Lutheran Home Of Southbury Inc - Southbury Nursing Home
General Information
UPDATEFederal Provider Number
75371
Provider Name
LUTHERAN HOME OF SOUTHBURY INC
Provider Address
990 NORTH MAIN STREET
SOUTHBURY, CT 6488
SOUTHBURY, CT 6488
Provider Phone Number
(203) 264-9135
Provider SSA County
40
Provider County Name
New Haven
Provider Website
Provider Description
Ownership Type
Non profit - Church related
Number of Certified Beds
120
Number of Residents in Certified Beds
109
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
LUTHERAN HOME OF SOUTHBURY INC
Date First Approved to Provide Medicare and Medicaid services
1991-10-01
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
1
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
4
Staffing Rating Footnote
RN Staffing Rating
4
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.71927
Reported LPN Staffing Hours per Resident per Day
0.80138
Reported RN Staffing Hours per Resident per Day
0.66193
Reported Licensed Staffing Hours per Resident per Day
1.46330
Reported Total Nurse Staffing Hours per Resident per Day
4.18258
Reported Physical Therapist Staffing Hours per Resident Per Day
0.08119
Expected CNA Staffing Hours per Resident per Day
2.37947
Expected LPN Staffing Hours per Resident per Day
0.53153
Expected RN Staffing Hours per Resident per Day
0.70357
Expected Total Nurse Staffing Hours per Resident per Day
3.61456
Adjusted CNA Staffing Hours per Resident per Day
2.80410
Adjusted LPN Staffing Hours per Resident per Day
1.25139
Adjusted RN Staffing Hours per Resident per Day
0.70298
Adjusted Total Nurse Staffing Hours per Resident per Day
4.66434
Cycle 1 Total Number of Health Deficiencies
8
Cycle 1 Number of Standard Health Deficiencies
8
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
76
Cycle 1 Standard Survey Health Date
2014-04-17
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
76
Cycle 2 Total Number of Health Deficiencies
6
Cycle 2 Number of Standard Health Deficiencies
6
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
48
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
48
Cycle 3 Total Number of Health Deficiencies
20
Cycle 3 Number of Standard Health Deficiencies
20
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
278
Cycle 3 Standard Health Survey Date
2012-04-24
Cycle 3 Number of Health Revisits
2
Cycle 3 Health Revisit Score
139
Cycle 3 Total Health Score
417
Total Weighted Health Survey Score
123.50000
Number of Facility Reported Incidents
3
Number of Substantiated Complaints
0
Number of Fines
1
Total Amount of Fines in Dollars
1365
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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