Four Winds Nursing Facility - Jackson Nursing Home
General Information
UPDATEFederal Provider Number
365669
Provider Name
FOUR WINDS NURSING FACILITY
Provider Address
215 SETH AVENUE
JACKSON, OH 45640
JACKSON, OH 45640
Provider Phone Number
(740) 286-7551
Provider SSA County
410
Provider County Name
Jackson
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
99
Number of Residents in Certified Beds
89
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
UNITED CHURCH HOMES, INC.
Date First Approved to Provide Medicare and Medicaid services
1986-02-07
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
1
Health Inspection Rating Footnote
QM Rating
4
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
2.08708
Reported LPN Staffing Hours per Resident per Day
0.89101
Reported RN Staffing Hours per Resident per Day
0.56011
Reported Licensed Staffing Hours per Resident per Day
1.45112
Reported Total Nurse Staffing Hours per Resident per Day
3.53820
Reported Physical Therapist Staffing Hours per Resident Per Day
0.03596
Expected CNA Staffing Hours per Resident per Day
2.47880
Expected LPN Staffing Hours per Resident per Day
0.64093
Expected RN Staffing Hours per Resident per Day
1.10049
Expected Total Nurse Staffing Hours per Resident per Day
4.22022
Adjusted CNA Staffing Hours per Resident per Day
2.06595
Adjusted LPN Staffing Hours per Resident per Day
1.15385
Adjusted RN Staffing Hours per Resident per Day
0.38030
Adjusted Total Nurse Staffing Hours per Resident per Day
3.37948
Cycle 1 Total Number of Health Deficiencies
6
Cycle 1 Number of Standard Health Deficiencies
6
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
28
Cycle 1 Standard Survey Health Date
2014-07-25
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
28
Cycle 2 Total Number of Health Deficiencies
15
Cycle 2 Number of Standard Health Deficiencies
12
Cycle 2 Number of Complaint Health Deficiencies
3
Cycle 2 Health Deficiency Score
108
Cycle 2 Standard Health Survey Date
2013-04-17
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
108
Cycle 3 Total Number of Health Deficiencies
6
Cycle 3 Number of Standard Health Deficiencies
6
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
24
Cycle 3 Standard Health Survey Date
2011-12-29
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
24
Total Weighted Health Survey Score
54.00000
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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