Holland Home - Raybrook Manor - Grand Rapids Nursing Home
General Information
UPDATEFederal Provider Number
235440
Provider Name
HOLLAND HOME - RAYBROOK MANOR
Provider Address
2121 RAYBROOK SE
GRAND RAPIDS, MI 49546
GRAND RAPIDS, MI 49546
Provider Phone Number
6162355702
Provider SSA County
400
Provider County Name
Kent
Ownership Type
Non profit - Corporation
Number of Certified Beds
101
Number of Residents in Certified Beds
98
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
HOLLAND HOME
Date First Approved to Provide Medicare and Medicaid services
1985-09-01
Continuing Care Retirement Community
Y
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
2
Health Inspection Rating Footnote
QM Rating
3
QM Rating Footnote
Staffing Rating
4
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
2.86786
Reported LPN Staffing Hours per Resident per Day
0.82245
Reported RN Staffing Hours per Resident per Day
0.80000
Reported Licensed Staffing Hours per Resident per Day
1.62245
Reported Total Nurse Staffing Hours per Resident per Day
4.49031
Reported Physical Therapist Staffing Hours per Resident Per Day
0.03010
Expected CNA Staffing Hours per Resident per Day
2.68336
Expected LPN Staffing Hours per Resident per Day
0.59112
Expected RN Staffing Hours per Resident per Day
0.82796
Expected Total Nurse Staffing Hours per Resident per Day
4.10244
Adjusted CNA Staffing Hours per Resident per Day
2.62240
Adjusted LPN Staffing Hours per Resident per Day
1.15482
Adjusted RN Staffing Hours per Resident per Day
0.72197
Adjusted Total Nurse Staffing Hours per Resident per Day
4.41200
Cycle 1 Total Number of Health Deficiencies
5
Cycle 1 Number of Standard Health Deficiencies
3
Cycle 1 Number of Complaint Health Deficiencies
4
Cycle 1 Health Deficiency Score
123
Cycle 1 Standard Survey Health Date
2014-08-28
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
123
Cycle 2 Total Number of Health Deficiencies
3
Cycle 2 Number of Standard Health Deficiencies
2
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
32
Cycle 2 Standard Health Survey Date
2013-08-16
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
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
2012-10-12
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
24
Total Weighted Health Survey Score
76.16700
Number of Facility Reported Incidents
12
Number of Substantiated Complaints
2
Number of Fines
1
Total Amount of Fines in Dollars
16251
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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