Avalon Care Center - Honolulu, Llc - Honolulu Nursing Home
General Information
Update InformationReport Incorrect Information
Federal Provider Number
125020
Provider Name
AVALON CARE CENTER - HONOLULU, LLC
Provider Address
1930 KAMEHAMEHA IV RD
HONOLULU, HI 96819
HONOLULU, HI 96819
Provider Phone Number
(808) 847-4834
Provider SSA County
20
Provider County Name
Honolulu
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
108
Number of Residents in Certified Beds
102
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
AVALON CARE CENTER - HONOLULU, LLC
Date First Approved to Provide Medicare and Medicaid services
1971-01-26
Continuing Care Retirement Community
N
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
5
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
3
Staffing Rating Footnote
RN Staffing Rating
5
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.44020
Reported LPN Staffing Hours per Resident per Day
0.20588
Reported RN Staffing Hours per Resident per Day
1.15343
Reported Licensed Staffing Hours per Resident per Day
1.35931
Reported Total Nurse Staffing Hours per Resident per Day
3.79951
Reported Physical Therapist Staffing Hours per Resident Per Day
0.11716
Expected CNA Staffing Hours per Resident per Day
2.73978
Expected LPN Staffing Hours per Resident per Day
0.65578
Expected RN Staffing Hours per Resident per Day
1.08298
Expected Total Nurse Staffing Hours per Resident per Day
4.47854
Adjusted CNA Staffing Hours per Resident per Day
2.18540
Adjusted LPN Staffing Hours per Resident per Day
0.26058
Adjusted RN Staffing Hours per Resident per Day
0.79581
Adjusted Total Nurse Staffing Hours per Resident per Day
3.41974
Cycle 1 Total Number of Health Deficiencies
3
Cycle 1 Number of Standard Health Deficiencies
3
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
12
Cycle 1 Standard Survey Health Date
2014-01-10
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
12
Cycle 2 Total Number of Health Deficiencies
2
Cycle 2 Number of Standard Health Deficiencies
2
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
8
Cycle 2 Standard Health Survey Date
2012-09-18
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
8
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
20
Cycle 3 Standard Health Survey Date
2011-04-15
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
20
Total Weighted Health Survey Score
12.00000
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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