Andover Subacute And Rehab Ii - Andover Nursing Home
General Information
UPDATEFederal Provider Number
315248
Provider Name
ANDOVER SUBACUTE AND REHAB II
Provider Address
99 MULFORD ROAD
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
543
Number of Residents in Certified Beds
505
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
ANDOVER REHAB CENTER SERVICES TWO INC
Date First Approved to Provide Medicare and Medicaid services
1987-12-01
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
1
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
2
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
2.17653
Reported LPN Staffing Hours per Resident per Day
0.37267
Reported RN Staffing Hours per Resident per Day
0.32386
Reported Licensed Staffing Hours per Resident per Day
0.69653
Reported Total Nurse Staffing Hours per Resident per Day
2.87306
Reported Physical Therapist Staffing Hours per Resident Per Day
0.01020
Expected CNA Staffing Hours per Resident per Day
2.01117
Expected LPN Staffing Hours per Resident per Day
0.54759
Expected RN Staffing Hours per Resident per Day
0.75092
Expected Total Nurse Staffing Hours per Resident per Day
3.30968
Adjusted CNA Staffing Hours per Resident per Day
2.65544
Adjusted LPN Staffing Hours per Resident per Day
0.56487
Adjusted RN Staffing Hours per Resident per Day
0.32226
Adjusted Total Nurse Staffing Hours per Resident per Day
3.49913
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
2014-08-05
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
20
Cycle 2 Total Number of Health Deficiencies
14
Cycle 2 Number of Standard Health Deficiencies
10
Cycle 2 Number of Complaint Health Deficiencies
6
Cycle 2 Health Deficiency Score
100
Cycle 2 Standard Health Survey Date
2013-08-20
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
100
Cycle 3 Total Number of Health Deficiencies
6
Cycle 3 Number of Standard Health Deficiencies
4
Cycle 3 Number of Complaint Health Deficiencies
2
Cycle 3 Health Deficiency Score
161
Cycle 3 Standard Health Survey Date
2012-07-26
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
161
Total Weighted Health Survey Score
70.16700
Number of Facility Reported Incidents
6
Number of Substantiated Complaints
9
Number of Fines
1
Total Amount of Fines in Dollars
1788
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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