Keystone Nursing Care Center Inc - Keystone Nursing Home
General Information
Update InformationReport Incorrect Information
Federal Provider Number
165604
Provider Name
KEYSTONE NURSING CARE CENTER INC
Provider Address
250 FIFTH STREET
KEYSTONE, IA 52249
KEYSTONE, IA 52249
Provider Phone Number
(319) 442-3234
Provider SSA County
50
Provider County Name
Benton
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
45
Number of Residents in Certified Beds
42
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
KEYSTONE NURSING CARE CENTER INC
Date First Approved to Provide Medicare and Medicaid services
2012-07-17
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
2
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
2.69405
Reported LPN Staffing Hours per Resident per Day
0.60238
Reported RN Staffing Hours per Resident per Day
0.67619
Reported Licensed Staffing Hours per Resident per Day
1.27857
Reported Total Nurse Staffing Hours per Resident per Day
3.97262
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00714
Expected CNA Staffing Hours per Resident per Day
2.23931
Expected LPN Staffing Hours per Resident per Day
0.53714
Expected RN Staffing Hours per Resident per Day
0.74037
Expected Total Nurse Staffing Hours per Resident per Day
3.51682
Adjusted CNA Staffing Hours per Resident per Day
2.95197
Adjusted LPN Staffing Hours per Resident per Day
0.93081
Adjusted RN Staffing Hours per Resident per Day
0.68243
Adjusted Total Nurse Staffing Hours per Resident per Day
4.55333
Cycle 1 Total Number of Health Deficiencies
2
Cycle 1 Number of Standard Health Deficiencies
2
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
12
Cycle 1 Standard Survey Health Date
2014-10-23
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
4
Cycle 2 Number of Standard Health Deficiencies
4
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
87
Cycle 2 Standard Health Survey Date
2013-08-22
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
87
Cycle 3 Total Number of Health Deficiencies
1
Cycle 3 Number of Standard Health Deficiencies
1
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
4
Cycle 3 Standard Health Survey Date
2012-06-29
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
4
Total Weighted Health Survey Score
35.66700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
0
Number of Fines
1
Total Amount of Fines in Dollars
4713
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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