Golden Livingcenter - Surry Community - Mount Airy Nursing Home
General Information
UPDATEFederal Provider Number
345191
Provider Name
GOLDEN LIVINGCENTER - SURRY COMMUNITY
Provider Address
542 ALLRED MILL ROAD
MOUNT AIRY, NC 27030
MOUNT AIRY, NC 27030
Provider Phone Number
(336) 789-5076
Provider SSA County
850
Provider County Name
Surry
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
120
Number of Residents in Certified Beds
98
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
GGNSC MOUNT AIRY LLC
Date First Approved to Provide Medicare and Medicaid services
1981-05-01
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
4
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
3
QM Rating Footnote
Staffing Rating
4
Staffing Rating Footnote
RN Staffing Rating
4
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.20918
Reported LPN Staffing Hours per Resident per Day
0.83673
Reported RN Staffing Hours per Resident per Day
1.03418
Reported Licensed Staffing Hours per Resident per Day
1.87092
Reported Total Nurse Staffing Hours per Resident per Day
4.08009
Reported Physical Therapist Staffing Hours per Resident Per Day
0.14133
Expected CNA Staffing Hours per Resident per Day
2.47737
Expected LPN Staffing Hours per Resident per Day
0.65102
Expected RN Staffing Hours per Resident per Day
1.15850
Expected Total Nurse Staffing Hours per Resident per Day
4.28690
Adjusted CNA Staffing Hours per Resident per Day
2.18807
Adjusted LPN Staffing Hours per Resident per Day
1.06676
Adjusted RN Staffing Hours per Resident per Day
0.66701
Adjusted Total Nurse Staffing Hours per Resident per Day
3.83644
Cycle 1 Total Number of Health Deficiencies
2
Cycle 1 Number of Standard Health Deficiencies
2
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
8
Cycle 1 Standard Survey Health Date
2014-10-23
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
8
Cycle 2 Total Number of Health Deficiencies
6
Cycle 2 Number of Standard Health Deficiencies
5
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
20
Cycle 2 Standard Health Survey Date
2013-08-22
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
20
Cycle 3 Total Number of Health Deficiencies
3
Cycle 3 Number of Standard Health Deficiencies
1
Cycle 3 Number of Complaint Health Deficiencies
2
Cycle 3 Health Deficiency Score
16
Cycle 3 Standard Health Survey Date
2012-05-04
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
16
Total Weighted Health Survey Score
13.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
6
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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