Citizens Memorial Healthcare Facility
1218 West Locust, Po Box 590, Bolivar, MO 65613


Citizens Memorial Healthcare Facility is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 265545. The address is 1218 West Locust, Po Box 590, Bolivar, MO 65613. The zip code is 65613. The phone number is 4173267648.


Citizens Memorial Healthcare Facility · 1218 West Locust, Po Box 590, Bolivar, MO 65613

Federal Provider Number 265545
Provider Name CITIZENS MEMORIAL HEALTHCARE FACILITY
Address 1218 WEST LOCUST, PO BOX 590
BOLIVAR, MO 65613
Phone Number 4173267648
SSA County Code 821
County Name Polk
Ownership Type Non profit - Other
Certified Beds 111
Certified Beds Residents 107
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 09/27/1993
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 4
Health Inspection Rating 3
Quality Measure Rating 5
Staffing Rating 3
RN Staffing Rating 3
Reported CNA Staffing Hours per Resident per Day 2.5472
Reported LPN Staffing Hours per Resident per Day 0.24533
Reported RN Staffing Hours per Resident per Day 0.57196
Reported Licensed Staffing Hours per Resident per Day 0.81729
Reported Total Nurse Staffing Hours per Resident per Day 3.36449
Reported Physical Therapist Staffing Hours per Resident Per Day 0.05981
Expected CNA Staffing Hours per Resident per Day 2.31802
Expected LPN Staffing Hours per Resident per Day 0.59729
Expected RN Staffing Hours per Resident per Day 0.8578
Expected Total Nurse Staffing Hours per Resident per Day 3.77311
Adjusted CNA Staffing Hours per Resident per Day 2.6963
Adjusted LPN Staffing Hours per Resident per Day 0.34091
Adjusted RN Staffing Hours per Resident per Day 0.49821
Adjusted Total Nurse Staffing Hours per Resident per Day 3.59436
Cycle 1 Total Number of Health Deficiencies 4
Cycle 1 Number of Standard Health Deficiencies 4
Cycle 1 Health Deficiency Score 52
Cycle 1 Standard Survey Health Date 03/02/2017
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 52
Cycle 2 Total Number of Health Deficiencies 5
Cycle 2 Number of Standard Health Deficiencies 5
Cycle 2 Health Deficiency Score 32
Cycle 2 Standard Health Survey Date 03/25/2016
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 32
Cycle 3 Total Number of Health Deficiencies 1
Cycle 3 Number of Standard Health Deficiencies 1
Cycle 3 Health Deficiency Score 4
Cycle 3 Standard Health Survey Date 01/23/2015
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 4
Total Weighted Health Survey Score 37.333
Total Amount of Fines in Dollars $0.00
Processing Date 08/01/2017

Owner or Manager · Citizens Memorial Healthcare Facility

Owner Name Role Association Date
BABB, DONALD (Individual) DIRECTOR since 09/24/1986
DONNELL, WILLIAM (Individual) DIRECTOR since 03/14/2012
FULBRIGHT, GARY (Individual) OFFICER since 09/24/1986
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) OFFICER since 07/01/1991
TILLEY, KIM (Individual) MANAGING EMPLOYEE since 12/31/2014

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