Pine Ridge Extended Care Center - Pagosa Springs Nursing Home
General Information
UPDATEFederal Provider Number
65366
Provider Name
PINE RIDGE EXTENDED CARE CENTER
Provider Address
119 BASTILLE DRIVE
PAGOSA SPRINGS, CO 81147
PAGOSA SPRINGS, CO 81147
Provider Phone Number
9707314330
Provider SSA County
30
Provider County Name
Archuleta
Ownership Type
For profit - Corporation
Number of Certified Beds
60
Number of Residents in Certified Beds
53
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
PINE RIDGE EXTEND CARE CENTER, LLC
Date First Approved to Provide Medicare and Medicaid services
1998-01-16
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
3
Health Inspection Rating Footnote
QM Rating
2
QM Rating Footnote
Staffing Rating
4
Staffing Rating Footnote
RN Staffing Rating
4
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.80283
Reported LPN Staffing Hours per Resident per Day
0.11321
Reported RN Staffing Hours per Resident per Day
0.66321
Reported Licensed Staffing Hours per Resident per Day
0.77642
Reported Total Nurse Staffing Hours per Resident per Day
3.57925
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00000
Expected CNA Staffing Hours per Resident per Day
2.20884
Expected LPN Staffing Hours per Resident per Day
0.62439
Expected RN Staffing Hours per Resident per Day
0.88712
Expected Total Nurse Staffing Hours per Resident per Day
3.72035
Adjusted CNA Staffing Hours per Resident per Day
3.11354
Adjusted LPN Staffing Hours per Resident per Day
0.15049
Adjusted RN Staffing Hours per Resident per Day
0.55860
Adjusted Total Nurse Staffing Hours per Resident per Day
3.87802
Cycle 1 Total Number of Health Deficiencies
7
Cycle 1 Number of Standard Health Deficiencies
7
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
64
Cycle 1 Standard Survey Health Date
2014-10-23
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
64
Cycle 2 Total Number of Health Deficiencies
13
Cycle 2 Number of Standard Health Deficiencies
13
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
68
Cycle 2 Standard Health Survey Date
2014-01-09
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
10
Cycle 3 Number of Standard Health Deficiencies
10
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
56
Cycle 3 Standard Health Survey Date
2012-10-18
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
56
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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