Arleigh Burke Pavilion - Mc Lean Nursing Home
General Information
UPDATEFederal Provider Number
495410
Provider Name
ARLEIGH BURKE PAVILION
Provider Address
1739 KIRBY ROAD
MC LEAN, VA 22101
MC LEAN, VA 22101
Provider Phone Number
(703) 506-6900
Provider SSA County
290
Provider County Name
Fairfax
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
49
Number of Residents in Certified Beds
48
Provider Type
Medicare
Provider Resides in Hospital
N
Legal Business Name
VINSON HALL LLC
Date First Approved to Provide Medicare and Medicaid services
2012-12-17
Continuing Care Retirement Community
Y
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Both
Automatic Sprinkler Systems in All Required Areas
Yes
Rating Detail Information
Overall Rating
5
Overall Rating Footnote
Health Inspection Rating
4
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
3.45417
Reported LPN Staffing Hours per Resident per Day
1.77708
Reported RN Staffing Hours per Resident per Day
0.79375
Reported Licensed Staffing Hours per Resident per Day
2.57083
Reported Total Nurse Staffing Hours per Resident per Day
6.02500
Reported Physical Therapist Staffing Hours per Resident Per Day
0.11875
Expected CNA Staffing Hours per Resident per Day
2.60791
Expected LPN Staffing Hours per Resident per Day
0.68969
Expected RN Staffing Hours per Resident per Day
1.12879
Expected Total Nurse Staffing Hours per Resident per Day
4.42639
Adjusted CNA Staffing Hours per Resident per Day
3.24991
Adjusted LPN Staffing Hours per Resident per Day
2.13860
Adjusted RN Staffing Hours per Resident per Day
0.52542
Adjusted Total Nurse Staffing Hours per Resident per Day
5.48667
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
32
Cycle 1 Standard Survey Health Date
2014-11-20
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
5
Cycle 2 Number of Standard Health Deficiencies
5
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
20
Cycle 2 Standard Health Survey Date
2013-12-12
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
20
Cycle 3 Total Number of Health Deficiencies
4
Cycle 3 Number of Standard Health Deficiencies
4
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
28
Cycle 3 Standard Health Survey Date
2012-11-16
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
28
Total Weighted Health Survey Score
27.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
0
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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