Nancy Ann Nursing Home, Inc. - Foster Nursing Home
General Information
UPDATEFederal Provider Number
415115
Provider Name
NANCY ANN NURSING HOME, INC.
Provider Address
47 EAST KILLINGLY ROAD
FOSTER, RI 2825
FOSTER, RI 2825
Provider Phone Number
(401) 647-2170
Provider SSA County
30
Provider County Name
Providence
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
20
Number of Residents in Certified Beds
16
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
Legal Business Name Not Available
Date First Approved to Provide Medicare and Medicaid services
1992-03-11
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
3
Health Inspection Rating Footnote
QM Rating
3
QM Rating Footnote
Staffing Rating
5
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
2.81250
Reported LPN Staffing Hours per Resident per Day
0.00000
Reported RN Staffing Hours per Resident per Day
1.64375
Reported Licensed Staffing Hours per Resident per Day
1.64375
Reported Total Nurse Staffing Hours per Resident per Day
4.45625
Reported Physical Therapist Staffing Hours per Resident Per Day
0.01250
Expected CNA Staffing Hours per Resident per Day
2.48796
Expected LPN Staffing Hours per Resident per Day
0.54139
Expected RN Staffing Hours per Resident per Day
0.72306
Expected Total Nurse Staffing Hours per Resident per Day
3.75241
Adjusted CNA Staffing Hours per Resident per Day
2.77377
Adjusted LPN Staffing Hours per Resident per Day
0.00000
Adjusted RN Staffing Hours per Resident per Day
1.69864
Adjusted Total Nurse Staffing Hours per Resident per Day
4.78698
Cycle 1 Total Number of Health Deficiencies
2
Cycle 1 Number of Standard Health Deficiencies
2
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
8
Cycle 1 Standard Survey Health Date
2014-11-07
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
8
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
16
Cycle 2 Standard Health Survey Date
2014-01-16
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
16
Cycle 3 Total Number of Health Deficiencies
1
Cycle 3 Number of Standard Health Deficiencies
1
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
0
Cycle 3 Standard Health Survey Date
2013-02-14
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
0
Total Weighted Health Survey Score
9.33300
Number of Facility Reported Incidents
0
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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