Hilty Memorial Home Inc - Pandora Nursing Home
General Information
UPDATEFederal Provider Number
366032
Provider Name
HILTY MEMORIAL HOME INC
Provider Address
304 HILTY DRIVE
PANDORA, OH 45877
PANDORA, OH 45877
Provider Phone Number
(419) 384-3218
Provider SSA County
700
Provider County Name
Putnam
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
61
Number of Residents in Certified Beds
51
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
HILTY MEMORIAL HOME
Date First Approved to Provide Medicare and Medicaid services
1995-11-09
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
3
Overall Rating Footnote
Health Inspection Rating
3
Health Inspection Rating Footnote
QM Rating
1
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
3.36373
Reported LPN Staffing Hours per Resident per Day
0.60784
Reported RN Staffing Hours per Resident per Day
1.04608
Reported Licensed Staffing Hours per Resident per Day
1.65392
Reported Total Nurse Staffing Hours per Resident per Day
5.01765
Reported Physical Therapist Staffing Hours per Resident Per Day
0.03235
Expected CNA Staffing Hours per Resident per Day
2.58475
Expected LPN Staffing Hours per Resident per Day
0.68675
Expected RN Staffing Hours per Resident per Day
1.08132
Expected Total Nurse Staffing Hours per Resident per Day
4.35281
Adjusted CNA Staffing Hours per Resident per Day
3.19319
Adjusted LPN Staffing Hours per Resident per Day
0.73463
Adjusted RN Staffing Hours per Resident per Day
0.72285
Adjusted Total Nurse Staffing Hours per Resident per Day
4.64657
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
20
Cycle 1 Standard Survey Health Date
2015-03-19
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
20
Cycle 2 Total Number of Health Deficiencies
4
Cycle 2 Number of Standard Health Deficiencies
4
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
16
Cycle 2 Standard Health Survey Date
2014-01-16
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
16
Cycle 3 Total Number of Health Deficiencies
6
Cycle 3 Number of Standard Health Deficiencies
6
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
32
Cycle 3 Standard Health Survey Date
2012-09-20
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
32
Total Weighted Health Survey Score
20.66700
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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