Boulevard Manor, Llc - Detroit Nursing Home
General Information
UPDATEFederal Provider Number
235242
Provider Name
BOULEVARD MANOR, LLC
Provider Address
464 E GRAND BLVD
DETROIT, MI 48207
DETROIT, MI 48207
Provider Phone Number
(313) 579-2255
Provider SSA County
810
Provider County Name
Wayne
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
87
Number of Residents in Certified Beds
81
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
BOULEVARD MANOR L.L.C.
Date First Approved to Provide Medicare and Medicaid services
1976-01-01
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
2
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
4
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
2.16481
Reported LPN Staffing Hours per Resident per Day
1.19877
Reported RN Staffing Hours per Resident per Day
0.47284
Reported Licensed Staffing Hours per Resident per Day
1.67160
Reported Total Nurse Staffing Hours per Resident per Day
3.83642
Reported Physical Therapist Staffing Hours per Resident Per Day
0.07963
Expected CNA Staffing Hours per Resident per Day
2.14671
Expected LPN Staffing Hours per Resident per Day
0.58360
Expected RN Staffing Hours per Resident per Day
0.88587
Expected Total Nurse Staffing Hours per Resident per Day
3.61619
Adjusted CNA Staffing Hours per Resident per Day
2.47438
Adjusted LPN Staffing Hours per Resident per Day
1.70489
Adjusted RN Staffing Hours per Resident per Day
0.39882
Adjusted Total Nurse Staffing Hours per Resident per Day
4.27639
Cycle 1 Total Number of Health Deficiencies
4
Cycle 1 Number of Standard Health Deficiencies
3
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
40
Cycle 1 Standard Survey Health Date
2014-08-07
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
40
Cycle 2 Total Number of Health Deficiencies
20
Cycle 2 Number of Standard Health Deficiencies
14
Cycle 2 Number of Complaint Health Deficiencies
6
Cycle 2 Health Deficiency Score
241
Cycle 2 Standard Health Survey Date
2013-07-12
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
241
Cycle 3 Total Number of Health Deficiencies
13
Cycle 3 Number of Standard Health Deficiencies
7
Cycle 3 Number of Complaint Health Deficiencies
6
Cycle 3 Health Deficiency Score
159
Cycle 3 Standard Health Survey Date
2012-06-15
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
159
Total Weighted Health Survey Score
126.83300
Number of Facility Reported Incidents
19
Number of Substantiated Complaints
12
Number of Fines
1
Total Amount of Fines in Dollars
14512
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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