Story County Hospital Ltc - Nevada Nursing Home

General Information

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Federal Provider Number
160000000000000000000000000000
Provider Name
STORY COUNTY HOSPITAL LTC
Provider Address
630 SOUTH SIXTH STREET
NEVADA, IA 50201
Provider Phone Number
(515) 382-2111
Provider SSA County
840
Provider County Name
Story
Provider Website
Provider Description
Ownership Type
Government - County
Number of Certified Beds
80
Number of Residents in Certified Beds
58
Provider Type
Medicaid
Provider Resides in Hospital
Y
Legal Business Name
Legal Business Name Not Available
Date First Approved to Provide Medicare and Medicaid services
1974-03-31
Continuing Care Retirement Community
N
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
4
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
4
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
2.76897
Reported LPN Staffing Hours per Resident per Day
0.58190
Reported RN Staffing Hours per Resident per Day
0.50517
Reported Licensed Staffing Hours per Resident per Day
1.08707
Reported Total Nurse Staffing Hours per Resident per Day
3.85604
Reported Physical Therapist Staffing Hours per Resident Per Day
0.01810
Expected CNA Staffing Hours per Resident per Day
2.17785
Expected LPN Staffing Hours per Resident per Day
0.54464
Expected RN Staffing Hours per Resident per Day
0.74464
Expected Total Nurse Staffing Hours per Resident per Day
3.46712
Adjusted CNA Staffing Hours per Resident per Day
3.11969
Adjusted LPN Staffing Hours per Resident per Day
0.88679
Adjusted RN Staffing Hours per Resident per Day
0.50691
Adjusted Total Nurse Staffing Hours per Resident per Day
4.48306
Cycle 1 Total Number of Health Deficiencies
5
Cycle 1 Number of Standard Health Deficiencies
3
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
32
Cycle 1 Standard Survey Health Date
2014-05-08
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
32
Cycle 2 Total Number of Health Deficiencies
6
Cycle 2 Number of Standard Health Deficiencies
4
Cycle 2 Number of Complaint Health Deficiencies
2
Cycle 2 Health Deficiency Score
28
Cycle 2 Standard Health Survey Date
2013-02-28
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
10
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
76
Cycle 3 Standard Health Survey Date
2012-02-03
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
76
Total Weighted Health Survey Score
38.00000
Number of Facility Reported Incidents
1
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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