Lincoln County Care Center - Shoshone Nursing Home
General Information
UPDATEFederal Provider Number
135056
Provider Name
LINCOLN COUNTY CARE CENTER
Provider Address
511 EAST FOURTH STREET
SHOSHONE, ID 83352
SHOSHONE, ID 83352
Provider Phone Number
2088862228
Provider SSA County
310
Provider County Name
Lincoln
Ownership Type
For profit - Corporation
Number of Certified Beds
36
Number of Residents in Certified Beds
28
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
CHAROLAIS CARE IV, INC
Date First Approved to Provide Medicare and Medicaid services
1974-07-01
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
5
Overall Rating Footnote
Health Inspection Rating
5
Health Inspection Rating Footnote
QM Rating
3
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
3.57500
Reported LPN Staffing Hours per Resident per Day
0.84643
Reported RN Staffing Hours per Resident per Day
1.30000
Reported Licensed Staffing Hours per Resident per Day
2.14643
Reported Total Nurse Staffing Hours per Resident per Day
5.72143
Reported Physical Therapist Staffing Hours per Resident Per Day
0.04286
Expected CNA Staffing Hours per Resident per Day
2.57583
Expected LPN Staffing Hours per Resident per Day
0.72216
Expected RN Staffing Hours per Resident per Day
1.18424
Expected Total Nurse Staffing Hours per Resident per Day
4.48223
Adjusted CNA Staffing Hours per Resident per Day
3.40550
Adjusted LPN Staffing Hours per Resident per Day
0.97283
Adjusted RN Staffing Hours per Resident per Day
0.82024
Adjusted Total Nurse Staffing Hours per Resident per Day
5.14532
Cycle 1 Total Number of Health Deficiencies
1
Cycle 1 Number of Standard Health Deficiencies
1
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
8
Cycle 1 Standard Survey Health Date
2014-12-18
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
8
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
40
Cycle 2 Standard Health Survey Date
2013-09-27
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
16
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
100
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
100
Total Weighted Health Survey Score
34.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
1
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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