Countryside Conval Home Ltd Pa - Mercer Nursing Home
General Information
UPDATEFederal Provider Number
395879
Provider Name
COUNTRYSIDE CONVAL HOME LTD PA
Provider Address
8221 LAMOR ROAD
MERCER, PA 16137
MERCER, PA 16137
Provider Phone Number
(724) 662-5860
Provider SSA County
530
Provider County Name
Mercer
Provider Website
Provider Description
Ownership Type
For profit - Partnership
Number of Certified Beds
48
Number of Residents in Certified Beds
46
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
COUNTRYSIDE CONVALESCENT HOME LIMITED PARTNERSHIP
Date First Approved to Provide Medicare and Medicaid services
1992-09-11
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
3
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
2
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
1.96739
Reported LPN Staffing Hours per Resident per Day
0.56630
Reported RN Staffing Hours per Resident per Day
0.87826
Reported Licensed Staffing Hours per Resident per Day
1.44457
Reported Total Nurse Staffing Hours per Resident per Day
3.41195
Reported Physical Therapist Staffing Hours per Resident Per Day
0.06087
Expected CNA Staffing Hours per Resident per Day
2.65993
Expected LPN Staffing Hours per Resident per Day
0.66140
Expected RN Staffing Hours per Resident per Day
1.19210
Expected Total Nurse Staffing Hours per Resident per Day
4.51343
Adjusted CNA Staffing Hours per Resident per Day
1.81486
Adjusted LPN Staffing Hours per Resident per Day
0.71066
Adjusted RN Staffing Hours per Resident per Day
0.55049
Adjusted Total Nurse Staffing Hours per Resident per Day
3.04718
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
8
Cycle 1 Standard Survey Health Date
2015-02-13
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
3
Cycle 2 Number of Standard Health Deficiencies
3
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
28
Cycle 2 Standard Health Survey Date
2014-03-06
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
28
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
32
Cycle 3 Standard Health Survey Date
2013-02-08
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
32
Total Weighted Health Survey Score
18.66700
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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