The Village - Indianola Nursing Home

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Federal Provider Number
165167
Provider Name
THE VILLAGE
Provider Address
1203 NORTH E STREET
INDIANOLA, IA 50125
Provider Phone Number
(515) 961-7458
Provider SSA County
900
Provider County Name
Warren
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
54
Number of Residents in Certified Beds
49
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
WESLEY RETIREMENT SERVICES INC
Date First Approved to Provide Medicare and Medicaid services
1991-10-31
Continuing Care Retirement Community
Y
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
3
Health Inspection Rating Footnote
QM Rating
2
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
2.75204
Reported LPN Staffing Hours per Resident per Day
0.83367
Reported RN Staffing Hours per Resident per Day
0.75306
Reported Licensed Staffing Hours per Resident per Day
1.58673
Reported Total Nurse Staffing Hours per Resident per Day
4.33877
Reported Physical Therapist Staffing Hours per Resident Per Day
0.11633
Expected CNA Staffing Hours per Resident per Day
2.29506
Expected LPN Staffing Hours per Resident per Day
0.56979
Expected RN Staffing Hours per Resident per Day
0.85192
Expected Total Nurse Staffing Hours per Resident per Day
3.71678
Adjusted CNA Staffing Hours per Resident per Day
2.94226
Adjusted LPN Staffing Hours per Resident per Day
1.21439
Adjusted RN Staffing Hours per Resident per Day
0.66049
Adjusted Total Nurse Staffing Hours per Resident per Day
4.70546
Cycle 1 Total Number of Health Deficiencies
5
Cycle 1 Number of Standard Health Deficiencies
5
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
32
Cycle 1 Standard Survey Health Date
2014-04-10
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
2
Cycle 2 Number of Standard Health Deficiencies
2
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
12
Cycle 2 Standard Health Survey Date
2013-01-17
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
12
Cycle 3 Total Number of Health Deficiencies
2
Cycle 3 Number of Standard Health Deficiencies
2
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
4
Cycle 3 Standard Health Survey Date
2011-12-08
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
4
Total Weighted Health Survey Score
20.66700
Number of Facility Reported Incidents
0
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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