Envoy At The Village - Fork Union Nursing Home
General Information
UPDATEFederal Provider Number
495230
Provider Name
ENVOY AT THE VILLAGE
Provider Address
4238 JAMES MADSON HIGHWAY
FORK UNION, VA 23055
FORK UNION, VA 23055
Provider Phone Number
(434) 842-2916
Provider SSA County
320
Provider County Name
Fluvanna
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
60
Number of Residents in Certified Beds
57
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
ENVOY OF FORK UNION, LLC
Date First Approved to Provide Medicare and Medicaid services
1991-02-21
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
1
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
1
QM Rating Footnote
Staffing Rating
2
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
1.57544
Reported LPN Staffing Hours per Resident per Day
0.71053
Reported RN Staffing Hours per Resident per Day
0.64123
Reported Licensed Staffing Hours per Resident per Day
1.35175
Reported Total Nurse Staffing Hours per Resident per Day
2.92720
Reported Physical Therapist Staffing Hours per Resident Per Day
0.03421
Expected CNA Staffing Hours per Resident per Day
2.23621
Expected LPN Staffing Hours per Resident per Day
0.61991
Expected RN Staffing Hours per Resident per Day
0.97251
Expected Total Nurse Staffing Hours per Resident per Day
3.82863
Adjusted CNA Staffing Hours per Resident per Day
1.72866
Adjusted LPN Staffing Hours per Resident per Day
0.95134
Adjusted RN Staffing Hours per Resident per Day
0.49267
Adjusted Total Nurse Staffing Hours per Resident per Day
3.08185
Cycle 1 Total Number of Health Deficiencies
7
Cycle 1 Number of Standard Health Deficiencies
7
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
36
Cycle 1 Standard Survey Health Date
2015-02-05
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
36
Cycle 2 Total Number of Health Deficiencies
12
Cycle 2 Number of Standard Health Deficiencies
12
Cycle 2 Number of Complaint Health Deficiencies
6
Cycle 2 Health Deficiency Score
72
Cycle 2 Standard Health Survey Date
2014-01-28
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
72
Cycle 3 Total Number of Health Deficiencies
9
Cycle 3 Number of Standard Health Deficiencies
9
Cycle 3 Number of Complaint Health Deficiencies
9
Cycle 3 Health Deficiency Score
44
Cycle 3 Standard Health Survey Date
2013-01-16
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
44
Total Weighted Health Survey Score
49.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
6
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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