Rowley Memorial Masonic Home - Perry Nursing Home

General Information

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Federal Provider Number
165149
Provider Name
ROWLEY MEMORIAL MASONIC HOME
Provider Address
3000 EAST WILLIS AVENUE
PERRY, IA 50220
Provider Phone Number
(515) 465-5316
Provider SSA County
240
Provider County Name
Dallas
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
57
Number of Residents in Certified Beds
40
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
HERMAN L. ROWLEY MEMORIAL TRUST
Date First Approved to Provide Medicare and Medicaid services
1989-02-22
Continuing Care Retirement Community
Y
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
None
Automatic Sprinkler Systems in All Required Areas
Yes

Rating Detail Information

Overall Rating
4
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
3
QM Rating Footnote
Staffing Rating
5
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
2.80875
Reported LPN Staffing Hours per Resident per Day
0.25750
Reported RN Staffing Hours per Resident per Day
1.10750
Reported Licensed Staffing Hours per Resident per Day
1.36500
Reported Total Nurse Staffing Hours per Resident per Day
4.17375
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00750
Expected CNA Staffing Hours per Resident per Day
2.19093
Expected LPN Staffing Hours per Resident per Day
0.52848
Expected RN Staffing Hours per Resident per Day
0.72096
Expected Total Nurse Staffing Hours per Resident per Day
3.44038
Adjusted CNA Staffing Hours per Resident per Day
3.14561
Adjusted LPN Staffing Hours per Resident per Day
0.40441
Adjusted RN Staffing Hours per Resident per Day
1.14781
Adjusted Total Nurse Staffing Hours per Resident per Day
4.89015
Cycle 1 Total Number of Health Deficiencies
6
Cycle 1 Number of Standard Health Deficiencies
6
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
24
Cycle 1 Standard Survey Health Date
2015-02-19
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
24
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
28
Cycle 2 Standard Health Survey Date
2014-02-27
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
28
Cycle 3 Total Number of Health Deficiencies
10
Cycle 3 Number of Standard Health Deficiencies
9
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
40
Cycle 3 Standard Health Survey Date
2012-12-27
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
40
Total Weighted Health Survey Score
28.00000
Number of Facility Reported Incidents
1
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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