King City Manor - King City Nursing Home
General Information
UPDATEFederal Provider Number
265728
Provider Name
KING CITY MANOR
Provider Address
300 WEST FAIRVIEW
KING CITY, MO 64463
KING CITY, MO 64463
Provider Phone Number
(660) 535-4325
Provider SSA County
370
Provider County Name
Gentry
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
60
Number of Residents in Certified Beds
42
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
DAVIS MANAGEMENT SERVICES, INC.
Date First Approved to Provide Medicare and Medicaid services
2002-01-17
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
4
Health Inspection Rating Footnote
QM Rating
4
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
2.67738
Reported LPN Staffing Hours per Resident per Day
0.41905
Reported RN Staffing Hours per Resident per Day
0.90357
Reported Licensed Staffing Hours per Resident per Day
1.32262
Reported Total Nurse Staffing Hours per Resident per Day
4.00000
Reported Physical Therapist Staffing Hours per Resident Per Day
0.14167
Expected CNA Staffing Hours per Resident per Day
2.15874
Expected LPN Staffing Hours per Resident per Day
0.67983
Expected RN Staffing Hours per Resident per Day
1.00766
Expected Total Nurse Staffing Hours per Resident per Day
3.84622
Adjusted CNA Staffing Hours per Resident per Day
3.04321
Adjusted LPN Staffing Hours per Resident per Day
0.51162
Adjusted RN Staffing Hours per Resident per Day
0.67001
Adjusted Total Nurse Staffing Hours per Resident per Day
4.19206
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
2014-09-25
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
5
Cycle 2 Number of Standard Health Deficiencies
5
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
36
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
36
Cycle 3 Total Number of Health Deficiencies
0
Cycle 3 Number of Standard Health Deficiencies
0
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
0
Cycle 3 Standard Health Survey Date
2012-10-10
Cycle 3 Number of Health Revisits
0
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
0
Total Weighted Health Survey Score
18.00000
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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