Grace Brethren Village - Englewood Nursing Home
General Information
UPDATEFederal Provider Number
366263
Provider Name
GRACE BRETHREN VILLAGE
Provider Address
1010 TAYWOOD ROAD
ENGLEWOOD, OH 45322
ENGLEWOOD, OH 45322
Provider Phone Number
9378364011
Provider SSA County
580
Provider County Name
Montgomery
Ownership Type
Non profit - Corporation
Number of Certified Beds
45
Number of Residents in Certified Beds
37
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
GRACE BRETHREN VILLAGE INC.
Date First Approved to Provide Medicare and Medicaid services
2003-04-07
Continuing Care Retirement Community
Y
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Resident
Automatic Sprinkler Systems in All Required Areas
Yes
Rating Detail Information
Overall Rating
5
Overall Rating Footnote
Health Inspection Rating
5
Health Inspection Rating Footnote
QM Rating
3
QM Rating Footnote
Staffing Rating
3
Staffing Rating Footnote
RN Staffing Rating
3
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.51081
Reported LPN Staffing Hours per Resident per Day
0.92162
Reported RN Staffing Hours per Resident per Day
0.61216
Reported Licensed Staffing Hours per Resident per Day
1.53378
Reported Total Nurse Staffing Hours per Resident per Day
4.04459
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00811
Expected CNA Staffing Hours per Resident per Day
2.43312
Expected LPN Staffing Hours per Resident per Day
0.61659
Expected RN Staffing Hours per Resident per Day
0.95327
Expected Total Nurse Staffing Hours per Resident per Day
4.00298
Adjusted CNA Staffing Hours per Resident per Day
2.53205
Adjusted LPN Staffing Hours per Resident per Day
1.24060
Adjusted RN Staffing Hours per Resident per Day
0.47983
Adjusted Total Nurse Staffing Hours per Resident per Day
4.07280
Cycle 1 Total Number of Health Deficiencies
1
Cycle 1 Number of Standard Health Deficiencies
1
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
8
Cycle 1 Standard Survey Health Date
2014-12-31
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
8
Cycle 2 Total Number of Health Deficiencies
2
Cycle 2 Number of Standard Health Deficiencies
2
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
8
Cycle 2 Standard Health Survey Date
2013-11-21
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
0
Cycle 3 Number of Standard Health Deficiencies
0
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
0
Cycle 3 Standard Health Survey Date
2012-08-09
Cycle 3 Number of Health Revisits
0
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
0
Total Weighted Health Survey Score
6.66700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
0
Number of Fines
0
Total Amount of Fines in Dollars
0
Number of Payment Denials
0
Total Number of Penalties
0
Location
Processing Date
2015-06-01
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