Otterbein Portage Valley - Pemberville Nursing Home
General Information
UPDATEFederal Provider Number
365571
Provider Name
OTTERBEIN PORTAGE VALLEY
Provider Address
20311 PEMBERVILLE RD
PEMBERVILLE, OH 43450
PEMBERVILLE, OH 43450
Provider Phone Number
(419) 833-7000
Provider SSA County
880
Provider County Name
Wood
Provider Website
Provider Description
Ownership Type
Non profit - Church related
Number of Certified Beds
50
Number of Residents in Certified Beds
44
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
OTTERBEIN PORTAGE VALLEY
Date First Approved to Provide Medicare and Medicaid services
1981-12-15
Continuing Care Retirement Community
Y
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
4
Health Inspection Rating Footnote
QM Rating
3
QM Rating Footnote
Staffing Rating
3
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
2.27841
Reported LPN Staffing Hours per Resident per Day
0.91818
Reported RN Staffing Hours per Resident per Day
0.71364
Reported Licensed Staffing Hours per Resident per Day
1.63182
Reported Total Nurse Staffing Hours per Resident per Day
3.91023
Reported Physical Therapist Staffing Hours per Resident Per Day
0.10909
Expected CNA Staffing Hours per Resident per Day
2.60187
Expected LPN Staffing Hours per Resident per Day
0.74163
Expected RN Staffing Hours per Resident per Day
1.32114
Expected Total Nurse Staffing Hours per Resident per Day
4.66464
Adjusted CNA Staffing Hours per Resident per Day
2.14866
Adjusted LPN Staffing Hours per Resident per Day
1.02759
Adjusted RN Staffing Hours per Resident per Day
0.40362
Adjusted Total Nurse Staffing Hours per Resident per Day
3.37899
Cycle 1 Total Number of Health Deficiencies
3
Cycle 1 Number of Standard Health Deficiencies
3
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
28
Cycle 1 Standard Survey Health Date
2015-04-23
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
28
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
2014-02-06
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
2012-11-08
Cycle 3 Number of Health Revisits
0
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
0
Total Weighted Health Survey Score
14.00000
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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