Willow Haven Nursing Home - Tonkawa Nursing Home
General Information
Update InformationReport Incorrect Information
Federal Provider Number
375555
Provider Name
WILLOW HAVEN NURSING HOME
Provider Address
1301 NORTH 5TH STREET
TONKAWA, OK 74653
TONKAWA, OK 74653
Provider Phone Number
(580) 628-2529
Provider SSA County
350
Provider County Name
Kay
Provider Website
Provider Description
Ownership Type
For profit - Individual
Number of Certified Beds
49
Number of Residents in Certified Beds
37
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
ILA SEATON, LLC
Date First Approved to Provide Medicare and Medicaid services
2013-09-26
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
3
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
3
QM Rating Footnote
Staffing Rating
4
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
2.93784
Reported LPN Staffing Hours per Resident per Day
0.72162
Reported RN Staffing Hours per Resident per Day
0.59459
Reported Licensed Staffing Hours per Resident per Day
1.31622
Reported Total Nurse Staffing Hours per Resident per Day
4.25405
Reported Physical Therapist Staffing Hours per Resident Per Day
0.02162
Expected CNA Staffing Hours per Resident per Day
2.13603
Expected LPN Staffing Hours per Resident per Day
0.63417
Expected RN Staffing Hours per Resident per Day
0.91159
Expected Total Nurse Staffing Hours per Resident per Day
3.68179
Adjusted CNA Staffing Hours per Resident per Day
3.37476
Adjusted LPN Staffing Hours per Resident per Day
0.94445
Adjusted RN Staffing Hours per Resident per Day
0.48736
Adjusted Total Nurse Staffing Hours per Resident per Day
4.65742
Cycle 1 Total Number of Health Deficiencies
11
Cycle 1 Number of Standard Health Deficiencies
11
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
88
Cycle 1 Standard Survey Health Date
2015-03-11
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
88
Cycle 2 Total Number of Health Deficiencies
10
Cycle 2 Number of Standard Health Deficiencies
10
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
143
Cycle 2 Standard Health Survey Date
2014-01-23
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
143
Cycle 3 Total Number of Health Deficiencies
8
Cycle 3 Number of Standard Health Deficiencies
8
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
68
Cycle 3 Standard Health Survey Date
2013-03-05
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
68
Total Weighted Health Survey Score
103.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
0
Number of Fines
1
Total Amount of Fines in Dollars
3700
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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