Uintah Basin Rehabilitation And Senior Villa - Roosevelt Nursing Home
General Information
UPDATEFederal Provider Number
465084
Provider Name
UINTAH BASIN REHABILITATION AND SENIOR VILLA
Provider Address
265 NORTH 300 WEST
ROOSEVELT, UT 84066
ROOSEVELT, UT 84066
Provider Phone Number
4357222497
Provider SSA County
60
Provider County Name
Duchesne
Ownership Type
Non profit - Corporation
Number of Certified Beds
90
Number of Residents in Certified Beds
69
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
Y
Legal Business Name
BASIN CARE AND REHABILITATION CENTER
Date First Approved to Provide Medicare and Medicaid services
1981-10-01
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
3
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
1
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
2.75145
Reported LPN Staffing Hours per Resident per Day
0.80217
Reported RN Staffing Hours per Resident per Day
0.80217
Reported Licensed Staffing Hours per Resident per Day
1.60435
Reported Total Nurse Staffing Hours per Resident per Day
4.35579
Reported Physical Therapist Staffing Hours per Resident Per Day
0.08261
Expected CNA Staffing Hours per Resident per Day
2.56807
Expected LPN Staffing Hours per Resident per Day
0.74674
Expected RN Staffing Hours per Resident per Day
1.13534
Expected Total Nurse Staffing Hours per Resident per Day
4.45015
Adjusted CNA Staffing Hours per Resident per Day
2.62892
Adjusted LPN Staffing Hours per Resident per Day
0.89161
Adjusted RN Staffing Hours per Resident per Day
0.52793
Adjusted Total Nurse Staffing Hours per Resident per Day
3.94543
Cycle 1 Total Number of Health Deficiencies
4
Cycle 1 Number of Standard Health Deficiencies
4
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
20
Cycle 1 Standard Survey Health Date
2014-07-17
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
20
Cycle 2 Total Number of Health Deficiencies
9
Cycle 2 Number of Standard Health Deficiencies
9
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
52
Cycle 2 Standard Health Survey Date
2013-06-05
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
16
Cycle 3 Number of Standard Health Deficiencies
16
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
136
Cycle 3 Standard Health Survey Date
2011-09-15
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
136
Total Weighted Health Survey Score
50.00000
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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