Kit Carson Nursing & Rehabilitation Center - Jackson Nursing Home
General Information
UPDATEFederal Provider Number
56198
Provider Name
KIT CARSON NURSING & REHABILITATION CENTER
Provider Address
811 COURT STREET
JACKSON, CA 95642
JACKSON, CA 95642
Provider Phone Number
2092232231
Provider SSA County
20
Provider County Name
Amador
Ownership Type
For profit - Corporation
Number of Certified Beds
199
Number of Residents in Certified Beds
109
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
RAY PROPERTIES KIT CARSON INC.
Date First Approved to Provide Medicare and Medicaid services
1970-05-04
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Both
Automatic Sprinkler Systems in All Required Areas
Yes
Rating Detail Information
Overall Rating
3
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
2
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
2.99541
Reported LPN Staffing Hours per Resident per Day
0.80872
Reported RN Staffing Hours per Resident per Day
1.33670
Reported Licensed Staffing Hours per Resident per Day
2.14541
Reported Total Nurse Staffing Hours per Resident per Day
5.14083
Reported Physical Therapist Staffing Hours per Resident Per Day
0.05229
Expected CNA Staffing Hours per Resident per Day
2.18469
Expected LPN Staffing Hours per Resident per Day
0.58086
Expected RN Staffing Hours per Resident per Day
0.86193
Expected Total Nurse Staffing Hours per Resident per Day
3.62749
Adjusted CNA Staffing Hours per Resident per Day
3.36424
Adjusted LPN Staffing Hours per Resident per Day
1.15559
Adjusted RN Staffing Hours per Resident per Day
1.15877
Adjusted Total Nurse Staffing Hours per Resident per Day
5.71254
Cycle 1 Total Number of Health Deficiencies
18
Cycle 1 Number of Standard Health Deficiencies
7
Cycle 1 Number of Complaint Health Deficiencies
11
Cycle 1 Health Deficiency Score
88
Cycle 1 Standard Survey Health Date
2014-09-18
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
88
Cycle 2 Total Number of Health Deficiencies
7
Cycle 2 Number of Standard Health Deficiencies
7
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
32
Cycle 2 Standard Health Survey Date
2013-11-21
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
16
Cycle 3 Number of Standard Health Deficiencies
12
Cycle 3 Number of Complaint Health Deficiencies
4
Cycle 3 Health Deficiency Score
84
Cycle 3 Standard Health Survey Date
2012-12-06
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
84
Total Weighted Health Survey Score
68.66700
Number of Facility Reported Incidents
6
Number of Substantiated Complaints
10
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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