Andover Subacute And Rehab I - Andover Nursing Home
General Information
UPDATEFederal Provider Number
315044
Provider Name
ANDOVER SUBACUTE AND REHAB I
Provider Address
1 O'BRIEN LANE
ANDOVER, NJ 7821
ANDOVER, NJ 7821
Provider Phone Number
(973) 383-6200
Provider SSA County
360
Provider County Name
Sussex
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
159
Number of Residents in Certified Beds
124
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
ANDOVER SUBACUTE & REHAB CENTER SERVICES ONE INC
Date First Approved to Provide Medicare and Medicaid services
1967-01-01
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
5
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
5
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
2.59395
Reported LPN Staffing Hours per Resident per Day
0.44153
Reported RN Staffing Hours per Resident per Day
0.63266
Reported Licensed Staffing Hours per Resident per Day
1.07419
Reported Total Nurse Staffing Hours per Resident per Day
3.66814
Reported Physical Therapist Staffing Hours per Resident Per Day
0.04960
Expected CNA Staffing Hours per Resident per Day
2.29198
Expected LPN Staffing Hours per Resident per Day
0.57840
Expected RN Staffing Hours per Resident per Day
0.86911
Expected Total Nurse Staffing Hours per Resident per Day
3.73949
Adjusted CNA Staffing Hours per Resident per Day
2.77698
Adjusted LPN Staffing Hours per Resident per Day
0.63360
Adjusted RN Staffing Hours per Resident per Day
0.54391
Adjusted Total Nurse Staffing Hours per Resident per Day
3.95399
Cycle 1 Total Number of Health Deficiencies
6
Cycle 1 Number of Standard Health Deficiencies
6
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
24
Cycle 1 Standard Survey Health Date
2014-09-10
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
24
Cycle 2 Total Number of Health Deficiencies
1
Cycle 2 Number of Standard Health Deficiencies
1
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
4
Cycle 2 Standard Health Survey Date
2013-07-29
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
4
Cycle 3 Total Number of Health Deficiencies
5
Cycle 3 Number of Standard Health Deficiencies
1
Cycle 3 Number of Complaint Health Deficiencies
4
Cycle 3 Health Deficiency Score
64
Cycle 3 Standard Health Survey Date
2012-07-03
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
64
Total Weighted Health Survey Score
24.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
2
Number of Fines
1
Total Amount of Fines in Dollars
80535
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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