Crestwood Care Center - Shelby Nursing Home
General Information
UPDATEFederal Provider Number
365284
Provider Name
CRESTWOOD CARE CENTER
Provider Address
225 W MAIN STREET
SHELBY, OH 44875
SHELBY, OH 44875
Provider Phone Number
4193471266
Provider SSA County
710
Provider County Name
Richland
Ownership Type
For profit - Corporation
Number of Certified Beds
130
Number of Residents in Certified Beds
120
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
MIDLAND LEASING CO., LLC
Date First Approved to Provide Medicare and Medicaid services
1972-05-09
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
Yes
Rating Detail Information
Overall Rating
2
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
1
Staffing Rating Footnote
RN Staffing Rating
2
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.23333
Reported LPN Staffing Hours per Resident per Day
0.73917
Reported RN Staffing Hours per Resident per Day
0.53375
Reported Licensed Staffing Hours per Resident per Day
1.27292
Reported Total Nurse Staffing Hours per Resident per Day
3.50625
Reported Physical Therapist Staffing Hours per Resident Per Day
0.01625
Expected CNA Staffing Hours per Resident per Day
2.64791
Expected LPN Staffing Hours per Resident per Day
0.72543
Expected RN Staffing Hours per Resident per Day
1.14297
Expected Total Nurse Staffing Hours per Resident per Day
4.51630
Adjusted CNA Staffing Hours per Resident per Day
2.06953
Adjusted LPN Staffing Hours per Resident per Day
0.84572
Adjusted RN Staffing Hours per Resident per Day
0.34893
Adjusted Total Nurse Staffing Hours per Resident per Day
3.12940
Cycle 1 Total Number of Health Deficiencies
3
Cycle 1 Number of Standard Health Deficiencies
3
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
24
Cycle 1 Standard Survey Health Date
2015-01-15
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
10
Cycle 2 Number of Standard Health Deficiencies
9
Cycle 2 Number of Complaint Health Deficiencies
3
Cycle 2 Health Deficiency Score
52
Cycle 2 Standard Health Survey Date
2013-10-03
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
5
Cycle 3 Number of Standard Health Deficiencies
5
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
16
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
16
Total Weighted Health Survey Score
32.00000
Number of Facility Reported Incidents
0
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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