Facility record report · CMS certification number 025030
PROVIDENCE KODIAK ISLAND MED LTC
KODIAK, Alaska · Medicare and Medicaid
Finances, as filed
Not yet extracted for this facility.
Ownership, as filed with CMS
Care Compare
As filed in the CMS file dated 1 August 2026 (Care Compare ownership).
| Owner or manager | Role | Type | Ownership percentage | Association |
|---|---|---|---|---|
| CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. | Ownership Data Not Available | CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. | CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. | CMS paused the expanded ownership disclosure on Form CMS-855A in guidance dated December 11, 2025; this field has not been filed under the current cycle. |
Medicare enrollment
Not yet extracted for this facility.
Changes in ownership
No change in ownership appears in the CMS files on record since 20 September 2022.
Inspections
| Inspection cycle | Health inspection | Fire safety inspection | Health deficiencies | Fire safety deficiencies |
|---|---|---|---|---|
| 1 | 5 December 2025 | 5 December 2025 | 11 | 5 |
| 2 | 22 November 2024 | 22 November 2024 | 6 | 3 |
| 3 | 22 September 2023 | 22 September 2023 | 9 | 7 |
From the Care Compare inspection summary file NH_SurveySummary_Aug2026.csv, processed on 1 August 2026.
Deficiencies cited
26 deficiencies on file, newest inspection first
| Inspection date | Inspection type | Tag | Category | What was cited | Scope and severity | Complaint | Corrected | Correction date |
|---|---|---|---|---|---|---|---|---|
| 5 December 2025 | Health | F 0550 | Resident Rights Deficiencies | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | F | No | Deficient, Provider has date of correction | 19 January 2026 |
| 5 December 2025 | Health | F 0605 | Freedom from Abuse, Neglect, and Exploitation Deficiencies | Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function. | D | No | Deficient, Provider has date of correction | 19 January 2026 |
| 5 December 2025 | Health | F 0607 | Freedom from Abuse, Neglect, and Exploitation Deficiencies | Develop and implement policies and procedures to prevent abuse, neglect, and theft. | F | No | Deficient, Provider has date of correction | 19 January 2026 |
| 5 December 2025 | Health | F 0656 | Resident Assessment and Care Planning Deficiencies | Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | F | No | Deficient, Provider has date of correction | 19 January 2026 |
| 5 December 2025 | Health | F 0676 | Quality of Life and Care Deficiencies | Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. | E | No | Deficient, Provider has date of correction | 19 January 2026 |
| 5 December 2025 | Health | F 0684 | Quality of Life and Care Deficiencies | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | D | No | Deficient, Provider has date of correction | 19 January 2026 |
| 5 December 2025 | Health | F 0699 | Quality of Life and Care Deficiencies | Provide care or services that was trauma informed and/or culturally competent. | D | No | Deficient, Provider has date of correction | 19 January 2026 |
| 5 December 2025 | Health | F 0732 | Nursing and Physician Services Deficiencies | Post nurse staffing information every day. | C | No | Deficient, Provider has date of correction | 19 January 2026 |
| 5 December 2025 | Health | F 0812 | Nutrition and Dietary Deficiencies | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | F | No | Deficient, Provider has date of correction | 19 January 2026 |
| 5 December 2025 | Health | F 0838 | Administration Deficiencies | Conduct and document a facility-wide assessment to determine what resources are necessary to care for residents competently during both day-to-day operations (including nights and weekends) and emergencies. | F | No | Deficient, Provider has date of correction | 19 January 2026 |
| 5 December 2025 | Health | F 0947 | Nursing and Physician Services Deficiencies | Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention. | F | No | Deficient, Provider has date of correction | 19 January 2026 |
| 22 November 2024 | Health | F 0550 | Resident Rights Deficiencies | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | D | No | Deficient, Provider has date of correction | 6 January 2025 |
| 22 November 2024 | Health | F 0700 | Quality of Life and Care Deficiencies | Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail. | E | No | Deficient, Provider has date of correction | 6 January 2025 |
| 22 November 2024 | Health | F 0727 | Nursing and Physician Services Deficiencies | Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis. | F | No | Deficient, Provider has date of correction | 6 January 2025 |
| 22 November 2024 | Health | F 0812 | Nutrition and Dietary Deficiencies | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | F | No | Deficient, Provider has date of correction | 6 January 2025 |
| 22 November 2024 | Health | F 0880 | Infection Control Deficiencies | Provide and implement an infection prevention and control program. | D | No | Deficient, Provider has date of correction | 6 January 2025 |
| 22 November 2024 | Health | F 0908 | Environmental Deficiencies | Keep all essential equipment working safely. | F | No | Deficient, Provider has date of correction | 6 January 2025 |
| 22 September 2023 | Health | F 0565 | Resident Rights Deficiencies | Honor the resident's right to organize and participate in resident/family groups in the facility. | E | No | Deficient, Provider has date of correction | 16 October 2023 |
| 22 September 2023 | Health | F 0568 | Resident Rights Deficiencies | Properly hold, secure, and manage each resident's personal money which is deposited with the nursing home. | E | No | Deficient, Provider has date of correction | 16 October 2023 |
| 22 September 2023 | Health | F 0604 | Freedom from Abuse, Neglect, and Exploitation Deficiencies | Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment. | D | No | Deficient, Provider has date of correction | 16 October 2023 |
| 22 September 2023 | Health | F 0641 | Resident Assessment and Care Planning Deficiencies | Ensure each resident receives an accurate assessment. | D | No | Deficient, Provider has date of correction | 1 December 2023 |
| 22 September 2023 | Health | F 0732 | Nursing and Physician Services Deficiencies | Post nurse staffing information every day. | F | No | Deficient, Provider has date of correction | 16 October 2023 |
| 22 September 2023 | Health | F 0760 | Pharmacy Service Deficiencies | Ensure that residents are free from significant medication errors. | D | No | Deficient, Provider has date of correction | 16 October 2023 |
| 22 September 2023 | Health | F 0800 | Nutrition and Dietary Deficiencies | Provide each resident with a nourishing, palatable, well-balanced diet that meets his or her daily nutritional and special dietary needs. | D | No | Deficient, Provider has date of correction | 16 October 2023 |
| 22 September 2023 | Health | F 0812 | Nutrition and Dietary Deficiencies | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | F | No | Deficient, Provider has date of correction | 16 October 2023 |
| 22 September 2023 | Health | F 0881 | Infection Control Deficiencies | Implement a program that monitors antibiotic use. | F | No | Deficient, Provider has date of correction | 16 October 2023 |
From the Care Compare health citations file NH_HealthCitations_Aug2026.csv, processed on 1 August 2026.
Penalties
Not yet extracted for this facility.
Care Compare provider information
| Field | As filed |
|---|---|
| Provider Type | Medicare and Medicaid |
| Ownership Type | Non profit - Corporation |
| Legal Business Name | Legal Business Name Not Available |
| Date First Approved to Provide Medicare and Medicaid Services | 1994-09-20 |
| Provider Resides in Hospital | N |
| Continuing Care Retirement Community | N |
| Urban | N |
| County/Parish | Kodiak Island |
| Telephone Number | 9074867800 |
| Provider Changed Ownership in Last 12 Months | N |
| With a Resident and Family Council | Resident |
| Automatic Sprinkler Systems in All Required Areas | Yes |
| Number of Certified Beds | 22 |
| Average Number of Residents per Day | 21.5 |
| Overall Rating | 3 |
| Health Inspection Rating | 2 |
| QM Rating | 5 |
| Long-Stay QM Rating | 5 |
| Processing Date | 2026-08-01 |
From the Care Compare Provider Information file NH_ProviderInfo_Aug2026.csv, processed on 1 August 2026.
Every change on this record
No change has appeared in the CMS files since this record began.
How to read this report
Every figure is printed as the CMS file it came from printed it. Each cost-report figure carries the worksheet, line and column of form CMS-2540 it was read from, so a reader holding the same public file can go to that cell; each Care Compare and Medicare enrollment section names its file and the date CMS stamped on it.
A figure the filing does not carry is left out, and so is a figure whose value the filing’s own arithmetic contradicts. Net income is printed with what the form’s own arithmetic shows about it — plainly where it follows from the lines above it, and at a stated confidence, saying what is left unaccounted for, where it does not. An ownership field left empty carries the dated sentence on CMS’s pause of the expanded Form CMS-855A disclosure. A source that holds nothing for this facility says so in its section.
This report carries no percentile and no score, and it does not place this facility above or below another. The five facilities above are the one comparison it draws: the nearest certified bed counts in the same state at the same fiscal year, listed by name. Nurse staffing is printed in its own section, on its own page, apart from the cost-report figures.
How to cite this report
Velarion Records, PROVIDENCE KODIAK ISLAND MED LTC — facility record report, CMS certification number 025030. https://velarionrecords.com/facility/025030/report.
- Provider information, inspections, deficiencies and penalties: CMS Care Compare, file dated 1 August 2026.
- Care Compare ownership: CMS file dated 1 August 2026.
- Medicare enrollment ownership: CMS file dated 1 August 2026.
- Nurse staffing: CMS Payroll-Based Journal, quarters 2022Q3 to 2025Q3.
Published by VELARIONAI LLC · Andrew Richardson, founder. Corrections: hello@velarionrecords.com, quoting certification number 025030. Velarion Records publishes these records as filed.
Nurse staffing, quarter by quarter
Hours this facility reported to CMS’s Payroll-Based Journal, one row per quarter, oldest first, each with how its figures are derived and the file it came from.
| Quarter | Quarter ended | Days reported | Resident days | Registered nurse hours | Licensed practical nurse hours | Nurse aide hours | Total nurse hours |
|---|---|---|---|---|---|---|---|
| 2022Q3 | 30 September 2022 | 92 | 1,898 | 2,063.87 | 907.88 | 8,733.65 | 11,705.4 |
| 2025Q2 | 30 June 2025 | 91 | 1,986 | 2,969.29 | 936.68 | 9,227.4 | 13,133.37 |
| 2025Q3 | 30 September 2025 | 92 | 1,999 | 2,976.39 | 773.39 | 9,818.1 | 13,567.88 |
| Quarter | Registered nurse hours per resident day | Licensed practical nurse hours per resident day | Nurse aide hours per resident day | Total nurse hours per resident day |
|---|---|---|---|---|
| 2022Q3 | 1.087392 | 0.478335 | 4.601502 | 6.167229 |
| 2025Q2 | 1.495111 | 0.471641 | 4.646224 | 6.612976 |
| 2025Q3 | 1.488939 | 0.386888 | 4.911506 | 6.787334 |
How each quarter is derived, and its file
- 2022Q3: From CMS file Payroll_Based_Journal_Daily_Nurse_Staffing_:_2022-09-30.csv: days_reported = distinct WorkDate rows for this PROVNUM and CY_Qtr; resident_days = sum of MDScensus over those days; hours = each Hrs_* column summed over those days; rn_hours = Hrs_RNDON + Hrs_RNadmin + Hrs_RN; lpn_hours = Hrs_LPNadmin + Hrs_LPN; aide_hours = Hrs_CNA + Hrs_NAtrn + Hrs_MedAide; total_nurse_hours = rn_hours + lpn_hours + aide_hours; each *_hprd = its hours / resident_days, rounded to 6 decimal places, null when resident_days is 0.
Payroll_Based_Journal_Daily_Nurse_Staffing_:_2022-09-30.csv - 2025Q2: From CMS file Payroll_Based_Journal_Daily_Nurse_Staffing_:_2025-04-01.csv: days_reported = distinct WorkDate rows for this PROVNUM and CY_Qtr; resident_days = sum of MDScensus over those days; hours = each Hrs_* column summed over those days; rn_hours = Hrs_RNDON + Hrs_RNadmin + Hrs_RN; lpn_hours = Hrs_LPNadmin + Hrs_LPN; aide_hours = Hrs_CNA + Hrs_NAtrn + Hrs_MedAide; total_nurse_hours = rn_hours + lpn_hours + aide_hours; each *_hprd = its hours / resident_days, rounded to 6 decimal places, null when resident_days is 0.
Payroll_Based_Journal_Daily_Nurse_Staffing_:_2025-04-01.csv - 2025Q3: From CMS file Payroll_Based_Journal_Daily_Nurse_Staffing_:_2025-07-01.csv: days_reported = distinct WorkDate rows for this PROVNUM and CY_Qtr; resident_days = sum of MDScensus over those days; hours = each Hrs_* column summed over those days; rn_hours = Hrs_RNDON + Hrs_RNadmin + Hrs_RN; lpn_hours = Hrs_LPNadmin + Hrs_LPN; aide_hours = Hrs_CNA + Hrs_NAtrn + Hrs_MedAide; total_nurse_hours = rn_hours + lpn_hours + aide_hours; each *_hprd = its hours / resident_days, rounded to 6 decimal places, null when resident_days is 0.
Payroll_Based_Journal_Daily_Nurse_Staffing_:_2025-07-01.csv