Cumberland Valley Manor - Burkesville Nursing Home
General Information
UPDATEFederal Provider Number
185270
Provider Name
CUMBERLAND VALLEY MANOR
Provider Address
301 SOUTH MAIN STREET
BURKESVILLE, KY 42717
BURKESVILLE, KY 42717
Provider Phone Number
(270) 864-4315
Provider SSA County
271
Provider County Name
Cumberland
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
84
Number of Residents in Certified Beds
83
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
CUMBERLAND VALLEY MANOR, INC.
Date First Approved to Provide Medicare and Medicaid services
1991-06-19
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
2
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
1
QM Rating Footnote
Staffing Rating
4
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
3.37108
Reported LPN Staffing Hours per Resident per Day
0.65843
Reported RN Staffing Hours per Resident per Day
0.87470
Reported Licensed Staffing Hours per Resident per Day
1.53313
Reported Total Nurse Staffing Hours per Resident per Day
4.90421
Reported Physical Therapist Staffing Hours per Resident Per Day
0.06867
Expected CNA Staffing Hours per Resident per Day
2.62364
Expected LPN Staffing Hours per Resident per Day
0.70134
Expected RN Staffing Hours per Resident per Day
1.04239
Expected Total Nurse Staffing Hours per Resident per Day
4.36737
Adjusted CNA Staffing Hours per Resident per Day
3.15273
Adjusted LPN Staffing Hours per Resident per Day
0.77922
Adjusted RN Staffing Hours per Resident per Day
0.62700
Adjusted Total Nurse Staffing Hours per Resident per Day
4.52639
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
48
Cycle 1 Standard Survey Health Date
2014-02-20
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
48
Cycle 2 Total Number of Health Deficiencies
11
Cycle 2 Number of Standard Health Deficiencies
3
Cycle 2 Number of Complaint Health Deficiencies
8
Cycle 2 Health Deficiency Score
92
Cycle 2 Standard Health Survey Date
2013-05-09
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
92
Cycle 3 Total Number of Health Deficiencies
14
Cycle 3 Number of Standard Health Deficiencies
9
Cycle 3 Number of Complaint Health Deficiencies
5
Cycle 3 Health Deficiency Score
136
Cycle 3 Standard Health Survey Date
2012-02-16
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
136
Total Weighted Health Survey Score
77.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
3
Number of Fines
1
Total Amount of Fines in Dollars
3933
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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