Lutheran Retirement Home - Jamestown Nursing Home
General Information
UPDATEFederal Provider Number
335268
Provider Name
LUTHERAN RETIREMENT HOME
Provider Address
715 FALCONER STREET
JAMESTOWN, NY 14701
JAMESTOWN, NY 14701
Provider Phone Number
(716) 665-4905
Provider SSA County
60
Provider County Name
Chautauqua
Provider Website
Provider Description
Ownership Type
Non profit - Church related
Number of Certified Beds
148
Number of Residents in Certified Beds
134
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
LUTHERAN SOCIAL SERVICES OF UPSTATE NEW YORK, INC.
Date First Approved to Provide Medicare and Medicaid services
1968-08-29
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
Partial
Rating Detail Information
Overall Rating
2
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
2
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
2.30522
Reported LPN Staffing Hours per Resident per Day
1.07799
Reported RN Staffing Hours per Resident per Day
0.88507
Reported Licensed Staffing Hours per Resident per Day
1.96306
Reported Total Nurse Staffing Hours per Resident per Day
4.26828
Reported Physical Therapist Staffing Hours per Resident Per Day
0.09328
Expected CNA Staffing Hours per Resident per Day
2.47276
Expected LPN Staffing Hours per Resident per Day
0.63842
Expected RN Staffing Hours per Resident per Day
1.00086
Expected Total Nurse Staffing Hours per Resident per Day
4.11204
Adjusted CNA Staffing Hours per Resident per Day
2.28745
Adjusted LPN Staffing Hours per Resident per Day
1.40147
Adjusted RN Staffing Hours per Resident per Day
0.66075
Adjusted Total Nurse Staffing Hours per Resident per Day
4.18405
Cycle 1 Total Number of Health Deficiencies
5
Cycle 1 Number of Standard Health Deficiencies
5
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
28
Cycle 1 Standard Survey Health Date
2014-08-22
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
28
Cycle 2 Total Number of Health Deficiencies
10
Cycle 2 Number of Standard Health Deficiencies
9
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
465
Cycle 2 Standard Health Survey Date
2013-09-27
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
465
Cycle 3 Total Number of Health Deficiencies
8
Cycle 3 Number of Standard Health Deficiencies
6
Cycle 3 Number of Complaint Health Deficiencies
2
Cycle 3 Health Deficiency Score
52
Cycle 3 Standard Health Survey Date
2012-10-03
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
52
Total Weighted Health Survey Score
177.66700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
4
Number of Fines
1
Total Amount of Fines in Dollars
6370
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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