Goodwill Mennonite Home, Inc. - Grantsville Nursing Home
General Information
UPDATEFederal Provider Number
215250
Provider Name
GOODWILL MENNONITE HOME, INC.
Provider Address
891 DORSEY HOTEL ROAD
GRANTSVILLE, MD 21536
GRANTSVILLE, MD 21536
Provider Phone Number
(301) 895-5194
Provider SSA County
110
Provider County Name
Garrett
Provider Website
Provider Description
Ownership Type
Non profit - Church related
Number of Certified Beds
107
Number of Residents in Certified Beds
101
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
GOODWILL MENNONITE HOME, INC.
Date First Approved to Provide Medicare and Medicaid services
1993-07-02
Continuing Care Retirement Community
Y
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
2
Health Inspection Rating Footnote
QM Rating
1
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
2.71238
Reported LPN Staffing Hours per Resident per Day
0.74406
Reported RN Staffing Hours per Resident per Day
0.55396
Reported Licensed Staffing Hours per Resident per Day
1.29802
Reported Total Nurse Staffing Hours per Resident per Day
4.01040
Reported Physical Therapist Staffing Hours per Resident Per Day
0.02475
Expected CNA Staffing Hours per Resident per Day
2.52562
Expected LPN Staffing Hours per Resident per Day
0.57332
Expected RN Staffing Hours per Resident per Day
0.84668
Expected Total Nurse Staffing Hours per Resident per Day
3.94563
Adjusted CNA Staffing Hours per Resident per Day
2.63514
Adjusted LPN Staffing Hours per Resident per Day
1.07718
Adjusted RN Staffing Hours per Resident per Day
0.48887
Adjusted Total Nurse Staffing Hours per Resident per Day
4.09707
Cycle 1 Total Number of Health Deficiencies
9
Cycle 1 Number of Standard Health Deficiencies
9
Cycle 1 Number of Complaint Health Deficiencies
9
Cycle 1 Health Deficiency Score
44
Cycle 1 Standard Survey Health Date
2015-01-16
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
44
Cycle 2 Total Number of Health Deficiencies
10
Cycle 2 Number of Standard Health Deficiencies
9
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
68
Cycle 2 Standard Health Survey Date
2013-10-24
Cycle 2 Number of Health Revisits
2
Cycle 2 Health Revisit Score
34
Cycle 2 Total Health Score
102
Cycle 3 Total Number of Health Deficiencies
10
Cycle 3 Number of Standard Health Deficiencies
9
Cycle 3 Number of Complaint Health Deficiencies
10
Cycle 3 Health Deficiency Score
64
Cycle 3 Standard Health Survey Date
2012-09-27
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
64
Total Weighted Health Survey Score
66.66700
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
4
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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