Iowa Nursing Homes >> Storm Lake Nursing Homes >> North Lake Manor

North Lake Manor - Storm Lake Nursing Home

General Information

UPDATE
Federal Provider Number
165596
Provider Name
NORTH LAKE MANOR
Provider Address
1325 NORTH LAKE AVENUE
STORM LAKE, IA 50588
Provider Phone Number
7127323254
Provider SSA County
100
Provider County Name
Buena Vista
Ownership Type
For profit - Partnership
Number of Certified Beds
72
Number of Residents in Certified Beds
34
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
JP SENIOR HEALTHCARE LLC
Date First Approved to Provide Medicare and Medicaid services
2009-09-30
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
2
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
5
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
2.77500
Reported LPN Staffing Hours per Resident per Day
0.72059
Reported RN Staffing Hours per Resident per Day
1.15441
Reported Licensed Staffing Hours per Resident per Day
1.87500
Reported Total Nurse Staffing Hours per Resident per Day
4.65000
Reported Physical Therapist Staffing Hours per Resident Per Day
0.08382
Expected CNA Staffing Hours per Resident per Day
2.23388
Expected LPN Staffing Hours per Resident per Day
0.56231
Expected RN Staffing Hours per Resident per Day
0.84855
Expected Total Nurse Staffing Hours per Resident per Day
3.64473
Adjusted CNA Staffing Hours per Resident per Day
3.04807
Adjusted LPN Staffing Hours per Resident per Day
1.06363
Adjusted RN Staffing Hours per Resident per Day
1.01653
Adjusted Total Nurse Staffing Hours per Resident per Day
5.14268
Cycle 1 Total Number of Health Deficiencies
11
Cycle 1 Number of Standard Health Deficiencies
6
Cycle 1 Number of Complaint Health Deficiencies
11
Cycle 1 Health Deficiency Score
139
Cycle 1 Standard Survey Health Date
2014-10-09
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
139
Cycle 2 Total Number of Health Deficiencies
12
Cycle 2 Number of Standard Health Deficiencies
7
Cycle 2 Number of Complaint Health Deficiencies
5
Cycle 2 Health Deficiency Score
80
Cycle 2 Standard Health Survey Date
2013-07-18
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
6
Cycle 3 Number of Standard Health Deficiencies
4
Cycle 3 Number of Complaint Health Deficiencies
3
Cycle 3 Health Deficiency Score
40
Cycle 3 Standard Health Survey Date
2012-06-29
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
40
Total Weighted Health Survey Score
102.83300
Number of Facility Reported Incidents
4
Number of Substantiated Complaints
9
Number of Fines
2
Total Amount of Fines in Dollars
34515
Number of Payment Denials
0
Total Number of Penalties
2
Location
Processing Date
2015-06-01

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