Otterbein North Shore - Lakeside Nursing Home
General Information
UPDATEFederal Provider Number
366358
Provider Name
OTTERBEIN NORTH SHORE
Provider Address
9400 NORTH SHORE BLVD
LAKESIDE, OH 43440
LAKESIDE, OH 43440
Provider Phone Number
(419) 798-8203
Provider SSA County
630
Provider County Name
Ottawa
Provider Website
Provider Description
Ownership Type
Non profit - Church related
Number of Certified Beds
10
Number of Residents in Certified Beds
8
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
NORTH SHORE RETIREMENT COMMUNITY
Date First Approved to Provide Medicare and Medicaid services
2007-10-10
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
5
Overall Rating Footnote
Health Inspection Rating
5
Health Inspection Rating Footnote
QM Rating
5
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
3.75625
Reported LPN Staffing Hours per Resident per Day
2.41875
Reported RN Staffing Hours per Resident per Day
2.37500
Reported Licensed Staffing Hours per Resident per Day
4.79375
Reported Total Nurse Staffing Hours per Resident per Day
8.55000
Reported Physical Therapist Staffing Hours per Resident Per Day
0.66250
Expected CNA Staffing Hours per Resident per Day
2.37642
Expected LPN Staffing Hours per Resident per Day
0.78455
Expected RN Staffing Hours per Resident per Day
1.58565
Expected Total Nurse Staffing Hours per Resident per Day
4.74662
Adjusted CNA Staffing Hours per Resident per Day
3.87840
Adjusted LPN Staffing Hours per Resident per Day
2.55886
Adjusted RN Staffing Hours per Resident per Day
1.11916
Adjusted Total Nurse Staffing Hours per Resident per Day
7.26078
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
4
Cycle 1 Standard Survey Health Date
2014-09-04
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
4
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
2013-06-28
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
2012-05-03
Cycle 3 Number of Health Revisits
0
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
0
Total Weighted Health Survey Score
2.00000
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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