Washington Nursing Homes >> Mercer Island Nursing Homes >> Covenant Shores Health Center

Covenant Shores Health Center - Mercer Island Nursing Home

General Information

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Federal Provider Number
505504
Provider Name
COVENANT SHORES HEALTH CENTER
Provider Address
9107 FORTUNA DRIVE
MERCER ISLAND, WA 98040
Provider Phone Number
(206) 268-3039
Provider SSA County
160
Provider County Name
King
Provider Website
Provider Description
Ownership Type
Non profit - Church related
Number of Certified Beds
43
Number of Residents in Certified Beds
38
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
COVENANT RETIREMENT COMMUNITIES WEST
Date First Approved to Provide Medicare and Medicaid services
1997-09-04
Continuing Care Retirement Community
Y
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
5
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
4
Staffing Rating Footnote
RN Staffing Rating
5
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
3.05921
Reported LPN Staffing Hours per Resident per Day
0.29474
Reported RN Staffing Hours per Resident per Day
1.24605
Reported Licensed Staffing Hours per Resident per Day
1.54079
Reported Total Nurse Staffing Hours per Resident per Day
4.60000
Reported Physical Therapist Staffing Hours per Resident Per Day
0.16184
Expected CNA Staffing Hours per Resident per Day
2.62617
Expected LPN Staffing Hours per Resident per Day
0.63845
Expected RN Staffing Hours per Resident per Day
1.17964
Expected Total Nurse Staffing Hours per Resident per Day
4.44426
Adjusted CNA Staffing Hours per Resident per Day
2.85830
Adjusted LPN Staffing Hours per Resident per Day
0.38317
Adjusted RN Staffing Hours per Resident per Day
0.78927
Adjusted Total Nurse Staffing Hours per Resident per Day
4.17215
Cycle 1 Total Number of Health Deficiencies
8
Cycle 1 Number of Standard Health Deficiencies
8
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
36
Cycle 1 Standard Survey Health Date
2014-12-12
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
36
Cycle 2 Total Number of Health Deficiencies
13
Cycle 2 Number of Standard Health Deficiencies
9
Cycle 2 Number of Complaint Health Deficiencies
4
Cycle 2 Health Deficiency Score
84
Cycle 2 Standard Health Survey Date
2013-10-28
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
84
Cycle 3 Total Number of Health Deficiencies
6
Cycle 3 Number of Standard Health Deficiencies
5
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
36
Cycle 3 Standard Health Survey Date
2012-06-23
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
36
Total Weighted Health Survey Score
52.00000
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
6
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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