Lake Stockton Healthcare Facility
811 Owen Mill Road, Po Box 945, Stockton, MO 65785


Lake Stockton Healthcare Facility is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 265466. The address is 811 Owen Mill Road, Po Box 945, Stockton, MO 65785. The zip code is 65785. The phone number is 4172765126.


Lake Stockton Healthcare Facility · 811 Owen Mill Road, Po Box 945, Stockton, MO 65785

Federal Provider Number 265466
Provider Name LAKE STOCKTON HEALTHCARE FACILITY
Address 811 OWEN MILL ROAD, PO BOX 945
STOCKTON, MO 65785
Phone Number 4172765126
SSA County Code 190
County Name Cedar
Ownership Type Non profit - Corporation
Certified Beds 75
Certified Beds Residents 59
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name CITIZENS MEMORIAL HEALTH CARE FOUNDATION
Date First Approved to Provide Medicare Medicaid Services 09/20/1991
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 Both
Automatic Sprinkler Systems in All Required Areas Yes
Overall Rating 5
Health Inspection Rating 5
Quality Measure Rating 5
Staffing Rating 4
RN Staffing Rating 4
Reported CNA Staffing Hours per Resident per Day 2.54407
Reported LPN Staffing Hours per Resident per Day 0.6322
Reported RN Staffing Hours per Resident per Day 0.5839
Reported Licensed Staffing Hours per Resident per Day 1.2161
Reported Total Nurse Staffing Hours per Resident per Day 3.76017
Expected CNA Staffing Hours per Resident per Day 2.0846
Expected LPN Staffing Hours per Resident per Day 0.56316
Expected RN Staffing Hours per Resident per Day 0.79739
Expected Total Nurse Staffing Hours per Resident per Day 3.44515
Adjusted CNA Staffing Hours per Resident per Day 2.99453
Adjusted LPN Staffing Hours per Resident per Day 0.93176
Adjusted RN Staffing Hours per Resident per Day 0.54714
Adjusted Total Nurse Staffing Hours per Resident per Day 4.39948
Cycle 1 Standard Survey Health Date 03/10/2017
Cycle 2 Total Number of Health Deficiencies 2
Cycle 2 Number of Standard Health Deficiencies 2
Cycle 2 Health Deficiency Score 24
Cycle 2 Standard Health Survey Date 05/12/2016
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 24
Cycle 3 Total Number of Health Deficiencies 2
Cycle 3 Number of Standard Health Deficiencies 2
Cycle 3 Health Deficiency Score 12
Cycle 3 Standard Health Survey Date 04/16/2015
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 12
Total Weighted Health Survey Score 10
Total Amount of Fines in Dollars $0.00
Processing Date 08/01/2017

Owner or Manager · Lake Stockton Healthcare Facility

Owner Name Role Association Date
BABB, DONALD (Individual) DIRECTOR since 09/24/1986
COSTELLO, KEVIN (Individual) MANAGING EMPLOYEE since 09/01/2011
DONNELL, WILLIAM (Individual) DIRECTOR since 03/14/2012
FULBRIGHT, GARY (Individual) OFFICER since 09/24/1986
GREGORY, BRADLEY (Individual) DIRECTOR since 07/01/1991
GREGORY, BRADLEY (Individual) OFFICER since 07/01/1991
HUNTER, DEREK (Individual) DIRECTOR since 07/01/2007
JOHNSON, NEALE (Individual) DIRECTOR since 08/18/2011
MEENTS, DANA (Individual) DIRECTOR since 10/14/2010
MEYER, RENEE (Individual) MANAGING EMPLOYEE since 07/01/1997
MOLDER, CATHERINE (Individual) OFFICER since 03/01/2002
PAYNE, RUSSEL (Individual) DIRECTOR since 02/16/2012
STRADER, DAVE (Individual) DIRECTOR since 07/01/1991
STRADER, DAVE (Individual) OFFICER since 07/01/1991

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