Caribou Memorial Living Ctr
300 South Third West, Soda Springs, ID 83276


Caribou Memorial Living Ctr is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 135060. The address is 300 South Third West, Soda Springs, ID 83276. The zip code is 83276. The phone number is 2085473341.


Caribou Memorial Living Ctr · 300 South Third West, Soda Springs, ID 83276

Federal Provider Number 135060
Provider Name CARIBOU MEMORIAL LIVING CTR
Address 300 SOUTH THIRD WEST
SODA SPRINGS, ID 83276
Phone Number 2085473341
SSA County Code 140
County Name Caribou
Ownership Type Government - City/county
Certified Beds 30
Certified Beds Residents 24
Provider Type Medicare and Medicaid
Resides in Hospital true
Legal Business Name CARIBOU MEMORIAL HOSPITAL
Date First Approved to Provide Medicare Medicaid Services 08/21/1975
Continuing Care Retirement Community false
Special Focus Facility false
Most Recent Health Inspection More Than 2 Years Ago false
Changed Ownership Last 12 Months false
With Resident Family Council Resident
Automatic Sprinkler Systems in All Required Areas Yes
Overall Rating 3
Health Inspection Rating 4
Quality Measure Rating 1
Staffing Rating Footnote Data Not Available
RN Staffing Rating Footnote Data Not Available
Reported Staffing Footnote Data Not Available
Physical Therapist Staffing Footnote Data Not Available
Expected CNA Staffing Hours per Resident per Day 2.19422
Expected LPN Staffing Hours per Resident per Day 0.70398
Expected RN Staffing Hours per Resident per Day 1.03989
Expected Total Nurse Staffing Hours per Resident per Day 3.93809
Cycle 1 Total Number of Health Deficiencies 6
Cycle 1 Number of Standard Health Deficiencies 6
Cycle 1 Health Deficiency Score 28
Cycle 1 Standard Survey Health Date 05/27/2016
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 28
Cycle 2 Total Number of Health Deficiencies 13
Cycle 2 Number of Standard Health Deficiencies 13
Cycle 2 Health Deficiency Score 92
Cycle 2 Standard Health Survey Date 02/27/2015
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 92
Cycle 3 Total Number of Health Deficiencies 9
Cycle 3 Number of Standard Health Deficiencies 9
Cycle 3 Health Deficiency Score 56
Cycle 3 Standard Health Survey Date 12/06/2013
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 56
Total Weighted Health Survey Score 54
Number of Fines 1
Total Amount of Fines in Dollars $1235.00
Total Number of Penalties 1
Processing Date 08/01/2017

Owner or Manager · Caribou Memorial Living Ctr

Owner Name Role Association Date
CARIBOU COUNTY (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 10/05/2007
CARIBOU MEMORIAL HOSPITAL (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 10/05/2007
GIBBS, BONNE (Individual) DIRECTOR since 07/28/2008
HENDERSON, SHERI (Individual) MANAGING EMPLOYEE since 07/16/2007
HORSLEY, JODI (Individual) MANAGING EMPLOYEE since 02/26/1997
KIMBALL, GEORGE (Individual) DIRECTOR since 01/30/2006
KNOX, CHRISTINE (Individual) DIRECTOR since 06/01/2015
MAZZA, DOUG (Individual) DIRECTOR since 11/30/2015
SIMS, FREDERICK (Individual) DIRECTOR since 09/30/2012
SMITH, JON (Individual) DIRECTOR since 03/05/2016
SMITH, JON (Individual) MANAGING EMPLOYEE since 09/09/2013

street_number: 300
route: South 3rd Street West (South 3rd St W)
locality, political: Soda Springs
admin_level_2, political: Caribou County
admin_level_1, political: Idaho (ID)
country, political: United States (US)
postal_code: 83276
types : street_address
latitude: 42.6525578
longitude: -111.6133451
latlng: (42.6525578, -111.6133451)


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