Pine Grove Health Center - Pascoag Nursing Home
General Information
UPDATEFederal Provider Number
415099
Provider Name
PINE GROVE HEALTH CENTER
Provider Address
999 SOUTH MAIN STREET
PASCOAG, RI 2859
PASCOAG, RI 2859
Provider Phone Number
(401) 568-3091
Provider SSA County
30
Provider County Name
Providence
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
71
Number of Residents in Certified Beds
59
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
BURRILLVILLE NURSING HOME INC
Date First Approved to Provide Medicare and Medicaid services
1991-09-01
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
1
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
1
QM Rating Footnote
Staffing Rating
2
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
2.08305
Reported LPN Staffing Hours per Resident per Day
0.25763
Reported RN Staffing Hours per Resident per Day
1.08220
Reported Licensed Staffing Hours per Resident per Day
1.33983
Reported Total Nurse Staffing Hours per Resident per Day
3.42288
Reported Physical Therapist Staffing Hours per Resident Per Day
0.03475
Expected CNA Staffing Hours per Resident per Day
2.37952
Expected LPN Staffing Hours per Resident per Day
0.75181
Expected RN Staffing Hours per Resident per Day
1.22761
Expected Total Nurse Staffing Hours per Resident per Day
4.35894
Adjusted CNA Staffing Hours per Resident per Day
2.14798
Adjusted LPN Staffing Hours per Resident per Day
0.28442
Adjusted RN Staffing Hours per Resident per Day
0.65870
Adjusted Total Nurse Staffing Hours per Resident per Day
3.16528
Cycle 1 Total Number of Health Deficiencies
11
Cycle 1 Number of Standard Health Deficiencies
7
Cycle 1 Number of Complaint Health Deficiencies
4
Cycle 1 Health Deficiency Score
36
Cycle 1 Standard Survey Health Date
2014-07-18
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
36
Cycle 2 Total Number of Health Deficiencies
5
Cycle 2 Number of Standard Health Deficiencies
5
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
20
Cycle 2 Standard Health Survey Date
2013-04-25
Cycle 2 Number of Health Revisits
2
Cycle 2 Health Revisit Score
10
Cycle 2 Total Health Score
30
Cycle 3 Total Number of Health Deficiencies
2
Cycle 3 Number of Standard Health Deficiencies
2
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
12
Cycle 3 Standard Health Survey Date
2012-05-10
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
12
Total Weighted Health Survey Score
30.00000
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
2
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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