North Village Park - Moberly Nursing Home
General Information
UPDATEFederal Provider Number
265330
Provider Name
NORTH VILLAGE PARK
Provider Address
2041 SILVA LANE
MOBERLY, MO 65270
MOBERLY, MO 65270
Provider Phone Number
(660) 263-1894
Provider SSA County
870
Provider County Name
Randolph
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
183
Number of Residents in Certified Beds
170
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
NORTH VILLAGE PARK, LLC
Date First Approved to Provide Medicare and Medicaid services
1988-07-01
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
1
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
4
QM Rating Footnote
Staffing Rating
2
Staffing Rating Footnote
RN Staffing Rating
1
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.25412
Reported LPN Staffing Hours per Resident per Day
0.36382
Reported RN Staffing Hours per Resident per Day
0.26324
Reported Licensed Staffing Hours per Resident per Day
0.62706
Reported Total Nurse Staffing Hours per Resident per Day
2.88118
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00618
Expected CNA Staffing Hours per Resident per Day
1.63537
Expected LPN Staffing Hours per Resident per Day
0.54122
Expected RN Staffing Hours per Resident per Day
0.70380
Expected Total Nurse Staffing Hours per Resident per Day
2.88039
Adjusted CNA Staffing Hours per Resident per Day
3.38206
Adjusted LPN Staffing Hours per Resident per Day
0.55794
Adjusted RN Staffing Hours per Resident per Day
0.27947
Adjusted Total Nurse Staffing Hours per Resident per Day
4.03200
Cycle 1 Total Number of Health Deficiencies
16
Cycle 1 Number of Standard Health Deficiencies
14
Cycle 1 Number of Complaint Health Deficiencies
4
Cycle 1 Health Deficiency Score
108
Cycle 1 Standard Survey Health Date
2014-07-17
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
108
Cycle 2 Total Number of Health Deficiencies
6
Cycle 2 Number of Standard Health Deficiencies
3
Cycle 2 Number of Complaint Health Deficiencies
3
Cycle 2 Health Deficiency Score
16
Cycle 2 Standard Health Survey Date
2013-08-08
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
16
Cycle 3 Total Number of Health Deficiencies
13
Cycle 3 Number of Standard Health Deficiencies
10
Cycle 3 Number of Complaint Health Deficiencies
3
Cycle 3 Health Deficiency Score
56
Cycle 3 Standard Health Survey Date
2012-07-26
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
56
Total Weighted Health Survey Score
68.66700
Number of Facility Reported Incidents
5
Number of Substantiated Complaints
11
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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