Wickliffe Country Place - Wickliffe Nursing Home
General Information
UPDATEFederal Provider Number
365381
Provider Name
WICKLIFFE COUNTRY PLACE
Provider Address
1919 BISHOP RD
WICKLIFFE, OH 44092
WICKLIFFE, OH 44092
Provider Phone Number
4409449400
Provider SSA County
440
Provider County Name
Lake
Ownership Type
For profit - Corporation
Number of Certified Beds
170
Number of Residents in Certified Beds
137
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
3G OPERATING COMPANY LLC
Date First Approved to Provide Medicare and Medicaid services
1978-07-13
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
2
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
3
QM Rating Footnote
Staffing Rating
2
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
2.20328
Reported LPN Staffing Hours per Resident per Day
1.12701
Reported RN Staffing Hours per Resident per Day
0.61825
Reported Licensed Staffing Hours per Resident per Day
1.74526
Reported Total Nurse Staffing Hours per Resident per Day
3.94854
Reported Physical Therapist Staffing Hours per Resident Per Day
0.11058
Expected CNA Staffing Hours per Resident per Day
2.46475
Expected LPN Staffing Hours per Resident per Day
0.75842
Expected RN Staffing Hours per Resident per Day
1.28884
Expected Total Nurse Staffing Hours per Resident per Day
4.51202
Adjusted CNA Staffing Hours per Resident per Day
2.19340
Adjusted LPN Staffing Hours per Resident per Day
1.23337
Adjusted RN Staffing Hours per Resident per Day
0.35843
Adjusted Total Nurse Staffing Hours per Resident per Day
3.52751
Cycle 1 Total Number of Health Deficiencies
7
Cycle 1 Number of Standard Health Deficiencies
4
Cycle 1 Number of Complaint Health Deficiencies
7
Cycle 1 Health Deficiency Score
32
Cycle 1 Standard Survey Health Date
2014-12-17
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
32
Cycle 2 Total Number of Health Deficiencies
0
Cycle 2 Number of Standard Health Deficiencies
0
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
0
Cycle 2 Standard Health Survey Date
2013-11-27
Cycle 2 Number of Health Revisits
0
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
8
Cycle 3 Number of Standard Health Deficiencies
6
Cycle 3 Number of Complaint Health Deficiencies
2
Cycle 3 Health Deficiency Score
107
Cycle 3 Standard Health Survey Date
2012-09-21
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
107
Total Weighted Health Survey Score
33.83300
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
6
Number of Fines
1
Total Amount of Fines in Dollars
3250
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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Homestead I
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Madison Health Care
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