Forestville Health & Rehabilitation Center - Forestville Nursing Home
General Information
UPDATEFederal Provider Number
215020
Provider Name
FORESTVILLE HEALTH & REHABILITATION CENTER
Provider Address
7420 MARLBORO PIKE
FORESTVILLE, MD 20747
FORESTVILLE, MD 20747
Provider Phone Number
3017360240
Provider SSA County
160
Provider County Name
Prince Georges
Ownership Type
For profit - Corporation
Number of Certified Beds
160
Number of Residents in Certified Beds
125
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
MARLBORO LEASING CO., LLC
Date First Approved to Provide Medicare and Medicaid services
1971-02-20
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
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
2.15360
Reported LPN Staffing Hours per Resident per Day
1.09920
Reported RN Staffing Hours per Resident per Day
0.61120
Reported Licensed Staffing Hours per Resident per Day
1.71040
Reported Total Nurse Staffing Hours per Resident per Day
3.86400
Reported Physical Therapist Staffing Hours per Resident Per Day
0.04360
Expected CNA Staffing Hours per Resident per Day
2.34727
Expected LPN Staffing Hours per Resident per Day
0.62692
Expected RN Staffing Hours per Resident per Day
0.95783
Expected Total Nurse Staffing Hours per Resident per Day
3.93203
Adjusted CNA Staffing Hours per Resident per Day
2.25124
Adjusted LPN Staffing Hours per Resident per Day
1.45526
Adjusted RN Staffing Hours per Resident per Day
0.47679
Adjusted Total Nurse Staffing Hours per Resident per Day
3.96116
Cycle 1 Total Number of Health Deficiencies
7
Cycle 1 Number of Standard Health Deficiencies
5
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
32
Cycle 1 Standard Survey Health Date
2014-10-28
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
32
Cycle 2 Total Number of Health Deficiencies
13
Cycle 2 Number of Standard Health Deficiencies
10
Cycle 2 Number of Complaint Health Deficiencies
3
Cycle 2 Health Deficiency Score
48
Cycle 2 Standard Health Survey Date
2013-10-03
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
19
Cycle 3 Number of Standard Health Deficiencies
14
Cycle 3 Number of Complaint Health Deficiencies
5
Cycle 3 Health Deficiency Score
64
Cycle 3 Standard Health Survey Date
2012-11-08
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
64
Total Weighted Health Survey Score
42.66700
Number of Facility Reported Incidents
5
Number of Substantiated Complaints
13
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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