Shady Oaks Care Center - Lake City Nursing Home

General Information

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Federal Provider Number
165082
Provider Name
SHADY OAKS CARE CENTER
Provider Address
1409 WEST MAIN STREET
LAKE CITY, IA 51449
Provider Phone Number
(712) 464-3106
Provider SSA County
120
Provider County Name
Calhoun
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
80
Number of Residents in Certified Beds
69
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
MANOR OF LAKE CITY, INC
Date First Approved to Provide Medicare and Medicaid services
1968-09-06
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
4
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
4
QM Rating Footnote
Staffing Rating
4
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
2.07174
Reported LPN Staffing Hours per Resident per Day
0.58768
Reported RN Staffing Hours per Resident per Day
0.92536
Reported Licensed Staffing Hours per Resident per Day
1.51304
Reported Total Nurse Staffing Hours per Resident per Day
3.58478
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00652
Expected CNA Staffing Hours per Resident per Day
2.04840
Expected LPN Staffing Hours per Resident per Day
0.55349
Expected RN Staffing Hours per Resident per Day
0.77898
Expected Total Nurse Staffing Hours per Resident per Day
3.38087
Adjusted CNA Staffing Hours per Resident per Day
2.48166
Adjusted LPN Staffing Hours per Resident per Day
0.88126
Adjusted RN Staffing Hours per Resident per Day
0.88761
Adjusted Total Nurse Staffing Hours per Resident per Day
4.27401
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
16
Cycle 1 Standard Survey Health Date
2015-04-23
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
3
Cycle 2 Number of Standard Health Deficiencies
2
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
28
Cycle 2 Standard Health Survey Date
2014-02-06
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
1
Cycle 3 Number of Standard Health Deficiencies
1
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
8
Cycle 3 Standard Health Survey Date
2012-12-13
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
8
Total Weighted Health Survey Score
18.66700
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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