Tabor Manor Care Center - Tabor Nursing Home

General Information

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Federal Provider Number
165546
Provider Name
TABOR MANOR CARE CENTER
Provider Address
209 MAIN STREET
TABOR, IA 51653
Provider Phone Number
(712) 629-2645
Provider SSA County
350
Provider County Name
Fremont
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
67
Number of Residents in Certified Beds
63
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
TABOR MANOR CARE CENTER INC
Date First Approved to Provide Medicare and Medicaid services
2004-04-01
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
1
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
2
QM Rating Footnote
Staffing Rating
3
Staffing Rating Footnote
RN Staffing Rating
2
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.48889
Reported LPN Staffing Hours per Resident per Day
0.53889
Reported RN Staffing Hours per Resident per Day
0.30794
Reported Licensed Staffing Hours per Resident per Day
0.84683
Reported Total Nurse Staffing Hours per Resident per Day
3.33572
Reported Physical Therapist Staffing Hours per Resident Per Day
0.06905
Expected CNA Staffing Hours per Resident per Day
2.34183
Expected LPN Staffing Hours per Resident per Day
0.55132
Expected RN Staffing Hours per Resident per Day
0.76139
Expected Total Nurse Staffing Hours per Resident per Day
3.65454
Adjusted CNA Staffing Hours per Resident per Day
2.60778
Adjusted LPN Staffing Hours per Resident per Day
0.81129
Adjusted RN Staffing Hours per Resident per Day
0.30220
Adjusted Total Nurse Staffing Hours per Resident per Day
3.67924
Cycle 1 Total Number of Health Deficiencies
12
Cycle 1 Number of Standard Health Deficiencies
6
Cycle 1 Number of Complaint Health Deficiencies
6
Cycle 1 Health Deficiency Score
40
Cycle 1 Standard Survey Health Date
2014-12-18
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
40
Cycle 2 Total Number of Health Deficiencies
14
Cycle 2 Number of Standard Health Deficiencies
11
Cycle 2 Number of Complaint Health Deficiencies
3
Cycle 2 Health Deficiency Score
76
Cycle 2 Standard Health Survey Date
2013-10-14
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
10
Cycle 3 Number of Standard Health Deficiencies
10
Cycle 3 Number of Complaint Health Deficiencies
2
Cycle 3 Health Deficiency Score
64
Cycle 3 Standard Health Survey Date
2012-08-14
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
64
Total Weighted Health Survey Score
56.00000
Number of Facility Reported Incidents
5
Number of Substantiated Complaints
4
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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