Golden Livingcenter-sleepy Hollow - Annandale Nursing Home
General Information
UPDATEFederal Provider Number
495155
Provider Name
GOLDEN LIVINGCENTER-SLEEPY HOLLOW
Provider Address
6700 COLUMBIA PK
ANNANDALE, VA 22003
ANNANDALE, VA 22003
Provider Phone Number
(703) 256-7000
Provider SSA County
290
Provider County Name
Fairfax
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
222
Number of Residents in Certified Beds
187
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
BEVERLY ENTERPRISES - VIRGINIA, INC
Date First Approved to Provide Medicare and Medicaid services
1985-04-01
Continuing Care Retirement Community
N
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
2
Overall Rating Footnote
Health Inspection Rating
2
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
2.14037
Reported LPN Staffing Hours per Resident per Day
0.68850
Reported RN Staffing Hours per Resident per Day
0.63984
Reported Licensed Staffing Hours per Resident per Day
1.32834
Reported Total Nurse Staffing Hours per Resident per Day
3.46871
Reported Physical Therapist Staffing Hours per Resident Per Day
0.08316
Expected CNA Staffing Hours per Resident per Day
2.49569
Expected LPN Staffing Hours per Resident per Day
0.66202
Expected RN Staffing Hours per Resident per Day
1.07790
Expected Total Nurse Staffing Hours per Resident per Day
4.23561
Adjusted CNA Staffing Hours per Resident per Day
2.10435
Adjusted LPN Staffing Hours per Resident per Day
0.86320
Adjusted RN Staffing Hours per Resident per Day
0.44354
Adjusted Total Nurse Staffing Hours per Resident per Day
3.30106
Cycle 1 Total Number of Health Deficiencies
14
Cycle 1 Number of Standard Health Deficiencies
14
Cycle 1 Number of Complaint Health Deficiencies
10
Cycle 1 Health Deficiency Score
80
Cycle 1 Standard Survey Health Date
2015-02-05
Cycle 1 Number of Health Revisits
2
Cycle 1 Health Revisit Score
40
Cycle 1 Total Health Score
120
Cycle 2 Total Number of Health Deficiencies
4
Cycle 2 Number of Standard Health Deficiencies
4
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
28
Cycle 2 Standard Health Survey Date
2014-01-16
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
28
Cycle 3 Total Number of Health Deficiencies
6
Cycle 3 Number of Standard Health Deficiencies
6
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
36
Cycle 3 Standard Health Survey Date
2012-11-16
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
36
Total Weighted Health Survey Score
75.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
14
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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