Edgewood Manor Nursing Center - Port Clinton Nursing Home
General Information
UPDATEFederal Provider Number
365489
Provider Name
EDGEWOOD MANOR NURSING CENTER
Provider Address
1330 S FULTON ST
PORT CLINTON, OH 43452
PORT CLINTON, OH 43452
Provider Phone Number
(419) 734-5506
Provider SSA County
630
Provider County Name
Ottawa
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
80
Number of Residents in Certified Beds
70
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
COVENANT CARE OHIO, INC.
Date First Approved to Provide Medicare and Medicaid services
1980-05-19
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
5
Overall Rating Footnote
Health Inspection Rating
5
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
3
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
2.39786
Reported LPN Staffing Hours per Resident per Day
0.62714
Reported RN Staffing Hours per Resident per Day
0.80214
Reported Licensed Staffing Hours per Resident per Day
1.42929
Reported Total Nurse Staffing Hours per Resident per Day
3.82714
Reported Physical Therapist Staffing Hours per Resident Per Day
0.07429
Expected CNA Staffing Hours per Resident per Day
2.67017
Expected LPN Staffing Hours per Resident per Day
0.67295
Expected RN Staffing Hours per Resident per Day
1.11496
Expected Total Nurse Staffing Hours per Resident per Day
4.45808
Adjusted CNA Staffing Hours per Resident per Day
2.20346
Adjusted LPN Staffing Hours per Resident per Day
0.77350
Adjusted RN Staffing Hours per Resident per Day
0.53756
Adjusted Total Nurse Staffing Hours per Resident per Day
3.46042
Cycle 1 Total Number of Health Deficiencies
1
Cycle 1 Number of Standard Health Deficiencies
1
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
4
Cycle 1 Standard Survey Health Date
2014-12-11
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
4
Cycle 2 Total Number of Health Deficiencies
3
Cycle 2 Number of Standard Health Deficiencies
3
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
12
Cycle 2 Standard Health Survey Date
2013-08-29
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
12
Cycle 3 Total Number of Health Deficiencies
0
Cycle 3 Number of Standard Health Deficiencies
0
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
0
Cycle 3 Standard Health Survey Date
2012-06-07
Cycle 3 Number of Health Revisits
0
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
0
Total Weighted Health Survey Score
6.00000
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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