Perry Lutheran Home - Perry Nursing Home
General Information
Update InformationReport Incorrect Information
Federal Provider Number
165606
Provider Name
PERRY LUTHERAN HOME
Provider Address
2323 EAST WILLIS AVENUE
PERRY, IA 50220
PERRY, IA 50220
Provider Phone Number
(515) 465-5342
Provider SSA County
240
Provider County Name
Dallas
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
73
Number of Residents in Certified Beds
52
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
LUTHERAN HOME FOR THE AGED ASSOCIATION-WEST
Date First Approved to Provide Medicare and Medicaid services
2012-03-01
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
2
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
2
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
1.78558
Reported LPN Staffing Hours per Resident per Day
1.06923
Reported RN Staffing Hours per Resident per Day
0.47019
Reported Licensed Staffing Hours per Resident per Day
1.53942
Reported Total Nurse Staffing Hours per Resident per Day
3.32500
Reported Physical Therapist Staffing Hours per Resident Per Day
0.03269
Expected CNA Staffing Hours per Resident per Day
2.33588
Expected LPN Staffing Hours per Resident per Day
0.51277
Expected RN Staffing Hours per Resident per Day
0.67462
Expected Total Nurse Staffing Hours per Resident per Day
3.52327
Adjusted CNA Staffing Hours per Resident per Day
1.87564
Adjusted LPN Staffing Hours per Resident per Day
1.73073
Adjusted RN Staffing Hours per Resident per Day
0.52077
Adjusted Total Nurse Staffing Hours per Resident per Day
3.80406
Cycle 1 Total Number of Health Deficiencies
10
Cycle 1 Number of Standard Health Deficiencies
8
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
96
Cycle 1 Standard Survey Health Date
2015-02-19
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
96
Cycle 2 Total Number of Health Deficiencies
11
Cycle 2 Number of Standard Health Deficiencies
5
Cycle 2 Number of Complaint Health Deficiencies
6
Cycle 2 Health Deficiency Score
76
Cycle 2 Standard Health Survey Date
2013-11-27
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
76
Cycle 3 Total Number of Health Deficiencies
21
Cycle 3 Number of Standard Health Deficiencies
12
Cycle 3 Number of Complaint Health Deficiencies
9
Cycle 3 Health Deficiency Score
171
Cycle 3 Standard Health Survey Date
2012-10-03
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
171
Total Weighted Health Survey Score
101.83300
Number of Facility Reported Incidents
4
Number of Substantiated Complaints
8
Number of Fines
2
Total Amount of Fines in Dollars
13780
Number of Payment Denials
0
Total Number of Penalties
2
Location
Processing Date
2015-06-01
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