Timberlake Care Center - Kansas City Nursing Home
General Information
UPDATEFederal Provider Number
265637
Provider Name
TIMBERLAKE CARE CENTER
Provider Address
12110 HOLMES ROAD
KANSAS CITY, MO 64145
KANSAS CITY, MO 64145
Provider Phone Number
(816) 941-3006
Provider SSA County
470
Provider County Name
Jackson
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
122
Number of Residents in Certified Beds
86
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
MISSION LAKE CONVELESCENT CENTER INC
Date First Approved to Provide Medicare and Medicaid services
1996-06-01
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
None
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
3
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
2.24244
Reported LPN Staffing Hours per Resident per Day
0.81512
Reported RN Staffing Hours per Resident per Day
0.44767
Reported Licensed Staffing Hours per Resident per Day
1.26279
Reported Total Nurse Staffing Hours per Resident per Day
3.50523
Reported Physical Therapist Staffing Hours per Resident Per Day
0.09884
Expected CNA Staffing Hours per Resident per Day
2.18970
Expected LPN Staffing Hours per Resident per Day
0.59874
Expected RN Staffing Hours per Resident per Day
0.97586
Expected Total Nurse Staffing Hours per Resident per Day
3.76430
Adjusted CNA Staffing Hours per Resident per Day
2.51280
Adjusted LPN Staffing Hours per Resident per Day
1.12995
Adjusted RN Staffing Hours per Resident per Day
0.34277
Adjusted Total Nurse Staffing Hours per Resident per Day
3.75348
Cycle 1 Total Number of Health Deficiencies
15
Cycle 1 Number of Standard Health Deficiencies
13
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
80
Cycle 1 Standard Survey Health Date
2014-12-16
Cycle 1 Number of Health Revisits
2
Cycle 1 Health Revisit Score
40
Cycle 1 Total Health Score
120
Cycle 2 Total Number of Health Deficiencies
14
Cycle 2 Number of Standard Health Deficiencies
14
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
92
Cycle 2 Standard Health Survey Date
2013-11-22
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
92
Cycle 3 Total Number of Health Deficiencies
11
Cycle 3 Number of Standard Health Deficiencies
6
Cycle 3 Number of Complaint Health Deficiencies
5
Cycle 3 Health Deficiency Score
56
Cycle 3 Standard Health Survey Date
2012-12-12
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
56
Total Weighted Health Survey Score
100.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
7
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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