BUENA VISTA CARE AND REHABILITATION CENTER

The information listed below provides an in-depth look into the type and quality of care offered at Buena Vista Care and Rehabilitation Center. It is important to note that when evaluating if a nursing home is right for you or a loved one, ratings should not be taken as the sole deciding factor, but as one of many aspects to be considered.

Address

BUENA VISTA CARE AND REHABILITATION CENTER
1400 BUENA VISTA
MIDWEST CITY, OK 73110
(405) 733-1794

Nursing Home Ratings

Health Inspections
Quality Measures
Nursing Staff
R.N. Staff Only
Overall Rating

Percent of Beds Occupied

68%

Number of Residents and Certified Beds

  • Residents: 127
  • Certified Beds: 187

This Facility Accepts

  • Medicare
  • Medicaid

Operational Details

  • Operated By For Profit - Corporation
  • Offers Only Resident Counseling
  • This Facility is Part of a Chain or Franchise

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Nearby Cities:

Del City | Oklahoma City | Moore

Resident Services

The information below lists services this facility has provided for residents from October through December 2010. During this period, the most common type of service provided was "Ultra-High Rehabilitation". To get a better idea of the types of services that are commonly performed, compare the "Percent of Service Days" column below. These services are based on submitted claims to Medicare and do not provide a complete overview of all the services provided by Buena Vista Care and Rehabilitation Center. For more information read our guide on how nursing facilities are reimbursed, types of services, and ADL index scores.

Resident ServicesResident ConditionsPercent of Service Days

Ultra-High Rehabilitation

Rehabilitation 720 Minutes Per Week Minimum
  • At least one rehabilitation discipline five days/week
  • A second rehabilitation discipline three days/week
ADL Index Range: 11-1630.2%
ADL Index Range: 6-1018.0%
ADL Index Range: 0-515.6%
Total Percent:63.8%
 

Very High Rehabilitation

Rehabilitation 500 Minutes Per Week Minimum
  • At least one rehabilitation discipline five days/week
ADL Index Range: 11-168.8%
ADL Index Range: 6-105.8%
ADL Index Range: 0-53.9%
Total Percent:18.5%
 

High Rehabilitation

Rehabilitation 325 Minutes Per Week Minimum
  • At least one rehabilitation discipline five days/week
ADL Index Range: 6-100.09%
Total Percent:0.09%
 

Medium Rehabilitation

Rehabilitation 150 Minutes Per Week Minimum
  • Five days any combination of three rehabilitation disciplines
ADL Index Range: 11-164.4%
ADL Index Range: 6-102.6%
ADL Index Range: 0-54.2%
Total Percent:11.2%
 

Special Care High

  • Comatose
  • Septicemia
  • Diabetes with daily injections and a change of order two or more days
  • Quadriplegia with ADL score greater or equal to 5
  • Chronic Obstructive Pulmonary Disease (COPD) and shortness of breath when lying flat
  • Fever with pneumonia, or vomiting, or weight loss, or feeding tube
  • Parenteral/IV feedings
  • Respiratory therapy for 7 days
  • Activities of Daily Living (ADL) score of 2 or more
ADL Index Range: 2-5
- No Signs of depression
0.9%
Total Percent:0.9%
 

Clinically Complex

  • Pneumonia, hemiplegia with ADL score >=5
  • Surgical wounds or open lesions with treatment
  • Burns
  • Chemotherapy while a resident
  • Oxygen therapy while a resident
  • IV medications or transfusions while a resident
  • Extensive Services, Special Care High or Special Care Low qualifier and ADL score of 0 or 1
ADL Index Range: 6-10
- No Signs of depression
0.3%
ADL Index Range: 2-5
- No Signs of depression
0.4%
Total Percent:0.7%
 

Behavioral Symptoms and Cognitive Performance

  • Cognitive impairment BIMS score less than or equal to 9
  • CPS great than or equal to 3
  • Hallucinations or delusions
  • Physical or verbal behavioral symptoms toward others
  • Other behavioral symptoms
  • Rejection of care or wandering
  • Activities of Daily Living (ADL) score of 5 or less
ADL Index Range: 2-5
- Less restorative nursing
1.9%
ADL Index Range: 0-1
- Less restorative nursing
1.8%
Total Percent:3.7%
 

Reduced Physical Function

  • Urinary and/or bowel training program
  • Passive and/or active range of motion (ROM)
  • Amputation/prosthesis training
  • Dressing or grooming training
  • Eating or swallowing training
  • Transfer training
  • Splint or brace assistance
  • Bed mobility and/or walking training
  • Communication training
ADL Index Range: 11-14
- Less restorative nursing
0.6%
ADL Index Range: 6-10
- Less restorative nursing
0.2%
ADL Index Range: 0-1
- Less restorative nursing
0.3%
Total Percent:1.1%
 

Rating Details For Buena Vista Care and Rehabilitation Center

Nursing Staff -

The nursing staff is the most important part of what determines the quality of care and comfort of a resident in a nursing home. Government regulations set expectations on time spent with each resident based on the services being provided. The breakdown below lists the nursing types (RN, LPN, LVN, CNA) and a comparison of the reported and expected hours per resident per day.

Nursing Hours Per Resident Per DayReportedExpected
Registered Nurse (RN) Hours52 Minutes1 Hour and 1 Minutes
Licensed Practical/Vocational Nurse (LPN/LVN) Hours42 Minutes39 Minutes
Certified Nursing Assistant (CNA) Hours1 Hour and 53 Minutes2 Hours and 21 Minutes
Total Licensed Nurse Hours1 Hour and 35 Minutes1 Hour and 40 Minutes
Total Nurse Hours3 Hours and 28 Minutes4 Hours and 1 Minutes

Quality of Care -

Medicare determines quality of care ratings for nursing facilities by surveying several "quality measures", which are broken down into long-term and short-term stay residents, as well as if the action is preventive or if there is a deficiency in the quality of care. State averages for Oklahoma are also provided for comparison purposes. Note: Figures below are averaged over the past nine months.

This FacilityOklahoma Average

Long-Term Stay Preventive Actions

Percent of Long-Stay Residents Who Were Assessed and Given Pneumococcal Vaccination80%90%
Percent of Long-Stay Residents Given Influenza Vaccination During the Flu Season71%94%

Long-Term Stay Deficiencies

Percent of Long-Stay Residents Whose Ability to Move About in and Around Their Room Got Worse7%8%
Percent of Long-Stay Residents Who Were Physically Restrained6%4%
Percent of Long-Stay Residents Who Have Moderate to Severe Pain4%6%
Percent of Low-Risk Long-Stay Residents Who Lose Control of Their Bowels or Bladder51%40%
Percent of Long-Stay Residents Who Have/Had a Catheter Inserted and Left in Their Bladder4%6%
Percent of High-Risk Long-Stay Residents Who Have Pressure Sores8%13%
Percent of Long-Stay Residents Who Had a Urinary Tract Infection7%10%
Percent of Low-Risk Long-Stay Residents Who Have Pressure Sores-3%
Percent of Long-Stay Residents Whose Need for Help with Daily Activities Has Increased12%11%
Percent of Long-Stay Residents Who Lose Too Much Weight10%8%
Percent of Long-Stay Residents Who Are More Depressed or Anxious14%9%
Percent of Long-Stay Residents Who Spend Most of Their Time in Bed or in a Chair4%6%

Short-Term Stay Preventive Actions

Percent of Short-Stay Residents Who Were Assessed and Given Pneumococcal Vaccination78%85%
Percent of Short-Stay Residents Given Influenza Vaccination During the Flu Season60%89%

Short-Term Stay Deficiencies

Percent of Short-Stay Residents Who Have Pressure Sores13%13%
Percent of Short-Stay Residents Who Have Delirium2%3%
Percent of Short-Stay Residents Who Had Moderate to Severe Pain13%23%

Health Inspection Details -

All Medicare and/or Medicaid certified nursing home must undergo health inspections on average once a year, but may be more frequent if the facility is peforming poorly. These inspections cover most aspects of life in a nursing home, and are broken down into deficiencies types, which including: Pharmacy Service, Administration, Resident Rights, Nutrition and Dietary, Resident Assessment, Environmental, and Mistreatment. Below are the list of deficiencies found by inspectors in the past few years along with the degree of harm and how many residents may have been affected. Note: The most recent health survey was on 06/14/2011.

Degree of Harm

  • - Potential for Minimal Harm
  • - Minimal Harm or Potential for Harm
  • - Resident Harmed
  • - Immediate Jeopardy to Resident Health

Residents Affected

  • - Isolated
  • - Some Residents
  • - Many Residents
Deficiencies Found By InspectorsDegree of HarmResidents Affected

Administration

Keep Accurate and Appropriate Medical Records.
  • Inspection Date: 06/14/2011
  • Correction Date: 06/22/2011

Environmental

Keep Safe, Clean and Homelike Surroundings.
  • Inspection Date: 02/11/2009
  • Correction Date: 03/18/2009
Keep Sound Levels Comfortable.
  • Inspection Date: 02/11/2009
  • Correction Date: 03/18/2009
Get Rid of Garbage Properly.
  • Inspection Date: 02/11/2009
  • Correction Date: 03/18/2009
Have a Program to Keep Infection from Spreading.
  • Inspection Date: 02/11/2009
  • Correction Date: 03/18/2009
Keep All Essential Equipment Working Safely.
  • Inspection Date: 02/11/2009
  • Correction Date: 03/18/2009
Make Sure That the Nursing Home Area is Safe, Easy to Use, Clean and Comfortable.
  • Inspection Date: 02/11/2009
  • Correction Date: 03/18/2009
Provide Needed Housekeeping and Maintenance.
  • Inspection Date: 03/26/2010
  • Correction Date: 04/30/2010
Make Sure That the Nursing Home Area is Safe, Easy to Use, Clean and Comfortable.
  • Inspection Date: 03/26/2010
  • Correction Date: 04/30/2010

Mistreatment

Keep Each Resident Free from Physical Restraints, Unless Needed for Medical Treatment.
  • Inspection Date: 02/11/2009
  • Correction Date: 03/18/2009

Nutrition and Dietary

Store, Cook, and Give out Food in a Safe and Clean Way.
  • Inspection Date: 02/11/2009
  • Correction Date: 03/18/2009

Pharmacy Service

Keep the Rate of Medication Errors (Wrong Drug, Wrong Dose, Wrong Time) to Less Than 5%.
  • Inspection Date: 02/11/2009
  • Correction Date: 03/18/2009
Make Sure That Residents Are Safe from Serious Medication Errors.
  • Inspection Date: 02/11/2009
  • Correction Date: 03/18/2009
Have Drugs and Other Similar Products Available, Which Are Needed Every Day and in Emergencies, and Give Them out Properly.
  • Inspection Date: 02/11/2009
  • Correction Date: 03/18/2009
Keep the Rate of Medication Errors (Wrong Drug, Wrong Dose, Wrong Time) to Less Than 5%.
  • Inspection Date: 06/14/2011
  • Correction Date: 06/26/2011
Properly Mark Drugs and Other Similar Products.
  • Inspection Date: 06/14/2011
  • Correction Date: 06/22/2011

Quality Care

Make Sure That Each Resident's Nutritional Needs Were Met.
  • Inspection Date: 02/11/2009
  • Correction Date: 03/18/2009

Resident Assessment

Keep Assessments Completed in the Preceding 15 Months in the Resident's Active Record.
  • Inspection Date: 02/11/2009
  • Correction Date: 03/18/2009
Make Sure All Assessments Are Accurate, Coordinated by an Rn, Done by the Right Professional, and Are Signed by the Person Completing Them.
  • Inspection Date: 03/26/2010
  • Correction Date: 04/30/2010

Resident Rights

Keep Each Resident's Personal and Medical Records Private and Confidential.
  • Inspection Date: 06/14/2011
  • Correction Date: 06/22/2011

Enforcement

Below is a list of any civil penalities or denials of payment for new admissions (DPNA) that this facility received in the previous three years. Note: Monetary figures are not available for DPNAs.

Action TakenDateAmount
Civil Money Penalty (CMP)08/21/2008$3,510
Denial of Payment for New Admission (DPNA)08/21/2008-

Deficiencies from Complaints and Incidents

The table below lists incident reports by the nursing staff or administration for Buena Vista Care and Rehabilitation Center, as well as complaints by residents or their family in the previous three years.

Degree of Harm

  • - Potential for Minimal Harm
  • - Minimal Harm or Potential for Harm
  • - Resident Harmed
  • - Immediate Jeopardy to Resident Health

Residents Affected

  • - Isolated
  • - Some Residents
  • - Many Residents
Formal ComplaintsDegree of HarmResidents Affected

Administration

Keep Accurate and Appropriate Medical Records.
  • Complaint Filed: 08/21/2008
  • Correction Date: 12/19/2008
Make Sure That Nurse Aides Show They Have the Skills to Be Able to Care for Residents.
  • Complaint Filed: 10/08/2008
  • Correction Date: 10/24/2008
Give or Get Lab Tests to Meet the Needs of Residents.
  • Complaint Filed: 10/08/2008
  • Correction Date: 10/24/2008
Give or Get Lab Tests to Meet the Needs of Residents.
  • Complaint Filed: 06/14/2011
  • Correction Date: 06/22/2011

Environmental

Make Sure That the Nursing Home Area is Free of Dangers That Cause Accidents.
  • Complaint Filed: 08/21/2008
  • Correction Date: 09/29/2008
Have a Program to Keep Infection from Spreading.
  • Complaint Filed: 08/21/2008
  • Correction Date: 09/29/2008
Provide Needed Housekeeping and Maintenance.
  • Complaint Filed: 09/02/2008
  • Correction Date: 09/29/2008
Have a Program to Keep Infection from Spreading.
  • Complaint Filed: 10/08/2008
  • Correction Date: 10/24/2008
Have a Program to Keep Infection from Spreading.
  • Complaint Filed: 03/24/2009
  • Correction Date: 03/27/2009
Provide Needed Housekeeping and Maintenance.
  • Complaint Filed: 06/14/2011
  • Correction Date: 07/01/2011
Have a Program to Keep Infection from Spreading.
  • Complaint Filed: 06/14/2011
  • Correction Date: 06/22/2011
Make Sure That the Nursing Home Area is Free of Dangers That Cause Accidents.
  • Complaint Filed: 06/14/2011
  • Correction Date: 06/22/2011

Mistreatment

1) Hire Only People Who Have No Legal History of Abusing, Neglecting or Mistreating Residents; or 2) Report and Investigate Any Acts or Reports of Abuse, Neglect or Mistreatment of Residents.
  • Complaint Filed: 03/24/2009
  • Correction Date: 03/27/2009
1) Hire Only People Who Have No Legal History of Abusing, Neglecting or Mistreating Residents; or 2) Report and Investigate Any Acts or Reports of Abuse, Neglect or Mistreatment of Residents.
  • Complaint Filed: 03/10/2011
  • Correction Date: 03/17/2011
Write and Use Policies That Forbid Mistreatment, Neglect and Abuse of Residents and Theft of Residents' Property.
  • Complaint Filed: 03/10/2011
  • Correction Date: 03/17/2011
Write and Use Policies That Forbid Mistreatment, Neglect and Abuse of Residents and Theft of Residents' Property.
  • Complaint Filed: 06/14/2011
  • Correction Date: 06/22/2011
1) Hire Only People Who Have No Legal History of Abusing, Neglecting or Mistreating Residents; or 2) Report and Investigate Any Acts or Reports of Abuse, Neglect or Mistreatment of Residents.
  • Complaint Filed: 06/14/2011
  • Correction Date: 06/22/2011
Protect Residents from Mistreatment, Neglect, And/Or Theft of Personal Property.
  • Complaint Filed: 06/14/2011
  • Correction Date: 05/11/2011

Nutrition and Dietary

Prepare Food That is Nutritional, Appetizing, Tasty, Attractive, Well-Cooked, and at the Right Temperature.
  • Complaint Filed: 09/02/2008
  • Correction Date: 09/29/2008
Store, Cook, and Give out Food in a Safe and Clean Way.
  • Complaint Filed: 09/02/2008
  • Correction Date: 09/29/2008
Store, Cook, and Give out Food in a Safe and Clean Way.
  • Complaint Filed: 06/14/2011
  • Correction Date: 06/22/2011
Make Sure That Residents Are Well Nourished.
  • Complaint Filed: 06/14/2011
  • Correction Date: 07/07/2011
Prepare Food That is Nutritional, Appetizing, Tasty, Attractive, Well-Cooked, and at the Right Temperature.
  • Complaint Filed: 06/14/2011
  • Correction Date: 06/22/2011

Pharmacy Service

Keep the Rate of Medication Errors (Wrong Drug, Wrong Dose, Wrong Time) to Less Than 5%.
  • Complaint Filed: 08/21/2008
  • Correction Date: 12/19/2008
Keep the Rate of Medication Errors (Wrong Drug, Wrong Dose, Wrong Time) to Less Than 5%.
  • Complaint Filed: 12/01/2008
  • Correction Date: 12/13/2008
Have Drugs and Other Similar Products Available, Which Are Needed Every Day and in Emergencies, and Give Them out Properly.
  • Complaint Filed: 06/14/2011
  • Correction Date: 06/22/2011

Quality Care

Make Sure That Each Resident Who Enters the Nursing Home Without a Catheter is Not Given a Catheter, Unless It is Necessary.
  • Complaint Filed: 08/21/2008
  • Correction Date: 09/29/2008
Make Sure That Residents Who Cannot Care for Themselves Receive Help with Eating/Drinking, Grooming and Hygiene.
  • Complaint Filed: 09/02/2008
  • Correction Date: 09/29/2008
Make Sure That Residents Who Cannot Care for Themselves Receive Help with Eating/Drinking, Grooming and Hygiene.
  • Complaint Filed: 10/08/2008
  • Correction Date: 10/24/2008
Give Residents Proper Treatment to Prevent New Bed (Pressure) Sores or Heal Existing Bed Sores.
  • Complaint Filed: 10/08/2008
  • Correction Date: 10/24/2008
Make Sure That Each Resident Who Enters the Nursing Home Without a Catheter is Not Given a Catheter, Unless It is Necessary.
  • Complaint Filed: 10/08/2008
  • Correction Date: 10/24/2008
Give Each Resident Care and Services to Get or Keep the Highest Quality of Life Possible.
  • Complaint Filed: 02/23/2011
  • Correction Date: 06/22/2011
Make Sure That Residents Who Cannot Care for Themselves Receive Help with Eating/Drinking, Grooming and Hygiene.
  • Complaint Filed: 02/23/2011
  • Correction Date: 06/22/2011
Give Each Resident Care and Services to Get or Keep the Highest Quality of Life Possible.
  • Complaint Filed: 03/10/2011
  • Correction Date: 03/17/2011
Make Sure That Residents Who Cannot Care for Themselves Receive Help with Eating/Drinking, Grooming and Hygiene.
  • Complaint Filed: 03/10/2011
  • Correction Date: 03/17/2011
Make Sure That Residents Who Cannot Care for Themselves Receive Help with Eating/Drinking, Grooming and Hygiene.
  • Complaint Filed: 06/14/2011
  • Correction Date: 06/22/2011
Give Each Resident Care and Services to Get or Keep the Highest Quality of Life Possible.
  • Complaint Filed: 06/14/2011
  • Correction Date: 06/22/2011

Resident Assessment

Develop a Complete Care Plan That Meets All of a Resident's Needs, with Timetables and Actions That Can Be Measured.
  • Complaint Filed: 08/21/2008
  • Correction Date: 09/29/2008
Develop a Complete Care Plan That Meets All of a Resident's Needs, with Timetables and Actions That Can Be Measured.
  • Complaint Filed: 10/08/2008
  • Correction Date: 10/24/2008
Make a Complete Assessment That Covers All Questions for Areas That Are Listed in Official Regulations.
  • Complaint Filed: 02/23/2011
  • Correction Date: 03/17/2011

Resident Rights

Provide Care in a Way That Keeps or Builds Each Resident's Dignity and Self Respect.
  • Complaint Filed: 08/21/2008
  • Correction Date: 12/19/2008
Try to Resolve Each Resident's Complaints Quickly.
  • Complaint Filed: 09/02/2008
  • Correction Date: 09/29/2008
Have a Private Telephone Available for Use.
  • Complaint Filed: 12/01/2008
  • Correction Date: 12/13/2008
Immediately Tell the Resident, Doctor, and a Family Member If: the Resident is Injured, There is a Major Change in Resident's Physical/Mental Health, There is a Need to Alter Treatment Significantly, or the Resident Must Be Transferred or Discharged.
  • Complaint Filed: 03/24/2009
  • Correction Date: 03/27/2009
Provide Care in a Way That Keeps or Builds Each Resident's Dignity and Self Respect.
  • Complaint Filed: 03/10/2011
  • Correction Date: 03/17/2011
Provide Care in a Way That Keeps or Builds Each Resident's Dignity and Self Respect.
  • Complaint Filed: 06/14/2011
  • Correction Date: 06/22/2011
Have a Private Telephone Available for Use.
  • Complaint Filed: 06/14/2011
  • Correction Date: 06/21/2011

Fire Safety

Nursing homes certified by Medicare and/or Medicaid are required to have fire safety inspections to meet Life Safety Code (LSC) standards. Below is a list of deficiencies that Buena Vista Care and Rehabilitation Center had in recent fire safety inspections. This information can be used to see if all standards were met, the degree of harm, the number of residents affected, and the date when deficiencies were corrected. Note: The most recent fire safety survey was on 06/14/2011.

Degree of Harm

  • - Potential for Minimal Harm
  • - Minimal Harm or Potential for Harm
  • - Resident Harmed
  • - Immediate Jeopardy to Resident Health

Residents Affected

  • - Isolated
  • - Some Residents
  • - Many Residents
Deficiencies Found By InspectorsDegree of HarmResidents Affected

Automatic Sprinkler Systems

An Approved Automatic Sprinkler System Connected to the Fire Alarm System.
  • Inspection Date: 02/10/2009
  • Correction Date: 03/31/2009
An Approved Automatic Sprinkler System Connected to the Fire Alarm System.
  • Inspection Date: 03/24/2010
  • Correction Date: 04/30/2010

Building Service Equipment

Restrictions on the Use of Portable Space Heaters.
  • Inspection Date: 03/24/2010
  • Correction Date: 04/30/2010
Properly Protected Cooking Facilities.
  • Inspection Date: 06/14/2011
  • Correction Date: 06/22/2011

Corridor Walls and Doors

Corridor and Hallway Doors That Block Smoke.
  • Inspection Date: 03/24/2010
  • Correction Date: 04/30/2010

Emergency Plans and Fire Drills

Record of Quarterly Fire Drills for Each Shift Under Varying Conditions.
  • Inspection Date: 06/14/2011
  • Correction Date: 07/01/2011

Exits and Egress

Exits That Are Accessible at All Times.
  • Inspection Date: 02/10/2009
  • Correction Date: 03/18/2009
Exits That Are Accessible at All Times.
  • Inspection Date: 06/14/2011
  • Correction Date: 06/29/2011

Fire Alarm Systems

A Fire Alarm System That Can Be Heard Throughout the Facility.
  • Inspection Date: 02/10/2009
  • Correction Date: 03/18/2009
Properly Maintained Smoke Detectors.
  • Inspection Date: 02/10/2009
  • Correction Date: 03/18/2009

Hazardous Area

Construction That Can Resist Fire for One Hour or an Approved Fire Extinguishing System.
  • Inspection Date: 02/10/2009
  • Correction Date: 03/31/2009
Construction That Can Resist Fire for One Hour or an Approved Fire Extinguishing System.
  • Inspection Date: 03/24/2010
  • Correction Date: 04/30/2010
Construction That Can Resist Fire for One Hour or an Approved Fire Extinguishing System.
  • Inspection Date: 06/14/2011
  • Correction Date: 06/29/2011

Medical Gases and Anesthetizing Areas

Proper Medical Gas Storage and Administration Areas.
  • Inspection Date: 02/10/2009
  • Correction Date: 03/31/2009

Miscellaneous

Fire Safety Features Required by Current Fire Safety Codes.
  • Inspection Date: 06/14/2011
  • Correction Date: 06/29/2011

Smoke Compartmentation and Control

Walls or Barriers That Prevent Smoke from Passing Through and Would Resist Fire for at Least One Hour.
  • Inspection Date: 02/10/2009
  • Correction Date: 03/18/2009
Smoke Barrier Doors That Can Resist Smoke for at Least 20 Minutes.
  • Inspection Date: 02/10/2009
  • Correction Date: 03/18/2009
Walls or Barriers That Prevent Smoke from Passing Through and Would Resist Fire for at Least One Hour.
  • Inspection Date: 03/24/2010
  • Correction Date: 04/30/2010
Walls or Barriers That Prevent Smoke from Passing Through and Would Resist Fire for at Least One Hour.
  • Inspection Date: 06/14/2011
  • Correction Date: 06/29/2011
Source: Medicare Nursing Home Compare; Oklahoma State Department of Health - Retrieved 2011