
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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