Kingston Rehabilitation Of Perrysburg - Perrysburg Nursing Home
General Information
UPDATEFederal Provider Number
366409
Provider Name
KINGSTON REHABILITATION OF PERRYSBURG
Provider Address
345 EAST BOUNDARY STREET
PERRYSBURG, OH 43551
PERRYSBURG, OH 43551
Provider Phone Number
(419) 873-6100
Provider SSA County
880
Provider County Name
Wood
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
62
Number of Residents in Certified Beds
40
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
KINGSTON CARE CENTER OF PERRYSBURG LLC
Date First Approved to Provide Medicare and Medicaid services
2013-08-03
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
5
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
4
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
3.48625
Reported LPN Staffing Hours per Resident per Day
0.31375
Reported RN Staffing Hours per Resident per Day
3.17125
Reported Licensed Staffing Hours per Resident per Day
3.48500
Reported Total Nurse Staffing Hours per Resident per Day
6.97125
Reported Physical Therapist Staffing Hours per Resident Per Day
0.36125
Expected CNA Staffing Hours per Resident per Day
2.44849
Expected LPN Staffing Hours per Resident per Day
0.78839
Expected RN Staffing Hours per Resident per Day
1.64106
Expected Total Nurse Staffing Hours per Resident per Day
4.87795
Adjusted CNA Staffing Hours per Resident per Day
3.49367
Adjusted LPN Staffing Hours per Resident per Day
0.33031
Adjusted RN Staffing Hours per Resident per Day
1.44392
Adjusted Total Nurse Staffing Hours per Resident per Day
5.76071
Cycle 1 Total Number of Health Deficiencies
6
Cycle 1 Number of Standard Health Deficiencies
4
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
20
Cycle 1 Standard Survey Health Date
2014-11-20
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
20
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
2013-08-03
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
0
Cycle 3 Number of Standard Health Deficiencies
0
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
0
Cycle 3 Standard Health Survey Date
0000-00-00
Cycle 3 Number of Health Revisits
0
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
0
Total Weighted Health Survey Score
12.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
2
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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