Polk City Nursing & Rehabilitation Center - Polk City Nursing Home
General Information
UPDATEFederal Provider Number
165170
Provider Name
POLK CITY NURSING & REHABILITATION CENTER
Provider Address
1002 WEST WASHINGTON AVENUE
POLK CITY, IA 50226
POLK CITY, IA 50226
Provider Phone Number
(515) 984-6511
Provider SSA County
760
Provider County Name
Polk
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
68
Number of Residents in Certified Beds
55
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
PINNACLE HEALTH FACILITIES XVII LP
Date First Approved to Provide Medicare and Medicaid services
1992-06-01
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
2
Health Inspection Rating Footnote
QM Rating
4
QM Rating Footnote
Staffing Rating
3
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
2.16636
Reported LPN Staffing Hours per Resident per Day
0.66455
Reported RN Staffing Hours per Resident per Day
0.81000
Reported Licensed Staffing Hours per Resident per Day
1.47455
Reported Total Nurse Staffing Hours per Resident per Day
3.64091
Reported Physical Therapist Staffing Hours per Resident Per Day
0.11727
Expected CNA Staffing Hours per Resident per Day
2.36256
Expected LPN Staffing Hours per Resident per Day
0.67407
Expected RN Staffing Hours per Resident per Day
1.11893
Expected Total Nurse Staffing Hours per Resident per Day
4.15556
Adjusted CNA Staffing Hours per Resident per Day
2.24994
Adjusted LPN Staffing Hours per Resident per Day
0.81827
Adjusted RN Staffing Hours per Resident per Day
0.54090
Adjusted Total Nurse Staffing Hours per Resident per Day
3.53169
Cycle 1 Total Number of Health Deficiencies
3
Cycle 1 Number of Standard Health Deficiencies
2
Cycle 1 Number of Complaint Health Deficiencies
3
Cycle 1 Health Deficiency Score
16
Cycle 1 Standard Survey Health Date
2014-07-10
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
16
Cycle 2 Total Number of Health Deficiencies
8
Cycle 2 Number of Standard Health Deficiencies
3
Cycle 2 Number of Complaint Health Deficiencies
5
Cycle 2 Health Deficiency Score
36
Cycle 2 Standard Health Survey Date
2013-04-18
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
36
Cycle 3 Total Number of Health Deficiencies
20
Cycle 3 Number of Standard Health Deficiencies
18
Cycle 3 Number of Complaint Health Deficiencies
2
Cycle 3 Health Deficiency Score
104
Cycle 3 Standard Health Survey Date
2012-02-27
Cycle 3 Number of Health Revisits
2
Cycle 3 Health Revisit Score
52
Cycle 3 Total Health Score
156
Total Weighted Health Survey Score
46.00000
Number of Facility Reported Incidents
3
Number of Substantiated Complaints
19
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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