National Church Residences Legacy Village - Xenia Nursing Home
General Information
UPDATEFederal Provider Number
366420
Provider Name
NATIONAL CHURCH RESIDENCES LEGACY VILLAGE
Provider Address
695 WYCLIFFE DRIVE
XENIA, OH 45385
XENIA, OH 45385
Provider Phone Number
(937) 372-0359
Provider SSA County
290
Provider County Name
Greene
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
2
Number of Residents in Certified Beds
2
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
TRADITIONS AT XENIA
Date First Approved to Provide Medicare and Medicaid services
2014-09-26
Continuing Care Retirement Community
Y
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
0
Overall Rating Footnote
Too New to Rate
Health Inspection Rating
0
Health Inspection Rating Footnote
Too New to Rate
QM Rating
0
QM Rating Footnote
Too New to Rate
Staffing Rating
0
Staffing Rating Footnote
Too New to Rate
RN Staffing Rating
0
RN Staffing Rating Footnote
Too New to Rate
Reported Staffing Footnote
Staffing Values not Reported because of Data Quality Concerns
Physical Therapist Staffing Footnote
Physical Therapy Staffing Values not Reported because of Data Quality Concerns
Reported CNA Staffing Hours per Resident per Day
0.00000
Reported LPN Staffing Hours per Resident per Day
0.00000
Reported RN Staffing Hours per Resident per Day
0.00000
Reported Licensed Staffing Hours per Resident per Day
0.00000
Reported Total Nurse Staffing Hours per Resident per Day
0.00000
Reported Physical Therapist Staffing Hours per Resident Per Day
0.00000
Expected CNA Staffing Hours per Resident per Day
2.24249
Expected LPN Staffing Hours per Resident per Day
0.87768
Expected RN Staffing Hours per Resident per Day
1.43868
Expected Total Nurse Staffing Hours per Resident per Day
4.55885
Adjusted CNA Staffing Hours per Resident per Day
0.00000
Adjusted LPN Staffing Hours per Resident per Day
0.00000
Adjusted RN Staffing Hours per Resident per Day
0.00000
Adjusted Total Nurse Staffing Hours per Resident per Day
0.00000
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
0000-00-00
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
0
Cycle 2 Number of Standard Health Deficiencies
0
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
0
Cycle 2 Standard Health Survey Date
0000-00-00
Cycle 2 Number of Health Revisits
0
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
0
Cycle 3 Number of Standard Health Deficiencies
0
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
0
Cycle 3 Standard Health Survey Date
0000-00-00
Cycle 3 Number of Health Revisits
0
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
0
Total Weighted Health Survey Score
0.00000
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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