Shady Acres Inc - West Kingston Nursing Home
General Information
UPDATEFederal Provider Number
415107
Provider Name
SHADY ACRES INC
Provider Address
415 GARDNER ROAD
WEST KINGSTON, RI 2892
WEST KINGSTON, RI 2892
Provider Phone Number
(401) 295-8520
Provider SSA County
50
Provider County Name
Washington
Provider Website
Provider Description
Ownership Type
For profit - Corporation
Number of Certified Beds
55
Number of Residents in Certified Beds
48
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
N
Legal Business Name
SHADY ACRES INC
Date First Approved to Provide Medicare and Medicaid services
1992-01-01
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
2
Health Inspection Rating Footnote
QM Rating
1
QM Rating Footnote
Staffing Rating
4
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
2.54583
Reported LPN Staffing Hours per Resident per Day
0.18646
Reported RN Staffing Hours per Resident per Day
1.25313
Reported Licensed Staffing Hours per Resident per Day
1.43958
Reported Total Nurse Staffing Hours per Resident per Day
3.98542
Reported Physical Therapist Staffing Hours per Resident Per Day
0.01146
Expected CNA Staffing Hours per Resident per Day
2.38071
Expected LPN Staffing Hours per Resident per Day
0.59418
Expected RN Staffing Hours per Resident per Day
0.94275
Expected Total Nurse Staffing Hours per Resident per Day
3.91763
Adjusted CNA Staffing Hours per Resident per Day
2.62388
Adjusted LPN Staffing Hours per Resident per Day
0.26046
Adjusted RN Staffing Hours per Resident per Day
0.99320
Adjusted Total Nurse Staffing Hours per Resident per Day
4.10065
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
16
Cycle 1 Standard Survey Health Date
2014-04-17
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
4
Cycle 2 Number of Standard Health Deficiencies
4
Cycle 2 Number of Complaint Health Deficiencies
0
Cycle 2 Health Deficiency Score
16
Cycle 2 Standard Health Survey Date
2013-06-13
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
2
Cycle 3 Number of Standard Health Deficiencies
2
Cycle 3 Number of Complaint Health Deficiencies
0
Cycle 3 Health Deficiency Score
20
Cycle 3 Standard Health Survey Date
2012-05-17
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
20
Total Weighted Health Survey Score
16.66700
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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