Shangri-la Rehab & Living Center - Blue Springs Nursing Home
General Information
UPDATEFederal Provider Number
265595
Provider Name
SHANGRI-LA REHAB & LIVING CENTER
Provider Address
930 NE DUNCAN ROAD
BLUE SPRINGS, MO 64014
BLUE SPRINGS, MO 64014
Provider Phone Number
(816) 229-6677
Provider SSA County
470
Provider County Name
Jackson
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
120
Number of Residents in Certified Beds
82
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
PETERSEN HEALTH OPERATIONS III, LLC
Date First Approved to Provide Medicare and Medicaid services
1994-12-01
Continuing Care Retirement Community
N
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
2
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
3
QM Rating Footnote
Staffing Rating
3
Staffing Rating Footnote
RN Staffing Rating
3
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.60305
Reported LPN Staffing Hours per Resident per Day
0.13963
Reported RN Staffing Hours per Resident per Day
0.54024
Reported Licensed Staffing Hours per Resident per Day
0.67988
Reported Total Nurse Staffing Hours per Resident per Day
3.28292
Reported Physical Therapist Staffing Hours per Resident Per Day
0.01220
Expected CNA Staffing Hours per Resident per Day
2.22702
Expected LPN Staffing Hours per Resident per Day
0.59027
Expected RN Staffing Hours per Resident per Day
0.83660
Expected Total Nurse Staffing Hours per Resident per Day
3.65389
Adjusted CNA Staffing Hours per Resident per Day
2.86800
Adjusted LPN Staffing Hours per Resident per Day
0.19634
Adjusted RN Staffing Hours per Resident per Day
0.48251
Adjusted Total Nurse Staffing Hours per Resident per Day
3.62165
Cycle 1 Total Number of Health Deficiencies
13
Cycle 1 Number of Standard Health Deficiencies
13
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
84
Cycle 1 Standard Survey Health Date
2014-07-18
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
84
Cycle 2 Total Number of Health Deficiencies
5
Cycle 2 Number of Standard Health Deficiencies
5
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
28
Cycle 2 Standard Health Survey Date
2013-08-07
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
11
Cycle 3 Number of Standard Health Deficiencies
9
Cycle 3 Number of Complaint Health Deficiencies
3
Cycle 3 Health Deficiency Score
72
Cycle 3 Standard Health Survey Date
2012-07-24
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
72
Total Weighted Health Survey Score
63.33300
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
4
Number of Fines
0
Total Amount of Fines in Dollars
0
Number of Payment Denials
1
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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