Rothermel L Caplan Tcu - Lebanon Nursing Home
General Information
UPDATEFederal Provider Number
395933
Provider Name
ROTHERMEL L CAPLAN TCU
Provider Address
WILLOW AT FOURTH ST POB 1282
LEBANON, PA 17046
LEBANON, PA 17046
Provider Phone Number
(717) 270-7729
Provider SSA County
460
Provider County Name
Lebanon
Provider Website
Provider Description
Ownership Type
Non profit - Corporation
Number of Certified Beds
19
Number of Residents in Certified Beds
14
Provider Type
Medicare
Provider Resides in Hospital
Y
Legal Business Name
THE GOOD SAMARITAN HOSPITAL
Date First Approved to Provide Medicare and Medicaid services
1994-08-24
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
5
Overall Rating Footnote
Health Inspection Rating
4
Health Inspection Rating Footnote
QM Rating
4
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
2.33929
Reported LPN Staffing Hours per Resident per Day
0.93571
Reported RN Staffing Hours per Resident per Day
2.57857
Reported Licensed Staffing Hours per Resident per Day
3.51429
Reported Total Nurse Staffing Hours per Resident per Day
5.85357
Reported Physical Therapist Staffing Hours per Resident Per Day
1.22500
Expected CNA Staffing Hours per Resident per Day
2.32803
Expected LPN Staffing Hours per Resident per Day
0.68833
Expected RN Staffing Hours per Resident per Day
1.50850
Expected Total Nurse Staffing Hours per Resident per Day
4.52487
Adjusted CNA Staffing Hours per Resident per Day
2.46557
Adjusted LPN Staffing Hours per Resident per Day
1.12829
Adjusted RN Staffing Hours per Resident per Day
1.27723
Adjusted Total Nurse Staffing Hours per Resident per Day
5.21455
Cycle 1 Total Number of Health Deficiencies
1
Cycle 1 Number of Standard Health Deficiencies
1
Cycle 1 Number of Complaint Health Deficiencies
0
Cycle 1 Health Deficiency Score
4
Cycle 1 Standard Survey Health Date
2015-04-23
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
4
Cycle 2 Total Number of Health Deficiencies
0
Cycle 2 Number of Standard Health Deficiencies
0
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
0
Cycle 2 Standard Health Survey Date
2014-05-29
Cycle 2 Number of Health Revisits
0
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
4
Cycle 3 Number of Standard Health Deficiencies
4
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
32
Cycle 3 Standard Health Survey Date
2013-04-25
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
32
Total Weighted Health Survey Score
7.33300
Number of Facility Reported Incidents
0
Number of Substantiated Complaints
0
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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