Providence Child Center - Portland Nursing Home
General Information
UPDATEFederal Provider Number
38A001
Provider Name
PROVIDENCE CHILD CENTER
Provider Address
830 NE 47TH AVENUE
PORTLAND, OR 97213
PORTLAND, OR 97213
Provider Phone Number
(503) 215-2400
Provider SSA County
250
Provider County Name
Multnomah
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
58
Number of Residents in Certified Beds
50
Provider Type
Medicaid
Provider Resides in Hospital
N
Legal Business Name
Legal Business Name Not Available
Date First Approved to Provide Medicare and Medicaid services
1974-09-01
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Family
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
5
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
3.93300
Reported LPN Staffing Hours per Resident per Day
0.57100
Reported RN Staffing Hours per Resident per Day
2.01600
Reported Licensed Staffing Hours per Resident per Day
2.58700
Reported Total Nurse Staffing Hours per Resident per Day
6.52000
Reported Physical Therapist Staffing Hours per Resident Per Day
0.05100
Expected CNA Staffing Hours per Resident per Day
2.80985
Expected LPN Staffing Hours per Resident per Day
1.08360
Expected RN Staffing Hours per Resident per Day
1.52308
Expected Total Nurse Staffing Hours per Resident per Day
5.41653
Adjusted CNA Staffing Hours per Resident per Day
3.43449
Adjusted LPN Staffing Hours per Resident per Day
0.43737
Adjusted RN Staffing Hours per Resident per Day
0.98902
Adjusted Total Nurse Staffing Hours per Resident per Day
4.85209
Cycle 1 Total Number of Health Deficiencies
3
Cycle 1 Number of Standard Health Deficiencies
3
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
16
Cycle 1 Standard Survey Health Date
2014-10-24
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
16
Cycle 2 Total Number of Health Deficiencies
2
Cycle 2 Number of Standard Health Deficiencies
2
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
12
Cycle 2 Standard Health Survey Date
2013-04-26
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
12
Cycle 3 Total Number of Health Deficiencies
6
Cycle 3 Number of Standard Health Deficiencies
5
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
24
Cycle 3 Standard Health Survey Date
2012-02-28
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
24
Total Weighted Health Survey Score
16.00000
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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