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Simpson Memorial Home - West Liberty Nursing Home

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Federal Provider Number
165418
Provider Name
SIMPSON MEMORIAL HOME
Provider Address
1000 NORTH MILLER STREET
WEST LIBERTY, IA 52776
Provider Phone Number
(319) 627-4775
Provider SSA County
690
Provider County Name
Muscatine
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
65
Number of Residents in Certified Beds
55
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
SIMPSON MEMORIAL HOME INC
Date First Approved to Provide Medicare and Medicaid services
2000-01-01
Continuing Care Retirement Community
Y
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Both
Automatic Sprinkler Systems in All Required Areas
Yes

Rating Detail Information

Overall Rating
3
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
2
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
2.56182
Reported LPN Staffing Hours per Resident per Day
0.52091
Reported RN Staffing Hours per Resident per Day
0.48364
Reported Licensed Staffing Hours per Resident per Day
1.00455
Reported Total Nurse Staffing Hours per Resident per Day
3.56637
Reported Physical Therapist Staffing Hours per Resident Per Day
0.05091
Expected CNA Staffing Hours per Resident per Day
2.49596
Expected LPN Staffing Hours per Resident per Day
0.56868
Expected RN Staffing Hours per Resident per Day
0.88131
Expected Total Nurse Staffing Hours per Resident per Day
3.94595
Adjusted CNA Staffing Hours per Resident per Day
2.51844
Adjusted LPN Staffing Hours per Resident per Day
0.76028
Adjusted RN Staffing Hours per Resident per Day
0.41004
Adjusted Total Nurse Staffing Hours per Resident per Day
3.64315
Cycle 1 Total Number of Health Deficiencies
3
Cycle 1 Number of Standard Health Deficiencies
2
Cycle 1 Number of Complaint Health Deficiencies
3
Cycle 1 Health Deficiency Score
28
Cycle 1 Standard Survey Health Date
2014-05-22
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
28
Cycle 2 Total Number of Health Deficiencies
5
Cycle 2 Number of Standard Health Deficiencies
4
Cycle 2 Number of Complaint Health Deficiencies
5
Cycle 2 Health Deficiency Score
36
Cycle 2 Standard Health Survey Date
2013-03-07
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
3
Cycle 3 Number of Standard Health Deficiencies
3
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
12
Cycle 3 Standard Health Survey Date
2011-12-27
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
12
Total Weighted Health Survey Score
28.00000
Number of Facility Reported Incidents
3
Number of Substantiated Complaints
1
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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