Pine Haven Home - Philmont Nursing Home
General Information
UPDATEFederal Provider Number
335632
Provider Name
PINE HAVEN HOME
Provider Address
NY ROUTE 217
PHILMONT, NY 12565
PHILMONT, NY 12565
Provider Phone Number
(518) 672-4021
Provider SSA County
200
Provider County Name
Columbia
Provider Website
Provider Description
Ownership Type
Government - County
Number of Certified Beds
120
Number of Residents in Certified Beds
94
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
COLUMBIA COUNTY
Date First Approved to Provide Medicare and Medicaid services
1979-02-01
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
2
Overall Rating Footnote
Health Inspection Rating
1
Health Inspection Rating Footnote
QM Rating
3
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
2.60798
Reported LPN Staffing Hours per Resident per Day
1.27340
Reported RN Staffing Hours per Resident per Day
0.56223
Reported Licensed Staffing Hours per Resident per Day
1.83564
Reported Total Nurse Staffing Hours per Resident per Day
4.44361
Reported Physical Therapist Staffing Hours per Resident Per Day
0.09202
Expected CNA Staffing Hours per Resident per Day
2.48481
Expected LPN Staffing Hours per Resident per Day
0.67202
Expected RN Staffing Hours per Resident per Day
1.08406
Expected Total Nurse Staffing Hours per Resident per Day
4.24089
Adjusted CNA Staffing Hours per Resident per Day
2.57532
Adjusted LPN Staffing Hours per Resident per Day
1.57276
Adjusted RN Staffing Hours per Resident per Day
0.38752
Adjusted Total Nurse Staffing Hours per Resident per Day
4.22358
Cycle 1 Total Number of Health Deficiencies
8
Cycle 1 Number of Standard Health Deficiencies
7
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
76
Cycle 1 Standard Survey Health Date
2014-08-11
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
76
Cycle 2 Total Number of Health Deficiencies
7
Cycle 2 Number of Standard Health Deficiencies
1
Cycle 2 Number of Complaint Health Deficiencies
6
Cycle 2 Health Deficiency Score
791
Cycle 2 Standard Health Survey Date
2013-11-08
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
791
Cycle 3 Total Number of Health Deficiencies
9
Cycle 3 Number of Standard Health Deficiencies
5
Cycle 3 Number of Complaint Health Deficiencies
4
Cycle 3 Health Deficiency Score
111
Cycle 3 Standard Health Survey Date
2013-01-07
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
111
Total Weighted Health Survey Score
320.16700
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
8
Number of Fines
2
Total Amount of Fines in Dollars
9425
Number of Payment Denials
0
Total Number of Penalties
2
Location
Processing Date
2015-06-01
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