Provider Name: CHAUTAUQUA GUEST HOME #3
Address: 302 NINTH STREET, CHARLES CITY, IA 50616
Phone: (641) 228-5351
County: Floyd (330)
Ownership Type: For profit - Corporation
Certified Beds: 65
Average Residents Per Day: 41.5 ()
Provider Type: Medicare and Medicaid, Resides in Hospital: No
Legal Business Name: CHAUTAUQUA GUEST HOMES INC.
First Approved Date: January 1, 1995
Affiliated Entity: ()
Retirement Community: N, Special Focus Status:
Ownership Change in Last 12 Months: N
Resident Family Council: None
Sprinkler System Status: Yes
Overall Rating: 4 ()
Health Inspection Rating: 4 ()
QM Rating: 4 ()
Long Stay QM Rating: 4 ()
Short Stay QM Rating: 5 ()
Staffing Rating: 4 ()
Staffing Report Note:
PT Staffing Note:
Nurse Aide Staff Hours Per Day, per resident: 2.82554, LPN Staff Hours Per Day: 0.2412, RN Staff Hours Per Day: 0.8788, Licensed Staff Hours Per Day: 1.1201
Total Nurse Staff Hours Per Day, per resident: 3.94567
Weekend Nurse Staff Hours: 3.69023, Weekend RN Staff Hours: 0.5672
PT Staff Hours Per Day, per resident: 0.0114
Nurse Staff Turnover: 52.1, Nurse Turnover Note:
RN Turnover: 42.9, RN Turnover Note:
Admin Left Number: 1, Admin Turnover Note:
Case Mix Nurse Aide Hours Per Day, per resident: 1.9896, Case Mix LPN Hours Per Day: 0.7077, Case Mix RN Hours Per Day: 0.3439
Adjusted Nurse Aide Hours Per Day, per resident: 2.89315, Adjusted LPN Hours Per Day: 0.2515, Adjusted RN Hours Per Day: 0.9627
Total Adjusted Nurse Hours Per Day, per resident: 4.08920
Adjusted Weekend Nurse Hours Per Day, per resident: 3.82447
Health Survey Dates and Scores: Cycle 1: 2024-01-18 (Score: 16), Cycle 2: 2022-07-28 (Score: 16), Cycle 3: 2021-03-22 (Score: 0)
Total Weighted Health Score: 13.333
Reported Incidents: 0, Substantiated Complaints: 4
Infection Control Citations: 2
Fines and Penalties: Number of Fines: 0, Total Fines in Dollars: 0.00, Payment Denials Number: 0, Total Penalties Number: 0
Location and GPS: 302 NINTH STREET,CHARLES CITY,IA,50616 (43.0557, -92.676)
Process Date: 2024-03-01
Each record details specific health deficiencies found during inspections, categorized by type, severity, and whether they were corrected. Below are the severity levels and their implications:
Type: Health, Deficiency: Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2023-10-06
Type: Health, Deficiency: Provide and implement an infection prevention and control program.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2023-10-06
Type: Health, Deficiency: Assess the resident when there is a significant change in condition
Severity: B - Level 1: No actual harm with potential for minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2024-01-31
Type: Health, Deficiency: Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Severity: E - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2024-01-31
Type: Health, Deficiency: Dispose of garbage and refuse properly.
Severity: F - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2022-07-29
Each record details specific fire safety deficiencies found during inspections, categorized by type, severity, and whether they were corrected. Below are the severity levels and their implications:
Type: Fire Safety, Tag: 0222, Version: New
Description: Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.
Severity: E - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2024-01-25
Type: Fire Safety, Tag: 0920, Version: New
Description: Ensure proper usage of power strips and extension cords.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2024-01-22
Type: Fire Safety, Tag: 0372, Version: New
Description: Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2022-08-04
Type: Fire Safety, Tag: 0353, Version: New
Description: Inspect, test, and maintain automatic sprinkler systems.
Severity: E - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2021-03-23
Type: Fire Safety, Tag: 0511, Version: New
Description: Have properly installed electrical wiring and gas equipment.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2021-03-23