Villages Of Jackson Creek, The - Independence Nursing Home
General Information
UPDATEFederal Provider Number
265820
Provider Name
VILLAGES OF JACKSON CREEK, THE
Provider Address
3980 SOUTH JACKSON DRIVE
INDEPENDENCE, MO 64057
INDEPENDENCE, MO 64057
Provider Phone Number
(816) 795-1433
Provider SSA County
470
Provider County Name
Jackson
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
120
Number of Residents in Certified Beds
115
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
VILLAGES OF JACKSON CREEK LLC
Date First Approved to Provide Medicare and Medicaid services
2008-02-22
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Both
Automatic Sprinkler Systems in All Required Areas
Yes
Rating Detail Information
Overall Rating
3
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
4
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
2.64174
Reported LPN Staffing Hours per Resident per Day
1.11522
Reported RN Staffing Hours per Resident per Day
0.61913
Reported Licensed Staffing Hours per Resident per Day
1.73435
Reported Total Nurse Staffing Hours per Resident per Day
4.37609
Reported Physical Therapist Staffing Hours per Resident Per Day
0.15913
Expected CNA Staffing Hours per Resident per Day
2.43502
Expected LPN Staffing Hours per Resident per Day
0.69100
Expected RN Staffing Hours per Resident per Day
1.23550
Expected Total Nurse Staffing Hours per Resident per Day
4.36153
Adjusted CNA Staffing Hours per Resident per Day
2.66200
Adjusted LPN Staffing Hours per Resident per Day
1.33955
Adjusted RN Staffing Hours per Resident per Day
0.37443
Adjusted Total Nurse Staffing Hours per Resident per Day
4.04436
Cycle 1 Total Number of Health Deficiencies
8
Cycle 1 Number of Standard Health Deficiencies
8
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
60
Cycle 1 Standard Survey Health Date
2014-09-03
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
60
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
24
Cycle 2 Standard Health Survey Date
2013-09-20
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
24
Cycle 3 Total Number of Health Deficiencies
6
Cycle 3 Number of Standard Health Deficiencies
6
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
32
Cycle 3 Standard Health Survey Date
2012-11-09
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
32
Total Weighted Health Survey Score
43.33300
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
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