Lake Stockton Healthcare Facility - Stockton Nursing Home
General Information
UPDATEFederal Provider Number
265466
Provider Name
LAKE STOCKTON HEALTHCARE FACILITY
Provider Address
811 OWEN MILL ROAD, PO BOX 945
STOCKTON, MO 65785
STOCKTON, MO 65785
Provider Phone Number
(417) 276-5126
Provider SSA County
190
Provider County Name
Cedar
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
75
Number of Residents in Certified Beds
61
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
CITIZENS MEMORIAL HEALTH CARE FOUNDATION
Date First Approved to Provide Medicare and Medicaid services
1991-09-20
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
5
Overall Rating Footnote
Health Inspection Rating
4
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
2.74016
Reported LPN Staffing Hours per Resident per Day
0.69426
Reported RN Staffing Hours per Resident per Day
0.60492
Reported Licensed Staffing Hours per Resident per Day
1.29918
Reported Total Nurse Staffing Hours per Resident per Day
4.03934
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00246
Expected CNA Staffing Hours per Resident per Day
2.27958
Expected LPN Staffing Hours per Resident per Day
0.54502
Expected RN Staffing Hours per Resident per Day
0.78645
Expected Total Nurse Staffing Hours per Resident per Day
3.61105
Adjusted CNA Staffing Hours per Resident per Day
2.94946
Adjusted LPN Staffing Hours per Resident per Day
1.05728
Adjusted RN Staffing Hours per Resident per Day
0.57473
Adjusted Total Nurse Staffing Hours per Resident per Day
4.50898
Cycle 1 Total Number of Health Deficiencies
3
Cycle 1 Number of Standard Health Deficiencies
3
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
28
Cycle 1 Standard Survey Health Date
2014-05-02
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
28
Cycle 2 Total Number of Health Deficiencies
0
Cycle 2 Number of Standard Health Deficiencies
0
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
0
Cycle 2 Standard Health Survey Date
2013-06-21
Cycle 2 Number of Health Revisits
0
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
3
Cycle 3 Number of Standard Health Deficiencies
3
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
12
Cycle 3 Standard Health Survey Date
2012-07-13
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
12
Total Weighted Health Survey Score
16.00000
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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