Qhc Humboldt North, Llc - Humboldt Nursing Home
General Information
Update InformationReport Incorrect Information
Federal Provider Number
165533
Provider Name
QHC HUMBOLDT NORTH, LLC
Provider Address
1111 11TH AVE NORTH
HUMBOLDT, IA 50548
HUMBOLDT, IA 50548
Provider Phone Number
(515) 332-2623
Provider SSA County
450
Provider County Name
Humboldt
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
90
Number of Residents in Certified Beds
56
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
QHC HUMBOLDT NORTH LLC
Date First Approved to Provide Medicare and Medicaid services
2004-03-01
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
3
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
3
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
1.38036
Reported LPN Staffing Hours per Resident per Day
0.73839
Reported RN Staffing Hours per Resident per Day
0.84732
Reported Licensed Staffing Hours per Resident per Day
1.58571
Reported Total Nurse Staffing Hours per Resident per Day
2.96607
Reported Physical Therapist Staffing Hours per Resident Per Day
0.08929
Expected CNA Staffing Hours per Resident per Day
2.21341
Expected LPN Staffing Hours per Resident per Day
0.53096
Expected RN Staffing Hours per Resident per Day
0.76706
Expected Total Nurse Staffing Hours per Resident per Day
3.51143
Adjusted CNA Staffing Hours per Resident per Day
1.53022
Adjusted LPN Staffing Hours per Resident per Day
1.15425
Adjusted RN Staffing Hours per Resident per Day
0.82538
Adjusted Total Nurse Staffing Hours per Resident per Day
3.40486
Cycle 1 Total Number of Health Deficiencies
6
Cycle 1 Number of Standard Health Deficiencies
5
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
28
Cycle 1 Standard Survey Health Date
2015-02-12
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
28
Cycle 2 Total Number of Health Deficiencies
6
Cycle 2 Number of Standard Health Deficiencies
6
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
40
Cycle 2 Standard Health Survey Date
2013-12-04
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
40
Cycle 3 Total Number of Health Deficiencies
6
Cycle 3 Number of Standard Health Deficiencies
6
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
32
Cycle 3 Standard Health Survey Date
2012-11-08
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
32
Total Weighted Health Survey Score
32.66700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
2
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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