Medicalodges Independence - Independence Nursing Home
General Information
UPDATEFederal Provider Number
175464
Provider Name
MEDICALODGES INDEPENDENCE
Provider Address
1000 MULBERRY, PO BOX 627
INDEPENDENCE, KS 67301
INDEPENDENCE, KS 67301
Provider Phone Number
(620) 331-8789
Provider SSA County
620
Provider County Name
Montgomery
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
55
Number of Residents in Certified Beds
41
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
MEDICALODGES INC
Date First Approved to Provide Medicare and Medicaid services
2003-05-09
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
2
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
1
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
2.60976
Reported LPN Staffing Hours per Resident per Day
1.12195
Reported RN Staffing Hours per Resident per Day
0.69390
Reported Licensed Staffing Hours per Resident per Day
1.81585
Reported Total Nurse Staffing Hours per Resident per Day
4.42561
Reported Physical Therapist Staffing Hours per Resident Per Day
0.02317
Expected CNA Staffing Hours per Resident per Day
2.51154
Expected LPN Staffing Hours per Resident per Day
0.57611
Expected RN Staffing Hours per Resident per Day
0.89962
Expected Total Nurse Staffing Hours per Resident per Day
3.98727
Adjusted CNA Staffing Hours per Resident per Day
2.54966
Adjusted LPN Staffing Hours per Resident per Day
1.61638
Adjusted RN Staffing Hours per Resident per Day
0.57634
Adjusted Total Nurse Staffing Hours per Resident per Day
4.47404
Cycle 1 Total Number of Health Deficiencies
9
Cycle 1 Number of Standard Health Deficiencies
9
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
72
Cycle 1 Standard Survey Health Date
2015-05-06
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
72
Cycle 2 Total Number of Health Deficiencies
14
Cycle 2 Number of Standard Health Deficiencies
14
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
116
Cycle 2 Standard Health Survey Date
2014-02-28
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
116
Cycle 3 Total Number of Health Deficiencies
17
Cycle 3 Number of Standard Health Deficiencies
16
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
112
Cycle 3 Standard Health Survey Date
2012-11-09
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
112
Total Weighted Health Survey Score
93.33300
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
1
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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