Andover Village Retirement Community - Andover Nursing Home
General Information
UPDATEFederal Provider Number
365411
Provider Name
ANDOVER VILLAGE RETIREMENT COMMUNITY
Provider Address
486 S MAIN ST
ANDOVER, OH 44003
ANDOVER, OH 44003
Provider Phone Number
4402935416
Provider SSA County
30
Provider County Name
Ashtabula
Ownership Type
For profit - Corporation
Number of Certified Beds
109
Number of Residents in Certified Beds
92
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
ANDOVER VILLAGE RETIREMENT COMMUNITY, LTD
Date First Approved to Provide Medicare and Medicaid services
1979-04-05
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
3
QM Rating Footnote
Staffing Rating
1
Staffing Rating Footnote
RN Staffing Rating
1
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
1.72120
Reported LPN Staffing Hours per Resident per Day
0.93913
Reported RN Staffing Hours per Resident per Day
0.44076
Reported Licensed Staffing Hours per Resident per Day
1.37989
Reported Total Nurse Staffing Hours per Resident per Day
3.10109
Reported Physical Therapist Staffing Hours per Resident Per Day
0.06196
Expected CNA Staffing Hours per Resident per Day
2.31492
Expected LPN Staffing Hours per Resident per Day
0.78552
Expected RN Staffing Hours per Resident per Day
1.40188
Expected Total Nurse Staffing Hours per Resident per Day
4.50231
Adjusted CNA Staffing Hours per Resident per Day
1.82439
Adjusted LPN Staffing Hours per Resident per Day
0.99230
Adjusted RN Staffing Hours per Resident per Day
0.23493
Adjusted Total Nurse Staffing Hours per Resident per Day
2.77639
Cycle 1 Total Number of Health Deficiencies
10
Cycle 1 Number of Standard Health Deficiencies
6
Cycle 1 Number of Complaint Health Deficiencies
4
Cycle 1 Health Deficiency Score
72
Cycle 1 Standard Survey Health Date
2015-02-05
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
72
Cycle 2 Total Number of Health Deficiencies
17
Cycle 2 Number of Standard Health Deficiencies
7
Cycle 2 Number of Complaint Health Deficiencies
10
Cycle 2 Health Deficiency Score
171
Cycle 2 Standard Health Survey Date
2013-10-24
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
18
Cycle 3 Number of Standard Health Deficiencies
14
Cycle 3 Number of Complaint Health Deficiencies
5
Cycle 3 Health Deficiency Score
92
Cycle 3 Standard Health Survey Date
2012-07-24
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
92
Total Weighted Health Survey Score
108.33300
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
29
Number of Fines
1
Total Amount of Fines in Dollars
12155
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
Nursiong Homes Nearby
Jefferson Healthcare Center
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Eagle Pointe Skilled Nursing & Rehab
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Austinburg Nsg And Rehab Ctr
2026 State Route 45 |
AUSTINBURG OH 44010 | 18.9 miles away
Ashtabula County Nursing Home
5740 Dibble Road |
KINGSVILLE OH 44048 | 20.5 miles away
Ashtabula County Medical Cente
2420 Lake Avenue |
ASHTABULA OH 44004 | 22.4 miles away
Country Club Ret Center I I I
925 E 26th St |
ASHTABULA OH 44004 | 22.4 miles away
Carington Park
2217 West Ave |
ASHTABULA OH 44004 | 22.7 miles away
Pine Grove Healthcare Center
840 Sherman Street |
GENEVA OH 44041 | 23.3 miles away
Geneva Village Retirement Community, Ltd
1140 South Broadway |
GENEVA OH 44041 | 23.4 miles away
Saybrook Landing
2300 Center Road |
ASHTABULA OH 44004 | 24.2 miles away
Lake Pointe Rehabilitation And Nursing Center
22 Parrish Road |
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Geneva Shores Nursing And Rehab
60 West St |
GENEVA OH 44041 | 24.3 miles away
Rae Ann Geneva
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GENEVA OH 44041 | 24.3 miles away
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