Lebanon Center, Genesis Healthcare - Lebanon Nursing Home
General Information
UPDATEFederal Provider Number
305050
Provider Name
LEBANON CENTER, GENESIS HEALTHCARE
Provider Address
RR #1 BOX 13K, 24 OLD ETNA ROAD
LEBANON, NH 3766
LEBANON, NH 3766
Provider Phone Number
(603) 448-2234
Provider SSA County
40
Provider County Name
Grafton
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
110
Number of Residents in Certified Beds
100
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
24 OLD ETNA ROAD OPERATIONS LLC
Date First Approved to Provide Medicare and Medicaid services
1995-05-01
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
2
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
4
QM Rating Footnote
Staffing Rating
2
Staffing Rating Footnote
RN Staffing Rating
2
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.10550
Reported LPN Staffing Hours per Resident per Day
1.08400
Reported RN Staffing Hours per Resident per Day
0.49100
Reported Licensed Staffing Hours per Resident per Day
1.57500
Reported Total Nurse Staffing Hours per Resident per Day
3.68050
Reported Physical Therapist Staffing Hours per Resident Per Day
0.10750
Expected CNA Staffing Hours per Resident per Day
2.40475
Expected LPN Staffing Hours per Resident per Day
0.63315
Expected RN Staffing Hours per Resident per Day
1.12189
Expected Total Nurse Staffing Hours per Resident per Day
4.15979
Adjusted CNA Staffing Hours per Resident per Day
2.14835
Adjusted LPN Staffing Hours per Resident per Day
1.42103
Adjusted RN Staffing Hours per Resident per Day
0.32702
Adjusted Total Nurse Staffing Hours per Resident per Day
3.56646
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
8
Cycle 1 Standard Survey Health Date
2014-07-10
Cycle 1 Number of Health Revisits
1
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
2013-05-31
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
11
Cycle 3 Number of Standard Health Deficiencies
7
Cycle 3 Number of Complaint Health Deficiencies
4
Cycle 3 Health Deficiency Score
52
Cycle 3 Standard Health Survey Date
2012-04-05
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
52
Total Weighted Health Survey Score
12.66700
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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