Montgomery Village Health Care Center - Gaithersburg Nursing Home
General Information
UPDATEFederal Provider Number
215272
Provider Name
MONTGOMERY VILLAGE HEALTH CARE CENTER
Provider Address
19301 WATKINS MILL ROAD
GAITHERSBURG, MD 20879
GAITHERSBURG, MD 20879
Provider Phone Number
3015272500
Provider SSA County
150
Provider County Name
Montgomery
Ownership Type
For profit - Corporation
Number of Certified Beds
147
Number of Residents in Certified Beds
121
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
19301 WATKINS MILL ROAD OPERATING COMPANY LLC
Date First Approved to Provide Medicare and Medicaid services
1995-03-14
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
2
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
4
Staffing Rating Footnote
RN Staffing Rating
4
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.07769
Reported LPN Staffing Hours per Resident per Day
0.97025
Reported RN Staffing Hours per Resident per Day
1.08099
Reported Licensed Staffing Hours per Resident per Day
2.05124
Reported Total Nurse Staffing Hours per Resident per Day
4.12893
Reported Physical Therapist Staffing Hours per Resident Per Day
0.16281
Expected CNA Staffing Hours per Resident per Day
2.49433
Expected LPN Staffing Hours per Resident per Day
0.69330
Expected RN Staffing Hours per Resident per Day
1.21320
Expected Total Nurse Staffing Hours per Resident per Day
4.40082
Adjusted CNA Staffing Hours per Resident per Day
2.04385
Adjusted LPN Staffing Hours per Resident per Day
1.16156
Adjusted RN Staffing Hours per Resident per Day
0.66577
Adjusted Total Nurse Staffing Hours per Resident per Day
3.78186
Cycle 1 Total Number of Health Deficiencies
18
Cycle 1 Number of Standard Health Deficiencies
14
Cycle 1 Number of Complaint Health Deficiencies
4
Cycle 1 Health Deficiency Score
96
Cycle 1 Standard Survey Health Date
2014-08-21
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
96
Cycle 2 Total Number of Health Deficiencies
16
Cycle 2 Number of Standard Health Deficiencies
10
Cycle 2 Number of Complaint Health Deficiencies
6
Cycle 2 Health Deficiency Score
80
Cycle 2 Standard Health Survey Date
2013-07-11
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
10
Cycle 3 Number of Standard Health Deficiencies
5
Cycle 3 Number of Complaint Health Deficiencies
5
Cycle 3 Health Deficiency Score
56
Cycle 3 Standard Health Survey Date
2012-07-27
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
56
Total Weighted Health Survey Score
84.00000
Number of Facility Reported Incidents
6
Number of Substantiated Complaints
10
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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