Medilodge Of Plymouth - Plymouth Nursing Home
General Information
UPDATEFederal Provider Number
235507
Provider Name
MEDILODGE OF PLYMOUTH
Provider Address
395 W ANN ARBOR TRAIL
PLYMOUTH, MI 48170
PLYMOUTH, MI 48170
Provider Phone Number
(734) 453-3983
Provider SSA County
810
Provider County Name
Wayne
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
46
Number of Residents in Certified Beds
40
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
PLYMOUTH OPCO LLC
Date First Approved to Provide Medicare and Medicaid services
1991-06-05
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
None
Automatic Sprinkler Systems in All Required Areas
Yes
Rating Detail Information
Overall Rating
3
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
4
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
2.50000
Reported LPN Staffing Hours per Resident per Day
0.22500
Reported RN Staffing Hours per Resident per Day
1.40250
Reported Licensed Staffing Hours per Resident per Day
1.62750
Reported Total Nurse Staffing Hours per Resident per Day
4.12750
Reported Physical Therapist Staffing Hours per Resident Per Day
0.10750
Expected CNA Staffing Hours per Resident per Day
2.56013
Expected LPN Staffing Hours per Resident per Day
0.57626
Expected RN Staffing Hours per Resident per Day
0.84595
Expected Total Nurse Staffing Hours per Resident per Day
3.98234
Adjusted CNA Staffing Hours per Resident per Day
2.39607
Adjusted LPN Staffing Hours per Resident per Day
0.32407
Adjusted RN Staffing Hours per Resident per Day
1.23878
Adjusted Total Nurse Staffing Hours per Resident per Day
4.17783
Cycle 1 Total Number of Health Deficiencies
8
Cycle 1 Number of Standard Health Deficiencies
4
Cycle 1 Number of Complaint Health Deficiencies
4
Cycle 1 Health Deficiency Score
44
Cycle 1 Standard Survey Health Date
2014-04-11
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
44
Cycle 2 Total Number of Health Deficiencies
7
Cycle 2 Number of Standard Health Deficiencies
4
Cycle 2 Number of Complaint Health Deficiencies
3
Cycle 2 Health Deficiency Score
40
Cycle 2 Standard Health Survey Date
2013-01-31
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
40
Cycle 3 Total Number of Health Deficiencies
11
Cycle 3 Number of Standard Health Deficiencies
10
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
159
Cycle 3 Standard Health Survey Date
2012-03-30
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
159
Total Weighted Health Survey Score
61.83300
Number of Facility Reported Incidents
5
Number of Substantiated Complaints
14
Number of Fines
1
Total Amount of Fines in Dollars
6000
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
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