Avalon By Otterbein Clearcreek - Centerville Nursing Home

General Information

UPDATE
Federal Provider Number
366368
Provider Name
AVALON BY OTTERBEIN CLEARCREEK
Provider Address
9320 AVALON CIRCLE
CENTERVILLE, OH 45458
Provider Phone Number
(937) 885-5426
Provider SSA County
840
Provider County Name
Warren
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
50
Number of Residents in Certified Beds
45
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
Legal Business Name Not Available
Date First Approved to Provide Medicare and Medicaid services
2008-11-10
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
5
Overall Rating Footnote
Health Inspection Rating
5
Health Inspection Rating Footnote
QM Rating
2
QM Rating Footnote
Staffing Rating
3
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
4.31889
Reported LPN Staffing Hours per Resident per Day
0.63556
Reported RN Staffing Hours per Resident per Day
0.58667
Reported Licensed Staffing Hours per Resident per Day
1.22222
Reported Total Nurse Staffing Hours per Resident per Day
5.54112
Reported Physical Therapist Staffing Hours per Resident Per Day
0.02667
Expected CNA Staffing Hours per Resident per Day
2.50647
Expected LPN Staffing Hours per Resident per Day
0.75205
Expected RN Staffing Hours per Resident per Day
1.40459
Expected Total Nurse Staffing Hours per Resident per Day
4.66311
Adjusted CNA Staffing Hours per Resident per Day
4.22795
Adjusted LPN Staffing Hours per Resident per Day
0.70144
Adjusted RN Staffing Hours per Resident per Day
0.31209
Adjusted Total Nurse Staffing Hours per Resident per Day
4.78987
Cycle 1 Total Number of Health Deficiencies
0
Cycle 1 Number of Standard Health Deficiencies
0
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
0
Cycle 1 Standard Survey Health Date
2015-02-19
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
0
Cycle 2 Total Number of Health Deficiencies
4
Cycle 2 Number of Standard Health Deficiencies
3
Cycle 2 Number of Complaint Health Deficiencies
4
Cycle 2 Health Deficiency Score
16
Cycle 2 Standard Health Survey Date
2013-11-14
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
16
Cycle 3 Total Number of Health Deficiencies
2
Cycle 3 Number of Standard Health Deficiencies
1
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
8
Cycle 3 Standard Health Survey Date
2012-08-09
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
8
Total Weighted Health Survey Score
6.66700
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
2
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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