Qhc Humboldt South, Llc - Humboldt Nursing Home

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Federal Provider Number
165534
Provider Name
QHC HUMBOLDT SOUTH, LLC
Provider Address
800 13TH STREET SOUTH
HUMBOLDT, IA 50548
Provider Phone Number
(515) 332-4104
Provider SSA County
450
Provider County Name
Humboldt
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
40
Number of Residents in Certified Beds
26
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
QHC HUMBOLDT SOUTH 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
5
Overall Rating Footnote
Health Inspection Rating
4
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
2.02500
Reported LPN Staffing Hours per Resident per Day
0.19231
Reported RN Staffing Hours per Resident per Day
1.02885
Reported Licensed Staffing Hours per Resident per Day
1.22115
Reported Total Nurse Staffing Hours per Resident per Day
3.24616
Reported Physical Therapist Staffing Hours per Resident Per Day
0.07115
Expected CNA Staffing Hours per Resident per Day
2.25361
Expected LPN Staffing Hours per Resident per Day
0.59571
Expected RN Staffing Hours per Resident per Day
0.88736
Expected Total Nurse Staffing Hours per Resident per Day
3.73668
Adjusted CNA Staffing Hours per Resident per Day
2.20480
Adjusted LPN Staffing Hours per Resident per Day
0.26794
Adjusted RN Staffing Hours per Resident per Day
0.86634
Adjusted Total Nurse Staffing Hours per Resident per Day
3.50176
Cycle 1 Total Number of Health Deficiencies
2
Cycle 1 Number of Standard Health Deficiencies
2
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
8
Cycle 1 Standard Survey Health Date
2014-02-27
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
8
Cycle 2 Total Number of Health Deficiencies
2
Cycle 2 Number of Standard Health Deficiencies
2
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
20
Cycle 2 Standard Health Survey Date
2012-12-06
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
20
Cycle 3 Total Number of Health Deficiencies
3
Cycle 3 Number of Standard Health Deficiencies
3
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
20
Cycle 3 Standard Health Survey Date
2011-12-02
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
20
Total Weighted Health Survey Score
14.00000
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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