Kingston Of Miamisburg - Miamisburg Nursing Home
General Information
UPDATEFederal Provider Number
365984
Provider Name
KINGSTON OF MIAMISBURG
Provider Address
1120 SOUTH DUNAWAY STREET
MIAMISBURG, OH 45342
MIAMISBURG, OH 45342
Provider Phone Number
(937) 866-9089
Provider SSA County
580
Provider County Name
Montgomery
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
113
Number of Residents in Certified Beds
90
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
KINGSTON OF MIAMISBURG, LLC
Date First Approved to Provide Medicare and Medicaid services
1995-03-13
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
4
Health Inspection Rating Footnote
QM Rating
2
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
2.05889
Reported LPN Staffing Hours per Resident per Day
1.40000
Reported RN Staffing Hours per Resident per Day
1.28444
Reported Licensed Staffing Hours per Resident per Day
2.68444
Reported Total Nurse Staffing Hours per Resident per Day
4.74333
Reported Physical Therapist Staffing Hours per Resident Per Day
0.03722
Expected CNA Staffing Hours per Resident per Day
2.52910
Expected LPN Staffing Hours per Resident per Day
0.74045
Expected RN Staffing Hours per Resident per Day
1.32485
Expected Total Nurse Staffing Hours per Resident per Day
4.59441
Adjusted CNA Staffing Hours per Resident per Day
1.99751
Adjusted LPN Staffing Hours per Resident per Day
1.56931
Adjusted RN Staffing Hours per Resident per Day
0.72441
Adjusted Total Nurse Staffing Hours per Resident per Day
4.16156
Cycle 1 Total Number of Health Deficiencies
2
Cycle 1 Number of Standard Health Deficiencies
0
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
8
Cycle 1 Standard Survey Health Date
2014-05-15
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
8
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
2013-02-28
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
32
Cycle 3 Standard Health Survey Date
2011-11-17
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
32
Total Weighted Health Survey Score
9.33300
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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