Boulder Park Terrace - Charlevoix Nursing Home
General Information
UPDATEFederal Provider Number
235526
Provider Name
BOULDER PARK TERRACE
Provider Address
14676 W UPRIGHT
CHARLEVOIX, MI 49720
CHARLEVOIX, MI 49720
Provider Phone Number
(231) 547-1005
Provider SSA County
140
Provider County Name
Charlevoix
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
61
Number of Residents in Certified Beds
51
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
CHARLEVOIX NURSING HOME CORPORATION
Date First Approved to Provide Medicare and Medicaid services
1992-08-14
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
4
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
3.11471
Reported LPN Staffing Hours per Resident per Day
0.62451
Reported RN Staffing Hours per Resident per Day
1.14118
Reported Licensed Staffing Hours per Resident per Day
1.76569
Reported Total Nurse Staffing Hours per Resident per Day
4.88040
Reported Physical Therapist Staffing Hours per Resident Per Day
0.11176
Expected CNA Staffing Hours per Resident per Day
2.33233
Expected LPN Staffing Hours per Resident per Day
0.71906
Expected RN Staffing Hours per Resident per Day
1.20859
Expected Total Nurse Staffing Hours per Resident per Day
4.25998
Adjusted CNA Staffing Hours per Resident per Day
3.27680
Adjusted LPN Staffing Hours per Resident per Day
0.72086
Adjusted RN Staffing Hours per Resident per Day
0.70553
Adjusted Total Nurse Staffing Hours per Resident per Day
4.61796
Cycle 1 Total Number of Health Deficiencies
2
Cycle 1 Number of Standard Health Deficiencies
1
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
8
Cycle 1 Standard Survey Health Date
2014-02-27
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
8
Cycle 2 Total Number of Health Deficiencies
4
Cycle 2 Number of Standard Health Deficiencies
4
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
32
Cycle 2 Standard Health Survey Date
2012-12-12
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
32
Cycle 3 Total Number of Health Deficiencies
5
Cycle 3 Number of Standard Health Deficiencies
5
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
40
Cycle 3 Standard Health Survey Date
2011-10-05
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
40
Total Weighted Health Survey Score
21.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
1
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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