Woodland Manor
1347 East Valley Watermill Road, Springfield, MO 65803


Woodland Manor is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 265749. The address is 1347 East Valley Watermill Road, Springfield, MO 65803. The zip code is 65803. The phone number is 4178331220.


Woodland Manor · 1347 East Valley Watermill Road, Springfield, MO 65803

Federal Provider Number 265749
Provider Name WOODLAND MANOR
Address 1347 EAST VALLEY WATERMILL ROAD
SPRINGFIELD, MO 65803
Phone Number 4178331220
SSA County Code 380
County Name Greene
Ownership Type For profit - Corporation
Certified Beds 180
Certified Beds Residents 89
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name EBG HEALTH CARE III INC
Date First Approved to Provide Medicare Medicaid Services 12/27/2002
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 1
Health Inspection Rating 1
Quality Measure Rating 3
Staffing Rating 2
RN Staffing Rating 2
Reported CNA Staffing Hours per Resident per Day 1.94944
Reported LPN Staffing Hours per Resident per Day 0.70562
Reported RN Staffing Hours per Resident per Day 0.38202
Reported Licensed Staffing Hours per Resident per Day 1.08764
Reported Total Nurse Staffing Hours per Resident per Day 3.03708
Reported Physical Therapist Staffing Hours per Resident Per Day 0.0118
Expected CNA Staffing Hours per Resident per Day 1.97563
Expected LPN Staffing Hours per Resident per Day 0.58905
Expected RN Staffing Hours per Resident per Day 0.84454
Expected Total Nurse Staffing Hours per Resident per Day 3.40923
Adjusted CNA Staffing Hours per Resident per Day 2.42117
Adjusted LPN Staffing Hours per Resident per Day 0.99425
Adjusted RN Staffing Hours per Resident per Day 0.33799
Adjusted Total Nurse Staffing Hours per Resident per Day 3.59089
Cycle 1 Total Number of Health Deficiencies 3
Cycle 1 Number of Standard Health Deficiencies 3
Cycle 1 Health Deficiency Score 28
Cycle 1 Standard Survey Health Date 03/03/2017
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 28
Cycle 2 Total Number of Health Deficiencies 3
Cycle 2 Number of Complaint Health Deficiencies 3
Cycle 2 Health Deficiency Score 170
Cycle 2 Standard Health Survey Date 01/15/2016
Cycle 2 Total Health Score 170
Cycle 3 Total Number of Health Deficiencies 7
Cycle 3 Number of Standard Health Deficiencies 7
Cycle 3 Health Deficiency Score 40
Cycle 3 Standard Health Survey Date 04/24/2015
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 40
Total Weighted Health Survey Score 77.333
Number of Substantiated Complaints 4
Number of Fines 1
Total Amount of Fines in Dollars $10790.00
Total Number of Penalties 1
Processing Date 08/01/2017

Owner or Manager · Woodland Manor

Owner Name Role Association Date
COLTRIN, BIANCA (Individual) MANAGING EMPLOYEE since 08/01/2008
GOURLEY, CAROL LYNN (Individual) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 05/01/1989
GOURLEY, CAROL LYNN (Individual) OFFICER since 01/01/1990
GOURLEY, EWING BERYL (Individual) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 05/01/1989
GOURLEY, EWING BERYL (Individual) OFFICER since 05/01/1989

street_number: 1347
route: East Valley Water Mill Road (E Valley Water Mill Rd)
locality, political: Springfield
admin_level_3, political: North Campbell No. 2 Township
admin_level_2, political: Greene County
admin_level_1, political: Missouri (MO)
country, political: United States (US)
postal_code: 65803
postal_code_suffix: 3739
types : street_address
latitude: 37.263447
longitude: -93.270258
latlng: (37.263447, -93.270258)


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