Crestline Nursing Center - Crestline Nursing Home
General Information
UPDATEFederal Provider Number
366002
Provider Name
CRESTLINE NURSING CENTER
Provider Address
327 WEST MAIN STREET
CRESTLINE, OH 44827
CRESTLINE, OH 44827
Provider Phone Number
(419) 683-3255
Provider SSA County
160
Provider County Name
Crawford
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
30
Number of Residents in Certified Beds
27
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
CRESTLINE FACILTY OPERATIONS, LLC
Date First Approved to Provide Medicare and Medicaid services
1995-06-08
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
3
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
2
QM Rating Footnote
Staffing Rating
1
Staffing Rating Footnote
RN Staffing Rating
1
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
1.69259
Reported LPN Staffing Hours per Resident per Day
0.73148
Reported RN Staffing Hours per Resident per Day
0.55741
Reported Licensed Staffing Hours per Resident per Day
1.28889
Reported Total Nurse Staffing Hours per Resident per Day
2.98148
Reported Physical Therapist Staffing Hours per Resident Per Day
0.03704
Expected CNA Staffing Hours per Resident per Day
2.64972
Expected LPN Staffing Hours per Resident per Day
0.88612
Expected RN Staffing Hours per Resident per Day
1.48279
Expected Total Nurse Staffing Hours per Resident per Day
5.01863
Adjusted CNA Staffing Hours per Resident per Day
1.56738
Adjusted LPN Staffing Hours per Resident per Day
0.68515
Adjusted RN Staffing Hours per Resident per Day
0.28089
Adjusted Total Nurse Staffing Hours per Resident per Day
2.39469
Cycle 1 Total Number of Health Deficiencies
6
Cycle 1 Number of Standard Health Deficiencies
6
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
24
Cycle 1 Standard Survey Health Date
2014-03-06
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
24
Cycle 2 Total Number of Health Deficiencies
1
Cycle 2 Number of Standard Health Deficiencies
1
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
4
Cycle 2 Standard Health Survey Date
2013-01-17
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
4
Cycle 3 Total Number of Health Deficiencies
1
Cycle 3 Number of Standard Health Deficiencies
1
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
4
Cycle 3 Standard Health Survey Date
2011-09-22
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
4
Total Weighted Health Survey Score
14.00000
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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