Friendship Village Of Dublin - Dublin Nursing Home
General Information
UPDATEFederal Provider Number
365560
Provider Name
FRIENDSHIP VILLAGE OF DUBLIN
Provider Address
6000 RIVERSIDE DR
DUBLIN, OH 43017
DUBLIN, OH 43017
Provider Phone Number
(614) 764-1600
Provider SSA County
250
Provider County Name
Franklin
Provider Website
Provider Description
Ownership Type
Non profit - Other
Number of Certified Beds
60
Number of Residents in Certified Beds
52
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
FRIENDSHIP VILLAGE OF DUBLIN OHIO, INC.
Date First Approved to Provide Medicare and Medicaid services
1981-07-15
Continuing Care Retirement Community
Y
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Both
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
5
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.09904
Reported LPN Staffing Hours per Resident per Day
0.39519
Reported RN Staffing Hours per Resident per Day
1.42308
Reported Licensed Staffing Hours per Resident per Day
1.81827
Reported Total Nurse Staffing Hours per Resident per Day
3.91731
Reported Physical Therapist Staffing Hours per Resident Per Day
0.13077
Expected CNA Staffing Hours per Resident per Day
2.59004
Expected LPN Staffing Hours per Resident per Day
0.70938
Expected RN Staffing Hours per Resident per Day
1.22702
Expected Total Nurse Staffing Hours per Resident per Day
4.52643
Adjusted CNA Staffing Hours per Resident per Day
1.98855
Adjusted LPN Staffing Hours per Resident per Day
0.46239
Adjusted RN Staffing Hours per Resident per Day
0.86659
Adjusted Total Nurse Staffing Hours per Resident per Day
3.48846
Cycle 1 Total Number of Health Deficiencies
3
Cycle 1 Number of Standard Health Deficiencies
3
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
20
Cycle 1 Standard Survey Health Date
2015-01-23
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
20
Cycle 2 Total Number of Health Deficiencies
9
Cycle 2 Number of Standard Health Deficiencies
9
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
36
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
36
Cycle 3 Total Number of Health Deficiencies
4
Cycle 3 Number of Standard Health Deficiencies
4
Cycle 3 Number of Complaint Health Deficiencies
2
Cycle 3 Health Deficiency Score
12
Cycle 3 Standard Health Survey Date
2012-06-28
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
12
Total Weighted Health Survey Score
24.00000
Number of Facility Reported Incidents
0
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
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