Mchs-westerville - Westerville Nursing Home
General Information
UPDATEFederal Provider Number
365206
Provider Name
MCHS-WESTERVILLE
Provider Address
140 OLD COUNTY LINE ROAD
WESTERVILLE, OH 43081
WESTERVILLE, OH 43081
Provider Phone Number
(614) 882-1511
Provider SSA County
250
Provider County Name
Franklin
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
174
Number of Residents in Certified Beds
120
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
MANOR CARE OF WESTERVILLE OH LLC
Date First Approved to Provide Medicare and Medicaid services
1968-10-29
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
1
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
3
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
2.39333
Reported LPN Staffing Hours per Resident per Day
0.93375
Reported RN Staffing Hours per Resident per Day
0.68583
Reported Licensed Staffing Hours per Resident per Day
1.61958
Reported Total Nurse Staffing Hours per Resident per Day
4.01291
Reported Physical Therapist Staffing Hours per Resident Per Day
0.13750
Expected CNA Staffing Hours per Resident per Day
2.58078
Expected LPN Staffing Hours per Resident per Day
0.77247
Expected RN Staffing Hours per Resident per Day
1.35537
Expected Total Nurse Staffing Hours per Resident per Day
4.70862
Adjusted CNA Staffing Hours per Resident per Day
2.27548
Adjusted LPN Staffing Hours per Resident per Day
1.00330
Adjusted RN Staffing Hours per Resident per Day
0.37809
Adjusted Total Nurse Staffing Hours per Resident per Day
3.43533
Cycle 1 Total Number of Health Deficiencies
24
Cycle 1 Number of Standard Health Deficiencies
22
Cycle 1 Number of Complaint Health Deficiencies
2
Cycle 1 Health Deficiency Score
287
Cycle 1 Standard Survey Health Date
2014-12-04
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
287
Cycle 2 Total Number of Health Deficiencies
13
Cycle 2 Number of Standard Health Deficiencies
5
Cycle 2 Number of Complaint Health Deficiencies
8
Cycle 2 Health Deficiency Score
60
Cycle 2 Standard Health Survey Date
2013-08-15
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
60
Cycle 3 Total Number of Health Deficiencies
7
Cycle 3 Number of Standard Health Deficiencies
5
Cycle 3 Number of Complaint Health Deficiencies
2
Cycle 3 Health Deficiency Score
48
Cycle 3 Standard Health Survey Date
2012-05-24
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
48
Total Weighted Health Survey Score
171.50000
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
10
Number of Fines
1
Total Amount of Fines in Dollars
27900
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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