Heritage Hall North - Agawam Nursing Home
General Information
UPDATEFederal Provider Number
225766
Provider Name
HERITAGE HALL NORTH
Provider Address
55 COOPER STREET
AGAWAM, MA 1001
AGAWAM, MA 1001
Provider Phone Number
(413) 786-8000
Provider SSA County
70
Provider County Name
Hampden
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
124
Number of Residents in Certified Beds
105
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
55 COOPER STREET OPERATIONS LLC
Date First Approved to Provide Medicare and Medicaid services
2002-12-10
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
4
Overall Rating Footnote
Health Inspection Rating
4
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
2.50762
Reported LPN Staffing Hours per Resident per Day
0.96048
Reported RN Staffing Hours per Resident per Day
1.01619
Reported Licensed Staffing Hours per Resident per Day
1.97667
Reported Total Nurse Staffing Hours per Resident per Day
4.48429
Reported Physical Therapist Staffing Hours per Resident Per Day
0.16524
Expected CNA Staffing Hours per Resident per Day
2.60767
Expected LPN Staffing Hours per Resident per Day
0.65876
Expected RN Staffing Hours per Resident per Day
1.10524
Expected Total Nurse Staffing Hours per Resident per Day
4.37166
Adjusted CNA Staffing Hours per Resident per Day
2.35956
Adjusted LPN Staffing Hours per Resident per Day
1.21016
Adjusted RN Staffing Hours per Resident per Day
0.68700
Adjusted Total Nurse Staffing Hours per Resident per Day
4.13475
Cycle 1 Total Number of Health Deficiencies
2
Cycle 1 Number of Standard Health Deficiencies
2
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
12
Cycle 1 Standard Survey Health Date
2014-08-19
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
12
Cycle 2 Total Number of Health Deficiencies
0
Cycle 2 Number of Standard Health Deficiencies
0
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
0
Cycle 2 Standard Health Survey Date
2013-07-26
Cycle 2 Number of Health Revisits
0
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
4
Cycle 3 Number of Standard Health Deficiencies
4
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
36
Cycle 3 Standard Health Survey Date
2012-06-26
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
36
Total Weighted Health Survey Score
12.00000
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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