Connecticut Nursing Homes >> Middlebury Nursing Homes >> Middlebury Convalescent Home

Middlebury Convalescent Home - Middlebury Nursing Home

General Information

UPDATE
Federal Provider Number
75146
Provider Name
MIDDLEBURY CONVALESCENT HOME
Provider Address
778 MIDDLEBURY RD
MIDDLEBURY, CT 6762
Provider Phone Number
2037582471
Provider SSA County
40
Provider County Name
New Haven
Ownership Type
For profit - Corporation
Number of Certified Beds
58
Number of Residents in Certified Beds
54
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
MIDDLEBURY CONVALESCENT HOME, INC.
Date First Approved to Provide Medicare and Medicaid services
1967-01-01
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
Yes

Rating Detail Information

Overall Rating
4
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
2
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
2.87130
Reported LPN Staffing Hours per Resident per Day
0.77500
Reported RN Staffing Hours per Resident per Day
0.89352
Reported Licensed Staffing Hours per Resident per Day
1.66852
Reported Total Nurse Staffing Hours per Resident per Day
4.53982
Reported Physical Therapist Staffing Hours per Resident Per Day
0.10556
Expected CNA Staffing Hours per Resident per Day
2.59096
Expected LPN Staffing Hours per Resident per Day
0.63593
Expected RN Staffing Hours per Resident per Day
0.91910
Expected Total Nurse Staffing Hours per Resident per Day
4.14600
Adjusted CNA Staffing Hours per Resident per Day
2.71919
Adjusted LPN Staffing Hours per Resident per Day
1.01150
Adjusted RN Staffing Hours per Resident per Day
0.72640
Adjusted Total Nurse Staffing Hours per Resident per Day
4.41379
Cycle 1 Total Number of Health Deficiencies
0
Cycle 1 Number of Standard Health Deficiencies
0
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
0
Cycle 1 Standard Survey Health Date
2014-05-01
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
0
Cycle 2 Total Number of Health Deficiencies
10
Cycle 2 Number of Standard Health Deficiencies
10
Cycle 2 Number of Complaint Health Deficiencies
3
Cycle 2 Health Deficiency Score
60
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
0
Cycle 3 Total Number of Health Deficiencies
4
Cycle 3 Number of Standard Health Deficiencies
4
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
16
Cycle 3 Standard Health Survey Date
2012-06-04
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
16
Total Weighted Health Survey Score
22.66700
Number of Facility Reported Incidents
1
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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