Clove Lakes Health Care And Rehabilitation Center - Staten Island Nursing Home
General Information
UPDATEFederal Provider Number
335239
Provider Name
CLOVE LAKES HEALTH CARE AND REHABILITATION CENTER
Provider Address
25 FANNING STREET
STATEN ISLAND, NY 10314
STATEN ISLAND, NY 10314
Provider Phone Number
(718) 289-7900
Provider SSA County
610
Provider County Name
Richmond
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
576
Number of Residents in Certified Beds
511
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
CLOVE LAKES HEALTH CARE AND REHABILITATION CENTER INC.
Date First Approved to Provide Medicare and Medicaid services
1969-06-25
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
Partial
Rating Detail Information
Overall Rating
5
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
3
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
2.43992
Reported LPN Staffing Hours per Resident per Day
0.59012
Reported RN Staffing Hours per Resident per Day
0.95636
Reported Licensed Staffing Hours per Resident per Day
1.54648
Reported Total Nurse Staffing Hours per Resident per Day
3.98640
Reported Physical Therapist Staffing Hours per Resident Per Day
0.12691
Expected CNA Staffing Hours per Resident per Day
2.70226
Expected LPN Staffing Hours per Resident per Day
0.71797
Expected RN Staffing Hours per Resident per Day
1.17311
Expected Total Nurse Staffing Hours per Resident per Day
4.59334
Adjusted CNA Staffing Hours per Resident per Day
2.21549
Adjusted LPN Staffing Hours per Resident per Day
0.68220
Adjusted RN Staffing Hours per Resident per Day
0.60914
Adjusted Total Nurse Staffing Hours per Resident per Day
3.49828
Cycle 1 Total Number of Health Deficiencies
1
Cycle 1 Number of Standard Health Deficiencies
0
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
4
Cycle 1 Standard Survey Health Date
2014-08-18
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
4
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
24
Cycle 2 Standard Health Survey Date
2013-08-09
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
24
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
24
Cycle 3 Standard Health Survey Date
2012-07-19
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
24
Total Weighted Health Survey Score
14.00000
Number of Facility Reported Incidents
3
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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