Pine Village - Moundridge Nursing Home
General Information
UPDATEFederal Provider Number
175414
Provider Name
PINE VILLAGE
Provider Address
86 TWENTY-SECOND AVE
MOUNDRIDGE, KS 67107
MOUNDRIDGE, KS 67107
Provider Phone Number
(620) 345-2901
Provider SSA County
560
Provider County Name
Mcpherson
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
74
Number of Residents in Certified Beds
69
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
MEMORIAL HOME, INC.
Date First Approved to Provide Medicare and Medicaid services
1997-04-01
Continuing Care Retirement Community
Y
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
5
Overall Rating Footnote
Health Inspection Rating
5
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
4
Staffing Rating Footnote
RN Staffing Rating
3
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
3.41304
Reported LPN Staffing Hours per Resident per Day
1.03841
Reported RN Staffing Hours per Resident per Day
0.49058
Reported Licensed Staffing Hours per Resident per Day
1.52899
Reported Total Nurse Staffing Hours per Resident per Day
4.94203
Reported Physical Therapist Staffing Hours per Resident Per Day
0.16594
Expected CNA Staffing Hours per Resident per Day
2.36236
Expected LPN Staffing Hours per Resident per Day
0.62853
Expected RN Staffing Hours per Resident per Day
0.92667
Expected Total Nurse Staffing Hours per Resident per Day
3.91756
Adjusted CNA Staffing Hours per Resident per Day
3.54500
Adjusted LPN Staffing Hours per Resident per Day
1.37125
Adjusted RN Staffing Hours per Resident per Day
0.39557
Adjusted Total Nurse Staffing Hours per Resident per Day
5.08501
Cycle 1 Total Number of Health Deficiencies
0
Cycle 1 Number of Standard Health Deficiencies
0
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
0
Cycle 1 Standard Survey Health Date
2015-02-24
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
0
Cycle 2 Total Number of Health Deficiencies
7
Cycle 2 Number of Standard Health Deficiencies
7
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
44
Cycle 2 Standard Health Survey Date
2013-12-11
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
44
Cycle 3 Total Number of Health Deficiencies
7
Cycle 3 Number of Standard Health Deficiencies
7
Cycle 3 Number of Complaint Health Deficiencies
6
Cycle 3 Health Deficiency Score
36
Cycle 3 Standard Health Survey Date
2012-09-20
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
36
Total Weighted Health Survey Score
20.66700
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
0
Total Number of Penalties
0
Location
Processing Date
2015-06-01
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