Montgomery Place Nursing Center - Independence Nursing Home
General Information
UPDATEFederal Provider Number
175511
Provider Name
MONTGOMERY PLACE NURSING CENTER
Provider Address
614 S 8TH ST
INDEPENDENCE, KS 67301
INDEPENDENCE, KS 67301
Provider Phone Number
(620) 331-2577
Provider SSA County
620
Provider County Name
Montgomery
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
43
Number of Residents in Certified Beds
30
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
AMERICARE AT MONTGOMERY PLACE
Date First Approved to Provide Medicare and Medicaid services
2008-10-08
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
3
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
2
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
1.44500
Reported LPN Staffing Hours per Resident per Day
0.78333
Reported RN Staffing Hours per Resident per Day
0.69333
Reported Licensed Staffing Hours per Resident per Day
1.47667
Reported Total Nurse Staffing Hours per Resident per Day
2.92166
Reported Physical Therapist Staffing Hours per Resident Per Day
0.02333
Expected CNA Staffing Hours per Resident per Day
2.39513
Expected LPN Staffing Hours per Resident per Day
0.58120
Expected RN Staffing Hours per Resident per Day
0.95911
Expected Total Nurse Staffing Hours per Resident per Day
3.93544
Adjusted CNA Staffing Hours per Resident per Day
1.48034
Adjusted LPN Staffing Hours per Resident per Day
1.11866
Adjusted RN Staffing Hours per Resident per Day
0.54014
Adjusted Total Nurse Staffing Hours per Resident per Day
2.99253
Cycle 1 Total Number of Health Deficiencies
11
Cycle 1 Number of Standard Health Deficiencies
9
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
56
Cycle 1 Standard Survey Health Date
2015-02-26
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
56
Cycle 2 Total Number of Health Deficiencies
18
Cycle 2 Number of Standard Health Deficiencies
18
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
108
Cycle 2 Standard Health Survey Date
2013-11-07
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
108
Cycle 3 Total Number of Health Deficiencies
13
Cycle 3 Number of Standard Health Deficiencies
13
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
84
Cycle 3 Standard Health Survey Date
2012-07-18
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
84
Total Weighted Health Survey Score
78.00000
Number of Facility Reported Incidents
1
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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