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Providence Kodiak Island Med Ltc

Summary: Providence Kodiak Island Med Ltc is located in Kodiak, Alaska. It was first approved by Medicare and Medicaid to provide nursing home services on 1994-09-20. It currently has 22 certified beds and 20 residents in the certified beds. Providence Kodiak Island Med Ltc earned a 3-star overall rating in the lasted Medicare and Medicaid Health Inspections (2015-08-01) [1]. See following table for more details.

Information of Providence Kodiak Island Med Ltc

Nursing Home Profile
Address 1915 E REZANOF DRIVE, Kodiak, AK 99615
Phone 907-486-7800
Number Certified Beds / Residents in Certified Beds 22 / 20
Certification Medicare and Medicaid
Ratings
Overall Rating ★★★ ☆☆ (3)  
Health Inspection Rating ★★★ ☆☆ (3)
Quality Rating ★★★ ☆☆ (3)
Staffing Rating ()
RN Staffing Rating ()
Staff and Nurse Hour Statistics
Reported CNA Staffing Hours per Resident per Day
Reported LPN Staffing Hours per Resident per Day
Reported RN Staffing Hours per Resident per Day
Reported Licensed Staffing Hours per Resident per Day
Reported Total Nurse Staffing Hours per Resident per Day
Reported Physical Therapist Staffing Hours per Resident Per Day
Expected CNA Staffing Hours per Resident per Day 2.73733
Expected LPN Staffing Hours per Resident per Day 0.55825
Expected RN Staffing Hours per Resident per Day 0.69883
Expected Total Nurse Staffing Hours per Resident per Day 3.99442
Adjusted CNA Staffing Hours per Resident per Day
Adjusted LPN Staffing Hours per Resident per Day
Adjusted RN Staffing Hours per Resident per Day
Adjusted Total Nurse Staffing Hours per Resident per Day
Notes: CNA=Certified nurse attendant;   LPN=Licensed practical nurse
Health Deficiencies & Scores
Cycle 1 Total Number of Health Deficiencies 10
Cycle 1 Number of Standard Health Deficiencies 10
Cycle 1 Number of Complaint Health Deficiencies 0
Cycle 1 Health Deficiency Score 100
Cycle 1 Standard Survey Health Date 2015-01-08
Cycle 1 Number of Health Revisits 1
Cycle 1 Health Revisit Score 0
Cycle 1 Total Health Score 100
Cycle 2 Total Number of Health Deficiencies 13
Cycle 2 Number of Standard Health Deficiencies 13
Cycle 2 Number of Complaint Health Deficiencies 0
Cycle 2 Health Deficiency Score 80
Cycle 2 Standard Survey Health Date 2013-11-20
Cycle 2 Number of Health Revisits 1
Cycle 2 Health Revisit Score 0
Cycle 2 Total Health Score 80
Cycle 3 Total Number of Health Deficiencies 2
Cycle 3 Number of Standard Health Deficiencies 2
Cycle 3 Number of Complaint Health Deficiencies 0
Cycle 3 Health Deficiency Score 12
Cycle 3 Standard Survey Health Date 2012-10-04
Cycle 3 Number of Health Revisits 1
Cycle 3 Health Revisit Score 0
Cycle 2 Total Health Score 12
Total Weighted Health Survey Score 78.667
Complaints, Fines & Penalties
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
Facility Information
Ownership Non profit - Corporation
Date First Approved to Provide Medicare and Medicaid 1994-09-20
Provider Resides in Hospital YES
Continuing Care Retirement Community N
Special Focus Facility N
Changed Ownership in Last 12 Months N
With a Resident and Family Council Both
Automatic Sprinkler Systems in All Required Areas Yes
Processing Date 2015-08-01

Ownership Information

Owner NameOwner RoleOwner Type%