Penick Village - Southern Pines Nursing Home
General Information
UPDATEFederal Provider Number
345111
Provider Name
PENICK VILLAGE
Provider Address
500 EAST RHODE ISLAND AVENUE
SOUTHERN PINES, NC 28387
SOUTHERN PINES, NC 28387
Provider Phone Number
(910) 692-0300
Provider SSA County
620
Provider County Name
Moore
Provider Website
Provider Description
Ownership Type
Non profit - Church related
Number of Certified Beds
24
Number of Residents in Certified Beds
46
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
EPISCOPAL HOME FOR THE AGEING IN THE DIOCESE OF NORTH CAROLINA INC
Date First Approved to Provide Medicare and Medicaid services
1974-01-01
Continuing Care Retirement Community
Y
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Both
Automatic Sprinkler Systems in All Required Areas
Yes
Rating Detail Information
Overall Rating
3
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
2
QM Rating Footnote
Staffing Rating
4
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
3.24674
Reported LPN Staffing Hours per Resident per Day
0.91739
Reported RN Staffing Hours per Resident per Day
0.67174
Reported Licensed Staffing Hours per Resident per Day
1.58913
Reported Total Nurse Staffing Hours per Resident per Day
4.83587
Reported Physical Therapist Staffing Hours per Resident Per Day
0.11196
Expected CNA Staffing Hours per Resident per Day
2.61877
Expected LPN Staffing Hours per Resident per Day
0.68516
Expected RN Staffing Hours per Resident per Day
1.07563
Expected Total Nurse Staffing Hours per Resident per Day
4.37956
Adjusted CNA Staffing Hours per Resident per Day
3.04209
Adjusted LPN Staffing Hours per Resident per Day
1.11133
Adjusted RN Staffing Hours per Resident per Day
0.46663
Adjusted Total Nurse Staffing Hours per Resident per Day
4.45089
Cycle 1 Total Number of Health Deficiencies
4
Cycle 1 Number of Standard Health Deficiencies
4
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
28
Cycle 1 Standard Survey Health Date
2014-05-01
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
28
Cycle 2 Total Number of Health Deficiencies
6
Cycle 2 Number of Standard Health Deficiencies
6
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
28
Cycle 2 Standard Health Survey Date
2013-02-07
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
28
Cycle 3 Total Number of Health Deficiencies
9
Cycle 3 Number of Standard Health Deficiencies
6
Cycle 3 Number of Complaint Health Deficiencies
3
Cycle 3 Health Deficiency Score
40
Cycle 3 Standard Health Survey Date
2011-12-15
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
40
Total Weighted Health Survey Score
30.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
1
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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