Blackstone Nursing Home - Blackstone Nursing Home
General Information
UPDATEFederal Provider Number
225725
Provider Name
BLACKSTONE NURSING HOME
Provider Address
8 BUTLER STREET
BLACKSTONE, MA 1504
BLACKSTONE, MA 1504
Provider Phone Number
5088835818
Provider SSA County
170
Provider County Name
Worcester
Ownership Type
For profit - Corporation
Number of Certified Beds
33
Number of Residents in Certified Beds
25
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
8 BUTLER ST., INC.
Date First Approved to Provide Medicare and Medicaid services
1997-04-01
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
4
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
3
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
2.65400
Reported LPN Staffing Hours per Resident per Day
0.86600
Reported RN Staffing Hours per Resident per Day
0.64800
Reported Licensed Staffing Hours per Resident per Day
1.51400
Reported Total Nurse Staffing Hours per Resident per Day
4.16800
Reported Physical Therapist Staffing Hours per Resident Per Day
0.01400
Expected CNA Staffing Hours per Resident per Day
2.38918
Expected LPN Staffing Hours per Resident per Day
0.57250
Expected RN Staffing Hours per Resident per Day
0.74543
Expected Total Nurse Staffing Hours per Resident per Day
3.70711
Adjusted CNA Staffing Hours per Resident per Day
2.72568
Adjusted LPN Staffing Hours per Resident per Day
1.25550
Adjusted RN Staffing Hours per Resident per Day
0.64954
Adjusted Total Nurse Staffing Hours per Resident per Day
4.53205
Cycle 1 Total Number of Health Deficiencies
1
Cycle 1 Number of Standard Health Deficiencies
1
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
0
Cycle 1 Standard Survey Health Date
2014-10-23
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
5
Cycle 2 Number of Standard Health Deficiencies
4
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
20
Cycle 2 Standard Health Survey Date
2013-08-22
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
2
Cycle 3 Number of Standard Health Deficiencies
1
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
4
Cycle 3 Standard Health Survey Date
2012-07-12
Cycle 3 Number of Health Revisits
0
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
4
Total Weighted Health Survey Score
7.33300
Number of Facility Reported Incidents
2
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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