Milwaukie Convalescent Ct - Milwaukie Nursing Home
General Information
UPDATEFederal Provider Number
385270
Provider Name
MILWAUKIE CONVALESCENT CT
Provider Address
12045 SE STANLEY AVENUE
MILWAUKIE, OR 97222
MILWAUKIE, OR 97222
Provider Phone Number
(503) 659-2323
Provider SSA County
20
Provider County Name
Clackamas
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
96
Number of Residents in Certified Beds
50
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
MILWAUKIE CONVALESCENT HOSPITAL, INC.
Date First Approved to Provide Medicare and Medicaid services
2005-10-18
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
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
3
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
3.54500
Reported LPN Staffing Hours per Resident per Day
0.56300
Reported RN Staffing Hours per Resident per Day
0.62300
Reported Licensed Staffing Hours per Resident per Day
1.18600
Reported Total Nurse Staffing Hours per Resident per Day
4.73100
Reported Physical Therapist Staffing Hours per Resident Per Day
0.06700
Expected CNA Staffing Hours per Resident per Day
2.19304
Expected LPN Staffing Hours per Resident per Day
0.60683
Expected RN Staffing Hours per Resident per Day
1.02950
Expected Total Nurse Staffing Hours per Resident per Day
3.82937
Adjusted CNA Staffing Hours per Resident per Day
3.96635
Adjusted LPN Staffing Hours per Resident per Day
0.77006
Adjusted RN Staffing Hours per Resident per Day
0.45217
Adjusted Total Nurse Staffing Hours per Resident per Day
4.97998
Cycle 1 Total Number of Health Deficiencies
3
Cycle 1 Number of Standard Health Deficiencies
2
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
16
Cycle 1 Standard Survey Health Date
2014-12-05
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
16
Cycle 2 Total Number of Health Deficiencies
4
Cycle 2 Number of Standard Health Deficiencies
4
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
28
Cycle 2 Standard Health Survey Date
2013-06-05
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
28
Cycle 3 Total Number of Health Deficiencies
28
Cycle 3 Number of Standard Health Deficiencies
25
Cycle 3 Number of Complaint Health Deficiencies
3
Cycle 3 Health Deficiency Score
277
Cycle 3 Standard Health Survey Date
2012-03-07
Cycle 3 Number of Health Revisits
2
Cycle 3 Health Revisit Score
139
Cycle 3 Total Health Score
416
Total Weighted Health Survey Score
86.66700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
4
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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