Hacienda Nursing Facility - Phoenix Nursing Home
General Information
UPDATEFederal Provider Number
35258
Provider Name
HACIENDA NURSING FACILITY
Provider Address
1402 EAST SOUTH MOUNTAIN AVENUE
PHOENIX, AZ 85040
PHOENIX, AZ 85040
Provider Phone Number
(602) 243-4231
Provider SSA County
60
Provider County Name
Maricopa
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
74
Number of Residents in Certified Beds
58
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
HACIENDA SKILLED NURSING FACILITY, INC
Date First Approved to Provide Medicare and Medicaid services
2000-12-04
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
4
QM Rating Footnote
Staffing Rating
5
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
4.20086
Reported LPN Staffing Hours per Resident per Day
1.46897
Reported RN Staffing Hours per Resident per Day
2.06724
Reported Licensed Staffing Hours per Resident per Day
3.53621
Reported Total Nurse Staffing Hours per Resident per Day
7.73707
Reported Physical Therapist Staffing Hours per Resident Per Day
0.10603
Expected CNA Staffing Hours per Resident per Day
2.65378
Expected LPN Staffing Hours per Resident per Day
0.98283
Expected RN Staffing Hours per Resident per Day
1.45675
Expected Total Nurse Staffing Hours per Resident per Day
5.09337
Adjusted CNA Staffing Hours per Resident per Day
3.88413
Adjusted LPN Staffing Hours per Resident per Day
1.24054
Adjusted RN Staffing Hours per Resident per Day
1.06033
Adjusted Total Nurse Staffing Hours per Resident per Day
6.12312
Cycle 1 Total Number of Health Deficiencies
0
Cycle 1 Number of Standard Health Deficiencies
0
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
0
Cycle 1 Standard Survey Health Date
2014-06-05
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
0
Cycle 2 Total Number of Health Deficiencies
11
Cycle 2 Number of Standard Health Deficiencies
11
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
80
Cycle 2 Standard Health Survey Date
2013-04-18
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
80
Cycle 3 Total Number of Health Deficiencies
5
Cycle 3 Number of Standard Health Deficiencies
3
Cycle 3 Number of Complaint Health Deficiencies
2
Cycle 3 Health Deficiency Score
24
Cycle 3 Standard Health Survey Date
2012-02-03
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
24
Total Weighted Health Survey Score
30.66700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
0
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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