St Luke's Elmore Long Term Care - Mountain Home Nursing Home
General Information
UPDATEFederal Provider Number
135006
Provider Name
ST LUKE'S ELMORE LONG TERM CARE
Provider Address
895 NORTH 6TH EAST
MOUNTAIN HOME, ID 83647
MOUNTAIN HOME, ID 83647
Provider Phone Number
2085878401
Provider SSA County
190
Provider County Name
Elmore
Ownership Type
Non profit - Corporation
Number of Certified Beds
38
Number of Residents in Certified Beds
19
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
Y
Legal Business Name
ST LUKE'S REGIONAL MEDICAL CENTER
Date First Approved to Provide Medicare and Medicaid services
1967-01-01
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
4
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.04474
Reported LPN Staffing Hours per Resident per Day
0.90263
Reported RN Staffing Hours per Resident per Day
0.99211
Reported Licensed Staffing Hours per Resident per Day
1.89474
Reported Total Nurse Staffing Hours per Resident per Day
3.93948
Reported Physical Therapist Staffing Hours per Resident Per Day
0.30000
Expected CNA Staffing Hours per Resident per Day
2.24856
Expected LPN Staffing Hours per Resident per Day
0.67317
Expected RN Staffing Hours per Resident per Day
1.24028
Expected Total Nurse Staffing Hours per Resident per Day
4.16202
Adjusted CNA Staffing Hours per Resident per Day
2.23128
Adjusted LPN Staffing Hours per Resident per Day
1.11291
Adjusted RN Staffing Hours per Resident per Day
0.59769
Adjusted Total Nurse Staffing Hours per Resident per Day
3.81537
Cycle 1 Total Number of Health Deficiencies
6
Cycle 1 Number of Standard Health Deficiencies
6
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
20
Cycle 1 Standard Survey Health Date
2015-02-27
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
20
Cycle 2 Total Number of Health Deficiencies
11
Cycle 2 Number of Standard Health Deficiencies
11
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
80
Cycle 2 Standard Health Survey Date
2013-11-22
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
4
Cycle 3 Number of Standard Health Deficiencies
3
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
44
Cycle 3 Standard Health Survey Date
2012-10-12
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
44
Total Weighted Health Survey Score
44.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
1
Number of Fines
1
Total Amount of Fines in Dollars
1170
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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