Angela Jane Pavilion - Philadelphia Nursing Home
General Information
UPDATEFederal Provider Number
396070
Provider Name
ANGELA JANE PAVILION
Provider Address
8410 ROOSEVELT BLVD
PHILADELPHIA, PA 19152
PHILADELPHIA, PA 19152
Provider Phone Number
2157081200
Provider SSA County
620
Provider County Name
Philadelphia
Ownership Type
For profit - Partnership
Number of Certified Beds
49
Number of Residents in Certified Beds
40
Provider Type
Medicare
Provider Resides in Hospital
N
Legal Business Name
TRINITY TRANSITION ASSOCIATES
Date First Approved to Provide Medicare and Medicaid services
2000-05-18
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
None
Automatic Sprinkler Systems in All Required Areas
Yes
Rating Detail Information
Overall Rating
4
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
2
QM Rating Footnote
Staffing Rating
4
Staffing Rating Footnote
RN Staffing Rating
3
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.20000
Reported LPN Staffing Hours per Resident per Day
2.20000
Reported RN Staffing Hours per Resident per Day
1.17125
Reported Licensed Staffing Hours per Resident per Day
3.37125
Reported Total Nurse Staffing Hours per Resident per Day
5.57125
Reported Physical Therapist Staffing Hours per Resident Per Day
0.42875
Expected CNA Staffing Hours per Resident per Day
2.52522
Expected LPN Staffing Hours per Resident per Day
0.82483
Expected RN Staffing Hours per Resident per Day
1.88546
Expected Total Nurse Staffing Hours per Resident per Day
5.23550
Adjusted CNA Staffing Hours per Resident per Day
2.13769
Adjusted LPN Staffing Hours per Resident per Day
2.21380
Adjusted RN Staffing Hours per Resident per Day
0.46416
Adjusted Total Nurse Staffing Hours per Resident per Day
4.28940
Cycle 1 Total Number of Health Deficiencies
2
Cycle 1 Number of Standard Health Deficiencies
2
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
8
Cycle 1 Standard Survey Health Date
2015-03-05
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
8
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
2014-01-15
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
3
Cycle 3 Number of Standard Health Deficiencies
3
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
24
Cycle 3 Standard Health Survey Date
2013-03-06
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
24
Total Weighted Health Survey Score
9.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
1
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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