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Kiowa Hospital District Manor - Kiowa Nursing Home

General Information

UPDATE
Federal Provider Number
17E597
Provider Name
KIOWA HOSPITAL DISTRICT MANOR
Provider Address
1020 MAIN STREET
KIOWA, KS 67070
Provider Phone Number
(620) 825-4117
Provider SSA County
30
Provider County Name
Barber
Provider Website
Provider Description
Ownership Type
Government - Hospital district
Number of Certified Beds
29
Number of Residents in Certified Beds
22
Provider Type
Medicaid
Provider Resides in Hospital
Y
Legal Business Name
Legal Business Name Not Available
Date First Approved to Provide Medicare and Medicaid services
1998-07-01
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
2
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
1
QM Rating Footnote
Staffing Rating
5
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
2.94091
Reported LPN Staffing Hours per Resident per Day
0.19318
Reported RN Staffing Hours per Resident per Day
1.16136
Reported Licensed Staffing Hours per Resident per Day
1.35455
Reported Total Nurse Staffing Hours per Resident per Day
4.29545
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00000
Expected CNA Staffing Hours per Resident per Day
2.30417
Expected LPN Staffing Hours per Resident per Day
0.52333
Expected RN Staffing Hours per Resident per Day
0.73157
Expected Total Nurse Staffing Hours per Resident per Day
3.55907
Adjusted CNA Staffing Hours per Resident per Day
3.13177
Adjusted LPN Staffing Hours per Resident per Day
0.30638
Adjusted RN Staffing Hours per Resident per Day
1.18617
Adjusted Total Nurse Staffing Hours per Resident per Day
4.86490
Cycle 1 Total Number of Health Deficiencies
10
Cycle 1 Number of Standard Health Deficiencies
10
Cycle 1 Number of Complaint Health Deficiencies
8
Cycle 1 Health Deficiency Score
80
Cycle 1 Standard Survey Health Date
2014-12-08
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
80
Cycle 2 Total Number of Health Deficiencies
16
Cycle 2 Number of Standard Health Deficiencies
10
Cycle 2 Number of Complaint Health Deficiencies
15
Cycle 2 Health Deficiency Score
136
Cycle 2 Standard Health Survey Date
2013-08-15
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
136
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
48
Cycle 3 Standard Health Survey Date
2012-04-24
Cycle 3 Number of Health Revisits
0
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
48
Total Weighted Health Survey Score
93.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
4
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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