Maple Grove Health Care Center - Lebanon Nursing Home

General Information

UPDATE
Federal Provider Number
495365
Provider Name
MAPLE GROVE HEALTH CARE CENTER
Provider Address
POST OFFICE BOX 2409
LEBANON, VA 24266
Provider Phone Number
2768890733
Provider SSA County
830
Provider County Name
Russell
Ownership Type
Non profit - Corporation
Number of Certified Beds
60
Number of Residents in Certified Beds
49
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
AFS OF LEBANON, INC
Date First Approved to Provide Medicare and Medicaid services
2002-11-22
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
4
Overall Rating Footnote
Health Inspection Rating
5
Health Inspection Rating Footnote
QM Rating
2
QM Rating Footnote
Staffing Rating
1
Staffing Rating Footnote
RN Staffing Rating
1
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.05102
Reported LPN Staffing Hours per Resident per Day
1.11837
Reported RN Staffing Hours per Resident per Day
0.39592
Reported Licensed Staffing Hours per Resident per Day
1.51429
Reported Total Nurse Staffing Hours per Resident per Day
3.56531
Reported Physical Therapist Staffing Hours per Resident Per Day
0.12041
Expected CNA Staffing Hours per Resident per Day
2.73399
Expected LPN Staffing Hours per Resident per Day
0.75537
Expected RN Staffing Hours per Resident per Day
1.21641
Expected Total Nurse Staffing Hours per Resident per Day
4.70576
Adjusted CNA Staffing Hours per Resident per Day
1.84075
Adjusted LPN Staffing Hours per Resident per Day
1.22887
Adjusted RN Staffing Hours per Resident per Day
0.24320
Adjusted Total Nurse Staffing Hours per Resident per Day
3.05400
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
24
Cycle 1 Standard Survey Health Date
2014-07-16
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
24
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
2013-08-01
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
2
Cycle 3 Number of Standard Health Deficiencies
2
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
8
Cycle 3 Standard Health Survey Date
2012-09-12
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
8
Total Weighted Health Survey Score
13.33300
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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