Licking Park Manor - Licking Nursing Home
General Information
UPDATEFederal Provider Number
265632
Provider Name
LICKING PARK MANOR
Provider Address
209 HICKORY STREET
LICKING, MO 65542
LICKING, MO 65542
Provider Phone Number
5736742111
Provider SSA County
989
Provider County Name
Texas
Ownership Type
Government - City/county
Number of Certified Beds
60
Number of Residents in Certified Beds
38
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
COMMUNITY CARE CENTER OF LICKING INC
Date First Approved to Provide Medicare and Medicaid services
1996-04-03
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
5
Overall Rating Footnote
Health Inspection Rating
5
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
2.75263
Reported LPN Staffing Hours per Resident per Day
0.51184
Reported RN Staffing Hours per Resident per Day
0.73684
Reported Licensed Staffing Hours per Resident per Day
1.24868
Reported Total Nurse Staffing Hours per Resident per Day
4.00131
Reported Physical Therapist Staffing Hours per Resident Per Day
0.02763
Expected CNA Staffing Hours per Resident per Day
2.34679
Expected LPN Staffing Hours per Resident per Day
0.57825
Expected RN Staffing Hours per Resident per Day
0.87975
Expected Total Nurse Staffing Hours per Resident per Day
3.80479
Adjusted CNA Staffing Hours per Resident per Day
2.87803
Adjusted LPN Staffing Hours per Resident per Day
0.73468
Adjusted RN Staffing Hours per Resident per Day
0.62582
Adjusted Total Nurse Staffing Hours per Resident per Day
4.23910
Cycle 1 Total Number of Health Deficiencies
0
Cycle 1 Number of Standard Health Deficiencies
0
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
0
Cycle 1 Standard Survey Health Date
2015-02-06
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
0
Cycle 2 Total Number of Health Deficiencies
2
Cycle 2 Number of Standard Health Deficiencies
2
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
12
Cycle 2 Standard Health Survey Date
2014-03-13
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
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
2013-04-26
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
4
Total Weighted Health Survey Score
4.66700
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
Nursiong Homes Nearby
Houston House
1000 North Industrial Drive, Po Box 199 |
HOUSTON MO 65483 | 13.8 miles away
Kabul Nursing Homes Inc
1000 Main Street |
CABOOL MO 65689 | 28.9 miles away
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