Fulton Presbyterian Manor
811 Center Street, Fulton, MO 65251


Fulton Presbyterian Manor is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 265581. The address is 811 Center Street, Fulton, MO 65251. The zip code is 65251. The phone number is 5736426646.


Fulton Presbyterian Manor · 811 Center Street, Fulton, MO 65251

Federal Provider Number 265581
Provider Name FULTON PRESBYTERIAN MANOR
Address 811 CENTER STREET
FULTON, MO 65251
Phone Number 5736426646
SSA County Code 130
County Name Callaway
Ownership Type Non profit - Corporation
Certified Beds 36
Certified Beds Residents 24
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name PRESBYTERIAN MANORS INC
Date First Approved to Provide Medicare Medicaid Services 07/01/1994
Continuing Care Retirement Community true
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 5
Health Inspection Rating 5
Quality Measure Rating 4
Staffing Rating 4
RN Staffing Rating 4
Reported CNA Staffing Hours per Resident per Day 3.72292
Reported LPN Staffing Hours per Resident per Day 2.02292
Reported RN Staffing Hours per Resident per Day 0.99167
Reported Licensed Staffing Hours per Resident per Day 3.01458
Reported Total Nurse Staffing Hours per Resident per Day 6.73751
Reported Physical Therapist Staffing Hours per Resident Per Day 0.08125
Expected CNA Staffing Hours per Resident per Day 2.35997
Expected LPN Staffing Hours per Resident per Day 0.64871
Expected RN Staffing Hours per Resident per Day 1.05848
Expected Total Nurse Staffing Hours per Resident per Day 4.06717
Adjusted CNA Staffing Hours per Resident per Day 3.87078
Adjusted LPN Staffing Hours per Resident per Day 2.58823
Adjusted RN Staffing Hours per Resident per Day 0.70004
Adjusted Total Nurse Staffing Hours per Resident per Day 6.67743
Cycle 1 Total Number of Health Deficiencies 2
Cycle 1 Number of Standard Health Deficiencies 2
Cycle 1 Health Deficiency Score 16
Cycle 1 Standard Survey Health Date 09/28/2016
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 16
Cycle 2 Total Number of Health Deficiencies 1
Cycle 2 Number of Standard Health Deficiencies 1
Cycle 2 Health Deficiency Score 8
Cycle 2 Standard Health Survey Date 08/13/2015
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 8
Cycle 3 Standard Health Survey Date 07/02/2014
Total Weighted Health Survey Score 10.667
Total Amount of Fines in Dollars $0.00
Processing Date 08/01/2017

Owner or Manager · Fulton Presbyterian Manor

Owner Name Role Association Date
BRENNECKE, GARY (Individual) DIRECTOR since 07/01/2015
COOK, JAMES (Individual) DIRECTOR since 07/01/2012
DELASHAW, JERRY (Individual) OFFICER since 09/01/2000
GAGE, RALPH (Individual) DIRECTOR since 07/01/2015
HARRIS, DANIEL (Individual) DIRECTOR since 07/01/2006
HIND, SHERRY (Individual) OFFICER since 07/01/1989
MCKELL, ELIZABETH (Individual) DIRECTOR since 07/01/2012
MILLER, JOAN (Individual) OFFICER since 09/01/1997
MORRISON, AARON (Individual) DIRECTOR since 07/01/2015
NELSON, ELEANOR (Individual) DIRECTOR since 07/01/2010
OTT, RAY (Individual) DIRECTOR since 09/01/2010
PRESBYTERIAN MANORS INC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
100%
since 03/30/1989
PRESBYTERIAN MANORS OF MID-AMERICA INC (Organization) OPERATIONAL/MANAGERIAL CONTROL since 03/30/1989
RADEBAUGH, TERESA (Individual) DIRECTOR since 07/01/2013
RIDGWAY, RONALD (Individual) DIRECTOR since 02/27/2007
SHOGREN, BRUCE (Individual) OFFICER since 08/05/1996
SMITH, DAWN (Individual) DIRECTOR since 09/28/2011
SMITH, DAWN (Individual) MANAGING EMPLOYEE since 09/28/2011
TAYLOR, WILLIAM (Individual) OFFICER since 07/01/2015
WEDEL, RANDY (Individual) DIRECTOR since 09/01/2010
WELLS, JOHN (Individual) DIRECTOR since 11/15/2011

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