Hazen Nursing Home - West Valley City Nursing Home
General Information
UPDATEFederal Provider Number
46A069
Provider Name
HAZEN NURSING HOME
Provider Address
2520 SOUTH REDWOOD ROAD
WEST VALLEY CITY, UT 84119
WEST VALLEY CITY, UT 84119
Provider Phone Number
8019721050
Provider SSA County
170
Provider County Name
Salt Lake
Ownership Type
For profit - Corporation
Number of Certified Beds
26
Number of Residents in Certified Beds
21
Provider Type
Medicaid
Provider Resides in Hospital
N
Legal Business Name
Legal Business Name Not Available
Date First Approved to Provide Medicare and Medicaid services
2008-07-21
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
1
Health Inspection Rating Footnote
QM Rating
3
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
2.86905
Reported LPN Staffing Hours per Resident per Day
0.90238
Reported RN Staffing Hours per Resident per Day
0.86429
Reported Licensed Staffing Hours per Resident per Day
1.76667
Reported Total Nurse Staffing Hours per Resident per Day
4.63572
Reported Physical Therapist Staffing Hours per Resident Per Day
0.01667
Expected CNA Staffing Hours per Resident per Day
2.56264
Expected LPN Staffing Hours per Resident per Day
0.62556
Expected RN Staffing Hours per Resident per Day
0.84181
Expected Total Nurse Staffing Hours per Resident per Day
4.03000
Adjusted CNA Staffing Hours per Resident per Day
2.74709
Adjusted LPN Staffing Hours per Resident per Day
1.19730
Adjusted RN Staffing Hours per Resident per Day
0.76716
Adjusted Total Nurse Staffing Hours per Resident per Day
4.63676
Cycle 1 Total Number of Health Deficiencies
13
Cycle 1 Number of Standard Health Deficiencies
13
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
88
Cycle 1 Standard Survey Health Date
2015-01-08
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
88
Cycle 2 Total Number of Health Deficiencies
12
Cycle 2 Number of Standard Health Deficiencies
12
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
72
Cycle 2 Standard Health Survey Date
2013-12-05
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
28
Cycle 3 Number of Standard Health Deficiencies
28
Cycle 3 Number of Complaint Health Deficiencies
2
Cycle 3 Health Deficiency Score
383
Cycle 3 Standard Health Survey Date
2012-10-03
Cycle 3 Number of Health Revisits
2
Cycle 3 Health Revisit Score
192
Cycle 3 Total Health Score
575
Total Weighted Health Survey Score
163.83300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
1
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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Woodland Park Rehabilitation And Care Center
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Deseret Care Center
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