Rose Vista Home, Inc. - Woodbine Nursing Home
General Information
Update InformationReport Incorrect Information
Federal Provider Number
165357
Provider Name
ROSE VISTA HOME, INC.
Provider Address
1109 NORMAL STREET
WOODBINE, IA 51579
WOODBINE, IA 51579
Provider Phone Number
(712) 647-2010
Provider SSA County
420
Provider County Name
Harrison
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
76
Number of Residents in Certified Beds
66
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
ROSE VISTA HOME INC
Date First Approved to Provide Medicare and Medicaid services
1997-10-01
Continuing Care Retirement Community
Y
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
4
Overall Rating Footnote
Health Inspection Rating
4
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
2.49470
Reported LPN Staffing Hours per Resident per Day
0.43258
Reported RN Staffing Hours per Resident per Day
0.67576
Reported Licensed Staffing Hours per Resident per Day
1.10833
Reported Total Nurse Staffing Hours per Resident per Day
3.60304
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00000
Expected CNA Staffing Hours per Resident per Day
2.20130
Expected LPN Staffing Hours per Resident per Day
0.63394
Expected RN Staffing Hours per Resident per Day
0.97881
Expected Total Nurse Staffing Hours per Resident per Day
3.81404
Adjusted CNA Staffing Hours per Resident per Day
2.78074
Adjusted LPN Staffing Hours per Resident per Day
0.56637
Adjusted RN Staffing Hours per Resident per Day
0.51586
Adjusted Total Nurse Staffing Hours per Resident per Day
3.80790
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
2014-11-20
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
2
Cycle 2 Number of Standard Health Deficiencies
2
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
36
Cycle 2 Standard Health Survey Date
2013-09-09
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
2
Cycle 3 Number of Standard Health Deficiencies
2
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
8
Cycle 3 Standard Health Survey Date
2012-07-26
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
8
Total Weighted Health Survey Score
13.33300
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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