Hollis Park Manor Nursing Home - Hollis Nursing Home
General Information
UPDATEFederal Provider Number
335333
Provider Name
HOLLIS PARK MANOR NURSING HOME
Provider Address
191 06 HILLSIDE AVENUE
HOLLIS, NY 11423
HOLLIS, NY 11423
Provider Phone Number
7184791010
Provider SSA County
590
Provider County Name
Queens
Ownership Type
For profit - Corporation
Number of Certified Beds
80
Number of Residents in Certified Beds
77
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
HOLLIS PARK MANOR NURSING HOME, INC.
Date First Approved to Provide Medicare and Medicaid services
1971-09-14
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
4
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
1
Staffing Rating Footnote
RN Staffing Rating
2
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.03506
Reported LPN Staffing Hours per Resident per Day
0.89805
Reported RN Staffing Hours per Resident per Day
0.51494
Reported Licensed Staffing Hours per Resident per Day
1.41299
Reported Total Nurse Staffing Hours per Resident per Day
3.44805
Reported Physical Therapist Staffing Hours per Resident Per Day
0.08377
Expected CNA Staffing Hours per Resident per Day
2.50399
Expected LPN Staffing Hours per Resident per Day
0.64212
Expected RN Staffing Hours per Resident per Day
1.12848
Expected Total Nurse Staffing Hours per Resident per Day
4.27459
Adjusted CNA Staffing Hours per Resident per Day
1.99419
Adjusted LPN Staffing Hours per Resident per Day
1.16082
Adjusted RN Staffing Hours per Resident per Day
0.34096
Adjusted Total Nurse Staffing Hours per Resident per Day
3.25148
Cycle 1 Total Number of Health Deficiencies
3
Cycle 1 Number of Standard Health Deficiencies
3
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
16
Cycle 1 Standard Survey Health Date
2015-02-13
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
16
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
12
Cycle 2 Standard Health Survey Date
2014-04-18
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
3
Cycle 3 Number of Standard Health Deficiencies
3
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
12
Cycle 3 Standard Health Survey Date
2013-05-30
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
12
Total Weighted Health Survey Score
14.00000
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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