Evergreen Valley Nursing Home - Plattsburgh Nursing Home
General Information
UPDATEFederal Provider Number
335528
Provider Name
EVERGREEN VALLEY NURSING HOME
Provider Address
8 BUSHEY BOULEVARD
PLATTSBURGH, NY 12901
PLATTSBURGH, NY 12901
Provider Phone Number
5185633261
Provider SSA County
90
Provider County Name
Clinton
Ownership Type
For profit - Individual
Number of Certified Beds
89
Number of Residents in Certified Beds
79
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
EVERGREEN VALLEY NURSING HOME
Date First Approved to Provide Medicare and Medicaid services
1976-07-01
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
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
2.50000
Reported LPN Staffing Hours per Resident per Day
0.99873
Reported RN Staffing Hours per Resident per Day
0.67595
Reported Licensed Staffing Hours per Resident per Day
1.67468
Reported Total Nurse Staffing Hours per Resident per Day
4.17468
Reported Physical Therapist Staffing Hours per Resident Per Day
0.02152
Expected CNA Staffing Hours per Resident per Day
2.53932
Expected LPN Staffing Hours per Resident per Day
0.69652
Expected RN Staffing Hours per Resident per Day
1.00885
Expected Total Nurse Staffing Hours per Resident per Day
4.24469
Adjusted CNA Staffing Hours per Resident per Day
2.41571
Adjusted LPN Staffing Hours per Resident per Day
1.19012
Adjusted RN Staffing Hours per Resident per Day
0.50064
Adjusted Total Nurse Staffing Hours per Resident per Day
3.96442
Cycle 1 Total Number of Health Deficiencies
9
Cycle 1 Number of Standard Health Deficiencies
5
Cycle 1 Number of Complaint Health Deficiencies
4
Cycle 1 Health Deficiency Score
72
Cycle 1 Standard Survey Health Date
2014-04-25
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
72
Cycle 2 Total Number of Health Deficiencies
3
Cycle 2 Number of Standard Health Deficiencies
2
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
12
Cycle 2 Standard Health Survey Date
2013-02-28
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
5
Cycle 3 Number of Standard Health Deficiencies
4
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
24
Cycle 3 Standard Health Survey Date
2012-01-26
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
24
Total Weighted Health Survey Score
44.00000
Number of Facility Reported Incidents
6
Number of Substantiated Complaints
1
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
Nursiong Homes Nearby
Clinton County Nursing Home
16 Flynn Avenue |
PLATTSBURGH NY 12901 | 0.1 mile away
Champlain Valley Physicians Hospital S N F
75 Beekman Street |
PLATTSBURGH NY 12901 | 1.4 miles away
Meadowbrook Healthcare
154 North Prospect Avenue |
PLATTSBURGH NY 12901 | 1.6 miles away
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