Sullivan County Memorial Hospital - Milan Nursing Home
General Information
UPDATEFederal Provider Number
26A300
Provider Name
SULLIVAN COUNTY MEMORIAL HOSPITAL
Provider Address
630 W THIRD STREET
MILAN, MO 63556
MILAN, MO 63556
Provider Phone Number
6602654212
Provider SSA County
987
Provider County Name
Sullivan
Ownership Type
Government - County
Number of Certified Beds
14
Number of Residents in Certified Beds
13
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
1988-07-18
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
5
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
5
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
1.34615
Reported LPN Staffing Hours per Resident per Day
1.60385
Reported RN Staffing Hours per Resident per Day
0.80769
Reported Licensed Staffing Hours per Resident per Day
2.41154
Reported Total Nurse Staffing Hours per Resident per Day
3.75769
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00000
Expected CNA Staffing Hours per Resident per Day
1.95409
Expected LPN Staffing Hours per Resident per Day
0.50030
Expected RN Staffing Hours per Resident per Day
0.57833
Expected Total Nurse Staffing Hours per Resident per Day
3.03273
Adjusted CNA Staffing Hours per Resident per Day
1.69032
Adjusted LPN Staffing Hours per Resident per Day
2.66078
Adjusted RN Staffing Hours per Resident per Day
1.04353
Adjusted Total Nurse Staffing Hours per Resident per Day
4.99447
Cycle 1 Total Number of Health Deficiencies
3
Cycle 1 Number of Standard Health Deficiencies
3
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
20
Cycle 1 Standard Survey Health Date
2015-01-21
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
5
Cycle 2 Number of Standard Health Deficiencies
5
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
40
Cycle 2 Standard Health Survey Date
2013-10-18
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
4
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
28
Cycle 3 Standard Health Survey Date
2013-03-27
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
28
Total Weighted Health Survey Score
28.00000
Number of Facility Reported Incidents
0
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
Nursiong Homes Nearby
Milan Health Care Center
52435 Infirmary Road |
MILAN MO 63556 | 0.9 mile away
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