Pearl City Nursing Home - Pearl City Nursing Home

General Information

UPDATE
Federal Provider Number
125043
Provider Name
PEARL CITY NURSING HOME
Provider Address
919 LEHUA AVENUE
PEARL CITY, HI 96782
Provider Phone Number
(808) 453-1919
Provider SSA County
20
Provider County Name
Honolulu
Ownership Type
For profit - Corporation
Number of Certified Beds
122
Number of Residents in Certified Beds
117
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
1995-11-17
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
2
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
4
QM Rating Footnote
Staffing Rating
4
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
2.57179
Reported LPN Staffing Hours per Resident per Day
0.36667
Reported RN Staffing Hours per Resident per Day
1.38718
Reported Licensed Staffing Hours per Resident per Day
1.75385
Reported Total Nurse Staffing Hours per Resident per Day
4.32564
Reported Physical Therapist Staffing Hours per Resident Per Day
0.03803
Expected CNA Staffing Hours per Resident per Day
2.56389
Expected LPN Staffing Hours per Resident per Day
0.68459
Expected RN Staffing Hours per Resident per Day
1.02212
Expected Total Nurse Staffing Hours per Resident per Day
4.27059
Adjusted CNA Staffing Hours per Resident per Day
2.46126
Adjusted LPN Staffing Hours per Resident per Day
0.44455
Adjusted RN Staffing Hours per Resident per Day
1.01407
Adjusted Total Nurse Staffing Hours per Resident per Day
4.08286
Cycle 1 Total Number of Health Deficiencies
13
Cycle 1 Number of Standard Health Deficiencies
13
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
245
Cycle 1 Standard Survey Health Date
2015-02-13
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
245
Cycle 2 Total Number of Health Deficiencies
10
Cycle 2 Number of Standard Health Deficiencies
10
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
52
Cycle 2 Standard Health Survey Date
2012-11-16
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
52
Cycle 3 Total Number of Health Deficiencies
11
Cycle 3 Number of Standard Health Deficiencies
11
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
44
Cycle 3 Standard Health Survey Date
2011-08-12
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
44
Total Weighted Health Survey Score
147.16700
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
0
Number of Fines
1
Total Amount of Fines in Dollars
23693
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01

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