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Providence Kodiak Island Med Ltc


Providence Kodiak Island Med Ltc Information

     
Facility Name Providence Kodiak Island Med Ltc
Location 1915 E Rezanof Drive, Kodiak, AK 99615
County (SSA Code) Kodiak Island Borough (150)
Phone Number 907-486-7800
Certification(s)Medicare and Medicaid
Number of Beds22
Average Number of Residents22
CCRC Facility? No
Medicare Overall Rating
Survey Rating
Quality Rating
Long Stay Quality Rating
Staff Quality Rating
Registered Nurse Quality Rating

Abuse Flag No
Sprinklers InstalledYes
Located In Hospital No
Resident Family CouncilBoth

Prodvider Business NameLegal Business Name Not Available
Ownership TypeNon profit - Corporation
Date First Approved1994-09-20

Reported Nurse Aide Staffing Hours per Resident per Day5.91596
Reported LPN Staffing Hours per Resident per Day0.3283
Reported RN Staffing - Hours per Resident per Day1.86064
Reported Licensed Staffing - Hours per Resident per Day (RN + LPN)2.18894
Reported Total Nurse Staffing - Hours per Resident per Day (Aide+LPN+RN)8.1049
Reported Physical Therapy Staffing - Hours per Resident Per Day0.04895
Case-Mix Nurse Aide Staffing - Hours per Resident per Day2.17067
Case-Mix LPN Staffing - Hours per Resident per Day0.64584
Case-Mix RN Staffing - Hours per Resident per Day0.3729
Case-Mix Total Nurse Staffing - Hours per Resident per Day (Aide+LPN+RN)3.18942
Adjusted Total Nurse Staffing - Hours per Resident per Day (Aide+LPN+RN)8.10177

Total Weighted Health Survey Score for three cycles55.167
Rating cycle 1 Standard Survey Health Date2019-03-15
Rating cycle 1 - Health Deficiency Score2
Rating cycle 1 - Total Health Inspection Score40
Date of Rating cycle 2 Standard Health Survey Date2018-05-18
Rating cycle 2 - Health Deficiency Score40
Date of Rating cycle 3 Standard Health Survey Date2017-03-20
Rating cycle 3 - Health Deficiency Score191
Rating cycle 3 - Total Health Inspection Score191

Number of Facility-Reported Incidents0
Number of Substantiated Complaints0
Number of Substantiated Complaints0
Total Number of Penalties0

Data Filing Date2020-10-01
Page Last Updated2020-11-28