Tablerock Healthcare - Kimberling City Nursing Home
General Information
UPDATEFederal Provider Number
265288
Provider Name
TABLEROCK HEALTHCARE
Provider Address
276 FOUNTAIN LANE
KIMBERLING CITY, MO 65686
KIMBERLING CITY, MO 65686
Provider Phone Number
(417) 739-2481
Provider SSA County
986
Provider County Name
Stone
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
120
Number of Residents in Certified Beds
86
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
N & R OF KIMBERLING CITY LLC
Date First Approved to Provide Medicare and Medicaid services
1984-10-26
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
2
Overall Rating Footnote
Health Inspection Rating
2
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
2.14593
Reported LPN Staffing Hours per Resident per Day
0.83779
Reported RN Staffing Hours per Resident per Day
0.53837
Reported Licensed Staffing Hours per Resident per Day
1.37616
Reported Total Nurse Staffing Hours per Resident per Day
3.52209
Reported Physical Therapist Staffing Hours per Resident Per Day
0.06628
Expected CNA Staffing Hours per Resident per Day
2.32321
Expected LPN Staffing Hours per Resident per Day
0.61899
Expected RN Staffing Hours per Resident per Day
0.83878
Expected Total Nurse Staffing Hours per Resident per Day
3.78098
Adjusted CNA Staffing Hours per Resident per Day
2.26646
Adjusted LPN Staffing Hours per Resident per Day
1.12339
Adjusted RN Staffing Hours per Resident per Day
0.47959
Adjusted Total Nurse Staffing Hours per Resident per Day
3.75490
Cycle 1 Total Number of Health Deficiencies
5
Cycle 1 Number of Standard Health Deficiencies
5
Cycle 1 Number of Complaint Health Deficiencies
4
Cycle 1 Health Deficiency Score
44
Cycle 1 Standard Survey Health Date
2014-07-16
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
44
Cycle 2 Total Number of Health Deficiencies
9
Cycle 2 Number of Standard Health Deficiencies
4
Cycle 2 Number of Complaint Health Deficiencies
5
Cycle 2 Health Deficiency Score
76
Cycle 2 Standard Health Survey Date
2013-07-29
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
76
Cycle 3 Total Number of Health Deficiencies
2
Cycle 3 Number of Standard Health Deficiencies
1
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
8
Cycle 3 Standard Health Survey Date
2012-08-31
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
8
Total Weighted Health Survey Score
48.66700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
12
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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