Locust Ridge Nursing Home Inc - Williamsburg Nursing Home
General Information
UPDATEFederal Provider Number
365336
Provider Name
LOCUST RIDGE NURSING HOME INC
Provider Address
12745 ELM CORNER ROAD
WILLIAMSBURG, OH 45176
WILLIAMSBURG, OH 45176
Provider Phone Number
5135799949
Provider SSA County
70
Provider County Name
Brown
Ownership Type
For profit - Individual
Number of Certified Beds
61
Number of Residents in Certified Beds
54
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
LOCUST RIDGE NURSING HOME INC
Date First Approved to Provide Medicare and Medicaid services
1978-03-01
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
3
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
1
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
2.05463
Reported LPN Staffing Hours per Resident per Day
0.88981
Reported RN Staffing Hours per Resident per Day
0.88611
Reported Licensed Staffing Hours per Resident per Day
1.77593
Reported Total Nurse Staffing Hours per Resident per Day
3.83055
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00278
Expected CNA Staffing Hours per Resident per Day
2.24157
Expected LPN Staffing Hours per Resident per Day
0.58081
Expected RN Staffing Hours per Resident per Day
0.80638
Expected Total Nurse Staffing Hours per Resident per Day
3.62876
Adjusted CNA Staffing Hours per Resident per Day
2.24907
Adjusted LPN Staffing Hours per Resident per Day
1.27156
Adjusted RN Staffing Hours per Resident per Day
0.82108
Adjusted Total Nurse Staffing Hours per Resident per Day
4.25505
Cycle 1 Total Number of Health Deficiencies
3
Cycle 1 Number of Standard Health Deficiencies
3
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
8
Cycle 1 Standard Survey Health Date
2014-08-14
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
1
Cycle 2 Number of Standard Health Deficiencies
1
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
8
Cycle 2 Standard Health Survey Date
2013-05-16
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
4
Cycle 3 Number of Standard Health Deficiencies
4
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
20
Cycle 3 Standard Health Survey Date
2012-02-17
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
20
Total Weighted Health Survey Score
10.00000
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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