Grand Lake Villa - Grove Nursing Home
General Information
UPDATEFederal Provider Number
375116
Provider Name
GRAND LAKE VILLA
Provider Address
103 HAR-BER ROAD
GROVE, OK 74345
GROVE, OK 74345
Provider Phone Number
9187862276
Provider SSA County
200
Provider County Name
Delaware
Ownership Type
For profit - Corporation
Number of Certified Beds
100
Number of Residents in Certified Beds
65
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
OAK LAKE, LLC
Date First Approved to Provide Medicare and Medicaid services
1992-01-07
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
2
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
1
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
2.35769
Reported LPN Staffing Hours per Resident per Day
0.45385
Reported RN Staffing Hours per Resident per Day
0.73692
Reported Licensed Staffing Hours per Resident per Day
1.19077
Reported Total Nurse Staffing Hours per Resident per Day
3.54846
Reported Physical Therapist Staffing Hours per Resident Per Day
0.02077
Expected CNA Staffing Hours per Resident per Day
2.05783
Expected LPN Staffing Hours per Resident per Day
0.58754
Expected RN Staffing Hours per Resident per Day
1.02907
Expected Total Nurse Staffing Hours per Resident per Day
3.67444
Adjusted CNA Staffing Hours per Resident per Day
2.81124
Adjusted LPN Staffing Hours per Resident per Day
0.64114
Adjusted RN Staffing Hours per Resident per Day
0.53507
Adjusted Total Nurse Staffing Hours per Resident per Day
3.89270
Cycle 1 Total Number of Health Deficiencies
11
Cycle 1 Number of Standard Health Deficiencies
6
Cycle 1 Number of Complaint Health Deficiencies
5
Cycle 1 Health Deficiency Score
193
Cycle 1 Standard Survey Health Date
2014-09-25
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
193
Cycle 2 Total Number of Health Deficiencies
14
Cycle 2 Number of Standard Health Deficiencies
9
Cycle 2 Number of Complaint Health Deficiencies
5
Cycle 2 Health Deficiency Score
116
Cycle 2 Standard Health Survey Date
2013-10-24
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
20
Cycle 3 Number of Standard Health Deficiencies
13
Cycle 3 Number of Complaint Health Deficiencies
9
Cycle 3 Health Deficiency Score
136
Cycle 3 Standard Health Survey Date
2012-11-30
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
136
Total Weighted Health Survey Score
157.83300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
17
Number of Fines
2
Total Amount of Fines in Dollars
18308
Number of Payment Denials
0
Total Number of Penalties
2
Location
Processing Date
2015-06-01
Nursiong Homes Nearby
Betty Ann Nursing Center
1400 South Main Street |
GROVE OK 74344 | 0.1 mile away
Grove Nursing Center
1503 West Har-ber Road |
GROVE OK 74344 | 1.2 miles away
Monroe Manor
226 East Monroe Street |
JAY OK 74346 | 10.6 miles away
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