Pilgrim Manor - Grand Rapids Nursing Home
General Information
UPDATEFederal Provider Number
235038
Provider Name
PILGRIM MANOR
Provider Address
2000 LEONARD N E
GRAND RAPIDS, MI 49505
GRAND RAPIDS, MI 49505
Provider Phone Number
(616) 458-1133
Provider SSA County
400
Provider County Name
Kent
Provider Website
Provider Description
Ownership Type
Non profit - Church related
Number of Certified Beds
55
Number of Residents in Certified Beds
48
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
PILGRIM MANOR INC
Date First Approved to Provide Medicare and Medicaid services
1967-01-01
Continuing Care Retirement Community
N
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
4
Health Inspection Rating Footnote
QM Rating
5
QM Rating Footnote
Staffing Rating
4
Staffing Rating Footnote
RN Staffing Rating
4
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
2.53125
Reported LPN Staffing Hours per Resident per Day
0.96458
Reported RN Staffing Hours per Resident per Day
0.91250
Reported Licensed Staffing Hours per Resident per Day
1.87708
Reported Total Nurse Staffing Hours per Resident per Day
4.40833
Reported Physical Therapist Staffing Hours per Resident Per Day
0.03229
Expected CNA Staffing Hours per Resident per Day
2.53706
Expected LPN Staffing Hours per Resident per Day
0.67808
Expected RN Staffing Hours per Resident per Day
1.15526
Expected Total Nurse Staffing Hours per Resident per Day
4.37040
Adjusted CNA Staffing Hours per Resident per Day
2.44808
Adjusted LPN Staffing Hours per Resident per Day
1.18069
Adjusted RN Staffing Hours per Resident per Day
0.59019
Adjusted Total Nurse Staffing Hours per Resident per Day
4.06588
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
36
Cycle 1 Standard Survey Health Date
2015-01-14
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
36
Cycle 2 Total Number of Health Deficiencies
4
Cycle 2 Number of Standard Health Deficiencies
4
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
20
Cycle 2 Standard Health Survey Date
2014-01-10
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
20
Cycle 3 Total Number of Health Deficiencies
2
Cycle 3 Number of Standard Health Deficiencies
1
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
4
Cycle 3 Standard Health Survey Date
2012-12-14
Cycle 3 Number of Health Revisits
0
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
4
Total Weighted Health Survey Score
25.33300
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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