Crestmont North Nursing Home - Lakewood Nursing Home
General Information
UPDATEFederal Provider Number
365875
Provider Name
CRESTMONT NORTH NURSING HOME
Provider Address
13330 DETROIT AVE
LAKEWOOD, OH 44107
LAKEWOOD, OH 44107
Provider Phone Number
(216) 228-9550
Provider SSA County
170
Provider County Name
Cuyahoga
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
74
Number of Residents in Certified Beds
63
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
CRESTMONT NURSING HOME NORTH CORP.
Date First Approved to Provide Medicare and Medicaid services
1992-05-22
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
3
Health Inspection Rating Footnote
QM Rating
4
QM Rating Footnote
Staffing Rating
3
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
2.75317
Reported LPN Staffing Hours per Resident per Day
0.82540
Reported RN Staffing Hours per Resident per Day
0.73651
Reported Licensed Staffing Hours per Resident per Day
1.56190
Reported Total Nurse Staffing Hours per Resident per Day
4.31508
Reported Physical Therapist Staffing Hours per Resident Per Day
0.03651
Expected CNA Staffing Hours per Resident per Day
2.49199
Expected LPN Staffing Hours per Resident per Day
0.76263
Expected RN Staffing Hours per Resident per Day
1.29497
Expected Total Nurse Staffing Hours per Resident per Day
4.54959
Adjusted CNA Staffing Hours per Resident per Day
2.71087
Adjusted LPN Staffing Hours per Resident per Day
0.89832
Adjusted RN Staffing Hours per Resident per Day
0.42497
Adjusted Total Nurse Staffing Hours per Resident per Day
3.82313
Cycle 1 Total Number of Health Deficiencies
5
Cycle 1 Number of Standard Health Deficiencies
5
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
20
Cycle 1 Standard Survey Health Date
2014-12-17
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
20
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
0
Cycle 2 Standard Health Survey Date
2013-08-30
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
12
Cycle 3 Number of Standard Health Deficiencies
3
Cycle 3 Number of Complaint Health Deficiencies
9
Cycle 3 Health Deficiency Score
64
Cycle 3 Standard Health Survey Date
2012-05-17
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
64
Total Weighted Health Survey Score
20.66700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
5
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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