Queens Blvd Ext Care Facility - Woodside Nursing Home
General Information
UPDATEFederal Provider Number
335791
Provider Name
QUEENS BLVD EXT CARE FACILITY
Provider Address
61 11 QUEENS BOULEVARD
WOODSIDE, NY 11377
WOODSIDE, NY 11377
Provider Phone Number
(718) 205-0288
Provider SSA County
590
Provider County Name
Queens
Provider Website
Provider Description
Ownership Type
For profit - Partnership
Number of Certified Beds
280
Number of Residents in Certified Beds
277
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
QUEENS BOULEVARD EXTENDED CARE FACILITY MANAGEMENT LLC
Date First Approved to Provide Medicare and Medicaid services
1995-12-29
Continuing Care Retirement Community
N
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
5
Overall Rating Footnote
Health Inspection Rating
5
Health Inspection Rating Footnote
QM Rating
4
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
2.77509
Reported LPN Staffing Hours per Resident per Day
0.50794
Reported RN Staffing Hours per Resident per Day
1.00307
Reported Licensed Staffing Hours per Resident per Day
1.51101
Reported Total Nurse Staffing Hours per Resident per Day
4.28610
Reported Physical Therapist Staffing Hours per Resident Per Day
0.15848
Expected CNA Staffing Hours per Resident per Day
2.65645
Expected LPN Staffing Hours per Resident per Day
0.74616
Expected RN Staffing Hours per Resident per Day
1.28323
Expected Total Nurse Staffing Hours per Resident per Day
4.68584
Adjusted CNA Staffing Hours per Resident per Day
2.56329
Adjusted LPN Staffing Hours per Resident per Day
0.56501
Adjusted RN Staffing Hours per Resident per Day
0.58407
Adjusted Total Nurse Staffing Hours per Resident per Day
3.68703
Cycle 1 Total Number of Health Deficiencies
1
Cycle 1 Number of Standard Health Deficiencies
0
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
8
Cycle 1 Standard Survey Health Date
2014-06-20
Cycle 1 Number of Health Revisits
0
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
8
Cycle 2 Total Number of Health Deficiencies
1
Cycle 2 Number of Standard Health Deficiencies
1
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
4
Cycle 2 Standard Health Survey Date
2013-05-31
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
4
Cycle 3 Total Number of Health Deficiencies
1
Cycle 3 Number of Standard Health Deficiencies
1
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
0
Cycle 3 Standard Health Survey Date
2012-04-11
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
0
Total Weighted Health Survey Score
5.33300
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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