Heritage Hall Blackstone - Blackstone Nursing Home
General Information
UPDATEFederal Provider Number
495353
Provider Name
HERITAGE HALL BLACKSTONE
Provider Address
900 S MAIN ST
BLACKSTONE, VA 23824
BLACKSTONE, VA 23824
Provider Phone Number
4342925301
Provider SSA County
670
Provider County Name
Nottoway
Ownership Type
For profit - Partnership
Number of Certified Beds
180
Number of Residents in Certified Beds
154
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
AMERICAN HEALTHCARE LLC
Date First Approved to Provide Medicare and Medicaid services
2001-10-01
Continuing Care Retirement Community
N
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
1
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
3
QM Rating Footnote
Staffing Rating
1
Staffing Rating Footnote
RN Staffing Rating
1
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.03247
Reported LPN Staffing Hours per Resident per Day
0.81526
Reported RN Staffing Hours per Resident per Day
0.36591
Reported Licensed Staffing Hours per Resident per Day
1.18117
Reported Total Nurse Staffing Hours per Resident per Day
3.21364
Reported Physical Therapist Staffing Hours per Resident Per Day
0.09968
Expected CNA Staffing Hours per Resident per Day
2.57744
Expected LPN Staffing Hours per Resident per Day
0.62744
Expected RN Staffing Hours per Resident per Day
0.97163
Expected Total Nurse Staffing Hours per Resident per Day
4.17651
Adjusted CNA Staffing Hours per Resident per Day
1.93490
Adjusted LPN Staffing Hours per Resident per Day
1.07845
Adjusted RN Staffing Hours per Resident per Day
0.28139
Adjusted Total Nurse Staffing Hours per Resident per Day
3.10160
Cycle 1 Total Number of Health Deficiencies
16
Cycle 1 Number of Standard Health Deficiencies
16
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
112
Cycle 1 Standard Survey Health Date
2015-02-27
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
112
Cycle 2 Total Number of Health Deficiencies
7
Cycle 2 Number of Standard Health Deficiencies
7
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
24
Cycle 2 Standard Health Survey Date
2014-02-19
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
2013-02-07
Cycle 3 Number of Health Revisits
0
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
0
Total Weighted Health Survey Score
64.00000
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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