Woodland Manor - Springfield Nursing Home
General Information
UPDATEFederal Provider Number
265749
Provider Name
WOODLAND MANOR
Provider Address
1347 EAST VALLEY WATERMILL ROAD
SPRINGFIELD, MO 65803
SPRINGFIELD, MO 65803
Provider Phone Number
4178331220
Provider SSA County
380
Provider County Name
Greene
Ownership Type
For profit - Corporation
Number of Certified Beds
180
Number of Residents in Certified Beds
78
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
EBG HEALTH CARE III INC
Date First Approved to Provide Medicare and Medicaid services
2002-12-27
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
4
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
3
QM Rating Footnote
Staffing Rating
3
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
2.20385
Reported LPN Staffing Hours per Resident per Day
0.83910
Reported RN Staffing Hours per Resident per Day
0.46859
Reported Licensed Staffing Hours per Resident per Day
1.30769
Reported Total Nurse Staffing Hours per Resident per Day
3.51154
Reported Physical Therapist Staffing Hours per Resident Per Day
0.03782
Expected CNA Staffing Hours per Resident per Day
1.98034
Expected LPN Staffing Hours per Resident per Day
0.58579
Expected RN Staffing Hours per Resident per Day
0.90426
Expected Total Nurse Staffing Hours per Resident per Day
3.47039
Adjusted CNA Staffing Hours per Resident per Day
2.73063
Adjusted LPN Staffing Hours per Resident per Day
1.18892
Adjusted RN Staffing Hours per Resident per Day
0.38720
Adjusted Total Nurse Staffing Hours per Resident per Day
4.07870
Cycle 1 Total Number of Health Deficiencies
2
Cycle 1 Number of Standard Health Deficiencies
2
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
16
Cycle 1 Standard Survey Health Date
2014-05-23
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
16
Cycle 2 Total Number of Health Deficiencies
6
Cycle 2 Number of Standard Health Deficiencies
6
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
32
Cycle 2 Standard Health Survey Date
2013-04-19
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
7
Cycle 3 Number of Standard Health Deficiencies
7
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
60
Cycle 3 Standard Health Survey Date
2012-05-11
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
60
Total Weighted Health Survey Score
28.66700
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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