Ashtabula County Nursing Home - Kingsville Nursing Home
General Information
UPDATEFederal Provider Number
365741
Provider Name
ASHTABULA COUNTY NURSING HOME
Provider Address
5740 DIBBLE ROAD
KINGSVILLE, OH 44048
KINGSVILLE, OH 44048
Provider Phone Number
(440) 224-2161
Provider SSA County
30
Provider County Name
Ashtabula
Provider Website
Provider Description
Ownership Type
Government - County
Number of Certified Beds
163
Number of Residents in Certified Beds
108
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
COUNTY OF ASHTABULA
Date First Approved to Provide Medicare and Medicaid services
1989-06-21
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
2
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
2
QM Rating Footnote
Staffing Rating
3
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
2.31157
Reported LPN Staffing Hours per Resident per Day
1.32917
Reported RN Staffing Hours per Resident per Day
0.68333
Reported Licensed Staffing Hours per Resident per Day
2.01250
Reported Total Nurse Staffing Hours per Resident per Day
4.32407
Reported Physical Therapist Staffing Hours per Resident Per Day
0.06435
Expected CNA Staffing Hours per Resident per Day
2.55753
Expected LPN Staffing Hours per Resident per Day
0.73517
Expected RN Staffing Hours per Resident per Day
1.20030
Expected Total Nurse Staffing Hours per Resident per Day
4.49299
Adjusted CNA Staffing Hours per Resident per Day
2.21773
Adjusted LPN Staffing Hours per Resident per Day
1.50063
Adjusted RN Staffing Hours per Resident per Day
0.42538
Adjusted Total Nurse Staffing Hours per Resident per Day
3.87935
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
16
Cycle 1 Standard Survey Health Date
2015-03-12
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
16
Cycle 2 Total Number of Health Deficiencies
11
Cycle 2 Number of Standard Health Deficiencies
11
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
56
Cycle 2 Standard Health Survey Date
2013-12-06
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
56
Cycle 3 Total Number of Health Deficiencies
6
Cycle 3 Number of Standard Health Deficiencies
6
Cycle 3 Number of Complaint Health Deficiencies
6
Cycle 3 Health Deficiency Score
40
Cycle 3 Standard Health Survey Date
2012-08-24
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
40
Total Weighted Health Survey Score
33.33300
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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