Evangelical Manor - Philadelphia Nursing Home
General Information
UPDATEFederal Provider Number
395413
Provider Name
EVANGELICAL MANOR
Provider Address
8401 ROOSEVELT BOULEVARD
PHILADELPHIA, PA 19152
PHILADELPHIA, PA 19152
Provider Phone Number
2156245800
Provider SSA County
620
Provider County Name
Philadelphia
Ownership Type
Non profit - Corporation
Number of Certified Beds
120
Number of Residents in Certified Beds
116
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
EVANGELICAL MANOR
Date First Approved to Provide Medicare and Medicaid services
1978-09-01
Continuing Care Retirement Community
Y
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
4
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
3
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
2.26466
Reported LPN Staffing Hours per Resident per Day
0.82759
Reported RN Staffing Hours per Resident per Day
0.51983
Reported Licensed Staffing Hours per Resident per Day
1.34741
Reported Total Nurse Staffing Hours per Resident per Day
3.61208
Reported Physical Therapist Staffing Hours per Resident Per Day
0.04914
Expected CNA Staffing Hours per Resident per Day
2.60758
Expected LPN Staffing Hours per Resident per Day
0.61601
Expected RN Staffing Hours per Resident per Day
0.96635
Expected Total Nurse Staffing Hours per Resident per Day
4.18993
Adjusted CNA Staffing Hours per Resident per Day
2.13102
Adjusted LPN Staffing Hours per Resident per Day
1.11509
Adjusted RN Staffing Hours per Resident per Day
0.40194
Adjusted Total Nurse Staffing Hours per Resident per Day
3.47498
Cycle 1 Total Number of Health Deficiencies
6
Cycle 1 Number of Standard Health Deficiencies
5
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
40
Cycle 1 Standard Survey Health Date
2015-03-20
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
40
Cycle 2 Total Number of Health Deficiencies
1
Cycle 2 Number of Standard Health Deficiencies
1
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
4
Cycle 2 Standard Health Survey Date
2014-02-04
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
1
Cycle 3 Number of Standard Health Deficiencies
1
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
8
Cycle 3 Standard Health Survey Date
2013-03-05
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
8
Total Weighted Health Survey Score
22.66700
Number of Facility Reported Incidents
2
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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