Rose Villa Senior Living Community - Milwaukie Nursing Home
General Information
UPDATEFederal Provider Number
38A031
Provider Name
ROSE VILLA SENIOR LIVING COMMUNITY
Provider Address
13505 SE RIVER ROAD
MILWAUKIE, OR 97222
MILWAUKIE, OR 97222
Provider Phone Number
(503) 654-3171
Provider SSA County
20
Provider County Name
Clackamas
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
45
Number of Residents in Certified Beds
35
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
2012-12-31
Continuing Care Retirement Community
Y
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
4
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
3
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
3.61714
Reported LPN Staffing Hours per Resident per Day
0.36143
Reported RN Staffing Hours per Resident per Day
0.70143
Reported Licensed Staffing Hours per Resident per Day
1.06286
Reported Total Nurse Staffing Hours per Resident per Day
4.68000
Reported Physical Therapist Staffing Hours per Resident Per Day
0.01000
Expected CNA Staffing Hours per Resident per Day
2.22187
Expected LPN Staffing Hours per Resident per Day
0.60449
Expected RN Staffing Hours per Resident per Day
0.82596
Expected Total Nurse Staffing Hours per Resident per Day
3.65232
Adjusted CNA Staffing Hours per Resident per Day
3.99456
Adjusted LPN Staffing Hours per Resident per Day
0.49626
Adjusted RN Staffing Hours per Resident per Day
0.63455
Adjusted Total Nurse Staffing Hours per Resident per Day
5.16511
Cycle 1 Total Number of Health Deficiencies
4
Cycle 1 Number of Standard Health Deficiencies
3
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
20
Cycle 1 Standard Survey Health Date
2014-05-23
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
20
Cycle 2 Total Number of Health Deficiencies
3
Cycle 2 Number of Standard Health Deficiencies
2
Cycle 2 Number of Complaint Health Deficiencies
1
Cycle 2 Health Deficiency Score
16
Cycle 2 Standard Health Survey Date
2012-11-02
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
16
Cycle 3 Total Number of Health Deficiencies
0
Cycle 3 Number of Standard Health Deficiencies
0
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
0
Cycle 3 Standard Health Survey Date
0000-00-00
Cycle 3 Number of Health Revisits
0
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
0
Total Weighted Health Survey Score
18.40000
Number of Facility Reported Incidents
1
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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