Derby Green Nursing Home - Derby Nursing Home
General Information
UPDATEFederal Provider Number
475048
Provider Name
DERBY GREEN NURSING HOME
Provider Address
PO BOX 24
DERBY, VT 5829
DERBY, VT 5829
Provider Phone Number
(802) 766-2201
Provider SSA County
90
Provider County Name
Orleans
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
23
Number of Residents in Certified Beds
23
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
NORTH COUNTRY HEALTH SERVICES INC
Date First Approved to Provide Medicare and Medicaid services
1994-05-12
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
5
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
5
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
2.40000
Reported LPN Staffing Hours per Resident per Day
0.67391
Reported RN Staffing Hours per Resident per Day
0.66957
Reported Licensed Staffing Hours per Resident per Day
1.34348
Reported Total Nurse Staffing Hours per Resident per Day
3.74348
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00000
Expected CNA Staffing Hours per Resident per Day
2.52978
Expected LPN Staffing Hours per Resident per Day
0.56493
Expected RN Staffing Hours per Resident per Day
0.71428
Expected Total Nurse Staffing Hours per Resident per Day
3.80899
Adjusted CNA Staffing Hours per Resident per Day
2.32782
Adjusted LPN Staffing Hours per Resident per Day
0.99012
Adjusted RN Staffing Hours per Resident per Day
0.70043
Adjusted Total Nurse Staffing Hours per Resident per Day
3.96158
Cycle 1 Total Number of Health Deficiencies
2
Cycle 1 Number of Standard Health Deficiencies
2
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
8
Cycle 1 Standard Survey Health Date
2014-05-07
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
8
Cycle 2 Total Number of Health Deficiencies
4
Cycle 2 Number of Standard Health Deficiencies
1
Cycle 2 Number of Complaint Health Deficiencies
3
Cycle 2 Health Deficiency Score
16
Cycle 2 Standard Health Survey Date
2013-03-20
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
16
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
2012-04-25
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
16
Total Weighted Health Survey Score
12.00000
Number of Facility Reported Incidents
11
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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